※一部利用できない機能があります
| 1.
論文 |
論文
|
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
…
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.
続きを見る
|
||||
| 2.
論文 |
論文
|
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
…
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.
続きを見る
|
||||
| 3.
論文 |
論文
|
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
…
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.
続きを見る
|
||||
| 4.
論文 |
論文
|
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
…
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.
続きを見る
|
||||
| 5.
論文 |
論文
|
川筋, 道雄 ; 榊原, 直樹 ; 渡辺, 洋宇 ; 北村, 昭洋 ; Kawasuji, Michio ; Sakakibara, Naoki ; Watanabe, Yoh ; Kitamura, Akihiro
概要:
金沢大学医薬保健研究域医学系<br />A new vein holder for a side-to-side anastomosis between a vein graft and the coronary artery is des
…
cribed. The holder is consisted of two nerve hooks, and those distance is adjusted. The technique for creating the diamond anastomosis is also described.
続きを見る
|
||||
| 6.
論文 |
論文
|
大竹, 裕志 ; 渡辺, 剛 ; 向井, 恵一 ; 三崎, 拓郎 ; 松永, 康弘 ; 松本, 勲 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Ohtake, Hiroshi ; Watanabe, Go ; Mukai, Kei-ichi ; Misaki, Takuro ; Matsunaga, Yasuhiro ; Matsumoto, Isao ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />To investigate whether the efficacy of laser ablation therapy is affected by the color of the target
…
organ, we irradiated 9 canine hearts through the epicardium with Nd-YAG laser (200 J, 400 J), and compared coagulated myocardial volume in the beating heart (reddish) with that in the stopped heart (whitish) infused with 0 degrees C saline (cardioplegic model) via a coronary artery. The coagulated myocardial volume of the beating heart was significantly larger than that of the arrested heart, indicating the YAG laser energy is absorbed by red myocardium to greater extent than it is by white myocardium. In conclusion, during intraoperative laser ablation, the presence or absence of blood in cardiac tissue is an important factor for safe irradiation.
続きを見る
|
||||
| 7.
論文 |
論文
|
手取屋, 岳夫 ; 川筋, 道雄 ; 榊原, 直樹 ; 竹村, 博文 ; 渡辺, 洋宇 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sakakibara, Naoki ; Takemura, Hirofumi ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />The pressure of in situ arterial graft was measured with Fiber Optic Transducer-Tipped Pressure Moni
…
toring System (Camino). Internal thoracic artery (ITA) and gastroepiploic artery (GEA) were prepared as in situ grafts, and the pressure at the end of each graft was recorded with ascending aortic pressure (Ao) and electrocardiogram, simultaneously. Although the peak systolic pressures of these grafts were identical, the systolic pressure of ITA and GEA formed narrow contours. While the diastolic pressures of Ao was sustained and high, the diastolic pressures of ITA and GEA showed rapid falling. Therefore, ITA and GEA had the risk of inadequate blood supply. This pressure measurement of in situ arterial graft was an easy and effective method for presumption of the ability of blood supply.
続きを見る
|
||||
| 8.
論文 |
論文
|
手取屋, 岳夫 ; 川筋, 道雄 ; 榊原, 直樹 ; 上山, 圭史 ; 渡辺, 洋宇 ; Tedoriya, Takeo ; Kawasuji, Michio ; Sakakibara, Naoki ; Ueyama, K. ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Arterial grafts have been used widely for coronary artery bypass grafting (CABG) because of their ex
…
cellent long patency. However, some clinical reports suggest that blood flow in arterial grafts may not be adequate compared with aorto-coronary bypass grafting. Pressure in arterial grafts was measured in patients undergoing CABG. The pressure tracing in the ascending aorta (AA) was maintained during diastole. The systolic pressure wave in ITA and GEA was narrow, while the diastolic pressures fell rapidly: the diastolic pressure in GEA was lower than in ITA. The area under the pressure wave was measured in diastole and in systole. Although there was no significant difference in systolic areas, the diastolic area were lower in ITA than in AA, and lower in GEA than in AA and in ITA. These results clarified that arterial grafts which belong to the systolic-dominant systemic circulation have disadvantages over aorto-coronary bypass grafts, in terms of physiological suitabilities to the diastolic-dominant coronary circulation.
続きを見る
|
||||
| 9.
論文 |
論文
|
小林, 孝一郎 ; 清水, 淳三 ; 大村, 健二 ; 村上, 眞也 ; 小田, 誠 ; 林, 義信 ; 家持, 健一 ; 関戸, 伸明 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Kobayashi, Ko-ichi ; Shimizu, Junzo ; Omura, Kenji ; Murakami, Shinya ; Oda, Makoto ; Hayashi, Yoshinobu ; Ietsugu, Ken-ichi ; Sekido, Nobuaki ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />We present a series of 8 consecutive patients who underwent the omental pedicle flap method in the f
…
ield of thoracic surgery. Four of them had empyema with bronchopleural fistula and four had mediastinal infection. A pedicle of omentum containing the right gastroepiploic artery was passed through a tunnel in the diaphragm into the empyema cavity or the mediastinal abscess cavity. All eight patients were cured successfully by single-stage procedures. We think this series demonstrates the value of omental pedicle flap method which lacks in symptoms due to defected organ and offers an excellent therapeutic effect with easy operative procedure. And, this method produce a quality of life. Further active application of this method can be expected in the management of chest problems.<br />4
続きを見る
|
||||
| 10.
論文 |
論文
|
榊原, 直樹 ; 浦山, 博 ; 松永, 康弘 ; 竹村, 博文 ; 村上, 眞也 ; 上山, 圭史 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Sakakibara, Naoki ; Urayama, Hiroshi ; Matsunaga, Yasuhiro ; Takemura, Hirofumi ; Murakami, Shinya ; Ueyama, K. ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic
…
replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients underwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism.
続きを見る
|
