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1.
J Artif Organs ; 2024 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-38512476

RESUMEN

We have adopted a simple and reproducible approach, "minimal manipulation approach," since January 2021 in five patients to minimize the risk of thromboembolic events during Zone 1 and 2 thoracic endovascular aortic repair (TEVARs) with shaggy aorta. The approach consists of two parts: ① Use of a 65-cm-long sheath (dry seal) to deliver the endografts without touching the protruding atheroma. Covering the atheroma with the first endograft delivered at Zone 3 to the mid-descending aorta (paving the aorta), and second endograft insertion and deployment through the paved aorta with first endograft. ② Protection of the left subclavian artery using balloon catheter during TEVAR. No in-hospital mortality was recorded, and none of the patients had stroke, spinal cord ischemia, or distal embolic events.

2.
J Artif Organs ; 2023 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-37227546

RESUMEN

PURPOSE: A narrow terminal aorta is a risk factor for endograft occlusion after endovascular aneurysm repair. To minimize limb complications, we used Gore Excluder legs positioned side-by-side at the terminal aorta. We investigated the outcomes of our strategy for endovascular aneurysm repair in patients with a narrow terminal aorta. METHODS: We enrolled 61 patients who underwent endovascular aneurysm repair with a narrow terminal aorta (defined as < 18 mm in diameter) from April 2013 to October 2021. The standard procedure involves complete treatment with the Gore Excluder device. When other types of main body endografts were used, they were deployed proximal to the terminal aorta, and we used the Gore Excluder leg device in the bilateral limbs. Postoperatively, the intraluminal diameter of the legs at the terminal aorta was measured to assess the configuration. RESULTS: During the follow-up period (mean: 2.7 ± 2.0 years), there were no aorta-related deaths, endograft occlusions, or leg-related re-interventions. There were no significant differences between the pre- and postoperative ankle-brachial pressure index values in the dominant and non-dominant legs (p = 0.44 and p = 0.17, respectively). Postoperatively, the mean difference rate (defined as [dominant leg diameter-non-dominant leg diameter]/terminal aorta diameter) was 7.5 ± 7.1%. The difference rate was not significantly correlated with the terminal aortic diameter, calcification thickness, or circumferential calcification (r = 0.16, p = 0.22; r = 0.07, p = 0.59; and r = - 0.07, p = 0.61, respectively). CONCLUSIONS: Side-by-side deployment of Gore Excluder legs produces acceptable outcomes for endovascular aneurysm repair with a narrow terminal aorta. The endograft expansion at the terminal aorta is tolerable without influencing calcification distribution.

3.
J Nucl Cardiol ; 29(5): 2652-2663, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34561849

RESUMEN

BACKGROUND: Transcatheter aortic valve replacement (TAVR) can rapidly improve cardiac sympathetic nervous function (CSNF) within 2 weeks in patients with aortic stenosis (AS). However, whether such short-term improvements will be sustained thereafter remains unclear. METHODS: Patients with severe AS who underwent TAVR between October 2017 and June 2019 were enrolled in this single-center, prospective, observational study. 123I-meta-iodobenzylguanidine imaging was performed at baseline, within 2 weeks after TAVR, and at 6 to 12 months post-TAVR to evaluate the heart-mediastinum ratio (H/M) and washout rate. RESULTS: Of 183 consecutive patients, 75 (19 men; median age: 86 years) were evaluated. The late H/M significantly improved within 2 weeks after TAVR (P = .041) and further improved over 6 to 12 months after TAVR (P = .041). Multivariate analysis revealed that the baseline mean aortic valve pressure gradient (mPG) was an independent predictor of mid-term improvement in the late H/M (> 0.1) (P = .037). Patients with a high baseline mPG (≥ 58 mmHg) exhibited a significantly greater increase in the late H/M than those with a low baseline mPG (< 42 mmHg) (0.24 vs 0.01; P = .029). CONCLUSION: CSNF demonstrated sustained improvement from within 2 weeks after TAVR until 6 to 12 months later. Such improvement was related to baseline hemodynamic AS severity.


Asunto(s)
Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , 3-Yodobencilguanidina , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Humanos , Radioisótopos de Yodo , Masculino , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del Tratamiento
4.
J Artif Organs ; 25(1): 82-85, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33945039

RESUMEN

A 72-year-old woman presented with exertional dyspnea. Echocardiography revealed severe mitral valve stenosis; therefore, mitral valve replacement was performed using a bioprosthetic valve. However, left ventricular wall rupture occurred following mitral valve replacement. Under re-cardiac arrest, we found a left ventricular tear under the posterior annulus of the mitral valve. We repaired the left ventricular muscle using a bovine pericardial patch and implanted a bioprosthetic valve again. Postoperatively, we implanted an Impella 5.0 heart pump through the right axillary artery to ensure left ventricular wall unloading. Systemic blood flow depended almost completely on mechanical circulatory assistance until postoperative day 3. After the fourth postoperative day, we started weaning the patient from Impella 5.0. Finally, it was completely discontinued on the sixth postoperative day. After that, the patient's condition was stable, and she was discharged 44 days postoperatively. Impella 5.0 is a potentially beneficial device for left ventricular unloading in patients with left ventricular wall rupture following mitral valve replacement.


Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Rotura Septal Ventricular , Anciano , Animales , Bovinos , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Rotura Septal Ventricular/cirugía
5.
Kyobu Geka ; 74(10): 746-751, 2021 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-34548440

RESUMEN

It has been reported that there are some risks of coronary artery graft injury while redo sternotomy was required for valve surgery after coronary artery bypass grafting (CABG). Also it is well known that clinical results after graft injury was poor. For avoiding graft injury, coronary artery graft must be placed away from the sternum at the time of initial CABG. For redo sternotomy, 3-dimensional-computed tomography can be useful. For aortic valve surgery after CABG, treatment of patent in-situ graft have to be discussed. For common practice, dissecting and clamping the patent in-situ graft during cardiac arrest were required. However, there are some reports showing good clinical results with moderate hypothermia, non-dissection and non-clamping graft. Furthermore, less mobidity rate results of transcatheter aortic valve implantation( TAVI) after CABG was reported. For mitral valve surgery after CABG, right mini-thoracotomy was reported as preferred procedure recently. Dissection area could be reduced than re-median sternotomy, although clamping aorta and patent graft were technically difficult. Two procedures were reported such as hypothermia and ventricular fibrillation or normothermia and beating heart. MitraClip procedure can be considered for high risk patients. Newly developed surgical and catheter technique may change the strategy for heart valve disease after CABG.


Asunto(s)
Enfermedades de las Válvulas Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Puente de Arteria Coronaria , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Esternotomía , Toracotomía
6.
Eur J Nucl Med Mol Imaging ; 47(7): 1657-1667, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31502014

RESUMEN

PURPOSE: The effects of transcatheter aortic valve replacement (TAVR) on cardiac sympathetic nervous (CSN) function have not been fully explored. This study aimed to investigate the early (within 2 weeks) effects of TAVR on CSN function in patients with severe aortic valve stenosis (AS) using 123I-metaiodobenzylguanidine (MIBG) scintigraphy. METHODS: Of 143 consecutive patients who were scheduled to undergo TAVR, 67 (18 men; median age 86 years) were evaluated in this single-centre prospective observational study. MIBG scintigraphy was performed at baseline and 3-14 days after the TAVR procedure to evaluate the heart-mediastinum ratio (H/M) and washout rate (WR). Differences between baseline and post-TAVR MIBG parameters were analysed. MIBG parameter changes were compared with echocardiographic parameters. Furthermore, factors involved in the improvement in MIBG parameters were investigated. RESULTS: All patients successfully underwent TAVR with improved echocardiographic parameters, including aortic valve area (AVA; 0.6 cm2 vs. 1.6 cm2), peak velocity (4.5 m/s vs. 2.0 m/s), mean pressure gradient (50 mmHg vs. 9 mmHg), and left ventricular ejection fraction (56% vs. 62%) (all p < 0.001). On MIBG imaging, delayed H/M significantly increased (2.57 vs. 2.68, p < 0.001), whereas WR decreased (32.2% vs. 26.8%, p < 0.001). In multivariate analysis, higher baseline WR was associated with improvement in WR (> 3%). Female sex, Clinical Frailty Scale score ≤ 5, baseline estimated glomerular filtration rate, and baseline AVA were predictors of improvement in delayed H/M (> 0.1). Baseline AVA and E/E' were independent predictors of improvement in both WR and delayed H/M. CONCLUSIONS: The CSN function was impaired in patients with AS, as assessed using MIBG scintigraphy. WR and delayed H/M improved immediately after TAVR. Improvement in CSN function may be related to echocardiographic AS severity at baseline before TAVR.


Asunto(s)
Estenosis de la Válvula Aórtica , Corazón , Radioisótopos de Yodo , Cintigrafía , Sistema Nervioso Simpático , Reemplazo de la Válvula Aórtica Transcatéter , 3-Yodobencilguanidina/metabolismo , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Femenino , Corazón/diagnóstico por imagen , Corazón/inervación , Humanos , Masculino , Índice de Severidad de la Enfermedad , Factores Sexuales , Volumen Sistólico , Sistema Nervioso Simpático/diagnóstico por imagen , Reemplazo de la Válvula Aórtica Transcatéter/normas , Resultado del Tratamiento , Función Ventricular Izquierda
7.
Surg Today ; 50(6): 540-550, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31147764

RESUMEN

Ischemic mitral regurgitation (MR) is a common complication of myocardial infarction. Left ventricular (LV) dysfunction and distortion of the subvalvular apparatus are the main contributors to ischemic MR. Coronary artery bypass grafting alone, mitral valve replacement, and mitral valve repair, with or without subvalvular procedures, have been performed for moderate-to-severe ischemic MR. Several randomized studies on the surgical treatment of ischemic MR have been performed; however, the optimal surgical strategy remains controversial because none have demonstrated a clear survival benefit. Since the mechanisms of ischemic MR are complex and multifactorial, comprehensive preoperative assessment of LV function and geometry (both global and regional), mitral valve configuration, viability testing, and exercise echocardiography are needed. A better understanding of this complicated disease and of the advantages and limitations of each procedure may help us devise more effective patient-specific surgical treatment strategies and achieve better outcomes.


Asunto(s)
Anuloplastia de la Válvula Mitral/métodos , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Puente de Arteria Coronaria , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Insuficiencia de la Válvula Mitral/complicaciones , Infarto del Miocardio/complicaciones , Infarto del Miocardio/cirugía , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
8.
Kyobu Geka ; 73(1): 22-27, 2020 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-31956246

RESUMEN

Functional mitral stenosis after mitral valve repair for degenerative mitral regurgitation( DMR) is an evolving concept. Mitral annuloplasty devices stabilize the mitral annulus, reduce leaflet stress and increase leaflet coaptation, which leads to improvement of repair durability at the cost of dynamic and physiological annular movement and diastolic annular area. An elevation in rest and peak transmitral gradient has been observed in some patients with annuloplasty devices, and this elevation may associate with worse prognosis as late atrial fibrillation or lower functional capacity after surgery. In this review, we summarize the current reports describing functional mitral stenosis after mitral valve repair for DMR.


Asunto(s)
Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Estenosis de la Válvula Mitral , Humanos , Válvula Mitral , Estenosis de la Válvula Mitral/cirugía , Pronóstico
10.
Surg Today ; 47(3): 335-343, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27506754

RESUMEN

PURPOSE: The selection of optimal grafts for the right coronary artery remains controversial. This study aims to evaluate the short- and long-term results of radial artery (RA) grafts and saphenous vein grafts (SVGs) to the right coronary artery. METHODS: We reviewed, retrospectively, isolated coronary artery bypass grafts, placed between 1997 and 2007, and compared the long-term results of patients who received RA (n = 110) grafts with those of patients who received SVGs (n = 264) using propensity-score matching for risk. The preoperative predictors of graft occlusion were investigated on a per case basis. RESULTS: Superior survival was noted in the unmatched RA group, but late outcomes after propensity-score matching yielded 91 patient pairs that were similar in the two groups. Graft failure was not correlated with mortality, but showed strong correlation with cardiac events in all patients. The predictors of graft occlusion in the RA group were mild proximal stenosis and low indexing glomerular filtration rates for body surface area, whereas those in the SVG were female gender and off-pump coronary artery bypass grafting. CONCLUSIONS: There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.


Asunto(s)
Puente de Arteria Coronaria , Vasos Coronarios/cirugía , Oclusión de Injerto Vascular , Complicaciones Posoperatorias , Puntaje de Propensión , Arteria Radial/trasplante , Vena Safena/trasplante , Anciano , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
11.
Heart Lung Circ ; 26(10): 1105-1112, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28131775

RESUMEN

BACKGROUND: To investigate the results of off-pump coronary artery grafting (OPCAB) with the proximal suture device (PSD) regarding postoperative stroke and graft patency. METHODS: The PSD was used in 376 patients (32.0%), aorta-no-touch OPCAB was performed in 523 patients (45.2%), on-pump beating coronary artery bypass surgery (CABG) (on-beat group) in 125 patients (10.6%) including 51 conversions (conversion rate: 5.4%), and CABG with aortic clamp use (clamp group) in 152 patients. In the PSD group, Enclose II was used in 267 patients (71.0%). RESULTS: The hospital mortality rate was 1.95%. There was no early stroke in the OPCAB group, whereas the early-stroke rate was 0.8% in the on-beat group and 2.6% in the clamp group. The incidences of stroke at one month were: PSD group, 1.6%; no-touch group, 1.1%; on-beat group, 1.6%; and clamp group, 4.6% (p=0.014). The rates of complete revascularisation were higher in the PSD and clamp groups (94.7 and 94.0%, respectively) compared with the no-touch and on-beat groups (81.5 and 84.9%, respectively; p<0.001). The vein graft patency rates were comparable between the PSD and clamp groups. In multiple logistic regression analysis, OPCAB using the PSD did not increase the risk of stroke compared with the no-touch group (adjusted odds ratio [AOR]: 1.40; p=0.594) or on-beat group (AOR: 0.99; p=0.206), but reduced the risk of stroke compared with the clamp group (AOR: 0.19; p=0.005). CONCLUSIONS: Off-pump coronary artery grafting using the PSD was a safe and effective procedure. It led to lower incidences of postoperative stroke and excellent rates of graft patency and complete revascularisation compared with conventional CABG.


Asunto(s)
Puente de Arteria Coronaria Off-Pump/métodos , Isquemia Miocárdica/cirugía , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo , Accidente Cerebrovascular/prevención & control , Técnicas de Sutura/instrumentación , Suturas , Anciano , Puente de Arteria Coronaria , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
12.
Circ J ; 80(1): 110-7, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26538373

RESUMEN

BACKGROUND: The aim of this study was to compare the short- and long-term outcomes of CABG in diabetes mellitus (DM) patients according to eGFR. METHODS AND RESULTS: A total of 573 DM patients receiving CABG between 1997 and 2012 were stratified according to preoperative eGFR: normal or mild chronic kidney disease (CKD), eGFR ≥60 ml/min/1.73 m(2); moderate CKD, eGFR 30-60 ml/min/1.73 m(2); severe CKD, eGFR <30 ml/min/1.73 m(2); and severe CKD requiring hemodialysis (HD). Off-pump and bilateral internal thoracic artery (BITA) grafting rates were 83.4 and 62.3%, respectively. Mediastinitis and in-hospital mortality rates were both 1.4%. On logistic regression analysis, preoperative congestive heart failure and CKD severity were independent predictors of postoperative renal failure and major complications. The mean follow-up period was 5.7 years (range, 0-15.5 years). Estimated 5-year survival (92.9±1.6%, 82.8±3.3%, and 47.3±7.0%, respectively, P<0.001) significantly decreased with declining kidney function. On Cox hazard modeling, CKD severity was an independent predictor of major cerebrocardiovascular events (normal/mild: hazard ratio [HR], 1; moderate: HR, 1.35; severe: HR, 1.83; HD: HR, 2.0, P=0.016) and of overall survival (normal/mild: HR, 1; moderate: HR, 1.65; severe: HR, 5.96; HD: HR, 10.93, P<0.001). BITA grafting was a strong protective factor for overall survival (HR, 0.63; P=0.022). CONCLUSIONS: In DM patients, early- and long-term outcomes after CABG are strongly influenced by CKD progression.


Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Diabetes Mellitus/cirugía , Complicaciones Posoperatorias/mortalidad , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal/mortalidad , Anciano , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/etiología , Tasa de Supervivencia
13.
Kyobu Geka ; 69(8): 573-80, 2016 07.
Artículo en Japonés | MEDLINE | ID: mdl-27440013

RESUMEN

OBJECTIVES: The purpose of this study was to evaluate early and long term surgical results of offpump coronary artery bypass( OPCAB) in comparison with on-pump coronary artery bypass( ONCAB) using single institutional and Japan national database( JACVSD). METHODS: Study 1:In our institution, between 1998 and 2012, 1,030 consecutive patients underwent isolated coronary artery bypass surgery. Using stratification method by propensity scores, early and late surgical results were evaluated. Study 2:In JACVSD, between 2008 and 2010, 24,287 patients who underwent isolated coronary artery bypass were reported. After propensity score matching, 2,955 cases in each group were selected. RESULTS: Study 1:OPCAB significantly reduced intubation period( p<0.001), intensive care unit( ICU) stay( p<0.001), and operative mortality( p=0.022). Kaplan-meier analyses showed there was no statistical difference between OPCAB and ONCAB in major adverse cardiac and cerebrovascular event (MACCE) and mortality. Long term result analyses showed risk of MACCE (p=0.886)and mortality (p=0.437)was similar in both groups. Study 2:Thirty day( p=0.051) and hospital mortality( p=0.053) were less frequent in OPCAB group. Rate of composite( p<0.001), re-bleeding( p=0.004), dialysis( p=0.005), prolonged intensive care unit stay( p<0.001), prolonged ventilation( p<0.001)and gastrointestinal bleeding( p<0.001)was significantly lower in OPCAB after matching. CONCLUSIONS: Both study showed less invasiveness of OPCAB.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Humanos , Japón , Puntaje de Propensión , Diálisis Renal , Estudios Retrospectivos , Resultado del Tratamiento
14.
Circ J ; 79(10): 2177-85, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26227150

RESUMEN

BACKGROUND: To investigate the relationship between age and both short- and long-term outcomes of off-pump coronary bypass grafting (OPCAB). METHODS AND RESULTS: The 780 patients undergoing OPCAB were divided into 3 groups: 262 aged <65 years (young), 329 aged 65-74 years (early elderly), and 189 aged >75 years (late elderly), and retrospectively analyzed. The follow-up rate was 94.9%, and mean follow-up period was 5.6±3.4 years. In-hospital mortality rates were similar among the groups (0.8% in young, 1.2% in early elderly, and 1.1% in late elderly; P=0.862). In logistic regression analysis, the risk factor for predicting major complications was the New York Heart Association (NYHA) classification (odds ratio: 1.555, P=0.001), and not age. The 10-year estimated rates free from cardiac death (89.6±3.2, 95.0±2.1, and 96.5±2.1%, log rank, P=0.16) and cardiac events (71.8±3.8, 66.8±4.3, and 59.9±7.7%, P=0.61) were not significantly different among the groups. In multivariate Cox models, independent risk factors predicting cardiac events were the NYHA classification (hazard ratio (HR): 1.265, P=0.009), and ejection fraction (HR: 0.986, P=0.016), but not age (young HR: 1.0, early elderly HR: 1.276; P=0.210, late elderly HR: 0.910; P=0.707). CONCLUSIONS: Both short- and long-term cardiac outcomes of OPCAB are not influenced by age at operation.


Asunto(s)
Puente de Arteria Coronaria Off-Pump/mortalidad , Muerte , Mortalidad Hospitalaria , Factores de Edad , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia
15.
J Heart Valve Dis ; 24(6): 744-751, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27997781

RESUMEN

BACKGROUND: Patients are occasionally encountered with high mitral pressure gradients after mitral valve repair for degenerative mitral regurgitation (MR), despite the use of a 'truesized' ring based on the anterior leaflet dimension. The study aim was to assess these patients at rest and during exercise, using echocardiography. METHODS: Sixty-seven patients who underwent mitral repair for degenerative disease using a semi-rigid, complete annuloplasty ring were assessed. A truesized ring was always selected for the annuloplasty. Of these patients, 20 were enrolled for exercise stress echocardiography. The indexed ring orifice area (iROA) was calculated by dividing the geometric orifice area of the annuloplasty ring by the patient's body surface area (BSA). Postoperatively, the patients were in sinus rhythm and had less than moderate MR. RESULTS: During peak exercise, seven patients were considered to have severe mitral stenosis (MS), with a mean pressure gradient (mPG) >15 mmHg. The annuloplasty rings used in these seven patients were significantly smaller than those used in the other 13 patients (28.6 ± 1.9 mm versus 33.1 ± 3.1 mm; p = 0.003). The mPG at peak exercise was strongly correlated with the iROA (r = -0.767, p <0.001). CONCLUSIONS: Mitral repair, even following the use of a true-sized ring, may be associated with severe MS when the ring size is relatively small for the patient's BSA. This association was shown to become more prominent during exercise.

16.
J Heart Valve Dis ; 23(3): 310-5, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-25296454

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Mitral valve regurgitation (MR) is known to deteriorate following adult atrial septal defect (ASD) repair in the mid to long-term. The study aim was to identify the risk factors for this deterioration. METHODS: Between 1995 and 2011, a total of 93 consecutive patients (aged > or = 18 years) underwent ASD repair at the authors' institution. Patients who underwent concomitant procedures, other than tricuspid annuloplasty or maze procedure, were excluded; hence, 74 patients were enrolled in the study. MR was evaluated by transthoracic echocardiography shortly after surgery and subsequently on a regular basis in the outpatient clinic. Risk factors for the deterioration of MR were estimated using Cox proportional hazards regression. RESULTS: The mean patient age at surgery was 48.0 +/- 17.1 years, and 20 patients (27%) had atrial fibrillation (AF) preoperatively. The mean follow up was 6.9 +/- 5.5 years. The degree of MR was not unchanged or not improved in 54 patients (73.0%) (group 1), but was increased by one grade in 12 patients (16.2%) (group 2), and by two or more grades in eight patients (10.8%) (group 3). At surgery, all patients in group 3 were aged > 50 years. In group 3, on echocardiography, the average end-diastolic left ventricular dimension was increased from 41.8 mm to 51.8 mm (p = 0.027), and enlargement of the mitral annulus was noted in seven patients. Four of the group 3 patients required reoperation for MR after ASD repair. The Cox proportional hazards model revealed preoperative AF (p = 0.045, hazard ratio (HR): 11.68, 95% confidence interval (95% CI): 1.05-129.48) and Qp/Qs > or = 2.8 (p = 0.015, HR: 9.19, 95% CI :1.53-55.04) to be independent risk factors of new-onset or aggravated MR (by two or more grades) after ASD repair. CONCLUSION: An earlier repair of ASD would be preferable in terms of MR aggravated after ASD repair. For elderly patients with a preoperative high Qp/Qs and AF, mitral valve annuloplasty with ASD repair should considered.


Asunto(s)
Defectos del Tabique Interatrial/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Adulto , Fibrilación Atrial/complicaciones , Femenino , Defectos del Tabique Interatrial/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Periodo Posoperatorio , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Ultrasonografía
17.
J Heart Valve Dis ; 22(6): 837-42, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24597406

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Echocardiography or cinefluoroscopy are standard modalities for evaluating implanted mechanical valve prostheses. The aim of the present study was to evaluate the validity of multidetector computed tomography (MDCT) with three-dimensional image reconstruction in a cine mode (four-dimensional (4D)-CT) for evaluating the functional and morphological findings of implanted mechanical valves. METHODS: A total of 37 patients who had received 45 implanted mechanical valves was studied using electrocardiogram-gated (16- or 256-row) MDCT. The mean age of patients at the MDCT examination was 65.1 +/- 10.1 years (range: 0.5-85 years). The series included 18 aortic and 27 mitral mechanical valves, in addition to 36 bileaflet valves and nine monoleaflet valves. Fifteen patients had atrial fibrillation, and seven had permanent pacemaker implantation. Volume-rendering 3D and multiplanar reformations were obtained, and valve leaflet movement was evaluated using reformatted images in a cine mode (4D images). The quality of mechanical valve leaflet visualization was scored on a four-grade scale (Leaflet index), and the level of artifact was also scored (Artifact index). RESULTS: There were two stuck-valve patients who required emergency surgery. Stuck mechanical leaflets could be visualized using 4D-CT. In all of the bileaflet mechanical valves the valve leaflet motions were visualized with 4D images. In contrast, in four of nine valves with monoleaflet valves the opening and closing angles could not be visualized because of radio-opacity of the leaflet. The median Leaflet index was 3.7 +/- 0.8, and the median Artifact index 3.0 + 0.8. The Leaflet and Artifact indices were significantly lower in monoleaflet valves (p < 0.0001, p = 0.0037, respectively). When using 256-row MDCT the Artifact index was superior to that achieved with 16-row MCDT, but was without statistical difference (p = 0.0654). CONCLUSION: Functional and morphological evaluations of mechanical valves with 4D-MDCT is promising in patients with bileaflet mechanical valves. However, the evaluation of monoleaflet valves is limited.


Asunto(s)
Válvula Aórtica/cirugía , Tomografía Computarizada Cuatridimensional , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Artefactos , Técnicas de Imagen Sincronizada Cardíacas , Distribución de Chi-Cuadrado , Electrocardiografía , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Tomografía Computarizada Multidetector , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Valor Predictivo de las Pruebas , Diseño de Prótesis , Interpretación de Imagen Radiográfica Asistida por Computador , Reoperación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento
18.
J Card Surg ; 28(5): 537-42, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23869415

RESUMEN

BACKGROUND AND AIM OF THE STUDY: The purpose of this study is to evaluate mid-long-term results of aortic arch replacement. METHODS: Between 1992 and 2012, 263 consecutive patients underwent aortic arch repair in our institution. Follow-up rate was 92%, and 243 patients were enrolled in this study. Two hundred twelve patients (87%) underwent total arch replacement using a four-branched graft with antegrade selective cerebral perfusion. Ninety-nine patients (41%) were operated on for acute aortic dissection. RESULTS: Hospital mortality was 13.2%. The mean follow-up duration was 3.6 ± 3.7 (0-19) years. Late mortality occurred in 38 patients, 4.3 ± 3.2 (0.3-14.1) years after surgery. The survival rates were 85%, 70%, and 50% at one, five, and 10 years. In the acute type A aortic dissection group, survival rate at one and five years was 86% and 79%. In the nonacute type A dissection group, one- and five-year survivals were 85% and 62% (log-rank test: p=0.0027). The causes of late mortality were respiratory failure in five, aortic aneurysm rupture in six, cancer in four, stroke in eight, others in seven, and unknown in eight. Twenty-six patients had another aortic intervention 3.6 ± 6.0 (0.04-19.6) years after arch repair. Seven patients had stroke after discharge 6.5 ± 3.9 (1.9-13.0) years after repair. CONCLUSIONS: Mid-long-term results after aortic arch repair with antegrade selective cerebral perfusion were satisfactory. Acute type A aortic dissection did not negatively influence the mid-long-term survival.


Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/cirugía , Disección Aórtica/mortalidad , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/mortalidad , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Circulación Cerebrovascular/fisiología , Perfusión/métodos , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Rotura de la Aorta , Puente Cardiopulmonar/métodos , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria , Accidente Cerebrovascular , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
19.
J Nutr Sci Vitaminol (Tokyo) ; 69(2): 129-135, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37121722

RESUMEN

We have previously reported that lipocalin-type prostaglandin D synthase (L-PGDS) in egg white reacts with IgE antibodies from children with egg allergies. However, antibodies against chicken L-PGDS are not commercially available, and the amount of L-PGDS in egg white is unclear. In this study, we prepared four monoclonal antibodies against chicken L-PGDS and developed a sandwich enzyme-linked immunosorbent assay (ELISA) and a highly sensitive immune complex transfer enzyme immunoassay (ICT-EIA) to quantify L-PGDS in hen egg whites. The detection sensitivity of ICT-EIA for L-PGDS (0.01 ng/mL) was 2,000-fold higher than that of ELISA, which could not be adapted to determine the amount of L-PGDS in egg white. Thus, ICT-EIA is a better method for quantification of trace allergens and expected to be applied to the quantification of other food allergens. Hen eggs (white-shelled eggs from Julia Lite hens, brown-shelled eggs, and iodine-enriched eggs from Boris Brown hens) were purchased from markets in Kochi City, Japan, and the amounts of L-PGDS in them were determined by ICT-EIA. The amounts of L-PGDS per hen egg white were: brown-shelled eggs, 1,179.3±214.3 µg/egg; iodine-enriched eggs, 607.7±126.1 µg/egg; and white-shelled eggs, 350.0±74.1 µg/egg. These results show that the amount of L-PGDS in hen eggs varies depending on the hen lineage; it could also be affected to some extent by other factors, such as feeds and breeding environment.


Asunto(s)
Alérgenos , Clara de Huevo , Complejo Antígeno-Anticuerpo , Anticuerpos Monoclonales , Ensayo de Inmunoadsorción Enzimática , Lipocalinas
20.
Semin Thorac Cardiovasc Surg ; 35(2): 239-248, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-35181442

RESUMEN

We aimed to investigate cardiac magnetic resonance imaging (MRI)-derived predictors of a lack of left ventricular (LV) reverse remodeling after undersized mitral annuloplasty (uMAP) for moderate ischemic mitral regurgitation (IMR). We retrospectively reviewed 31 patients who underwent uMAP for moderate IMR and cardiac MRI evaluation between 2004 and 2017. Cardiac MRI evaluation included cine MRI LV and right ventricular volumetric measurements and gadolinium-enhanced MRI assessment of myocardial scarring. LV dimensions were assessed preoperatively, postoperatively, and at follow-up using serial transthoracic echocardiography, and the mid-term (median, 49 months) predictors of a lack of LV reverse remodeling were analyzed. At the mid-term follow-up (mean follow-up period: 85 ± 40 months), 15 patients exhibited reverse LV remodeling. The relative reduction in LV dimension at follow-up was negatively correlated with the preoperative number of LV segments with myocardial infarction (MI) (defined as an LV segment with >25% enhancement). The optimal cut-off for predicting a lack of reverse LV remodeling at follow-up was >5 LV segments with MI, with a sensitivity and specificity of 92% and 92%, respectively. This cut-off value also predicted all-cause mortality at follow-up, with a sensitivity and specificity of 88% and 67%, respectively. The presence of >5 LV segments with MI on gadolinium-enhanced MRI might be a useful predictor of lack of reverse LV remodeling and all-cause mortality outcomes after undersized mitral annuloplasty for moderate IMR.


Asunto(s)
Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Isquemia Miocárdica , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/etiología , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Puente de Arteria Coronaria/efectos adversos , Estudios Retrospectivos , Gadolinio , Resultado del Tratamiento , Isquemia , Imagen por Resonancia Magnética/efectos adversos , Remodelación Ventricular , Anuloplastia de la Válvula Mitral/efectos adversos
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