2025/06/24 更新

写真a

アミタニ リョウスケ
網谷 亮輔
Amitani Ryosuke
所属
付属病院 心臓血管外科 助教
職名
助教
外部リンク

論文

  • Case of left ventricular thrombus managed with thrombectomy with left ventricular reconstruction in a patient who had coronavirus disease 2019 infection. 国際誌

    Kenji Suzuki, Shun-Ichiro Sakamoto, Atsushi Hiromoto, Yusuke Motoji, Ryosuke Amitani, Takako Yamaguchi, Yosuke Ishii

    Journal of cardiothoracic surgery   18 ( 1 )   8 - 8   2023年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Intracardiac thrombus is relatively rare in patients with coronavirus disease 2019 (COVID-19). However, if it occurs, thrombotic complications are likely to develop. In this case, we performed a successful thrombectomy on a patient who developed left ventricular thrombus after COVID-19 infection without complications. CASE PRESENTATION: A 52-year-old man sought medical care due to fever, dyspnea, and abnormalities in the taste and smell that persisted for 2 weeks. The patient was diagnosed with COVID-19 and was treated with remdesivir, baricitinib, and heparin. Three weeks after hospitalization, electrocardiogram revealed angina pectoris, and cardiac catherization showed left anterior descending coronary artery stenosis. In addition, global hypokinesis and a thrombus at the left ventricular apex were observed on echocardiography. Left ventricular reconstruction concomitant with coronary artery bypass grafting was performed. A thrombus in the left ventricle was resected via left apical ventriculotomy, and the bovine pericardium was covered and sutured on the infarction site to exclude it. The patient was extubated a day after surgery and was transferred to another hospital for recuperation after 20 days. He did not present with complications. CONCLUSIONS: Thrombotic events could be prevented via thrombectomy with left ventricular reconstruction using an intraventricular patch to exclude the residual thrombus.

    DOI: 10.1186/s13019-023-02108-5

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  • Surgical Management of Cardiac Implantable Electronic Device Complications in Patients Unsuitable for Transvenous Lead Extraction.

    Yasuo Miyagi, Hiroya Oomori, Motohiro Maeda, Tomohiro Murata, Keisuke Ota, Yusuke Motoji, Ryosuke Amitani, Hitomi Ueda, Motoko Morishima, Takayoshi Matsuyama, Jiro Kurita, Yuji Maruyama, Takashi Sasaki, Shun-Ichiro Sakamoto, Yosuke Ishii

    Circulation journal : official journal of the Japanese Circulation Society   87 ( 1 )   103 - 110   2022年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Although surgical approaches for infected or failing cardiac implantable electronic device (CIED) leads are more invasive than transvenous approaches, they are still required for patients considered unsuitable for transvenous procedures. In this study, surgical management with transvenous equipment for CIED complications was examined in patients unsuitable for transvenous lead extraction. METHODS AND RESULTS: We retrospectively examined 152 consecutive patients who underwent CIED extraction between April 2009 and December 2021 at the Department of Cardiovascular Surgery, Nippon Medical School. Nine patients (5.9%; mean [±SD] age 61.7±16.7 years) who underwent open heart surgery were identified as unsuitable for the isolated transvenous approach. CIED types included 5 pacemakers and 4 implantable cardioverter-defibrillators; the mean [±SD] lead age was 19.5±7.0 years. Indications for surgical management according to Heart Rhythm Society guidelines included failed prior to transvenous CIED extraction (n=6), intracardiac vegetation (n=2), and severe lead adhesion (n=1). Transvenous CIED extraction tools were used in all patients during or before surgery. Additional surgical procedures with CIED extraction included epicardial lead implantation (n=4) and tricuspid valve repair (n=3). All patients were discharged; during the follow-up period (mean 5.7±3.7 years), only 1 patient died (non-cardiac cause). CONCLUSIONS: Surgical procedures and transvenous extraction tools were combined in the removal strategy for efficacious surgical management of CIED leads. Intensive surgical procedures were safely performed in patients unsuitable for transvenous extraction.

    DOI: 10.1253/circj.CJ-22-0456

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  • Surgical Treatment of a Giant Popliteal Venous Aneurysm and Arteriovenous Fistula on the Adjacent Femoral Vein and Its Postoperative Findings.

    Atsushi Hiromoto, Shun-Ichiro Sakamoto, Yusuke Motoji, Ryosuke Amitani, Takako Yamaguchi, Kenji Suzuki, Hiromasa Yamashita, Makoto Watanabe, Eitaro Kodani, Yosuke Ishii

    Annals of vascular diseases   15 ( 3 )   197 - 200   2022年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    A case of a giant popliteal venous aneurysm that caused massive pulmonary thromboembolism with an arteriovenous fistula draining into the adjacent proximal femoral vein is reported herein. Deep veins in the lower leg were occluded by thrombi. The inlet and outlet orifice inside the aneurysm was closed and aneurysmorraphy was performed. The fistula was retained on the estimation that it would maintain the blood flow and prevent thrombus formation inside the femoral vein. The aneurysm was shrunk, the femoral vein was patent, and the fistula was not observed 1 year later, although it still existed 1 week after the operation.

    DOI: 10.3400/avd.cr.22-00044

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  • Combined cardiac surgery in a Marfan syndrome patient with severe scoliosis via lower hemisternotomy: a case report.

    Shun-Ichiro Sakamoto, Ryosuke Amitani, Yusuke Motoji, Takako Yamaguchi, Atsushi Hiromoto, Kenji Suzuki, Yosuke Ishii

    Surgical case reports   8 ( 1 )   140 - 140   2022年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Scoliosis is one of the symptoms manifested by patients with Marfan syndrome (MFS). Deformity of the thoracic cavity due to severe scoliosis may cause difficulty during cardiac surgery in terms of the surgical approach and instrument manipulation; however, only a few reports have been available regarding the surgical case of MFS with severe scoliosis. Here, we report a case of combined aortic valve replacement and left atrial appendage closure in a patient with MFS who had severe scoliosis using lower hemisternotomy. CASE PRESENTATION: A 62-year-old female with MFS was referred to our hospital after being diagnosed with severe aortic regurgitation and paroxysmal atrial fibrillation with a history of cerebral thromboembolism. The aortic valve showed severe insufficiency due to cusp prolapse, whereas the aortic root was moderately dilated (42 mm). Echocardiography revealed severe regurgitation with reduced left ventricular ejection function (32%) and massive left ventricular diastolic dimension (88 mm). Moreover, combined aortic valve replacement and left atrial appendage closure was indicated. However, the patient had chest deformity due to severe scoliosis. Thus, conventional full sternotomy or thoracotomy was considered an inappropriate surgical approach. Lower hemisternotomy was selected on the basis of three-dimensional reconstruction imaging of the aorta, left atrial appendage, sternum, and rib. Sternal elevation and rib retraction with the costal arch folded back provided enough surgical field for the combined procedures to be safely conducted. The postoperative course was uneventful, except for predicted prolonged mechanical ventilation with the assistance of intraaortic balloon pumping. Thereafter, the patient has been free from any cardiac and cerebrovascular event. CONCLUSIONS: Lower hemisternotomy can be useful for combined cardiac surgery in MFS with severe scoliosis.

    DOI: 10.1186/s40792-022-01504-8

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  • Postoperative Changes in Pulmonary Function after Valve Surgery: Oxygenation Index Early after Cardiopulmonary Is a Predictor of Postoperative Course. 国際誌

    Tomohiro Murata, Motohiro Maeda, Ryosuke Amitani, Atsushi Hiromoto, Makoto Shirakawa, Masaru Kambe, Yuji Maruyama, Hajime Imura

    Journal of clinical medicine   10 ( 15 )   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). METHODS: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. RESULTS: Median age and EuroSCORE II were 71.0 years (25-75 percentile: 59.5-77.0) and 2.46 (1.44-5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122-193). PaO2/FiO2 and AaDO2/PaO2 significantly deteriorated two hours, but not immediately, after CPB (both p < 0.0001). Decreased PaO2/FiO2 and AaDO2/PaO2 were correlated with ventilation time (r2 = 0.318 and 0.435) and intensive care unit (ICU) (r2 = 0.172 and 0.267) and hospital stays (r2 = 0.164 and 0.209). Early and delayed extubations (<6 and >24 h) were predicted by PaO2/FiO2 (377.2 and 213.1) and AaDO2/PaO2 (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700-0.911 and 0.677-0.859). CONCLUSIONS: PaO2/FiO2 and AaDO2/PaO2 two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.

    DOI: 10.3390/jcm10153262

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  • Response to letter by Dr. Imamura: implication of urine aquaporin-2 levels following cardiac surgery.

    Masahiro Fujii, Ryosuke Amitani, Ryuzo Bessho

    Heart and vessels   36 ( 3 )   431 - 431   2021年3月

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  • Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery.

    Masahiro Fujii, Ryosuke Amitani, Ryuzo Bessho

    Heart and vessels   35 ( 5 )   712 - 718   2020年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Aquaporin-2 is found in the apical cell membranes of the principal cells of the collecting duct of the kidney. Plasma arginine vasopressin has been reported to be markedly elevated during cardiac surgery. However fluctuations in urine aquaporin-2 levels have never been reported. We aimed to determine the responses of urine aquaporin-2 and evaluated the relationship between urine aquaporin-2 and plasma arginine vasopressin levels during perioperative periods in cardiac surgical patients. Eight patients undergoing elective isolated aortic valve replacement in normothermia were enrolled prospectively. Blood and urine samples were collected preoperatively and on postoperative days 1, 4, and 7. Patients received furosemide and spironolactone, as needed, during the clinical course; tolvaptan was not needed. Median plasma arginine vasopressin levels [with interquartile range] significantly increased to 1.5 [1.3-2.0], 15.3 [11.4-22.2]*, 2.2 [2.1-2.3], 1.7 [1.5-1.9] pg/mL preoperatively, on postoperative days 1, 4, and 7, respectively (*: p = 0.0001). Similarly, levels of urine aquaporin-2 markedly increased in 3.4 [1.9-5.6], 25.8 [18.4-33.5]**, 9.3 [5.9-14.0], 5.4 [5.3-6.1] (ng/mL), respectively (**p = 0.0004). A significant correlation between plasma arginine vasopressin and urine aquaporin-2 was observed during the entire investigation (R2 = 0.616, p < 0.0001). Plasma arginine vasopressin and urine aquaporin-2 levels were significantly elevated on postoperative day 1 in patients who underwent aortic valve replacement with cardiopulmonary bypass. A significant correlation between plasma arginine vasopressin and urine aquaporin-2 was observed. Urine aquaporin-2 should be further investigated as a potential biomarker for postoperative cardiac dysfunction.

    DOI: 10.1007/s00380-019-01533-8

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  • Long-term impact of critical silent cerebrovascular disease in patients undergoing coronary artery bypass surgery: a propensity score and multivariate analyses. 国際誌

    Hajime Imura, Yuji Maruyama, Ryosuke Amitani, Motohiro Maeda, Makoto Shirakawa, Takashi Nitta

    Perfusion   34 ( 2 )   147 - 153   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Cerebrovascular disease (CVD) with brain hypoperfusion is a strong risk factor for stroke. However, how this pathology influences long-term outcomes after coronary artery bypass graft (CABG) surgery is not known. METHODS: Magnetic resonance imaging/angiography (MRI/A) of the neck and brain was performed in 318 out of 575 consecutive CABG patients between May 2005 and April 2018. Critical CVD with chronic hypoperfusion was defined as multiple severe stenoses (⩾70%) and/or occlusion in the carotid and/or vertebral systems associated with reduced collateral flow due to severe contralateral and/or circle of Willis lesion. Fifty patients were identified to have this pathology (early results were previously reported). The entire cohort was followed up for 83.6 ± 53.7 months. Carotid endarterectomy was considered for symptomatic patients. Propensity matching was performed to compare long-term outcomes between patients with and without critical CVD. RESULTS: Patients with critical CVD at follow-up displayed significantly higher incidences of stroke than those without critical CVD (p=0.007), with an extremely high final incidence (approximately 40% at 8 years). However, survival (p=0.623) and incidences of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization and all causes of death) (p=0.881) were similar. The Cox hazard model revealed that critical CVD was the strongest risk factor for stroke (p=0.000; hazard ratio 6.572; 95% confidence interval 2.657-16.258) while not affecting survival and MACE. CONCLUSION: Critical CVD was the strongest risk factor for long-term stroke after CABG. However, survival and MACE-free rates were equivalent in patients with critical CVD and those without critical CVD.

    DOI: 10.1177/0267659118813042

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▼全件表示

共同研究・競争的資金等の研究課題

  • 多血小板血漿と生分解性徐放化ゲルを用いた新しい心筋再生治療の開発

    研究課題/領域番号:22K08927  2022年4月 - 2027年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    村田 智洋, 宮城 泰雄, 石井 庸介, 栗田 二郎, 網谷 亮輔

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    配分額:2470000円 ( 直接経費:1900000円 、 間接経費:570000円 )

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  • プレコンディショニング効果におけるアクアポリン7欠損の影響

    研究課題/領域番号:17K10740  2017年4月 - 2020年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    太田 恵介, 藤井 正大, 別所 竜蔵, 網谷 亮輔, 丸山 雄二

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    配分額:4680000円 ( 直接経費:3600000円 、 間接経費:1080000円 )

    虚血性プレコンディショニング(IPC)の研究では(3分虚血+5分再灌流)×2サイクルをIPCマナーの条件として採用した。野生型 (WT)とAQP7ノックアウト(KO)マウスから摘出した心臓をランゲンドルフ灌流装置にセットして、25分単純虚血に対する心筋保護効果を検討した。WTのマウスではコントロール群に対しIPC群は改善効果を認めたが、AQP7KOマウスでは差を認めなかった。薬剤性プレコンディショニング(PPC)の研究ではニコランジル(100&#181;M)を虚血前投与した。WT、AQP7KOマウスともにコントロール群に対しPPC群は改善効果を認めた。

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  • 周術期心不全治療のための水チャンネル・アクアポリンの研究

    研究課題/領域番号:16K10642  2016年4月 - 2019年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    網谷 亮輔, 藤井 正大, 別所 竜蔵

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    配分額:4810000円 ( 直接経費:3700000円 、 間接経費:1110000円 )

    人工心肺を使用した心臓手術を施行した患者の周術期(術前,第1,4,7病日)の血中AVPと尿中AQP2の変化を検討した.血中AVPは第1病日には有意に一過性上昇を示し,第4病日には減少に転じていることが認められた.尿中AQP2排泄は同様の変化がみられた.人工心肺をしないオフポンプ冠動脈バイパス術の患者の場合,血中AVPの変化はpump症例と同様であったが,尿中AQP2排泄は緩やかな変化であった.ランゲンドルフ灌流実験においてAQP7欠損がSt Thomas心筋保護液の効果に与える影響をAQP7-Knockoutマウスを作成して行い、25分虚血に対してSt Thomas心筋保護液は効果を発揮した.

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