Japanese heart journal
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Japanese heart journal · Mar 2001
Coronary artery bypass grafting with cardiopulmonary bypass is safe and contributes to favorable long-term results.
The aim of this study was to determine the indication for minimally invasive direct coronary artery surgery based on the operative and long-term results of conventional coronary artery bypass grafting with cardiopulmonary bypass. Operative results: The subjects included 505 patients who underwent isolated elective coronary artery bypass grafting with cardiopulmonary bypass from January 1995 through August 1999. The mean age at the time of surgery was 61.9 and the mean number of grafts per patient was 2.6. ⋯ The 10-year cardiac death free rate among patients undergoing complete revascularization was 96.3% and 88.7% among those receiving incomplete revascularization (p = 0.0016). The 10-year cardiac event free rates were 82.3% and 67.9%) among patients undergoing complete and incomplete revascularization, respectively (p = 0.0118). In view of the favorable operative and long-term results of conventional coronary artery bypass grafting, especially complete revascularization, we conclude that minimally invasive direct coronary artery grafting is an appropriate treatment for multi-vessel disease in carefully selected patients at a high risk for stroke and major comorbidities due to old age.
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Japanese heart journal · Jan 2001
Serum lipoprotein(a) and its relation to left ventricular thrombus in patients with acute myocardial infarction.
It is well known that the incidence of left ventricular (LV) thrombosis is high in patients with acute myocardial infarction (AMI). Due to the high degree of structural homology with plasminogen, lipoprotein(a) may produce thrombogenic effects by modulating the fibrinolytic system. However, the role of Lp(a) level in the formation of LV thrombus has not been studied. ⋯ In multivariate analyses, only peak creatine kinase level (p = 0.04) and LV wall motion score index (p = 0.002) were independent predictors of left ventricular thrombus formation. These results suggest that Lp (a) is not a risk factor for LV thrombus in patients with AMI. Our data demonstrate that the best predictors of LV thrombus formation after AMI are a high peak creatine kinase level and a high LV wall motion score index.
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Japanese heart journal · Jul 2000
Case ReportsIsolated right atrial tear following blunt chest trauma: report of three cases.
Blunt chest trauma causing isolated right atrial tear and cardiac tamponade in three patients is reported. All three patients presented with hypotension, elevated central venous pressure and altered consciousness. Echocardiographic examination demonstrated pericardial effusion in all three cases. ⋯ At operation, two patients had one tear in the right atrium, the other had two tears in the right atrium. All three patients recovered uneventfully. Early use of echocardiography to detect the presence of hemopericardium and cardiac tamponade in patients with suspected atrial rupture following blunt chest trauma is advocated.
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Japanese heart journal · Jan 2000
Modulation of the sympathovagal balance in drug refractory dilated cardiomyopathy, treated with permanent atrioventricular sequential pacing.
The aim of this study was to assess the long term efficacy of DDD pacing mode in selected patients with idiopathic dilated cardiomyopathy (IDCM) and drug refractory heart failure. The patients were evaluated according to the long term alteration of the sympathovagal balance (SVB). Patients with IDCM were considered eligible for DDD pacing if during temporary VDD pacing a 15% or more increase in the resting cardiac output was demonstrated. ⋯ In conclusion, DDD pacing with individualized AV delay as an adjunct therapy could be a valuable method in selected patients with IDCM and drug refractory heart failure. DDD pacing improves the SVB over the long term. This improvement is attributed to sympathetic activity withdrawal and is more pronounced during night and less during day time.
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Japanese heart journal · Nov 1999
Subarachnoid hemorrhage and myocardial damage clinical and experimental studies.
Subarachnoid hemorrhage (SAH) due to aneurysmal rupture is frequently complicated by cardiopulmonary episodes, including sudden death. We investigated the pathogenesis of cardiopulmonary complications from clinical observation of 715 cases with SAH. There was transient left ventricular asynergy in 9.4% (67/715) of the cases, which consisted of mechanical heart failure and myocardial necrosis. ⋯ The animal experiments showed that sympathetic nervous activity as well as cardiac contractility were transiently elevated, but cardiac function subsequently declined. Serum CK-MB was increased from the onset of SAH and a high value was maintained throughout the entire experimental period. In conclusion, extraordinary transient enhancement of sympathetic nervous activity induces myocardial damage resulting from what is characterized by "a panic myocardium."