記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present the case of an 86-year-old woman with a ruptured left coronary artery aneurysm associated with coronary-pulmonary artery fistula. She was transferred to our hospital with complaints of chest discomfort. Echocardiography revealed cardiac tamponade, and subsequently, a bloody pericardial effusion was drained. Coronary angiography and computed tomography revealed a ruptured left coronary artery aneurysm originating from a branch of the proximal left anterior descending artery and a coronary-pulmonary artery fistula. In the emergency operation, under cardiopulmonary bypass, the inlet and outlet vessels were ligated, and the aneurysm was plicated without arresting the heart. By utilising cardiopulmonary bypass, the pulmonary trunk was easily decompressed, and dissection around the aneurysm and identification of the inlet and outlet vessels were facilitated without cardiac arrest. Thus, to conclude, an on-pump beating-heart technique should be considered in such cases.

添付ファイル： coronary-pulmonary artery fistula.pdf

DOI： 10.1093/icvts/ivad067

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Editorial Committee of Annals of Vascular Diseases  

添付ファイル： contained ruptured AAA.pdf

DOI： 10.3400/avd.cr.22-00120

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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.

添付ファイル： s13019-023-02108-5.pdf

DOI： 10.1186/s13019-023-02108-5

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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.

添付ファイル： 87_CJ-22-0456.pdf

DOI： 10.1253/circj.CJ-22-0456

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Editorial Committee of Annals of Vascular Diseases  

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.

添付ファイル： 15_cr.22-00044.pdf

DOI： 10.3400/avd.cr.22-00044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Atrial fibrillation (AF) is frequently seen in patients with a volume-loaded left atrium (LA) such as mitral valve regurgitation (MR). Previous animal models have incomplete relevance to human AF associated with MR. METHODS: A novel experimental model with a combination of volume loading of LA by creating a shunt from the subclavian artery to pulmonary artery and electrical remodeling induced by continuous rapid LA pacing was designed and the electrophysiological effects were examined in 10 canines. Five weeks after the shunt surgery, the entire atrial epicardium was mapped during sustained AF with form-fitted electrode patches with 246 bipolar electrodes and a three-dimensional dynamic mapping system to characterize the induced AF. RESULTS: Three animals died of severe heart failure and pacing failure occurred in one. Remaining six animals were subjected to the analysis. The LA diameter increased progressively after the shunt surgery. Sustained AF was induced after 3 weeks of continuous rapid LA pacing in all animals. The activation maps revealed repetitive focal activations arising from the pulmonary veins, right or left atrial regions, and reentrant activations in the RA, which patterns of atrial activations are the same as those seen in human AF. CONCLUSION: The animal model with a combination of LA volume load and electrical remodeling was relevant to human AF associated with LA volume load. Studies using the present model may provide further knowledges of AF and may be useful in examining the effects of pharmacological and non-pharmacological therapies.

DOI： 10.1007/s11748-022-01866-8

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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.

添付ファイル： Mafan scoliosis.pdf

DOI： 10.1186/s40792-022-01504-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital malformation. Although there have been few reports on anaesthetic management of patients with KTWS, there is a lack of data on anaesthetic management for abdominal aortic aneurysm (AAA) surgeries in these patients. CASE PRESENTATION: A 74-year-old man (height, 160 cm and body weight, 51.5 kg) with KTWS was scheduled for AAA replacement. Abdominal computed tomography (CT) showed prominent tortuosity below the abdominal aorta with an infrarenal abdominal aortic aneurysm, right common iliac artery aneurysm, and right external iliac artery aneurysm. Moreover, a remarkably noted arteriovenous fistula had developed between the aneurysm and peripheral artery. General anaesthesia was induced. Furthermore, a central venous catheter and an 8.5 French sheath in the left internal jugular vein were inserted. During the operation, bleeding from a collateral vessel in the cross-clamped aorta led the surgeon to decide to perform aneurysmorrhaphy. Intraoperatively, blood loss was 1500 ml, and 20 units of red blood cell concentrate were used. CONCLUSIONS: Regarding AAA procedures in patients with KTWS, aortic cross-clamping may not sufficiently intercept blood flow due to collateral vessels. In these patients, the anaesthesiologist must be prepared to transfuse blood more rapidly and frequently than during normal AAA procedures.

添付ファイル： s12871-022-01761-y.pdf

DOI： 10.1186/s12871-022-01761-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The benefit of adding ganglionated plexi ablation to the maze procedure remains controversial. This study aims to compare the outcomes of the maze procedure with and without ganglionated plexi ablation. METHODS: This multicenter randomized study included 74 patients with atrial fibrillation associated with structural heart disease. Patients were randomly allocated to the ganglionated plexi ablation group (maze with ganglionated plexi ablation) or the maze group (maze without ganglionated plexi ablation). The lesion sets in the maze procedure were unified in all patients. High-frequency stimulation was applied to clearly identify and perform ganglionated plexi ablation. Patients were followed up for at least 6 months. The primary endpoint was a recurrence of atrial fibrillation. RESULTS: The intention-to-treat analysis included 69 patients (34 in the ganglionated plexi ablation group and 35 in the maze group). No surgical mortality was observed in either group. After a mean follow-up period of 16.3 ± 7.9 months, 86.8% of patients in the ganglionated plexi ablation group and 91.4% of those in the maze group did not experience atrial fibrillation recurrence. Kaplan-Meier atrial fibrillation-free curves showed no significant difference between the two groups (P = .685). Cox proportional hazards regression analysis indicated that left atrial dimension was the only risk factor for atrial fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval 1.017-1.024, P = .019). CONCLUSION: The addition of ganglionated plexi ablation to the maze procedure does not improve early outcome when treating atrial fibrillation associated with structural heart disease.

DOI： 10.1007/s11748-022-01820-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.

DOI： 10.2463/mrms.rev.2021-0137

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Chronic mesenteric ischemia (CMI) involving occlusion and/or stenosis of multiple mesenteric arteries is rare. We report our experience with a 66-year-old man who presented with a more than 3 months history of abdominal pain and vomiting/diarrhea. A diagnosis of CMI due to occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery by median arcuate ligament syndrome was made. Complete revascularization through iliac artery-SMA bypass grafting and arcuate ligament dissection assisted with staged-catheter intervention successfully alleviated the patient's symptoms. The patient has maintained a normal daily diet for 6 months postoperatively.

添付ファイル： A_Case_of_Chronic_Mesenteric_Ischemia_Complete_Rev.pdf

DOI： 10.3400/avd.cr.21-00109

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/joa3.12491

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-20-0637

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記述言語：英語  

A 69-year-old male patient with a history of percutaneous coronary intervention (PCI) to the proximal left anterior descending coronary artery (LAD) underwent another PCI to the stenosis of the medium LAD as part of therapy for angina pectoris. Interruption of stent delivery because of past stent led to stent entrapment and a stuck guidewire. A snare catheter device was applied to retrieve the stent; however, the device lost mobility. Surgical removal and coronary artery bypass grafting (CABG) were required. We herein report some surgical techniques for resolving this complication of PCI. <Learning objective: Despite the recent advancements in devices and/or technical skills, the complications of PCI will never be eliminated. This case report provides a suggestive lesson with regard to open heart surgery for PCI complication; furthermore, only a few reports have described details concerning these PCI complications from the viewpoint of a surgeon. Physicians and surgeons should learn the emergent surgical techniques for resolving PCI complications.>.

添付ファイル： entrapped stent.pdf

DOI： 10.1016/j.jccase.2021.03.001

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記述言語：英語   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

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記述言語：英語  

Vein cuff anastomosis is beneficial in cases in which a prosthetic graft is anastomosed to a small and thickened peripheral artery. Various types of vein cuff are currently in use, although their design is insufficient when a size discrepancy exists between the two vessels and the angle of anastomosis requires adjustment. We report a case of a patient who underwent below-knee femoropopliteal bypass using a new design of vein cuff (boat-form vein cuff) that increases the ease of cuff creation and enables surgeons to adjust the anastomotic size and angle.

添付ファイル： vein cuff.pdf

DOI： 10.1016/j.jvscit.2020.02.002

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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  

BACKGROUND: There have been a few cases of echogenic cardiac implantable electric device (CIED) lead-associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients. METHODS: Preoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open-heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed. RESULTS: A total of 106 patients underwent lead removal in our institute (April 2009-March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead-related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). CONCLUSIONS: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead-associated intracardiac masses.

DOI： 10.1002/joa3.12346

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomic mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in nonresectable cardiac tumors. OBJECTIVE: The purpose of this study was to evaluate the surgical procedures and late outcomes of the treatment of VT associated with cardiac tumors. METHODS: We examined six patients (age 1-65 years) who had undergone surgical treatment of VT associated with cardiac tumors between 2010 and 2016. The 4 pathologies of the cardiac tumors were lipoma 2, fibroma 2, hemangioma 1, and lymphoma 1. Intraoperative epicardial mapping using CARTO was performed in 5 patients(80%). Surgical procedures and long-term outcomes were evaluated. RESULTS: Arrhythmogenic substrates with abnormal electrograms, such as fractionated or late potential, were identified locally or circumferentially beside the tumor in every patient. Complete tumor resection with cryoablation was performed in 3 patients. Two patients underwent partial tumor resection with cryoablation. Cryoablation without tumor resection was performed in 1 patient. No mortality and morbidity occurred. Additional catheter ablation was required in 2 patients to treat occurrence of nonclinical VT and induction of clinical VT during hospital stay. Mean follow-up time was 90 ± 52.5 months. There was no recurrence of clinical VT. CONCLUSION: The outcomes of surgical treatment of VT associated with cardiac tumors were excellent. Intraoperative CARTO mapping was beneficial to eliminate the VT substrates associated with nonresectable cardiac tumors.

DOI： 10.1016/j.hrthm.2019.08.025

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 52-year-old man who had undergone total arch replacement for type A aortic dissection 2 months before. He was admitted to our hospital with hemoptysis due to aortobronchial fistula. We planned to perform 1-stage open chest surgery, but he passed away before the surgery. We considered that earlier open surgery or emergency endovascular stent grafting might have been effective in avoiding this result.

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

添付ファイル： pericardial patch.pdf

DOI： 10.1186/s40792-018-0558-5

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1053/j.semtcvs.2018.01.004

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 77-year-old male with many comorbidities underwent off pump coronary artery bypass grafting. A severely atherosclerotic ascending aorta was revealed by preoperative computed tomography(CT) and epiaortic echography during operation. Therefore, V-composite saphenous vein grafting was adopted for non left anterior descending artery (LAD) coronary lesions in addition to left internal thoracic artery-left anterior descending artery bypass grafting. He was discharged with no complications and all grafts were confirmed to be patent by postoperative CT. V-composite saphenous vein grafting for avoiding cerebrovascular complications might be one of the useful options in coronary artery revascularization for non-LAD lesions in elderly patients or those with many comorbidities, especially with a severely atherosclerotic ascending aorta.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

On the basis of computed tomography (CT) examination, a prosthetic graft infection of very late onset was suspected in a 72-year-old man who had undergone replacement of an bifurcated prosthetic graft 6 years earlier because of an abdominal aortic aneurysm and bilateral common iliac artery aneurysms. Emergency CT-guided needle aspiration was performed, and analysis of directly aspirated fluid confirmed the rapid diagnosis. Instead of conventional emergency surgery, CT-guided catheter drainage was the initial treatment and led to the gradual improvement of symptoms and laboratory data. Elective staged surgery was performed later to examine the cavity around the prosthetic graft. The cavity was then filled with in-situ omentum. Thus, CT-guided catheter drainage as the initial treatment and following omentopexy as the staged surgery avoided the need for highly invasive conventional surgery.

DOI： 10.1272/jnms.83.203

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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: In a U lesion set, the left atrium (LA) roof between the right and left superior pulmonary veins is not ablated, to allow activation to propagate across the posterior LA and to recruit this segment as a contractile atrial component. In contrast, the box lesion set isolates the entire posterior LA.
Methods: To compare the two lesion sets, postoperative freedom from atrial fibrillation (AF) and LA transport function were examined in 402 patients who underwent surgery for AF with a U lesion (n = 329) or box lesion (n = 73) set. Patients who underwent pulmonary vein isolation alone or other simplified procedures were excluded from the study. LA transport function was quantified at 20 +/- 33 months postoperatively by the ratio of peak velocity of the A wave to the E wave (peak A/E) of the transmitral Doppler flow.
Results: In patients with long-standing persistent AF, freedom from AF was 85% with the U lesion set and 77% with the box lesion set at 5 years after the maze procedure, and 82% and 77%, respectively, at 10 years after the procedure. There was no significant difference between the U lesion set and box lesion set in patients with long-standing persistent AF (P = .30) and those with paroxysmal or persistent AF (P = .90). Proportional hazards analysis identified increased LA diameter (P = .003) and long-standing persistent AF (P = .03), but not the type of lesion set (P = .51), as predictive of postoperative AF recurrence. The postoperative peak A/E was significantly greater after the U lesion set than after the box lesion set (0.42 +/- 0.22 vs 0.23 +/- 0.17), and multiple regression analysis demonstrated that the type of lesion set and preoperative LA diameter significantly affected postoperative A/E.
Conclusions: The U lesion set restores sinus rhythm frequently as the box lesion set and provides better LA transport function. A dilated LA is a risk factor for postoperative recurrence of AF and poor postoperative LA transport function.

DOI： 10.1016/j.jtcvs.2015.10.108

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担当区分：筆頭著者  

添付ファイル： 21_21.031.pdf

DOI： 10.7793/jcoron.21.031

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

Thoracoscopic surgery for the treatment of Wolff-Parkinson-White syndrome is rare. We report a case of thoracoscopic surgical ablation of the epicardial pathway in a 13-year-old female patient. Intraoperative electroanatomic mapping was performed to identify the exact location of accessory electrical conduction in the right atrioventricular groove. Stamping ablation using a bipolar radiofrequency pen device achieved irreversible disappearance of the delta wave. Eight months after the surgical procedure, there has been no recurrence of arrhythmia in this patient. (C) 2015 by The Society of Thoracic Surgeons

添付ファイル： PIIS0003497515007080.pdf

DOI： 10.1016/j.athoracsur.2015.04.081

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

添付ファイル： Infant Congenital Fibroma.pdf

DOI： 10.1016/j.athoracsur.2014.04.130

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

Background. Ganglionated plexi ablation during atrial fibrillation surgery is not technically standardized for precise ganglionated plexi locations or ablation sequence. We aimed to identify precise active ganglionated plexi locations in patients with structural heart disease and explore the feasibility of anatomic ganglionated plexi ablation without prior mapping in patients with atrial fibrillation.
Methods. Thirty patients with valvular disease-associated atrial fibrillation underwent ganglionated plexi ablation and a modified maze procedure. In 20 patients, ganglionated plexi mapping was performed to identify active plexi. According to mapping results, anatomically determined plexi were ablated without mapping in the final 10 patients. Ganglionated plexi ablation outcomes with and without prior mapping were compared between perioperative and early postoperative periods.
Results. Active ganglionated plexi common to more than 20% of patients were identified in the superior and inferior right pulmonary veins, superior left pulmonary vein, interatrial groove, and inferior left atrium. Inferior left atrial plexi ablation resulted in maximum vagal modulation. Compared with ablation using mapping, anatomic ablation yielded more vagal modulation in heart rate variability and decreased the requisite cardiopulmonary bypass time.
Conclusions. The sequential pacing and ablation technique identified an optimal ablation sequence that best ensured vagal reflex elimination from all ganglionated plexi. Anatomic ablation using a predetermined ganglionated plexi map may be a viable alternative to individual plexus mapping before ablation. (C) 2014 by The Society of Thoracic Surgeons

添付ファイル： PIIS0003497514013289.pdf

DOI： 10.1016/j.athoracsur.2014.06.044

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Adult patients with atrial septal defect frequently experience atrial fibrillation. However, the electrophysiologic mechanism has not been directly examined, and the optimal surgical procedure has not been determined. Methods Ten patients undergoing operations for atrial septal defect and atrial fibrillation underwent intraoperative mapping by use of 253 epicardial electrodes. There were 7 men and 3 women, whose average age was 54 ± 11 years. Eight patients had a secundum defect and 2 a primum defect. There were 4 patients with paroxysmal atrial fibrillation and 6 with long-standing persistent atrial fibrillation. A modified biatrial Maze procedure was performed in 6 patients and pulmonary vein isolation with no other left atrial lesions in 4. Results The reentrant or focal activations driving atrial fibrillation were confined within the right atrium in all patients with paroxysmal atrial fibrillation, whereas multiple focal activations arising from the pulmonary veins or posterior left atrium and reentrant activations in the left atrium were observed in 5 of 6 patients with long-standing persistent atrial fibrillation. In 9 patients, sinus rhythm was restored postoperatively and 8 of those patients have been free of any atrial fibrillation during a follow-up period of 94 ± 45 months. Conclusions The pattern of the atrial activation during atrial fibrillation correlated with the type of atrial fibrillation and varied from a simple right atrial reentry to complex reentrant and focal activations in the left atrium. © 2013 The Society of Thoracic Surgeons.

DOI： 10.1016/j.athoracsur.2013.05.063

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1161/CIRCULATIONAHA.112.118075

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: Double potential mapping using bipolar electrodes that straddle the ablation line should identify the site of incomplete ablation as a conduction gap without constructing the activation maps. Methods: Bipolar electrograms were recorded during pacing using 11 custom-made bipolar electrodes straddling the ablation line created by a bipolar radiofrequency ablation device on the lateral right atrium in seven canines. A linear ablation was made with an ablation device, of which one jaw was inserted into the atrium through a purse-string suture. A 3-mm-wide tape was placed on both jaws 10 mm from the tip of the ablation electrode to intentionally create an incomplete ablation lesion. The activation times at each dipole across the ablation line were defined as the times of the maximum positive and negative derivatives of the double potentials, and the site of conduction gap was determined as the site of the earliest activation across the linear ablation. The lateral right atrium was mapped simultaneously with 45 different bipolar electrodes to construct the activation maps and the earliest activation site across the ablation line was determined. Results: The double potential mapping located the conduction gap on a real-time basis without displaying any maps. There was no significant change in the accuracy between the different times after ablation and different pacing cycle lengths. Conclusions: Double potential mapping locates the conduction gap on a real-time basis and would be useful in beating-heart epicardial ablation in off-pump setting. © 2013 by the International Society for Minimally Invasive Cardiothoracic Surgery.

DOI： 10.1097/IMI.0b013e318280603f

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

Purpose. An electroanatomic mapping system using an electromagnetic navigation technology constructs a 3-dimensional structure of the heart with high geometric accuracy of the data that provides a precise localization of the substrates of arrhythmias. The system was tested for the feasibility and efficacy in intraoperative mapping.
Description. The strength of the magnetic field is measured by a location sensor with three different frequencies generated by a location pad placed beneath the operating table, and the spatial location of the sensor is determined. By roving the catheter on the heart while the local electrogram is recorded simultaneously, the 3-dimensional figure of the heart is reconstructed and an activation or voltage map is generated.
Evaluation. The system was used in 19 patients with ventricular tachycardia or other arrhythmias. The focus or reentrant circuit of the tachycardia was precisely located and a map-guided procedure was successfully performed in all patients. Cardiopulmonary bypass allowed for the tachycardias to be mapped without any hemodynamic compromise.
Conclusions. Intraoperative mapping using the electroanatomic mapping system enables a precise localization of the tachycardia substrate. (Ann Thorac Surg 2012;93:1285-8) (C) 2012 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2011.12.081

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記述言語：英語  

Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined. © 2012 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-011-0849-2

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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  

DOI： 10.1007/s10840-011-9592-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier B.V.  

The patient was a 29-year-old male who had been diagnosed with transposition of the great arteries with an intact ventricular septum. At the age of 6 months, he underwent a Senning operation. At the age of 10 years, a dual-chamber (DDD) pacemaker was implanted via the right subclavian vein for the treatment of sick sinus syndrome. At the age of 25, the generator was removed due to a lead fracture, and a new pacemaker was implanted via the left subclavian vein, leaving the previous lead in the right subclavian vein. Later, the patient developed pain in the right precordium, cramping of the major pectoral muscle, and non-sustained ventricular tachycardia, suggesting physical stimulation of the left ventricle (functional right ventricle) by the residual leads. Therefore, lead extraction using an excimer laser sheath was planned. However, the leads adhered strongly to the vessels, and extraction was considered to involve a high risk of injury to the blood vessels, particularly the superior vena cava (SVC). We inserted a thoracoscope via the right precordial third intercostal space and observed the SVC via the thoracic cavity in order to immediately detect any complications. Using this approach, it was possible to extract the lead safely with an excimer laser sheath. © 2012 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.joa.2012.03.013

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記述言語：英語   出版者・発行元：Japanese Heart Rhythm Society  

Objective: Radiofrequency catheter ablation of non-ischemic VT frequently fails because of a possible non-transmural ablation due to an epicardial or intramural activation focus or hypertrophic myocardium. Methods: Surgeries for non-ischemic VT were performed in 17 patients from 2002 to 2011. The underlying heart diseases were cardiomyopathy in 11 patients, an idiopathic LV aneurysm in 2, an LV lipoma in 2, idiopathic VT in 1, and ARVC in 1. The indication for the surgery was medically refractory or incessant VT in all, including in 10 patients with VT storms. Ten patients had an ICD or CRTD implanted preoperatively and 10 had undergone a failed endocardial and/or epicardial RFCA. In the patients with HCM, the thickness of the LV at the origin of the VT was 14.3±1.9 mm. All the patients underwent a map-guided procedure for VT. Results: There were no operative or late deaths. The intraoperative electro-anatomical mapping demonstrated epicardial or intramural origin or reentry in the HCM patients. There was one early recurrence of clinical VT and an additional endocardial RFCA was performed. Three patients were inducible of non-clinical VT or VF, and an ICD was implanted. There were no recurrences of VT or ICD shocks in any patients during a follow-up period of 42±33 months. Conclusions: The surgery provides an excellent suppression of VT in the patients with non-ischemic VT.

DOI： 10.4020/jhrs.27.SY07_5

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記述言語：英語   出版者・発行元：Japanese Heart Rhythm Society  

We performed GP ablation combined with a radial procedure for the treatment of AF in 14 patients. A total of 35 sites at 5 anatomical GP areas were stimulated to identify active GP with marked vagal reflex during high frequency stimulation. The active GPs were ablated randomly one by one using sequential pacing and an ablation technique. Postoperative heart rate variability and surgical outcome at short- and mid-term follow-up was then examined. An average of 4.3±2.0 active GPs were identified in each patient. Atrial fibrillation recurred in 7 patients (50%) 10 days postoperatively. Heart rate variability showed that high-frequency spectral component was significantly smaller in the patients who retained in sinus rhythm compared to patients with recurring AF (20.6±12.7 vs 148.2±124.9, p<0.05). Thirteen patients (92%) restored sinus rhythm at discharge and maintained in sinus rhythm without recurrence of AF at a mean follow-up of 7.4±4.7 months. GP ablation combined with a radial procedure resulted in a satisfactory outcome at short- and mid-term follow-up.

DOI： 10.4020/jhrs.27.SY03_4

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記述言語：英語   出版者・発行元：Japanese Heart Rhythm Society  

Background: Because placement of a coronary sinuslead is not alwayspossible for anatomical or technical reasons, surgical implantation of anepicardial LV lead is occasionally indicated. There are two different surgical approaches: a median sternotomyand a left-lateral mini thoracotomy, and bothsuture and screw types of myocardial lead have unique specification. Methods: The manipulation performance was compared between the two types of lead in 57 patients who underwent surgical implantation of anLV epicardial lead from 2000 to 2010. Serial changes in the LV pacing threshold were examinedin 10 patients (suture and screw type in 5 patients each) at implantation, 1 week, and 3 months after implantation. Results: The median sternotomy approach allowed the suture type lead to be implanted easily and freely on any desired site on the high lateral LV wall, because of the widely opened operating field. Meanwhile the left-lateral mini thoracotomyapproach provided a limited field of the high lateral LV and allowed only the screw type lead to be implanted. There was no significant serial change in the pacing threshold in both suture and screw types and no significant difference between the types (suture type: 1.56±1.2 V, 1.42±1.0 V, 1.12±0.8 V, screw type: 1.56±1.3 V, 1.22±0.5 V, 1.36±0.4 V, at implantation, 1 week, and 3 months after implantation, respectively). Conclusion: The suture type is recommended in the surgery through a median sternotomy and the screw typelead through a left-lateral mini thoracotomy.

DOI： 10.4020/jhrs.27.OP54_1

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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: Over recent years, a variety of energy sources have been used to replace the traditional incisions of the Cox maze procedure for the surgical treatment of atrial fibrillation. This study evaluated the safety and efficacy of a new bipolar radiofrequency ablation device for atrial ablation in a long-term porcine model.
Methods: Six pigs underwent a Cox maze IV procedure on a beating heart off cardiopulmonary bypass using the AtriCure Isolator II bipolar ablation device (AtriCure, Inc, Cincinnati, Ohio). In addition, 6 pigs underwent median sternotomy and pericardiotomy alone to serve as a control group. All animals were allowed to survive for 30 days. Each pig underwent induction of atrial fibrillation and was then humanely killed to remove the heart en bloc for histologic assessment. Magnetic resonance imaging scans were also obtained preoperatively and postoperatively to assess atrial and ventricular function, pulmonary vein anatomy, valve function, and coronary artery patency.
Results: All animals survived the operation. Electrical isolation of the left atrial appendage and the pulmonary veins was documented by pacing acutely and at 30 days in all animals. No animal that underwent the Cox maze IV procedure was able to be induced into atrial fibrillation at 30 days postoperatively, compared with all the sham animals. All 257 ablations examined were discrete, linear, and transmural, with a mean lesion width of 2.2 +/- 1.1 mm and a mean lesion depth of 5.3 +/- 3.0 mm.
Conclusions: The AtriCure Isolator II device was able to create reliable long-term transmural lesions of the modified Cox maze procedure on a beating heart without cardiopulmonary bypass 100% of the time. There were no discernible effects on ventricular or valvular function. (J Thorac Cardiovasc Surg 2010; 140: 203-8)

DOI： 10.1016/j.jtcvs.2009.06.034

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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: Surgical ablation of ganglionated plexi has been proposed to increase efficacy of surgery for atrial fibrillation. This experimental canine study examined electrophysiologic attenuation and recovery of atrial vagal effects after ganglionated plexi ablation alone or with standard surgical lesion sets for atrial fibrillation.
Methods: Dogs were divided into 3 groups: group 1 (n = 6) had focal ablation of the 4 major epicardial ganglionated plexi fat pads, group 2 (n = 6) had pulmonary vein isolation with ablation, and group 3 (n = 6) had posterior left atrial isolation with ablation. All fat pads were ablated. Sinus and atrioventricular interval changes during bilateral vagosympathetic trunk stimulation were examined before and both immediately and 4 weeks after ablation. Vagally induced effective refractory period changes and mean QRST area changes (index of local innervation) were examined in 5 atrial regions.
Results: Sinus and atrioventricular interval changes and heart rate variability decreased immediately after ablation, but only sinus interval changes were restored significantly after 4 weeks in all groups. Ablation-modified vagal effects on effective refractory period or QRST area changed heterogeneously in groups 1 and 2. In group 3, regional vagal effects were attenuated extensively postablation in both atria. Posterior left atrial isolation with ablation incrementally denervated the atria. In the long term, vagal stimulation increased QRST area changes relative to control values in all groups. Heart rate variability was also assessed.
Conclusions: Ganglionated plexi ablation significantly reduced atrial vagal innervation. Restoration of vagal effects at 4 weeks suggests early atrial reinnervation. (J Thorac Cardiovasc Surg 2010;139:444-52)

添付ファイル： vagal denervation.pdf

DOI： 10.1016/j.jtcvs.2009.04.056

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

The Cox maze procedure is an effective treatment of atrial fibrillation, with a long-term freedom from recurrence greater than 90%. The original procedure was highly invasive and required cardiopulmonary bypass. Modifications of the procedure that eliminate the need for cardiopulmonary bypass have been proposed, including use of alternative energy sources to replace cut-and-sew lesions with lines of ablation made from the epicardium on the beating heart. This has been challenging because atrial wall muscle thickness is extremely variable, and the muscle can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices (four radiofrequency, two microwave, two lasers, one cryothermic) for creating continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. The maximum penetration of any device was 8.3 mm. All devices except one, the AtriCure Isolator pen, failed to penetrate 2 mm in some nontransmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration.

DOI： 10.1016/j.hrthm.2009.07.028

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

We experienced an unusual case of partial atrioventricular septal defect in an elderly patient. A preoperative ultrasonic cardiogram revealed the mitral leaflet pouching toward the right atrium and suggested the presence of a ventricular septal defect underneath the atrioventricular valve. The mitral aneurysm was diagnosed as a septal aneurysm on preoperative ultrasonic cardiogram. A crescent-shaped Dacron patch (InterVascular S. A., La Ciotat Cedex, France) was placed beneath the atrioventricular valve to prevent rupture of the mitral aneurysm and support the anterior mitral leaflet by creating a new annulus. We believe that this is the first report describing this type of mitral aneurysm and its surgical repair. (Ann Thorac Surg 2009; 88: 1341-3) (C) 2009 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2009.02.057

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: To perform a minimally invasive procedure for atrial fibrillation without cardiopulmonary bypass, it is necessary to create transmural lesions on the beating heart. Although bipolar radiofrequency clamps can isolate the pulmonary veins, they have difficulty in performing any other left atrial lesions, particularly those of the traditional Cox-Maze procedure. This study examined the performance of an internally cooled, bipolar radiofrequency device designed for such an application. Methods: Eleven domestic pigs underwent median sternotomy. Five animals had eight atrial lesions created with the radiofrequency device at times of 20, 30, 40, and 50 seconds. In six other pigs, the device was compared with another technology that has been used clinically for epicardial, beating heart ablation, the Guidant Flex 4 microwave device. The tissue was stained with 2,3,5-triphenyl-tetrazoluim chloride, and the lesions were sectioned at 5-mm intervals. Lesion width, depth, and transmurality were evaluated. Results: The radiofrequency device had a linear dose-response relationship. Lesions were wider and deeper with increasing ablation times. A total of 40%, 45%, 60%, and 67% of lesions were transmural at times of 20, 30, 40, and 50 seconds, respectively. Ninety-one percent of lesions in tissue up to 4-mm thick were transmural after 50 seconds. However, performance in thicker tissue was poor. Lesions created by the device were deeper and more likely to be transmural than the Flex 4. Conclusions: This internally cooled, bipolar radiofrequency device can reliably create transmural lesions on tissue up to 4-mm thick and performs better than a microwave device. Copyright © 2009 by the International Society for Minimally Invasive Cardiothoracic Surgery.

DOI： 10.1097/IMI.0b013e3181a348a2

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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: The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model.
Methods: After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure-volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group.
Results: Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days.
Conclusions: Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wallmotion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation.

DOI： 10.1016/j.jtcvs.2008.01.053

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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: The introduction of ablation technology has simplified surgical intervention for atrial fibrillation. However, most ablation devices cannot create focal transmural lesions on the beating heart and have difficulty ablating specific regions of the atria, such as the atrioventricular isthmus, coronary sinus, and ganglionated plexus. The purpose of this study was to examine the efficacy of a pen-type bipolar radiofrequency ablation device on both arrested and beating hearts.
Methods: Endocardial and epicardial atrial tissues in the free wall, left atrial roof, atrioventricular annuli, and coronary sinus were ablated for varying time intervals (2.5-15 seconds) in porcine cardioplegically arrested (n = 6) and beating (n = 9) hearts. The hearts were stained with 1% 2,3,5-triphenyl-tetrazolium chloride solution and sectioned to determine lesion depth and width. In 5 animals epicardial fat pads containing ganglionated plexus were stimulated and ablated.
Results: Lesion depth increased with ablation time similarly in both arrested and beating hearts. Transmurality was fully achieved in the thin atrial tissue (&lt; 4 mm) at 10 seconds in the beating and arrested hearts. The device had a maximal penetration depth of 6.1 mm. Epicardial ablation of the coronary sinus showed complete penetration through the left posterior atrium only in the arrested heart. Seven of 17 fat pads demonstrated a vagal response. All vagal responses were eliminated after ablation.
Conclusion: The bipolar pen effectively ablated atrial tissue in both arrested and beating hearts. This device might allow the surgeon to ablate tissue in regions not accessible to other devices during atrial fibrillation surgery.

DOI： 10.1016/j.jtcvs.2008.04.030

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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: A bioengineered microporous polycarbonate-siloxane polyurethane graft has been developed for coronary artery bypass grafting. Biological agents can be impregnated into its absorbable collagen and hyaluronan microstructure and stable macrostructure to promote patency. The objective of this study was to examine the in vivo biological performance and biomechanical characteristics of this graft.
Methods: Three types of graft (3.6-mm internal diameter, 24-mm length) were manufactured: heparin alone (H) grafts, heparin and sirolimus (HS) grafts, and grafts without any drug impregnation (C). All H and HS grafts were impregnated with 54 U of heparin in the microstructure for early elution to prevent acute graft thrombosis and 56 U of heparin in the macrostructure to prevent late thrombosis. In addition to the heparin, the HS graft was impregnated with 2.1 mg of sirolimus in the macrostructure for prolonged elution to inhibit intimal hyperplasia. All grafts (3.6-mm internal diameter, 24-mm length) were implanted into the abdominal aortas of rabbits (n = 55). Expanded polyte-trafluoroethylene grafts (4.0-mm internal diameter, 24-mm length; n = 7) were implanted as controls. At 1, 3, and 6 months after surgery, the grafts were removed for histologic, scanning electron microscopic, immunohistochemical, and biomechanical evaluations.
Results: The patency rate was 100% in the H, HS, and C grafts at each time point. Although the expanded polytetrafluoroethylene grafts were patent at 1 and 3 months after surgery, 1 of 2 grafts (50%) were occluded at 6 months. None of the H or HS grafts had any stenosis or thrombus. Scanning electron microscopic examination proved that endothelial cells propagated smoothly from the anastomotic sites after 6 months in the H and HS grafts in comparison with the expanded polytetrafluoroethylene grafts, which had rare endothelialization. Neointima formation was inhibited in the HS graft compared with the H or C graft at 6 months (123 +/- 126 mu m vs 206 +/- 158 mu m or 202 +/- 67 mu m; P &lt; 05). In addition, the H, HS, and C grafts had greater cellular infiltration inside the graft than the expanded polytetrafluoroethylene grafts. All grafts except the expanded polytetrafluoroethylene graft had marked neocapillary formation 6 months after surgery. The graft compliance between 80 and 120 mm Hg was 6.0% +/- 2.5% and 6.2% +/- 0.9% at 6 months in the H and HS grafts, respectively. The graft macrostructure was unchanged according to the biomechanical evaluation in the H and HS grafts.
Conclusion: A unique drug-eluting graft had excellent patency throughout the 6 months after implantation. The heparin-sirolimus graft encouraged luminal endothelialization without excessive intimal hyperplasia. This graft performed significantly better than the expanded polytetrafluoroethylene graft. This graft has the potential to become an implantable graft for coronary artery bypass grafting.

DOI： 10.1016/j.jtcvs.2007.09.077

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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: The importance of each ablation line in the Cox maze procedure for treatment of atrial fibrillation remains poorly defined. This study evaluated differences in surgical outcomes of the procedure performed either with a single connecting lesion between the right and left pulmonary vein isolations versus 2 connecting lesions (the box lesion), which isolated the entire posterior left atrium.
Methods: Data were collected prospectively on 137 patients who underwent the Cox maze procedure from April 2002 through September 2006. Before May 2004, the pulmonary veins were connected with a single bipolar radiofrequency ablation lesion (n +/- 56), whereas after this time, a box lesion was routinely performed (n 5 81). The mean follow-up was 11.8 +/- 69.6 months.
Results: The incidence of early atrial tachyarrhythmia was significantly higher in the single connecting lesion group compared with that in the box lesion group (71% vs 37%, P &lt; .001). The overall freedom from atrial fibrillation recurrence was significantly higher in the box lesion group at 1 (87% vs 69%, P = .015) and 3 (96% vs 85%, P = .028) months. The use of antiarrhythmic drugs was significantly lower in the box lesion group at 3 (35% vs 58%, P = .018) and 6 (15% vs 44%, P = .002) months.
Conclusions: Isolating the entire posterior left atrium by creating a box lesion instead of a single connecting lesion between the pulmonary veins showed a significantly lower incidence of early atrial tachyarrhythmias, higher freedom from atrial fibrillation recurrence at 1 and 3 months, and lower use of antiarrhythmic drugs at 3 and 6 months. A complete box lesion should be included in all patients undergoing the Cox maze procedure.

DOI： 10.1016/j.jtcvs.2007.10.063

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

We report a case of nonocclusive mesenteric ischemia (NOMI), which developed after grafting for a descending thoracic aortic aneurysm in a hemodialysis patient. On postoperative day 5, acute increases in serum enzyme levels developed. Emergency angiography revealed severe vasoconstriction in the superior mesenteric artery (SMA) and other splanchnic arteries. Therefore an infusion of papaverine hydrochloride was started into the SMA. Although serum enzyme levels decreased, metabolic acidosis occurred the next day. An emergency laparotomy revealed segmental diffuse necrotic small intestine and colon. Despite a resection of the small intestine and sigmoid colon, the patient died of septic shock several days later. NOMI is uncommon, but it is a catastrophic event that can occur after cardiovascular surgery. If intestinal gangrene is suspected, prompt mesenteric angiography and vasodilator therapy followed by exploratory laparotomy should be performed without delay.

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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: The effects of ablation lines on myocardial innervation and response to autonomic stimuli are unclear. This study examined the effects of radiofrequency ablation on atrial autonomic innervation and compared pulmonary vein isolation and the biatrial Cox maze procedure.
Methods: In 12 acute canines right and left vagosympathetic trunks and right and left stellate ganglia were isolated. Each nerve was stimulated before bipolar ablation, after pulmonary vein isolation, and after the Cox maze procedure. Nadolol (n = 6) and atropine (n = 6) were administered to block sympathetic and parasympathetic responses, respectively. Changes in heart rate and atrioventricular interval were compared. Changes in QRST area relative to an isoelectric baseline (index of local innervation) were calculated.
Results: Sympathetic stimulation of each nerve and parasympathetic stimulation of the vagosympathetic trunks caused significant changes in heart rate and atrioventricular interval. After pulmonary vein isolation, the effect of 33% of the nerves on heart rate changes was eliminated. The Cox maze procedure eliminated right stellate sympathetic effects on heart rate. Fifty percent of the nerves caused heart rate changes after the Cox maze procedure. There was no significant effect of either lesion set on atrioventricular interval changes. Stimulation of 50% of nerves after pulmonary vein isolation produced local area changes significantly different from control area. After the Cox maze procedure, a different 50% of the nerves produced local changes different from those seen after pulmonary vein isolation.
Conclusions: Surgical ablation procedures disrupted innervation, affecting heart rate but not atrioventricular interval. Autonomic innervation affecting the atria was changed by pulmonary vein isolation and additionally by the Cox maze procedure. Residual autonomic effects were present even after the complete Cox maze procedure.

DOI： 10.1016/j.jtcvs.2007.11.044

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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  

A 73-year-old man on dialysis for chronic renal dysfunction was referred to our hospital for surgical treatment of an abdominal aortic aneurysm (AAA). Preoperative angiography showed a remarkably developed meandering artery branching from the inferior mesenteric artery (IMA). The superior mesenteric and celiac arteries were occluded at the origin, and all blood flow to the abdominal organs was apparently supplied by collateral circulation from the IMA. Considering the risk of mesenteric ischemia after aortic clamping in conjunction during surgery, we used a perfusion catheter with a 12-F balloon to create a shunt to the IMA from the subclavian artery. The operation was successful and the patient recovered uneventfully. We describe this surgical procedure for its effectiveness in preventing postoperative mesenteric ischemia in a rare case of an AAA with complex branching lesions.

DOI： 10.1007/s00595-006-3362-y

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

Objective: The atrial conduction properties associated with cardiac disease are speculated as the background of postoperative atrial fibrillation (POAF). We examined the atrial conduction patterns and conduction properties during sinus rhythm (SR) in patients that had undergone cardiac operations and evaluated the incidence of POAF in all patients. Methods: Fifty-two, patients with stable SR who underwent cardiac surgery, with a diagnosis of valvular disease in 25, ischemic heart disease in 24, and others in 3, were enrolled in this study. The epicardial recordings were made using a mapping system with 60 unipolar electrodes placed on the right atrium (RA) intraoperatively. The activation patterns of the RA were assessed, and the longitudinal, transverse and oblique conduction velocity and max anisotropic ratio were also examined. Results: Sinus activation was initiated from various sites (single origin at the high-lateral RA in 40, mid-lateral RA in 4, low-lateral RA in 2, and multiple origins in 6 patients) and it demonstrated anisotropic conduction (1.8 +/- 0.6) with the longitudinal conduction being more rapid than transverse and oblique conduction. Fifteen patients demonstrated non-uniform activation patterns such as, a localized conduction delay in seven, functional conduction block in two and mosaic-activation pattern associated with multiple origins in six. A total of 21 patients (44%) developed POAF A conduction delay and mosaic activation pattern was found significantly more often in patients with POAF than in patients who remained in sinus rhythm. Multivariate analysis revealed that non-uniform activation pattern (odds ratio = 8.71; 95% confidence interval [CI] = 1.74-43.67; p = 0.008) and TR (odds ratio = 4.95; 95% CI = 1.14-21.37; p = 0.032) were independently associated with the development of POAF. Although all patients had converted to SR at the time of discharge, the administration of antiarrhythmic drugs caused sinus bradycardia in two patients who demonstrated a mosaic activation pattern in RA. Conclusions: Cardiac surgery patients exhibited a variety of sinus activation patterns, which also provided an arrhythmogenic substrate for POAF. A better understanding of the sinus activation using an intraoperative mapping system may provide benefit in the clinical management of POAF. (c) 2006 Elsevier B.V. All rights reserved.

添付ファイル： 30-1-132.pdf

DOI： 10.1016/j.ejcts.2006.03.060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Floating right heart thrombi (FRHTs) are rare in patients with acute pulmonary thromboembolism (PTE). FRHTs are an extreme therapeutic emergency, and any delay in treatment could be lethal. Heparin, thrombolysis, and catheter therapy are used most frequently to treat acute PTE. Here we present three cases involving operative treatment of FRHTs associated with PTE. Diagnose were made with echocardiography before proceeding to emergency surgery. Thromboembolectomy was performed on cardiopulmonary bypass. One patient became brain dead 10 days postoperatively owing to cardiopulmonary arrest before surgery. The two survivors were subsequently discharged home after uneventful recoveries.

DOI： 10.1272/jnms.73.33

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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  

Interatrial Electrical Connections.Background: The atria are assumed to be connected electrically to each other at the level of the Bachmann's bundle, coronary sinus (CS) musculature, and interatrial septum, and these connections may have an important role in the interatrial conduction and perpetuation of various types of atrial tachyarrhythmias. However, the number, location, and preferential connections of the interatrial conduction related to the site of activation have not been examined yet.
Methods: The endocardium of both atria and the CS were mapped during continuous pacing from the left superior and inferior pulmonary veins, right pulmonary veins, upper and lower right atrium, or right atrial septum at various paced cycle lengths in 14 canines. The electrograms were recorded by custom-made form-fitted electrodes mounted on a specially designed device that allowed the septal aspects of the electrode forms to be spatially fixed to each other accurately.
Results: Four distinct interatrial electrical connections were identified at the Bachmann's bundle, CS, and antero-superior and postero-inferior septa. Decremental conduction was not seen in any of the connections. Bachmann's bundle was the most preferential connection during pacing from any epicardial site. The transseptal connections were evident only during pacing from the interatrial septum. The preference among the four connections was determined by the site of stimulation and the propagation of the activation related to the myocardial architecture.
Conclusion: These unique preferential connections may play a significant role in the interatrial conduction and perpetuation of atrial tachyarrhythmias.

DOI： 10.1111/j.1540-8167.2005.40659.x

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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, INC  

Background: Although current surgical procedures result in a high success rate for atrial fibrillation, they are not guided by electrophysiologic findings in individual patients and thus might include unnecessary incisions in some patients or be inappropriate for other patients. We sought to determine whether intraoperative mapping is beneficial for the surgical treatment of atrial fibrillation.
Methods: A 256-channel 3-dimensional dynamic mapping system with custom-made epicardial patch electrodes was used to examine the atrial activation during atrial fibrillation and to determine the optimal procedure in 37 patients with continuous and 9 patients with intermittent atrial fibrillation intraoperatively.
Results: Surgical intervention for atrial fibrillation was not indicated in 3 patients in whom the atrial electrograms had a low voltage over a broad area. Concurrent, multiple, and repetitive activations arising from the pulmonary veins or left atrial appendage were observed in all patients. A simple left atrial procedure consisting of pulmonary vein isolation and left atrial incisions without any right atrial incisions was performed in 8 patients in whom the right atrial activation was passive, and all (100%) were cured of atrial fibrillation. The radial procedure was performed in the remaining 35 patients, and 31 (89%) of the patients were cured of atrial fibrillation. In this subset of patients, 10 exhibited reentrant or focal activation in the posterior left atrium between the right and left pulmonary veins and required an additional linear ablation on the posterior left atrium. The total amount of postoperative bleeding after the simple left atrial procedure was significantly less than after the radial procedure (378 +/- 135 vs 711 +/- 364 mL, P = .03). The right and left atrial transport functions were well preserved after both the radial and simple left atrial procedures.
Conclusion: Intraoperative mapping facilitates determining the optimal procedure for atrial fibrillation in each patient.

DOI： 10.1016/j.jtcvs.2004.09.012

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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, INC  

Objective: We examined the atrial activation during atrial fibrillation to validate the rationale behind simplified surgical procedures.
Methods: Intraoperative mapping of the entire atrial epicardium was performed in 21 patients with permanent atrial fibrillation and mitral valve disease using a 256-channel, 3-dimensional dynamic mapping system.
Results: Concurrent multiple repetitive activations arose from the posterior left atrium adjacent to the pulmonary veins or the left atrial appendage in all patients. The fastest activation propagated toward the right atrium conducting through Bachmann's bundle, leaving the other activations confined to a small atrial region. As the activation propagated toward the right atrium, there was a progressive conduction delay or block in the pathway. As a result, the activation in the right atrium desynchronized with the left atrial activation and became irregular and complex. The average cycle length measured at the right atrial appendage was significantly longer than that at the left atrial foci (206 +/- 32 milliseconds vs 175 +/- 23 milliseconds, P &lt; .001). In addition to the passive activation, a focal activation and reentrant activation were also observed in the right atrium in 5 and 6 patients, respectively. The number of wave fronts in the right atrium was significantly greater than that in the left atrium (2.9 +/- 0.8 vs 0.6 +/- 0.7, P &lt; .001).
Conclusions: Multiple left atrial focal activations with fibrillatory conduction and right atrial focal or reentrant activations are the mechanism in permanent atrial fibrillation associated with mitral valve disease. Intraoperative mapping would facilitate the indication for simplified procedures confined to the left atrium or the pulmonary veins.

DOI： 10.1016/j.jtcvs.2003.05.001

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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, INC  

Background: Incisional atrial reentrant tachycardia is a life-threatening tachyarrhythmia after surgery for congenital heart disease. Slow conduction through an isthmus between anatomical barriers, such as a right atriotomy or the sites for cannulation, has been shown to be a prerequisite for perpetuation of the incisional atrial reentrant tachycardia. However, the conduction property through the isthmus has not been examined in detail.
Methods: To examine the conduction property, 2 tandem incisions were made on the lateral right atrium with various distances (3 to 20 mm) between the incisions in 16 canines. Four weeks after the surgery, the lateral right atrium was mapped epicardially during pacing to examine the conduction property through the isthmus. The conduction property was characterized by approximated curves of the conduction velocity through the isthmus in accordance with the pacing cycle lengths. The atrial tissue at the isthmus was examined microscopically.
Results: The approximated curves of the conduction velocity were classified into 3 different types. Decremental conduction was observed only in the isthmi between 5 and 15 mm in width. A small amount of surviving myocardium between the scars formed the critical isthmus microscopically (decremental type). In the isthmi wider than 15 mm in width, slow conduction was not seen at any paced cycle length (nondecremental type). In the extremely narrow isthmi less than 5 mm in width, all of the atrial myocardium at the isthmus was replaced by fibrous tissue. Conduction was blocked at the isthmus and the activation detoured around the incisions (block type). There was a statistically significant difference in the approximated curves between the 3 different types of conduction properties (P &lt; .01).
Conclusion: The width of the isthmus determines the conduction property through the isthmus that contributes to the development of the incisional atrial reentrant tachycardia. Thus, the incisional atrial reentrant tachycardia may be preventable by leaving a sufficient amount of surviving myocardium between the incisions or by connecting the incisions by an ablative procedure.

DOI： 10.1016/S0022-5223(02)73603-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Off-pump coronary artery bypass grafting (OPCAB) has become a more applicable procedure, even in patients with multi-vessel disease. However, the role of OPCAB for patients with acute coronary syndrome (ACS) requiring emergency revascularization has not been established yet. We reviewed our results of emergency coronary artery bypass grafting (CABG) for patients with ACS. Seventy-two patients with ACS who underwent emergency CABG were studied. Twenty-five underwent OPCAB and 47 on-pump CABG. OPCAB was mainly indicated for patients who were possibly at risk for cardiopulmonary bypass. When the coronary anatomy was suitable in younger or less risky patients, OPCAB was performed. Patients with multi-vessel disease or with a critical left main trunk lesion were not excluded from OPCAB. The mean number of grafted vessels was 2.6 per patient in the OPCAB group, and 3.8 per patient in the on-pump group (p<0.0001). However, none of the patients in either group required postoperative catheter intervention. Mean operative time was 195 minutes in the OPCAB group and 286 minutes in the on-pump group (p<0.0001). There were three postoperative deaths in the OPCAB group and four in the on-pump group. Multivariate logistic regression analysis revealed that preoperative cardiogenic shock was the only significant predictor for postoperative death (odds ratio, 7.33). The selection of the on-pump procedure or OPCAB did not correlate with operative death. Thus, we conclude that OPCAB can be performed safely and effectively in selected patients with ACS requiring emergency coronary revascularization.

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：Japanese Association for Thoracic Surgery  

Two patients in whom myocardial infarction in the inferior wall occurred after off-pump coronary artery bypass grafing (OPCAB) are described. In both patients, the right coronary artery had no critical lesion and was not grafted. There was no ischemic episode during operation. Coronary artery spasms and/or intracoronary thrombus formation may have been causes of these events. To our knowledge, this is the first report on perioperative myocardial infarction in OPCAB.

DOI： 10.1007/BF02719476

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：MEDIMOND S R L  

(Background) Off pump AF surgery reduces the surgical complications. However, the feasibility of off pump AF surgery using radiofrequency (RF) energy has not been examined. (Methods) A linear ablation was performed in the LA using RF energy in 18 canines either by the epicardial approach (EPI, N=9) or the endocardial approach (ENDO, N=9) on beating heart. The depth of the ablation lesion was examined histologically. A mapping study was performed 4 weeks postoperatively. (Results) Carbonization and coagulation were observed in 100% and 58.3%, respectively with ENDO, but not with EPI. Transmural lesion was demonstrated in 46.7% in EPI and 93.3% in ENDO. The atrial mapping demonstrated complete linear conduction block in ENDO, but not in EPI. (Conclusion) Ablation with the EPI may not be feasible and a preventive means for thromboembolic complications is crucial with the ENDO in off-pump AF surgery.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: During the early development of the Fontan operation, a number of physiologic and anatomical limits were proposed as selection criteria, and two criteria, pulmonary vascular resistance and ventricular function, have been important in predicting surgical outcome. The use of the bidirectional cavo pulmonary shunt as a staging procedure performed to control the pulmonary blood flow adequately and reduce ventricular volume over load has resulted in marked improvements in the early and late Fontan procedure results. METHODS AND RESULTS: At our hospital we perform systemic pulmonary shunt or pulmonary artery banding in patients if pulmonary blood flow can not be controlled adequately in the neonatal period and then perform bidirectional cavo pulmonary shunt six months afterwards. During this operation we also performed simultaneous surgical repair for pulmonary artery distortion, anomalies of pulmonary venous connection, restriction of bulboventricular foramen and atrioventricular valve regurgitation. To determine the efficacy of this staged approach in avoiding increases in pulmonary vascular resistance and impaired ventricular function, surgical results were investigated. From February 1995 to May 2001, eighteen patients with cardiac morphology unsuitable for biventricular repair were admitted to our hospital. Twenty-six palliative procedures, were performed including seven pulmonary artery banding, three systemic pulmonary shunt, thirteen bidirectional cavo pulmonary shunt, one original Glenn procedure, four repair of coarctation of the aorta, two total anomalous pulmonary venous connection repair, one mitral valve plasty, and two patients required Damus-Kaye-Stansel procedure to release restrictive bulboventricular foramen. Fifteen patients underwent a modified Fontan operation (total cavopulmonary connection) after these palliative procedures. The operative mortality rate for these palliative procedures was 3.8% (1/26). The operative mortality rate for Fontan operation was 7.1% (1/14). Three patients awaiting the Fontan operation were considered good candidates for a final operation and no patients in this series were considered unsuitable for Fontan completion. CONCLUSION: Our strategy of staged approach for Fontan procedure offers a good prognosis.

DOI： 10.1272/jnms.69.154

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Penetrating atherosclerotic ulcer (PAU) is defined as an atherosclerotic lesion in which an ulceration occurs in the diseased aortic intima leading to disruption of the internal elastic lamina. It may cause a pseudoaneurysm formation or transmural aortic rupture. We describe a patient in whom a ruptured PAU in the distal aortic arch was treated successfully by a surgical endovascular stent graft. Through a median sternotomy and under deep hypothermic circulatory arrest, the aorta was transected between the left common carotid and subclavian arteries. A dacron prosthetic graft with self-expanding original Z type stents attached inside of the distal half was inserted through the aortotomy to exclude the PAU. By performing the procedure through a median sternotomy, we could eliminate dissection around the ruptured aortic wall. The stented graft was secured safely in the thoracic aorta to exclude the ruptured ulceration located distal to the left subclavian artery. PAU should be recognized widely as a distinct cardiovascular surgical problem which may lead to intramural hematoma with or without dissection or rupture.

DOI： 10.1272/jnms.69.49

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

Background. Surgery for atrial fibrillation (AF) is performed with the aim of restoring sinus rhythm and atrial transport function, and preventing thromboembolism. The radial incision approach (RIA), in which the atrial incisions radiate from the sinus node toward the atrioventricular annular margins and parallel the coronary arteries, tvas developed as an outgrowth of and an alternative to the maze procedure in order to preserve a more physiological activation sequence and the atrial transport function.
Methods. To determine whether the RIA is a promising procedure for AF, 23 patients who had undergone the RIA (n = 10) or the maze procedure (n = 13) for chronic AF associated with valvular heart disease were examined in terms of the postoperative cardiac rhythm and atrial transport function.
Results. AF was cured in 90% of RIA patients and 92.3% of maze patients (not significant). One patient in each group required pacemaker implantation for an in-sufficient sinus rate postoperatively. The RIA was technically easier than the maze procedure, because the incisions were more linear and there was no isolation incision or "T-shape" incision in the left atrium. The left atrial transport function, assessed by transthoracic Doppler echocardiography, was greater after the RIA than after the maze procedure, while the right atrial transport function was equally preserved by both procedures. The peak atrial filling/early filling waves of the flow-velocity spectra across the mitral valve was significantly larger after the RIA than after the maze procedure (0.58 +/- 0.17 vs. 0.25 +/- 0.07, p &lt; 0.005). The left atrial filling fraction was significantly larger after the RIA than after the maze procedure (28.5% +/- 5.0% vs. 15.1% +/- 4.0%, p &lt; 0.001).
Conclusions. RIA provides a greater atrial transport function, and thus may represent a physiological alternative to the maze procedure as a surgical procedure for AF. (Ann Thorac Surg 1999;68:805-11) (C) 1999 by The Society of Thoracic Surgeons.

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)メディカルアイ  

胸部大動脈における手術における合併症率は近年の外科手技の発展にもかかわらず、依然として高い。そのため、大動脈瘤や大動脈解離といった疾病に対しては手術前の適切なリスク推定が求められる。このリスク推定において、血流が重要な役割を果たす事が、これまでのsimulationを併用した血流解析により推定されてきた。近年、4D Flow MRIにより非侵襲的にヒト血流が観測可能になった事で同分野の研究において、更なる発展が見込まれている。本稿では、胸部大動脈4D Flow MRIについての報告をsummarizeする。更に詳細な情報については磁気共鳴医学会の公式英文誌における4D Flow MRI特集号内の総説を参照頂きたい。なお、本稿で提示の図については、全て、本総説からの引用である。(著者抄録)

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

52歳男。慢性偽腔開存型Stanford B型大動脈解離の経過観察中に生じたStanford A型急性大動脈解離に対して緊急全弓部大動脈置換術後を施行し、術後合併症なく退院したが、2ヵ月後に喀血が出現し、大動脈気管支瘻(ABF)と診断した。若年齢であることなどから急性期の治療として保存的加療を選択し、待機的手術の方針とした。手術準備のため第12病日に手術予定としていたが、第10病日に大量喀血をきたして死亡した。反省点として、ABFでは状態が安定していても早急な手術介入が必要であり、本例における治療戦略として緊急開胸手術という選択肢だけでなく、胸部ステントグラフト内挿術(TEVAR)を過渡的治療として行うことで開胸手術までの猶予を得られた可能性や、TEVAR単独で治療が完遂した可能性もあったのではないかと考えられた。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00349&link_issn=&doc_id=20191129180013&doc_link_id=1570010136677781632&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1570010136677781632&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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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  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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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  

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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  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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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  

J-GLOBAL

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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  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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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  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

77歳男性。健診の胸部X線像で心拡大、肺うっ血と胸水貯留を指摘後、循環器内科へ受診、心エコー検査で左室壁運動異常と左室駆出率低下を認め、虚血性心筋炎の診断で入院となった。薬物療法により状態は改善したが、CAG検査では左冠状動脈主幹部病変を含む3枝病変があり、CABG適応と判断し、心臓血管外科へ紹介となった。術前CTでは上行大動脈-弓部大動脈-下行大動脈に著明な石灰化病変を認め、頸動脈エコーでは両側とも総頸動脈-内頸動脈の高度狭窄病変を認めた。手術所見では、上行大動脈に石灰化病変および粥腫による璧不正がびまん性に存在していたため、個別に2本のSVを吻合するスペースがないと判断し、2本のSVを用いて左回旋枝領域へのSVの方向と右冠状動脈へのSVの方向をイメージしながら上行大動脈への中枢側吻合口とSV同士の吻合口が重なる位置になるようにV-コンポジットグラフトを作成した。そして、Heartstringを用いて病変部を避けて上行大動脈へ吻合した。術後経過は良好で、患者は14日目に退院となった。

DOI： 10.15106/J00349.2017239794

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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  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

冠状動脈バイパス術後の弓部大動脈瘤への外科治療は、開存グラフトの温存を考慮した上での術式の選択が必要とされる。今回、われわれは再冠状動脈バイパス術が必要とされる胸部大動脈瘤に対して、再胸骨正中切開によるtotal debranching TEVARと心拍動下冠状動脈バイパス術のハイブリッド治療を施行し、良好な治療経過を得たので報告する。症例は73歳男性。冠状動脈バイパス術および腹部大動脈瘤に対する人工血管置換術の既往があり、胸部CTで56mm径の嚢状の遠位弓部大動脈瘤が認められた。術前冠状動脈造影では左内胸動脈は開存していたが、左前下行枝は造影されず、対角枝が造影され、左前下行枝は右冠状動脈からの側副血行で描出された。心筋シンチでの前壁中隔の虚血から同領域の血行再建が必要と判断された。手術は再胸骨正中切開にてアプローチした。上行大動脈に側々吻合した3分枝人工血管を用いて頸部分枝を再建後、心拍動下冠状動脈バイパス術(大伏在静脈グラフト-左前下行枝)を施行した。最後に人工血管からzone 0部位へと順行性にステントグラフトを内挿した。術後経過は良好であった。CABG術後のfunctional IMAを有する弓部大動脈瘤に対して、胸骨正中切開によるハイブリッド治療は有用である。(著者抄録)

DOI： 10.4326/jjcvs.45.135

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01122&link_issn=&doc_id=20160603150008&doc_link_id=10.4326%2Fjjcvs.45.135&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.45.135&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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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  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03097&link_issn=&doc_id=20150916180008&doc_link_id=%2Fap4heard%2F2015%2F001910%2F009%2F1112-1117%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fap4heard%2F2015%2F001910%2F009%2F1112-1117%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：日本静脈学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は29歳男性。左室後側壁血管腫に関連する複数個の心室頻拍(VT)を認め、心内膜・心外膜アプローチによるアブレーションが無効であったため開胸下に心内膜・心外膜側から腫瘍辺縁を冷凍凝固した。術後に右脚ブロック・右軸偏位型(VT1)および左脚ブロック・左軸偏位型(VT2)で同一頻拍周期(300 msec)の2種類のVTを認めた。腫瘍-僧帽弁輪間を峡部(mitral isthmus、MI)とし、VT1は僧帽弁輪を反時計方向回転、VT2は時計方向に旋回した。MIの興奮を冠静脈洞内の多極カテーテルにて記録、洞調律中は両方向から興奮の進入する遅延電位として記録され、VT1中は中隔から側壁方向、VT2中はその逆方向へ伝播する拡張期電位となった。洞調律中にMIの側壁出口付近を焼灼したところMI側壁部の興奮が遅延し、焼灼部遠位(前側壁基部)からの刺激で焼灼部のブロックが確認され、VT1、VT2ともに誘発不能となった。冠静脈洞の多極カテーテルでVT中の拡張期電位の興奮伝播および焼灼の効果を評価しえたMI-VTを経験したので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

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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  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は15歳、男性。Gorlin症候群(基底細胞癌、心臓腫瘍)に合併した心室頻拍(VT)の頻回発作を認め、アミオダロン内服、アブレーション施行するも抑制できず、手術目的に当院転院した。術前心内膜マッピングでは、左室後壁に腫瘍浸潤に一致する18cm2の広範囲の低電位領域を認め、その辺縁では全周性に遅延電位が記録された。プログラム刺激により誘発されたVTは2種類。VT#1(RBBB、左軸偏位、CL300ms)は、低電位領域の後中隔側で、VT#2(RBBB、右軸偏位、CL300ms)は後側壁側でpace mapが近似した。開胸下心外膜マッピングでも低電位領域辺縁を最早期とする多種類のVTが誘発され、腫瘍切除が困難であったため腫瘍を隔離するように凍結凝固し頻拍を抑制しえた。低電位領域辺縁の病理では線維腫の浸潤と心筋の錯綜配列様構造異常を認め、これが本頻拍の不整脈基質である可能性が示唆された。(著者抄録)

DOI： 10.11281/shinzo.46.S3_258

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：日本静脈学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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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  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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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  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：英語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：Elsevier B.V.  

The development and introduction of radiofrequency ablation devices allowed maze procedure to be performed safely and easily, further enabling off-pump pulmonary vein isolation through minithoracotomy or thoracoscopy. The outcomes of the maze procedure include the prevention of stroke and other complications related to atrial fibrillation (AF), improvement in cardiac performance, and relief of symptoms. The indications for the maze procedure have been discussed on the basis of available evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal AF, and can be performed with both endocardial catheter ablation and minimally invasive epicardial ablation. These 2 modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability adding other lesions indicated for persistent or long-standing persistent AF, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in the recurrence of AF and induction of atrial tachycardia. Intraoperative verification of a conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a box lesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure
however, the long-term effect on AF and autonomic nerve activities should be examined. Because the mechanism underlying AF varies in each patient, a tailor-made therapy, using a stepwise approach, with a hybrid procedure combining epicardial and endocardial ablation offers promising prospects in the nonpharmacological treatment of AF. © 2012 Japanese Heart Rhythm Society.

DOI： 10.1016/j.joa.2012.07.007

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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最初のメイズ手術から20年以上が経過したが,当初は広範囲の心房切開と再縫合を行っていた手術が,各種アブレーションデバイスの導入により低侵襲化され広く普及した.メイズ手術の有効性は,特に血栓塞栓症予防の観点から検討され手術適応のガイドラインが作成された.術前の左房径は術後心房細動再発の危険因子であり,高度左房拡大例に対する左房縫縮の効果が検討されている.アブレーションデバイスによる不完全焼灼に伴う遺残伝導は心房頻拍を発生させる可能性があり,焼灼線の伝導ブロックを術中に検証する手法が研究されている.心臓神経叢のアブレーションが心房細動手術の有効性を高める可能性が示唆されているが,長期成績など今後の検討課題は多い.(著者抄録)

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DOI： 10.4030/jjcs.33.824

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症例1は,急性心筋梗塞(前壁中隔)の79歳男性,右橈骨動脈アプローチにより,冠状動脈造影で左前下行枝に狭窄が認められた.直ちにステントを植え込みPCIを行った.拡張に成功し,集中治療室に入室し,以後順調に経過した.症例2はバイパス手術後,心筋梗塞の77歳男性,うっ血性心不全で入院し,冠状動脈造影でバイパスが大動脈との吻合部で完全閉塞し,左主幹部は90%狭窄,回旋枝は完全閉塞していた.心臓カテーテル検査,冠状動脈インターベンションの手順を紹介し,経橈骨動脈アプローチが実施できた症例とできなかった症例を提示した.本アプローチ法は橈骨動脈に攣縮を起こした場合等には実施困難なこともあるが,大多数の症例に適用可能で患者・医療従事者の負担を軽減する有効な方法と考えられる

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