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Okayama-shi, Japan

An 85-year-old woman had a history of coronary artery bypass grafting (CABG) performed 7 years ago, and dyspnea on effort had been worsening recently. Since echocardiography showed severe mitral valve regurgitation( MR), mitral valve repair was suggested. Preoperative enhanced computed tomography (CT) showed the patent functioning left internal thoracic artery (LITA) graft. Mitral valve replacement (MVR) using a 25 mm CEP bioprosthesis was performed successfully via resternotomy without any intraoperative injury of the heart. Myocardial protection without clamping of functioning LITA was done by both antegrade and retrograde continuous coronary perfusion (RCCP) under mild hypothermia. The postoperative clinical course was uneventful without any hemodynamic compromise. She was discharged on postoperative day 21 without any cardiac events following early introduction of cardiac rehabilitation. From these results, mitral valve reoperation by RCCP under mild hypothermia without control of functioning internal thoracic artery( ITA) grafts could be a safe option in some cases. Source

Furukawa H.,Okayama Central Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

In this study, we evaluated the initial clinical experience of early cardiac rehabilitation( CR) for very elderly patients over 85 years old after open heart surgery. From September 2007 to January 2011, 7 consecutive patients (85~90 years, mean 85.9 years, male:female=4:3) who underwent cardiac surgery in our institute were selected. Preoperative activity of daily living (ADL) scores were similar in all cases, and 1 patient used a cane for walking. Preoperative New York Heart Association (NYHA) classification was class III :3, class IV:4. Three patients were admitted for acute congestive heart failure approximately 1 month prior to surgery. Standard open heart surgery using bioprosthesis was performed: 3 patients underwent mitral valve replacement( MVR), 3 had aortic valve replacement( AVR), and 1 had tricuspid valve replacement (TVR). Postoperative clinical course was uneventful, and the mean time of ventilator support was 12.1 hours. Thereafter, early CR was introduced at the intensive care unit( ICU) in all patients, and the mean time of introduction of early rehabilitation was 1.7 days. In the last 4 cases, early CR was done the 1st day following surgery. CR was effectively performed in all cases without any problems or cardiac events, and all patients improved enough to leave their beds at 3~7 days, a mean of 4.4 days after surgery. The mean hospital stay after surgery was 30.9 days( 23 ~ 42 days), almost all patients were able to walk independently, and ADL scores at discharge were improved. Only 2 patients required a cane for walking. Postoperative NYHA classification was improved to class I :5, class II :2. From these results, early CR for very elderly patients over 85 years old could be a safe and effective tool to improve and maintain the ADL and quality of life following surgical intervention. Source

Furukawa H.,Okayama Central Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

An 81-year-old man had a history of Takotsubo cardiomyopathy induced by general fatigue after travel and acute gastritis 2 years previously. Recently, dyspnea on effort had been worsening. Since preoperative echocardiography showed severe aortic valve regurgitation (AR) with left ventricular (LV) dilatation, aortic valve replacement (AVR) by the standard procedure was indicated. Since the safety of the perioperative clinical course including recurrence of Takotsubo syndrome and hemodynamic compromise was unclear, a thorough examination was performed before surgical intervention. AVR with a 21 mm Mosaic bioprosthesis was performed. Transesophageal echocardiography (TEE) during operation did not demonstrate any sign of Takotsubo syndrome and good LV function was maintained. The patient was discharged on postoperative day 18 without any cardiac events including arrhythmia or clinical symptoms such as chest pain. Based on these results, open heart surgery under cardiopulmonary bypass (CPB) and cardiac arrest could be safely performed in patients with a history of Takotsubo cardiomyopathy with minimum use of cardiac agents including cathecholamine and sufficient perioperative removal of emotional and physical stress. Source

Kamomae T.,Nagoya University | Monzen H.,Kinki University | Nakayama S.,Okayama Central Hospital | Mizote R.,Okayama Central Hospital | And 3 more authors.
PLoS ONE | Year: 2015

Movement of the target object during cone-beam computed tomography (CBCT) leads to motion blurring artifacts. The accuracy of manual image matching in image-guided radiotherapy depends on the image quality. We aimed to assess the accuracy of target position localization using free-breathing CBCT during stereotactic lung radiotherapy. The Vero4DRT linear accelerator device was used for the examinations. Reference point discrepancies between the MV X-ray beam and the CBCT system were calculated using a phantom device with a centrally mounted steel ball. The precision of manual image matching between the CBCT and the averaged intensity (AI) images restructured from four-dimensional CT (4DCT) was estimated with a respiratory motion phantom, as determined in evaluations by five independent operators. Reference point discrepancies between the MV X-ray beam and the CBCT image-guidance systems, categorized as left-right (LR), anterior-posterior (AP), and superior-inferior (SI), were 0.33 ± 0.09, 0.16 ± 0.07, and 0.05 ± 0.04 mm, respectively. The LR, AP, and SI values for residual errors from manual image matching were -0.03 ± 0.22, 0.07 ± 0.25, and -0.79 ± 0.68 mm, respectively. The accuracy of target position localization using the Vero4DRT system in our center was 1.07 ± 1.23 mm (2 SD). This study experimentally demonstrated the sufficient level of geometric accuracy using the free-breathing CBCT and the image-guidance system mounted on the Vero4DRT. However, the inter-observer variation and systematic localization error of image matching substantially affected the overall geometric accuracy. Therefore, when using the free-breathing CBCT images, careful consideration of image matching is especially important. © 2015 Kamomae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source

Nakayama S.,Okayama Central Hospital | Monzen H.,Okayama Central Hospital | Monzen H.,Kinki University | Oonishi Y.,Okayama Central Hospital | And 4 more authors.
Physica Medica | Year: 2015

Purpose: Photographic film is widely used for the dose distribution verification of intensity-modulated radiation therapy (IMRT). However, analysis for verification of the results is subjective. We present a novel method for marking the isocenter using irradiation from a megavoltage (MV) beam transmitted through slits in a multi-leaf collimator (MLC). Methods: We evaluated the effect of the marking irradiation at 500 monitor units (MU) on the total transmission through the MLC using an ionization chamber and Radiochromic Film. Film dosimetry was performed for quality assurance (QA) of IMRT plans. Three methods of registration were used for each film: marking by irradiating with an MV beam through slits in the MLC (MLC-IC); marking with a fabricated phantom (Phantom-IC); and a subjective method based on isodose lines (Manual). Each method was subjected to local γ-analysis. Results: The effect of the marking irradiation on the total transmission was 0.16%, as measured by a ionization chamber at a 10-cm depth in a solid phantom, while the inter-leaf transmission was 0.3%, determined from the film. The mean pass rates for each registration method agreed within ±1% when the criteria used were a distance-to-agreement (DTA) of 3mm and a dose difference (DD) of 3%. For DTA/DD criteria of 2. mm/3%, the pass rates in the sagittal plane were 96.09±0.631% (MLC-IC), 96.27±0.399% (Phantom-IC), and 95.62±0.988% (Manual). Conclusion: The present method is a versatile and useful method of improving the objectivity of film dosimetry for IMRT QA. © 2015 Associazione Italiana di Fisica Medica. Source

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