Shigeru Sakakibara

Coronary arteriovenous fistula: Nine operated cases

Summary Nine operated cases of coronary arteriovenous fistula were reported, with a brief review of the literature. Retrograde aortography is the best diagnostic method, although a continuous murmur atypically located for patent ductus arteriosus is suggestive of this anomaly. In view of the relative simplicity of the operation, early correction should be made before severe complications appear.

Pathogenetic Mechanisms of Prolapsing Aortic Valve and Aortic Regurgitation Associated With Ventricular Septal Defect: Anatomical, Angiographic, and Surgical Considerations

The developmental mechanisms of prolapse and regurgitation of the aortic valve which complicate ventricular septal defect (VSD) were investigated from the anatomical, angiographic, and surgical viewpoints on the basis of autopsied heart specimens, preoperative thoracic aortography, and surgical records.Two major, conceptually distinct but functionally interdependent factors contribute to the aortic valves prolapse into the VSD. The major feature of the first category is the lack of anatomical support for the valve. In subpulmonary VSD, a regional defect of the conal septal musculature which supports a section of the right coronary sinus and the annulus was observed. In infracristal VSD, a deficiency of the sinus of Valsalva was noted.The hemodynamic effects, which actually produce prolapse of the anatomically unsupported valve into the VSD, is the second contributing factor. The left-to-right shunt of blood through the VSD during the early systolic phase pulls the sagging aortic valve into the defect. The distinctive feature of the second category is that prolapse of the anatomically unsupported valve is produced by hemodynamic effects. Diastolic aortic pressure does not appear to contribute greatly to bulging of the aortic valve into the right ventricular cavity. However, in the diastolic phase, the closed valve is subject to intra-aortic pressure, causing the free margin of the prolapsed cusp to hang down, to gradually become elongated, and finally to separate from the free margin of the other two cusps, and thus be rendered incompetent.

Congenital aneurysm of the sinus of Valsalva associated with ventricular septal defect: Anatomical aspects

Abstract On the basis of 55 operative and 15 autopsied specimens, the relation of VSD, aneurysm of the sinuses of Valsalva, and prolapsing aortic insufficiency has been discussed. Four types were grouped analogously to our previous classification of the congenital aneurysm of the sinus of Valsalva. With this classification as a basis, anatomical and angiocardiographic findings of the disease were compared and analyzed.

Ventricular septal defect with aortic insufficiency: Angiocardiographic aspects and a new classification

Abstract Based on 91 operated cases of VSD with AI and 67 biplane aortographies taken before surgical treatment, we have made a classification of this syndrome and have described our opinions on the aortographic aspects. Type 1 is subpulmonary VSD, which is further divided into subtypes a and b. Type 2 is infracristal VSD which is divided into subtypes a, b, and c. These two types, which are distinguished according to the position of the VSD, have two forms found in the lateral aortogram, as follows: (1) protruding aortic valve and sinus, and (2) nonprotruding aortic valve and sinus. Protruding AI is easily observed in aortography, and the protruding part frequently coincides with the position of the VSD as ascertained by operation. As to nonprotruding AI, however, aortography does not demonstrate the position of the deformed valve and the VSD, but can show only the grade of aortic regurgitation. Infundibular stenosis often accompanies this syndrome. This complication occurs mainly with Type 2 VSD with AI, but also occurs with Type 1 in a small number of cases. Of the cases associated with infundibular stenosis, AI is caused by the protrusion of the aortic valve and the sinus in some cases and by different factors in other cases.

Idiopathic postpartum cardiomyopathy: Report of a case with special reference to its ultrastructural changes in the myocardium as studied by endomyocardial biopsy

Abstract A 30-year-old woman who manifested clinical evidence of idiopathic postpartum cardiomyopathy was reported on and a literature review was also included. As a result of extensive light microscopic, electron microscopic, and histochemical studies, utilizing Konno and Sakakibaras biopsy technique, two types of peculiar deposits in the myocardial cells were observed. The first substance, which had a peculiar, fine, fibrous structure, was rather characteristic for this disease condition, while the second one was also encountered in many other conditions of the heart. On the basis of histochemical analysis, the first substance was assumed to be proteinaceous and it was stained negatively for mucopolysaccharide. The second substance seemed to be identical to that observed in mucoid or basophilic degeneration. The nature of these materials is unknown.

The direct diagnosis of human myocardial ischemia using 131I-MAA via the selective coronary catheter: Preliminary report

By direct injection of 131I-MAA into the coronary artery via a selective coronary catheter, scanning was carried out. As compared with the conventional method, the uptake of isotope into other organs was remarkably limited, and the ischemic area of the myocardium was distinctly demonstrated. The safety of injection of 131I-MAA into the coronary artery was confirmed in our animal experiments and the method was clinically used in 4 patients. The state of blood flow through the myocardial tissue itself cannot be demonstrated by coronary angiography itself but was definitely shown by our method. Combination of coronary angiography and myocardial scanning would certainly render more reliability in the diagnosis of ischemic heart diseases.

Myxoma of the right ventricle of the heart: Report of a case with successful removal and review of the literature

Abstract Myxomas of the right ventricle are extremely rare. We have reported the case of an 18-year-old woman who had such a tumor that was correctly diagnosed preoperatively and was successfully treated by surgical removal. To our knowledge, this constitutes the second case in the literature with such an outcome. The clinical features of these myxomas are ill defined but resemble those of pulmonary stenosis. The possibility of such a lesion should always be borne in mind and though of whenever doubt arises while one is considering pulmonary stenosis as a work-up diagnosis, and angiocardiography should be performed in order to clarify this obscure point. Intracardiac myxomas are histologically benign but hemodynamically “malignant,” and the almost sure fatality from the embolic phenomenon urges us to diagnose it and treat it early enough. A thorough review of the literature has been presented.

Congenital aneurysm of the sinus of valsalva criteria for recommending surgery

Abstract Based on our previously reported classification of congenital aneurysm of the sinuses of Valsalva, the indications for surgery and the operative technic are presented. Successful operations previously performed for this condition are reviewed briefly.

Surgical Considerations of Ventricular Septal Defect Associated with Complete Transposition of the Great Arteries and Pulmonary Stenosis With Special Reference to the Rastelli Operation

Ventricular septal defect (VSD) associated with complete transposition of the great arteries was studied, and each of the typical anatomic varieties was depicted to emphasize the characteristic features of the VSD. Among the 32 specimens, 13 cases were found to have a VSD lying anterosuperior to the origin of the papillary muscle of the conus, indicating that repair of the VSD could be performed without difficulty. Such a defect situated above the crista supraventricularis has proved to be technically most preferable, as shown in the case report. In contrast, the remaining 19 cases appeared to be inappropriate for the technique, as the VSD was overhung by a part of the tricuspid valve. Additional analysis was made of the angiocardiographic appearances of the VSD, demonstrating some characteristic patterns.

Natural history and surgical indications of ventricular septal defect

Abstract Two cases of VSD in patients over 40 years old were presented. Both of them were operated upon without any post-operative complications. Considering that the natural history of VSD patients is fairly good, and that most young children with VSD have spontaneous closure, we believe that asymptomatic patients with a small or moderate size VSD should be left for natural development without any surgical interruptions. Operations are indicated for patients with a large left-to-right shunt, bacterial endocarditis, occurrence of aortic insufficiency, and pulmonary hypertension.