記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Residual shunt after the closure of an inferior sinus venosus defect (ISVD) is a rare complication with a high rate of reintervention. CASE PRESENTATION: Here, we report a rare case of a patient with a recurrent defect identified 22 years after the closure of ISVD. The 25 × 10-mm defect was situated at the inferior vena cava-right atrial junction and was closed directly at 5 years of age. No residual shunt was detected, and when the patient reached 12 years of age, follow-up was discontinued. However, the residual atrial septal defect shunt was detected incidentally at 27 years of age. During the second surgery, the lower end of the original defect was opened and then closed using an expanded polytetrafluoroethylene patch. CONCLUSIONS: In light of the high rate of reintervention for residual shunt after ISVD closure, patch closure appeared to be a better option to reduce the tension in the inferior-posterior border. Moreover patients with this profile should be followed up closely at least in their childhood, including assessment by echocardiography.

DOI： 10.1272/jnms.JNMS.2023_90-301

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although the causative pathogens in cardiac implantable electronic device (CIED) infections are well known, the relationship between time after implantation and infection patterns has not been sufficiently investigated. This study investigated the microbiology and onset of CIED infections according to infection patterns. Methods and Results: This retrospective study included 97 patients who underwent CIED removal due to device-related infections between April 2009 and December 2018. After device implantation, infections peaked in the first year and declined gradually over 10 years. Most infections (>60%) occurred within 5 years. Staphylococcal infections, the predominant form of CIED infections, occurred throughout the study period. CIED infections were categorized as systemic (SI; n=26) or local (LI; n=71) infections according to clinical presentation, and as CIED pocket-related (PR; n=85) and non-pocket-related (non-PR; n=12) infections according to the pathogenic pathway. The main causative pathogen in SI was Staphylococcus aureus, whereas coagulase-negative staphylococci were mainly related to LI. Both SI and LI peaked in the first year after implantation and then decreased gradually. There was no significant microbiological difference between PR and non-PR infections. PR infections showed the same temporal distribution as the overall cohort. However, non-PR infections exhibited a uniform temporal distribution after the first year. Conclusions: The severity of CIED infections depends on the causative pathogen, whereas their temporal distribution is affected by the microbiological intrusion pathway.

DOI： 10.1253/circrep.CR-21-0095

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Operative mortality after endovascular aneurysm repair (EVAR) has been reported as lower than open surgical repair (OSR) for abdominal aortic aneurysm (AAA) in randomized controlled trials. However, many cohort studies have demonstrated similar mortality rates for both procedures. We compared operative mortality between EVAR and OSR, at our institution. METHODS: All AAA operations from 2012 to 2017 were reviewed, and baseline characteristics were collected. Outcomes included 30-day mortality, operative data, complications, length of hospital stay (LOS), costs, re-intervention, and survival rates were compared. A multivariable analysis with unbalanced characteristics was performed. RESULTS: We had a total of 162 patients, 100 having OSR and 62 for EVAR. The EVAR group was older, with higher ASA classification. Thirty-day mortality rate did not significantly differ (0/100 for OSR and 2/62 (3%) for EVAR; p = 0.145), while the EVAR group had less blood loss, shorter operative times, and LOS, but higher re-intervention rates (adjusted hazard ratio 6.4 (95%CI: 1.4, 26.8)). Survival rates did not significantly differ between the groups. EVAR cost approximately 1-million yen more. CONCLUSIONS: OSR had low 30-day mortality rate in selected low-risk patients whereas EVAR had less blood loss, shorter operative times, LOS and could be done in high-risk patients with low 30-day mortality but with higher re-intervention rate.

DOI： 10.1016/j.asjsur.2021.06.015

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Objective: Apicoaortic bypass has double outlets and its graft design is similar to that of a left ventricular assist device (LVAD). The left ventricular apex to the descending aorta (LV-DsAo) bypass is widely used in apicoaortic bypass. In contrast, the left ventricular apex to the ascending aorta (LV-AsAo) bypass is standard in LVAD surgery. This study aimed to evaluate the graft designs of apicoaortic bypass and their effects on flow distribution and energy loss (EL). Methods: A simulation study using computational fluid dynamics was performed on the geometry and hemodynamics data obtained from a 30-year-old patient who underwent a LV-DsAo bypass. The ratio of the cardiac output (CO) through the ascending aorta (AsAo) and apicoaortic conduit was set at 50:50, 30:70, and 10:90. Regional blood flow (RBF) and EL were calculated for the different distribution ratios. As an alternative to the LV-DsAo bypass, a virtual LV-AsAo bypass surgery was performed, and each parameter was compared with that of the LV-DsAo bypass. Results: At a distribution ratio of 50:50, the RBF to the head and EL were 16.4% of the total CO and 62.0 mW in the LV-DsAo bypass, and 32.3% and 81.5 mW in the LV-AsAo bypass, respectively. The RBF to the head decreased with the CO through the AsAo in the LV-DsAo bypass, but it was constant in the LV-AsAo bypass. The EL increased inversely with the CO through the AsAo in both graft designs. Conclusion: The regional blood flow distribution was different, but the trend of the EL which increased inversely with the CO through the AsAo was similar between the LV-DsAo and LV-AsAo bypasses.

DOI： 10.1007/s11748-020-01527-8

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Postoperative pain management in thoracotomy patients often is difficult. Furthermore, pediatric patients present more challenges because of their inability to effectively communicate their pain intensity. The purpose of this study was to evaluate the use of continuous field block through intercostal muscles as postoperative pain management in pediatric thoracotomy. METHODS: Between 2014 and 2018, 11 patients underwent an ASD closure using a cardiopulmonary bypass via a mini-right thoracotomy through the fourth intercostal space. At the time of chest closure, a single-shot field block via the fourth intercostal muscles was performed with levobupivacaine (0.6 mg/kg). The first five patients were only given the single-shot field block (Single group). The remaining six patients were given levobupivacaine continuously (0.1 mg/kg/hr) through an indwelling catheter until the chest tube removal (Continuous group). The groups' vital signs, total amounts of acetaminophen used, postoperative courses were compared. RESULTS: Although the heart rate did not differ between the groups, the respiratory rate was significantly higher in the Single group versus the Continuous group at 16 and 32 hr post-surgery (35.6±9.7/min vs. 18.5±4.7/min; p=0.007, 43.0±10.4 vs. 25.3±3.1; p=0.042, respectively). The accumulated dosage of acetaminophen given by postoperative day 2 was significantly higher in the Single group versus the Continuous group (55.3±22.1 mg/kg vs. 7.8±17.4 mg/kg; p=0.012). CONCLUSIONS: Continuous field block via intercostal muscles after ASD closure via a mini-right thoracotomy in children was effective to stabilize the vital signs and reduce the analgesic medication use.

DOI： 10.1272/jnms.JNMS.2021_88-507

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/joa3.12346

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/joa3.12346

記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本成人先天性心疾患学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

DOI： 10.1186/s40792-019-0726-2

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

DOI： 10.1016/j.hrthm.2019.08.025

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We examined the outcome of modified-maze procedures reflecting a single-center strategy in the treatment of atrial fibrillation (AF) associated with atrial septal defect (ASD) in adults. METHODS: A retrospective chart review was performed for 29 patients who underwent surgical ASD closure and 2 types of maze procedures (full and simplified maze procedures) for AF. The outcome related to the each procedure was examined. A Cox proportional hazards analysis was performed to assess the independent predictors of AF and atrial tachycardia (AT) recurrence. RESULTS: The rates of freedom from AF and AT recurrence at 1 and 4 years were 86.6% and 72.2% in the full maze group and 78.5% and 62.8% in the simplified maze group, respectively (p = 0.70). The only risk factor for recurrence was the age at the time of surgery. A receiver operating characteristic curve analysis gave an optimum cut-off value of 58 years of age for predicting recurrence within 2 years (58.4% for ≥ 58 years versus 5.9% for < 58 years, p = 0.003). CONCLUSIONS: Simplification of the maze procedure was not associated with AF or AT recurrence. The age at the time of surgery might be a clinical predictor of success or failure in adult patients.

DOI： 10.1007/s00595-018-1709-9

PubMed

researchmap

DOI： 10.1007/s11748-019-01084-9

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Objective: The preferred surgical approach for systemic-pulmonary shunts has changed from thoracotomy to sternotomy in our institution, to concomitantly manage the ductus arteriosus during surgery. The purpose of this study was to compare the outcomes of systemic-pulmonary shunts for neonates with functionally univentricular hearts based on surgical approach. Methods: Fifty-two neonates with functionally univentricular hearts underwent systemic-pulmonary shunt via sternotomy (n = 28) or thoracotomy (n = 24). Patient characteristics, achievement rates of right heart bypass, and survival rates were compared for the different approaches. Results: Prenatal diagnosis was made more common in the sternotomy group (p = 0.006). The shunt was placed more centrally in the sternotomy group. The ductus arteriosus was ligated or banded in most patients in the sternotomy group (26/28) and in a few patients in the thoracotomy group (6/24). Frequency of ductal management in the early postoperative phase was not different between the groups (21 vs 25 %), but three new incisions had to be made in the thoracotomy group. No differences were seen in the achievement rates of bidirectional cavopulmonary shunts (86 vs 87 % at 10 months of age) and total cavopulmonary connection (81 vs 81 % at 2 years of age), or in the survival rates (92 vs 96 % at 8 years). Conclusions: There were no differences in short- and long-term outcomes between the groups. The sternotomy approach might be preferable in the current era of prenatal diagnosis, to allow simultaneous duct management during systemic-pulmonary shunt surgery, particularly in patients with large ducts associated with functionally univentricular hearts.

DOI： 10.1007/s11748-016-0673-9

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

We present three children who underwent coronary angioplasty for the surgical treatment of a congenital obstruction of the left main coronary artery. An azygos vein patch or graft was a feasible and useful material for reconstructing congenital ostial stenosis and atresia of the left main coronary artery.

DOI： 10.1007/s11748-014-0403-0

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present the case of a neonate who was successfully treated with emergency hybrid palliation soon after birth, including a stent insertion into a severely thickened atrial septum and bilateral pulmonary artery banding. The patient was prenatally diagnosed with severe pulmonary venous hypertension owing to mitral atresia and intact atrial septum associated with functional single ventricle and coarctation of the aorta. © 2014, SAGE Publications. All rights reserved.

DOI： 10.1177/2150135114558068

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Extracorporeal life support (ECLS) is used after congenital heart surgery for several indications, including failure to separate from cardiopulmonary bypass, postoperative low cardiac output syndrome, and extracorporeal cardiopulmonary resuscitation. Here, we assessed the outcomes of ECLS in children after cardiac surgery at our institution. Medical records of all children who required postoperative ECLS at our institution were reviewed. Between 2003 and 2011, 36 (1.4%) of 2541 pediatric cardiac surgical cases required postoperative ECLS. Median age of patients was 64 days (range: 0 days-4.1 years). ECLS was in the form of either extracorporeal membrane oxygenation (ECMO; n = 24) or ventricular assist system (VAS; n = 12). Mean duration of ECLS was 4.9 +/- 4.2 days. Overall, 21 patients (58%) were weaned off ECLS, and 17 patients (47%) were successfully discharged from the hospital. Patients with biventricular heart (BVH) had higher survival-to-hospital discharge rates compared with those with univentricular heart (UVH) (P = 0.019). Regarding ECLS type, UVH patients who received VAS showed higher rates of device discontinuation than UVH patients who received ECMO (P = 0.012). However, rates of hospital discharge were not significantly different between UVH patients who received VAS or ECMO. Surgical interventions, such as banding of Blalock-Taussig shunt to reduce pulmonary blood flow or placing bidirectional cavopulmonary shunt to minimize ventricular volume overload, were effective for weaning off ECLS in patients with UVH. ECLS is beneficial to children with low cardiac output after cardiac surgery. Rates of survival-to-hospital discharge were higher in BVH patients than UVH patients. Additional interventions to reduce ventricular volume load may be effective for discontinuing ECLS in patients with UVH.

DOI： 10.1111/aor.12191

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

A 4-month-old child with severe infantile Marfan syndrome underwent successful repair of an extremely dilated aortic root and severe aortic valve insufficiency using a prosthetic valved conduit. (C) 2013 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2012.12.054

Web of Science

PubMed

researchmap

DOI： 10.1177/2150135112443268

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Objectives: This study investigated the time-dependent remodeling and growth potential of porcine small intestine submucosa as a biomaterial for the reconstruction of pulmonary arteries in a lamb model.
Methods: Left pulmonary arteries were partially replaced with small intestine submucosal biomaterial in 6 lambs. Two animals each were humanely killed at 1, 3, and 6 months. Computed tomographic angiography, macroscopic examination of the implanted patch, and microscopic analysis of tissue explants were performed.
Results: All animals survived without complications. Patency and arborization of the pulmonary arteries were detected 6 months after implantation. There was no macroscopic narrowing or aneurysm formation in the patch area. The luminal appearance of the patch was similar to the intimal layer of the adjacent native pulmonary artery. Scanning electron microscopy showed that the luminal surface of the patch was covered by confluent cells. Immunohistochemical examination confirmed endothelialization of the luminal side of the patch in all of the explanted patches. The presence of smooth muscle cells in the medial layer was confirmed at all time points; however, expression of elastin, growth of the muscular layer, and complete degradation of patch material were detectable only after 6 months. The presence of c-Kit-positive cells suggests migration of multipotent cells into the patch, which may play a role in remodeling the small intestine submucosal biomaterial.
Conclusions: Our data confirmed that remodeling and growth potential of the small intestine submucosal biomaterial are time dependent. Additional experiments are required to investigate the stability of the patch material over a longer period. (J Thorac Cardiovasc Surg 2012; 144: 963-9)

DOI： 10.1016/j.jtcvs.2012.07.024

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Sheep models are widely used to evaluate the feasibility of various cardiac assist devices. Anticoagulation therapy postoperatively, however, is seldomly reported on. Continuous heparin infusion is often used, but is cumbersome due to long-term line management with the risk of infection and dislodgement. We contemplated using warfarin instead and started a pilot dose-finding study. Three sheep were given oral warfarin between 0.1 and 0.3 mg/kg/day. Prothrombin time was monitored and INR was calculated daily. If the INR did not reach a target of 2.5-3.5, warfarin dose was doubled. We found that sheep required a dose of warfarin between 1.6 and 2.4 mg/kg/day to raise the INR to the target zone. In a subsequent study to evaluate the effect of diet on INR in sheep, three sheep were fed alfalfa hay or alfalfa pellets in a crossover design. All the animals were given warfarin at the dose of 1.6 mg/kg. The diet was switched when the INR reached the target zone of 2.5-3.5. Hay-fed animals reached the target INR on days 6 and 7. On the other hand, pellet-fed animals did not reach the target value by day 7 with the initial dose and required 2.4 mg/kg of warfarin to achieve the goal. Hay raised the INR faster and higher than pellets with the same warfarin dose. Hay may be advantageous when using oral warfarin therapy in sheep.

DOI： 10.3109/08941939.2011.598219

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Single ventricle congenital heart defects are usually palliated with the end result of a Fontan circulation. Despite improving results, this circulation is still associated with long-term failure. We previously developed an animal model of mechanical cavopulmonary circulation support that was successful in the acute and mid-term period. In the current study, we evaluated longer support durations in five Western-breed sheep. Through a right thoracotomy we instituted mechanical support from the inferior vena cava to the pulmonary artery, using a Heartmate II axial flow pump (Thoratec Corp., Pleasanton, CA). Postoperatively, the animals were anticoagulated with heparin iv. Hemodynamics, pump flow, anticoagulation, and hepatic and renal function were monitored daily. All animals survived the operation. Signs of moderate liver and kidney injury in general reversed quickly. Two animals had a fatal pump thrombosis. When anticoagulation was effective, hemodynamics and pump flow were maintained to normal values. Effective anticoagulation was difficult to achieve because of the high variability in response to heparin. Survival up to 18 days was accomplished. This study is the longest reported survival of animals with a mechanically assisted cavopulmonary circulation. The performance of the Thoratec Heartmate II has been good, but the issue of effective anticoagulation has not yet been solved. ASAIO Journal 2012; 58:60-64.

DOI： 10.1097/MAT.0b013e31823c0aa4

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

The aim of this study is to evaluate the effect of temperature on cerebral oxygen metabolism at total body flow bypass and antegrade cerebral perfusion (ACP). Neonatal piglets were put on cardiopulmonary bypass (CPB) with the initial flow rate of 200 mL/kg/min. After cooling to 18 degrees C (n = 6) or 25 degrees C (n = 7), flow was reduced to 100 mL/kg/min (half-flow, HF) for 15 min and ACP was initiated at 40 mL/kg/min for 45 min. Following rewarming, animals were weaned from bypass and survived for 4 h. At baseline, HF, ACP, and 4 h post-CPB, cerebral blood flow (CBF) was measured using fluorescent microspheres. Cerebral oxygen extraction (CEO2) and cerebral metabolic rate of oxygen (CMRO2) were monitored. Regional cranial oxygen saturation (rSO(2)) was continuously recorded throughout the procedure using near-infrared spectroscopy. At 18 degrees C, CBF trended lower at HF and ACP and matched baseline after CPB. CEO2 trended lower at HF and ACP, and trended higher after CPB compared with baseline. CMRO2 at ACP matched that at HF. Cranial rSO(2) was significantly greater at HF and ACP (P &lt; 0.001, P &lt; 0.001) and matched baseline after CPB. At 25 degrees C, CBF trended lower at HF, rebounded and trended higher at ACP, and matched baseline after CPB. CEO2 was equal at HF and ACP and trended higher after CPB compared with baseline. CMRO2 at ACP was greater than that at HF (P = 0.001). Cranial rSO(2) was significantly greater at HF (P = 0.01), equal at ACP, and lower after CPB (P = 0.03). Lactate was significantly higher at all time points (P = 0.036, P &lt; 0.001, and P &lt; 0.001). ACP provided sufficient oxygen to the brain at a total body flow rate of 100 mL/kg/min at deep hypothermia. Although ACP provided minimum oxygenation to the brain which met the oxygen requirement, oxygen metabolism was altered during ACP at moderate hypothermia. ACP strategy at moderate hypothermia needs further investigation.

DOI： 10.1111/j.1525-1594.2010.01131.x

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Objective: Antegrade cerebral perfusion is widely used in neonatal heart surgery, yet commonly used flow rates have never been standardized. The objective of this study was to determine the antegrade cerebral perfusion flow rate that most closely matches standard cardiopulmonary bypass conditions.
Methods: Nine neonatal piglets underwent deep hypothermic cardiopulmonary bypass at a total body flow of 100 mL/kg/min (baseline). Antegrade cerebral perfusion was conducted via innominate artery cannulation at perfusion rates of 10, 30, and 50 mL/kg/min in random order. Cerebral blood flow was measured using fluorescent microspheres. Regional oxygen saturation and cerebral oxygen extraction were monitored.
Results: Cerebral blood flow was as follows: baseline, 60 +/- 17 mL/100 g/min; antegrade cerebral perfusion at 50 mL/kg/min, 56 +/- 17 mL/100 g/min; antegrade cerebral perfusion at 30 mL/kg/min, 36 +/- 9 mL/100 g/min; and antegrade cerebral perfusion at 10 mL/kg/min, 13 +/- 6 mL/100 g/min. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow matched baseline (P = .87), as did regional oxygen saturation (P = .13). Antegrade cerebral perfusion at 30 mL/kg/min provided approximately 60% of baseline cerebral blood flow (P &lt; .002); however, regional oxygen saturation was equal to baseline (P = .93). Antegrade cerebral perfusion at 10 mL/kg/min provided 20% of baseline cerebral blood flow (P &lt; .001) and a lower regional oxygen saturation than baseline (P = .011). Cerebral oxygen extraction at antegrade cerebral perfusion rates of 30 and 50 mL/kg/min was equal to baseline (P = .53,.48) but greater than baseline (P &lt; .0001) at an antegrade cerebral perfusion rate of 10 mL/kg/min. The distributions of cerebral blood flow and regional oxygen saturation were equal in each brain hemisphere at all antegrade cerebral perfusion rates.
Conclusion: Cerebral blood flow increased with antegrade cerebral perfusion rate. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow was equal to baseline, but regional oxygen saturation and cerebral oxygen extraction trends suggested more oxygenation than baseline. An antegrade cerebral perfusion rate of 30 mL/kg/min provided only 60% of baseline cerebral blood flow, but cerebral oxygen extraction and regional oxygen saturation were equal to baseline. An antegrade cerebral perfusion rate that closely matches standard cardiopulmonary bypass conditions is between 30 and 50 mL/kg/min. (J Thorac Cardiovasc Surg 2010;139:530-5)

DOI： 10.1016/j.jtcvs.2009.12.005

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Total cavopulmonary connection (CPC) has a significant incidence of late failure due to increased systemic venous pressure and low cardiac output. Mechanical support could prevent failure by correcting hemodynamics. We established a model of inferior CPC using an axial flow pump (Thoratec HeartMate II, Thoratec Corp. Pleasanton, CA) in a group of ten 47-57 kg sheep and assessed hemodynamics and metabolism as a potential chronic treatment option for failed Fontan circulation. After pilot studies (n = 7), three animals underwent pump-supported inferior CPC to assess hemodynamic and metabolic responses. Pump inflow was connected to the inferior vena cava (IVC) and outflow to the main pulmonary artery. The IVC was ligated at the right atrium. Hemodynamic and biochemical parameters were recorded over four days. The first seven animals died from pump-related causes (graft kinking, three; pump thrombosis, one) or other causes (GI bleeding, one; suspected stroke, two). The subsequent three animals were electively euthanized on postoperative day four due to IRB requirements. Over the four day postoperative period, pump flow was 3.43 +/- 0.62 L/min and IVC pressure 4.05 +/- 3.21 mm Hg (mean +/- SD). Lactate levels remained normal. Low pressure and high-volume IVC flow was sustained by mechanical support. We will next attempt chronic pump implantation. ASAIO Journal 2009; 55:406-411.

DOI： 10.1097/MAT.0b013e3181a0a570

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective. Bilateral pulmonary artery banding is considered an option for initial palliation in high-risk patients with hypoplastic left heart syndrome or related anomalies. However, there are potential interim morbidities, including ductal constriction, compromised growth of the ascending aorta, and pulmonary artery stenosis at the banding site. In addition, there are still controversies regarding the optimal timing and choice of the second-stage operation. Methods. Between February 2003 and October 2005, twelve high-risk patients with hypoplastic left heart syndrome or related anomalies underwent bilateral pulmonary artery banding. An atrial septal defect was created simultaneously when the septum was intact or the defect was restrictive. After the procedure, intravenous prostaglandin E1 was continuously administered. Results. The median weight was 3.0 kg (range 1.8-3.6 kg), and the median age was 16 days (range 0-27 days). Atrial septum defect creation was performed simultaneously in two patients. Ten of the twelve patients were discharged from the hospital. One patient died of progressive multiple organ failure and another patient died of cerebral hemorrhage. Eight patients developed various degrees of ductal constriction and required dose adjustment of prostaglandin E1. Two patients underwent ductal arteriosus stent placement: one was unsuccessful owing to the size mismatch between the stent and the ductus. The diameter of the ascending aorta remained unchanged until the time of the second-stage operation, except in two patients who had a sufficiently sized aorta at the time of pulmonary artery banding. Pulmonary arterial branch stenosis developed at the banding site in three patients. At the time of the second-stage operation, the Norwood procedure was performed in seven patients, biventricular repair in two, and Norwood plus Glenn procedure in one. Conclusion. Bilateral pulmonary artery banding is an option to salvage high-risk neonates with hypoplastic left heart syndrome or related anomalies. However, it is associated with high interstage morbidity, and patients may benefi t from early conversion to the Norwood operation. © 2008 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-007-0207-6

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective. There is a paucity of information regarding appropriate management of children with Down's syndrome and a functional single ventricle. We report the results of bidirectional superior cavopulmonary shunts in six patients with Down's syndrome with a functional single ventricle. Methods. Between January 1991 and December 2004, we identified six patients with Down's syndrome among 263 who had undergone bidirectional superior cavopulmonary shunts (BCPSs). There were four males and two females. The age at BCPS ranged from 1 to 12 years (mean 4.3 ± 3.9 years), and body weight varied between 8.2 and 29.4 kg (mean 13.8 ± 7.8 kg). All six patients had an unbalanced complete atrioventricular septal defect, with right ventricular hypoplasia present in five and left ventricular hypoplasia in one. Results. There were no operative deaths, but one case required takedown of the BCPS. Except for this case, postoperative courses were generally uneventful. The median duration of follow-up was 46 months (range 12-80 months). Only two of five survivors after BCPS underwent a subsequent Fontan procedure, and one of these patients died of pulmonary hypertension post-operatively. The remaining three patients appeared to have significant risk factors for the Fontan procedure due to severe common atrioventricular valve regurgitation or persistent pulmonary vascular obstructive disease, including one who has completely dropped out from the Fontan track. Conclusion. Down's syndrome is a risk factor in patients with functionally single ventricle due to persistent pulmonary hypertension and airway obstruction. These results show that single ventricle repair in patients with Down's syndrome is accompanied with difficulties, and patient selection for the Fontan procedure should be done carefully. © 2008 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-007-0201-z

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Background: Local delivery of stromal cell-derived factor-1 alpha (SDF-1) has been demonstrated to improve hind limb ischemia through enhanced neovascularization in animals. It was hypothesized that local administration of SDF-1 also contributes to neovascularization of ischemic heart.
Methods: Acute myocardial infarction was created by left coronary artery ligation in C57BL/6J mice. Immediately after infarction induction, mice were treated by injection directly into the center of ischemic myocardium either with saline (control group) or SDF-1 (SDF-1 group). Cardiac function was measured on echocardiogram 2 and 4 weeks after infarction. On week 4 mice were killed to evaluate infarction size and capillary vessel density. To determine the contribution of bone marrow cells to angiogenesis, the same procedures were performed on C57BL/6J chimeric mice reconstituted with green fluorescent protein-positive bone marrow cells.
Results: Fractional shortening was greater in the SDF-1 group at 4 weeks (0.31 +/- 0.06% vs 0.23 +/- 0.03%, P = 0.037). The infarct area was smaller in the SDF-1 group compared to the control group (9.31 +/- 2.76% vs 18.07 +/- 5.69%, P = 0.028). Green fluorescent protein-positive cells accumulated predominantly at the peri-infarction site, and were located with the capillary vessels. Capillary vessel density was significantly increased in the SDF-1 group (13.08 +/- 4.11 vessels/mm(2) vs 34.50 +/- 7.59 vessels/mm(2), P = 0.014).
Conclusion: SDF-1 protects against deterioration of cardiac function after acute myocardial infarction by promoting angiogenesis. The safety and long-term prognosis of this treatment remains to be determined.

DOI： 10.1111/j.1442-200X.2007.02491.x

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tricuspid regurgitation (TR) is known to be a risk factor for mortality in the surgical management of patients with hypoplastic left heart syndrome (HLHS). Concomitant repair for TR should be considered when the TR is moderate to severe to achieve successful Fontan completion. The present case was a 20-month-old girl who was diagnosed with HLHS (mitral atresia and aortic atresia). She underwent a Norwood procedure as the first palliation followed by a Glenn procedure. After that, she gradually developed TR, which progressed to a severe state at the time of the Fontan procedure. An edge-to-edge tricuspid valve repair, in which the anterior and septal leaflets were sutured together, was performed simultaneously with the extracardiac Fontan procedure. Discharge echocardiography revealed that the degree of TR was less than mild. The technique is simple, not time-consuming, and may be an effective adjunct for successful completion of the Fontan procedure in these patients. © 2007 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-007-0176-9

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 10-year-old boy had undergone conventional two-stage surgery that includeed repair of aortic coarctation with pulmonary artery banding as an initial operation followed by closure of a ventricular septal defect as a secondary procedure. Following these procedures, aortic coarctation recurred, and balloon angioplasty was performed three times. Aortic recoarctation, however, persisted, and aortic stenosis and regurgitation and pulmonary stenosis gradually developed. An operation was therefore performed to repair recoarctation, aortic stenosis and regurgitation, and pulmonary stenosis. Patch aortoplasty was performed for recoarctation. The aortic valve was replaced with a 19 mm On-X valve, with Konno root enlargement. Pulmonary arterial patch plasty was also performed. During aortic arch reconstruction, selective cerebral perfusion was performed via the innominate artery and left carotid artery, and the lower half of the body was perfused through a cannula in the left femoral artery. The postoperative course was uneventful, and aortography revealed a well-reconstructed aortic arch free of obstruction. There were no valve-related complications.

DOI： 10.1272/jnms.74.173

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm, while the indications for surgical therapy remain controversial. We have adopted coronary artery bypass grafting (CABG) even in young children for giant coronary aneurysms (more than 8 mm diameter) with or without a stenotic region when myocardial ischemia is detected. We hypothesized that a shorter time-period from diagnosis of acute Kawasaki disease (KD) to CABG would lead to better postoperative results. To elucidate the validity of our strategy, we evaluated preoperative patient characteristics and long-term outcome. Methods: Twenty-one patients (mean age: 12.0 years old) with Kawasaki coronary disease had undergone CABG during the last 12 years. The mean age at the time of acute KD was 2.7 years and the mean time range from diagnosis of acute KD to CABG was 8.1 years. The incidence of preoperative reduced ventricular function was 10 per 21 patients (47.6%). A multivariate logistic regression analysis using patient characteristics showed that the time range from acute KD to CABG was the only predictor for ventricular functional deterioration (p=0.03, odds ratio 1.55. 95%CI: 1.033-2.325). Based on these results, we divided the patients into two groups of short time range (mean: 3.7 years
group S) and long time range (mean: 13.9 years
group L). Results: Preoperative left ventricular functional deterioration was recognized more frequently in group L (9/9, 100%) than in group S (1/12, 8.3%) (p&lt
0.01). Myocardial infarction was documented significantly higher in the group L (6/9, 66.7%) than group S (1/12, 8.3%) (p=0.04). There was no surgical mortality in either group. The arterial grafts demonstrated good potential for growth and graft patency was 96.9%. Moreover, seven of the giant aneurysms proximal to the graft anastomosis showed complete thrombotic occlusion after CABG without development of myocardial infarction. The cardiac events free rate of group L and group S was 66.7% and 100%, respectively, during the postoperative follow up periods of 5.5 ± 1.1 years (group L) and 4.7 ± 1.1 years (group S). Conclusions: We successfully applied CABG for Kawasaki coronary disease. Based on our experience, a short interval after acute KD appears to be ideal for surgical treatment of Kawasaki coronary disease.

DOI： 10.1272/jnms.71.279

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本成人先天性心疾患学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：日本静脈学会  

researchmap

記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

researchmap

記述言語：日本語   出版者・発行元：日本低温医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：日本臨床外科学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児外科学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本不整脈学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

researchmap