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| 1.
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岩, 喬 ; 三崎, 拓郎 ; 坪田, 誠 ; Iwa, Takashi ; Misaki, Takuro ; Tsubota, Makoto
概要:
Simultaneous recording of epicardial activation from multiple sites during anti-arrhythmic surgery is essential to determine the location of the arrhythmic source. We formed a new sock from Presnet tubular dressing material with 87 snap
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electrodes. Bipolar recording sites, 1.0 mm in diameter and separated 1.5 mm, are constructed of gold and attached to steel wire directly at the male snap without button. This new Sock and Snap electrode was used to record in 7 patients; 5 of WPW syndrome and 2 of non-ischemic ventricular tachycardia. Satisfactory epicardial contact was obtained in all patients without any hemodynamic change. We could get a rapid display of epicardial mapping using a computer.
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| 2.
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川筋, 道雄 ; Rosenthal, Arvo ; 沢, 重治 ; 竹村, 博文 ; 藤井, 奨 ; 岩, 喬 ; Kawasuji, Michio ; Sawa, Shigeharu ; Takemura, Hirofumi ; Fujii, Susumu ; Iwa, Takashi
概要:
Transesophageal two-dimensional echocardiography (TEE) was evaluated in 14 patients who underwent coronary bypass surgery. The TEE transducer was positioned to view the left ventricular short axis at the level of the papillary
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muscle. Global left ventricular function was assessed by measuring left ventricular end-diastolic and end-systolic area and computing the fractional area change (FAC). Regional left ventricular function was analyzed after dividing the short axis view of the left ventricle into four anatomic segments. The mean FAC was 48% after intubation, 48% after skin incision, 47% after sternotomy, and 51% after pericardiotomy. The mean FAC increased significantly to 55% 0 to 30 minutes after cardiopulmonary bypass, and was 53% at the end of the operation. In 5 patients, FAC decreased and regional wall motion abnormalities appeared around sternotomy. These abnormalities was considered due to transient myocardial ischemia. In 7 patients, a paradoxical motion of the ventricular septum occurred at closing of the sternum. TEE was performed without complication and found to be a good method for assessing global and regional left ventricular function.
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| 3.
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松本, 康 ; 川筋, 道雄 ; 渡辺, 剛 ; 岩, 喬 ; Matumoto, Yasushi ; Kawasuji, Michio ; Watanabe, Go ; Iwa, Takashi
概要:
A patient with complex cardiac anomalies who developed severe respiratory insufficiency due to high pulmonary blood flow from a giant PDA was treated successfully by PDA banding. PDA-dependent heart disease causes a reduction in
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pulmonary blood flow in many patients and is often treated by palliative shunt operation. Although the present patient had PDA-dependent heart disease, heart failure occurred due to increased pulmonary blood flow through PDA and required surgical treatment. We performed PDA banding, because it is technically simple and allows adjustment of the postoperative pulmonary blood flow according to the degree of constriction. The degree of constriction was determined according to the PaO2 value. SO2 levels of 60-70% have been used as an index of the extent of banding, but PaO2 is considered to be equally appropriate.
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大竹, 裕志 ; 岩, 喬 ; 三崎, 拓郎 ; 渡辺, 剛 ; 向, 歩 ; 坪田, 誠 ; 近江, 三喜男 ; Ohtake, Hiroshi ; Iwa, Takashi ; Misaki, Takuro ; Watanabe, Go ; Mukai, A. ; Tsubota, Makoto ; Ohmi, Mikio
概要:
The occurrence of both tricuspid atresia and WPW syndrome is quite rare. To our knowledge, only two operated cases have been reported. In this report, a 8-year-old boy with this combination was reported. Tachycardia via the right
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side accessory pathway was for the first time pointed out after Kreutzer's operation. Epicardial mapping showed the earliest excitation at the right free wall. When fatty tissue around this area was removed by CUSA, a large cardiac vein appeared. By holding this vein with a forceps, the delta wave disappeared temporarily. ACP seemed to be present near this vein. Permanent disappearance of the delta wave was obtained after ligation and division. Four months after surgery, he is free from tachycardia attacks.
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| 5.
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渡辺, 剛 ; 三崎, 拓郎 ; 松永, 康弘 ; 市橋, 匠 ; 坪田, 誠 ; 渡辺, 洋宇 ; 岩, 喬 ; Watanabe, Go ; Misaki, Takuro ; Matsunaga, Yasuhiro ; Ichihashi, Takumi ; Tsubota, Makoto ; Watanabe, Yoh ; Iwa, Takashi
概要:
Two cases of atrial tachyarrhythmias with atrial flutter requiring cryosurgical treatment are reported. In two cases, preoperative electrophysiological studies revealed supraventricular reentrant tachyarrhythmias during atrial flutter and
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showed enhanced conduction through the AV node that conducted atrial impulses rapidly to the ventricle. Based on intraoperative endocardial mapping, the earliest excitation site was localized along the AV node and His bundle during supraventricular tachyarrhythmias in one case. The cryosurgical treatment was administered at Koch's triangles and in one case additionally at coronary sinus. After the operation, supraventricular tachyarrhythmias were not inducible and no clinical recurrences have occurred. Normal atrioventricular conduction was preserved in two cases. We concluded that cryosurgical treatment is useful for the treatment of the atrial tachyarrhythmias.
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渡辺, 進一郎 ; 渡辺, 洋宇 ; 清水, 淳三 ; 坪田, 誠 ; 徳楽, 正人 ; 龍沢, 泰彦 ; 荒能, 義彦 ; 岩, 喬 ; Watanabe, Shin-ichiro ; Watanabe, Yoh ; Shimizu, Junzo ; Tsubota, Makoto ; Tokuraku, Masato ; Tatsuzawa, Y. ; Arano, Y. ; Iwa, Takashi
概要:
A 62-year-old woman with adenoid cystic carcinoma which recurred 10 years after sleeve middle lobectomy was reported. Completion pneumonectomy was performed and her postoperative course was uneventful. If pulmonary function permits,
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reoperation for recurrent lung cancer should be attempted.
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| 7.
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清水, 淳三 ; 渡辺, 洋宇 ; 林, 義信 ; 小田, 誠 ; 岩, 喬 ; 高松, 秀行 ; 藤村, 政樹 ; 水上, 勇治 ; Shimizu, Junzo ; Watanabe, Yoh ; Hayashi, Yoshinobu ; Oda, Makoto ; Iwa, Takashi ; Takamatsu, Hideyuki ; Fujimura, Masaki ; Mizukami, Yuji
概要:
Leiomyoma of the trachea and bronchus is a rare tumor. Only 45 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the intermediate bronchus which was successfully operated on. A 45-year-old man
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suffered from a repeated episode of pneumonia in the right lower lobe. Bronchoscopy revealed a polypoid mass on the intermediate bronchus. The diagnosis of leiomyoma was made by bronchoscopic biopsy. Sleeve resection of the intermediate bronchus including the tumor and end-to-end anastomosis was performed. His postoperative course was uneventful and bronchoscopic findings showed clear healing of the anastomotic site. The resected specimen contained a tumor with smooth surface having protrusion into the bronchial lumen with 6 x 5 x 4 mm in size. The final pathological diagnosis was leiomyoma of the intermediate bronchus with no evidence of malignancy.
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| 8.
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清水, 淳三 ; 渡辺, 洋宇 ; 小田, 誠 ; 林, 義信 ; 渡辺, 進一郎 ; 龍沢, 泰彦 ; 岩, 喬 ; Shimizu, Junzo ; Watanabe, Yoh ; Oda, Makoto ; Hayashi, Yoshinobu ; Watanabe, Shin-ichiro ; Tatsuzawa, Y. ; Iwa, Takashi
概要:
This report analyzes the operative indication for the small lesion of advanced lung cancer. The subjects consisted of 25 patients with T1N2 lung cancer, one T1N3, four T1M1 and five small lung cancer lesion with dissemination, which was
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regarded as the small lesion of advanced lung cancer. The cumulative 5-year survival rate after operation for 25 patients with T1N2 lesion was 30.6%. Of 25 patients, 18 were selected patients who underwent a curative operation with a 5-year survival of 37.0%. In the remaining 7 patients, who underwent a non-curative operation, 5-year survival was 0%. As to mediastinal lymph node involvement, it is possible that metastasis to more than two levels of mediastinal lymph nodes or to the upper mediastinal lymph nodes (#1-3) are poor prognostic factors in T1N2 lesion. Another group except T1N2 could not be the comparative materials because they were much fewer in number. But T4 cases associated with small lung cancer lesion with dissemination and T1M1 cases associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have a long-term survival. We conclude that T1N2 patients with metastasis to within one level of mediastinal lymph node, which will possibly have a curative operation, is a proper operative indication for the small lesion of advanced lung cancer.
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| 9.
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竹村, 博文 ; 川筋, 道雄 ; 澤, 重治 ; 藤井, 奨 ; 岩, 喬 ; Takemura, Hirofumi ; Kawasuji, Michio ; Sawa, Shigeharu ; Fujii, Susumu ; Iwa, Takashi
概要:
Ten patients with solitary stenosis of the left main coronary artery underwent coronary artery bypass grafting. All patients suffered from unstable angina and were in NYHA class III or IV. Two of them required intravenous infusion of
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nitroglycerin preoperatively. The degree of stenosis of the left main coronary artery was 75% in 3 patients, 90% in 5, 95% in one and total obstruction in the other one. Five patients received saphenous vein grafts to the LAD and circumflex artery and the other 5 patients received IMA grafts to the LAD and saphenous vein grafts to the circumflex arteries. In 2 patients with 75% stenosis of the left main coronary artery we found narrow internal mammary artery grafts, the so called "string sign", on postoperative angiography. Although several causes of string sign were proposed previously, we supposed that the main cause of the "string sign" was the competition for flow between the IMA graft and the native coronary artery or grafted coronary artery. Postoperatively, all patients showed improvements in cardiac function and were in NYHA class I. No evidence of ischemic findings was found in postoperative exercise stress tests.
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| 10.
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手取屋, 岳夫 ; 川筋, 道雄 ; 沢, 重治 ; 榊原, 直樹 ; 岩, 喬 ; 滝, 淳一 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sawa, Shigeharu ; Sakakibara, Naoki ; Iwa, Takashi ; Taki, Jun-ichi
概要:
The sequential change of left ventricular function during exercise and recovery after exercise was assessed in 50 patients who had undergone coronary bypass surgery before and after the operation by means of continuous ventricular
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function monitoring system (VEST). Cardiac response was divided into 4 types with respect to the profiles of the left ventricular ejection fraction during exercise. Type A continued to increase; type B initially increased but decreased in severe exercise stages; type C did not change during exercise; type D continued to decrease. Most patients showed type C or D before surgery but showed type A after surgery. 9 patients with occluded grafts or ungrafted coronary arteries showed type B, C or D. Two patients with extended infarction and poor left ventricular function showed type C after surgery. In recovery period after exercise, the ejection fraction showed an overshoot. The mean ratio of peak ejection fraction during recovery to ejection fraction at rest increased from +62 +/- 12% before operation to +68 +/- 16% after operation (p less than 0.05). The recovery time after exercise was decreased from 195 sec before operation to 98 sec after operation (p less than 0.01). VEST revealed response of left ventricular function during exercise and recovery after exercise as far as detail abnormalities.
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