Language：Japanese   Publisher：日本医科大学医学会  

72歳女性。胸背部痛を主訴に救急要請し、ドクターヘリにて当院へ搬送された。胸腹部CTにて急性大動脈解離と診断され、選択的順行性脳灌流下に4分枝付人工血管を用いて腕頭動脈まで部分弓部大動脈人工血管置換術が行われた。術後2日で抜管し、3日より経口摂取を開始したが、心嚢ドレーン排液の白濁化が持続しており、その排液は胸腔ドレーンからでなく、心嚢内の傍人工血管に留置したドレーンからの排液であったことから、乳糜心嚢液の合併と診断された。そこで、無脂肪食とソマトスタチンアナログ製剤の皮下注射を行ったところ、ドレーン排液量はやや減少したものの、100mL/日以上は流出が持続した。第7病日にリンパ管造影検査を施行した結果、リンパ管損傷部は大動脈弓部小彎に位置し、術中の大動脈壁剥離時に損傷した可能性が考えられた。胸管の結紮が必要と思われたが、リンパ管造影検査後からはドレーン排液量は著明に減少し、第17病日にドレーン抜去が可能となり、第27病日に軽快退院となった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20220831380010&doc_link_id=%2Fcw1nimed%2F2022%2F001803%2F012%2F0294-0298%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2022%2F001803%2F012%2F0294-0298%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

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

DOI： 10.1253/circrep.CR-21-0095

PubMed

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Language：English  

Giant cell arteritis is reportedly associated with thoracic aortic aneurysm and acute aortic dissection. We encountered a patient with giant cell arteritis who suffered acute aortic dissection three times within a short period. A pathological specimen of the ascending aorta taken at surgery for type A acute aortic dissection revealed the typical features of giant cell arteritis. Giant cell arteritis patients might be at greater risk of acute aortic dissection than healthy individuals.

DOI： 10.1177/0218492320960866

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Spatial dispersion of atrial activation is a cause of postoperative atrial fibrillation (PoAF) after cardiac surgery. This study evaluated whether temporal dispersion of atrial activation causes PoAF after surgery in a clinical setting. METHODS: Nineteen patients were enrolled. Postoperative atrial activation was evaluated by 24-hour Holter electrocardiography, with atrial pacing wires on the right atrium, for 5 days after cardiac surgery. No patient received antiarrhythmic drugs, including beta-blockers. The cycle length of 15 continuous atrial beats was measured at 4 time points: (i) earlier than 12 hours before PoAF, as a control, (ii) just before PoAF onset, (iii) during PoAF, and (iv) just before cessation of PoAF. Inhomogeneity of atrial activation was quantified by using the variation coefficient for a cycle length of 15 atrial beats during each phase. RESULTS: The median inhomogeneity index of atrial activation (interquartile range) was 0.102 (0.046-0.136) in controls, 0.943 (0.582-1.610) just before PoAF onset (vs. control; p=0.009), 0.966 (0.631-1.117) during PoAF, and 0.471 (0.138-0.645) just before cessation of PoAF. CONCLUSIONS: Dispersion of atrial activation significantly increased just before PoAF onset. Temporal dispersion of atrial activation is a precursory variation of PoAF.

DOI： 10.1272/jnms.JNMS.2020_87-402

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/joa3.12346

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/joa3.12346

Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

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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Publishing type：Research paper (scientific journal)  

© 2018 The Author(s) The purpose of this study was to determine the 22-year experience of the relationship between preoperative left atrial diameter (LAD) and atrial fibrillation (AF) recurrence after AF surgery. Between November 1993 and April 2015, 244 patients underwent AF surgery concomitant with mitral valve surgery, and were completely followed up in our institute. The full-maze procedure was performed in 231 patients and pulmonary vein isolation in 13. Three quartiles divided the list of sorted LAD data into 4 groups: group Q1: LAD = 40.5 ± 4.3 (n = 55), group Q2: LAD = 47.9 ± 2.0 (n = 61), group Q3: LAD = 54.2 ± 1.6 (n = 66), and group Q4: LAD = 64.2 ± 5.6 (n = 62). The AF cure rates for 22 years were verified between the groups. Although the AF cure rate of the full-maze procedure was 94%, 80%, 63%, and 51% at 1, 5, 10, and 20 years after AF surgery, respectively, it was 100% at 5 and 10 years after the pulmonary vein isolation (P = 0.088). Although there were no significant differences in the AF cure rate between groups Q1-Q3, the AF cure rate was significantly lower in group Q4 than the other groups (P < 0.001). A multivariate Cox proportional hazard model revealed that the preoperative LAD and cardiothoracic ratio were significant risk factors of AF recurrence (hazard ratio 1.063 per 1-mm increase, P = 0.003, and hazard ratio 1.064 per 1% increase, P = 0.043, respectively). AF surgery was effective for 22 years after surgery for AF concomitant with mitral valve disease. A preoperative LAD of ≥58.0 mm and the cardiothoracic ratio were risk factors of AF recurrence after AF surgery.

DOI： 10.1053/j.semtcvs.2018.01.004

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

閉塞性動脈硬化症において動脈内膜肥厚を伴う占拠性の動脈硬化病変のある症例では、動脈内膜摘除術が行われる。しかし、高度石灰化がある場合には石灰化した部位の内膜を摘除することは容易ではない。今回われわれは、総大腿動脈が全周性に石灰化していた症例に対して、超音波外科吸引装置(CUSA)を用いて除石灰しながら動脈内膜摘除術を行いパッチ形成した症例を提示する。症例は69歳男性。右下肢の間欠性跛行を主訴に来院した。画像診断にて右大腿動脈から浅大腿動脈、大腿深動脈にかけて高度石灰化を伴う狭窄病変を認め、CUSAを用いて動脈内膜摘除と除石灰を行い、逆Y字型のePTFEグラフトでパッチ形成を行った。術後2年の時点で狭窄の増悪はなく、良好に開存している。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL TRIBUNE INC  

This report describes a case of surgical treatment for a coronary artery saccular aneurysm of the left main bifurcation. A coronary artery saccular aneurysm (7 mm x 10 mm) and three vessel disease, including the left main trunk, were diagnosed by coronary angiography. A surgical resection and saphenous vein patch repair of the left main coronary artery aneurysm was performed concomitantly with coronary artery bypass grafting. The pathological findings of the aneurysm clarified that the aneurysm wall was atrophic and extremely thin because of a collapsed trilaminar arterial structure due to atherosclerosis. A coronary computed tomographic scan revealed no aneurysmal formation in the patent left main trunk and patent grafts 3 years after surgery.

DOI： 10.5761/atcs.cr.16-00064

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Language：Japanese   Publisher：(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。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00349&link_issn=&doc_id=20161209110019&doc_link_id=1390846634896118272&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390846634896118272&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Language：Japanese   Publisher：The Japanese Society for Cardiovascular Surgery  

Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass graft (CABG) surgery requires an appropriate surgical procedure to preserve the functional graft. We present a case of hybrid procedure of thoracic endovascular aortic repair combined with a redo off-pump CABG via median sternotomy. The patient was a 76-year-old man with a history of CABG and abdominal aortic replacement in a different country. Chest computed tomography revealed a saccular-shaped aortic aneurysm in the distal aortic arch with diameter of 5.6 cm. Coronary angiography revealed theLIMA graft was patent but anastomosed to the diagonal branch and the left anterior descending artery (LAD) was totally occluded and was opacified through the right coronary artery. Significant ischemic change in the anteroseptal wall suggested a requirement of surgical revascularization of LAD. The chest was opened via re-midsternotomy. Then the 3 arch vessels were reconstructed with a trifurcated artificial graft attached to the ascending aorta and coronary artery bypass grafting was performed on the beating heart. Finally, the aneurysm was excluded by introducing a stent graft through the graft to zone 0. The patient&#039;s postoperative course was uneventful and he was discharged on postoperative day 16. A hybrid procedure via median sternotomy was useful in the surgery for TAA with the functional LIMA after CABG.

DOI： 10.4326/jjcvs.45.135

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Other Link： 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

Language：Japanese   Publisher：(NPO)日本冠疾患学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Objective: Although recent progress has expanded the indications for thoracic aortic surgery to include elderly patients, the procedure remains extremely invasive. We performed a chart review to determine the early and late outcomes of thoracic aortic surgery using hypothermic circulatory arrest (HCA) and antegrade selective cerebral perfusion (ASCP) in octogenarians.
Materials and Methods: Of 79 patients who underwent surgery for thoracic aortic aneurysms from April 2007 through December 2012, 8 patients 80 years or older were selected for analysis. Mean age at the time of surgery was 84.3 +/- 1.39 years. The diagnoses were aortic dissection in 5 patients and degenerative thoracic aneurysm in 3 patients. All patients underwent surgery with HCA. The lowest body temperature was 25 degrees C. ASCP was used as an additional brain-protection technique. Emergency operations were performed in 5 patients (62.5%).
Results: The mean duration of HCA was 60.4 +/- 19.7 minutes, that of aortic cross-clamping time was 143.0 +/- 30.4 minutes, and mean pump time was 207.8 +/- 44.4 minutes. The hospital mortality rate was 0%. Major postoperative complications occurred in 3 (37.5%) patients: stroke, temporary neurologic dysfunction, and paraparesis in 1 patient each. No patients required temporary dialysis for new-onset renal dysfunction. There were no deaths during the 65-month follow-up period.
Conclusion: The early and late outcomes after thoracic aortic surgery at our hospital using RCA with ASCP in octogenarians are acceptable. The operations are performed with an acceptable operative risk, even under emergency situations, including acute aortic dissection.

DOI： 10.1272/jnms.81.12

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jacc.2012.08.1040

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

A 70-year-old man presented with sudden onset of global aphasia and right hemiplegia. Brain MRI revealed occlusion of the left middle cerebral artery. He was diagnosed as having a hyperacute cerebral infarction. Intravenous thrombolytic therapy was started, and the neurological symptoms were resolved after 11 h. Echocardiography showed a mobile mass in the left atrium, suspicious of a myxoma. The tumor was resected and pathologically diagnosed as a myxoma. In this patient, intravenous thrombolytic therapy was effective, and no adverse effects were observed. This suggests that, even with complications of myxoma, thrombolytic therapy can be considered if there are no contraindications.

DOI： 10.2169/internalmedicine.50.5545

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は生後4ヵ月、女児。生直後より心不全を認め、心エコー上の診断は、左室低形成を伴う完全型房室中隔欠損、両大血管右室起始症および著明な左室収縮能低下を伴う拡張型心筋症であった。生後1ヵ月よりカルベジロールを導入するも効果がみられず、心不全症状は増悪。カテーテル検査にて、拡大した左室がdamping chamberとなって、右室からの心室拍出量を減少させており、外科適応と考えられた。啼鳴時に急変し、挿管、ICU管理となり、人工呼吸管理、ミルリノン投与下で当院転院。著明に拡張し収縮能の低下した左室が右室からの全身への心拍出を減少させていると考えられ、収縮能の改善と心拍出の障害を改善させるため、入院2日目に心室縮小形成手術を施行。術後心機能が改善したところで、high flow、両心室のdyssynchronyに対し、両方向性グレン手術および両心室ペーシングを行った。その後経過良好にて引き続きフォンタン手術を予定し、退院となった。心室縮小手術による心機能改善がその後の治療継続のために必要であった症例と考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J00679&link_issn=&doc_id=20090121260008&doc_link_id=10.11281%2Fshinzo.41.51&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.41.51&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

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

DOI： 10.1007/s11748-007-0207-6

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Event date： 2007.6

Language：Japanese  

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Event date： 2007.6

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Event date： 2007.5

Language：Japanese  

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Event date： 2007.5

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Event date： 2007.2

Language：Japanese  

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Event date： 2007.1

Language：Japanese  

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Event date： 2007.1

Language：Japanese  

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Event date： 2006.10

Language：Japanese  

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Event date： 2006.10

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.9

Language：Japanese  

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Event date： 2006.6

Language：Japanese  

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Event date： 2006.4

Language：Japanese  

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Event date： 2006.4

Language：Japanese  

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Event date： 2006.3

Language：Japanese  

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Event date： 2006.3

Language：Japanese  

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Event date： 2006.3

Language：Japanese  

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Event date： 2006.3

Language：Japanese  

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Event date： 2006.2

Language：Japanese  

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Event date： 2006.2

Language：Japanese  

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Event date： 2005.4

Language：Japanese  

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Event date： 2005.3

Language：English  

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Event date： 2005.2

Language：Japanese  

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Event date： 2005.1

Language：English  

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Event date： 2004.9

Language：Japanese  

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Event date： 2004.5

Language：Japanese  

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Event date： 2004.3

Language：Japanese  

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Event date： 2004.2

Language：Japanese  

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Event date： 2004.2

Language：Japanese  

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Event date： 2004.2

Language：Japanese  

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Event date： 2004.2

Language：Japanese  

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Event date： 2003.11

Language：Japanese  

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Event date： 2002.10

Language：Japanese  

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Event date： 2002.4

Language：Japanese  

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Event date： 2002.3

Language：Japanese  

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Event date： 2002.3

Language：Japanese  

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Event date： 2002.3

Language：Japanese  

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Event date： 2001.9

Language：Japanese  

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Event date： 2001.9

Language：Japanese  

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Event date： 2001.3

Language：Japanese  

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Event date： 2001.3

Language：Japanese  

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Event date： 2001.3

Language：Japanese  

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Event date： 2001.3

Language：Japanese  

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Event date： 2000.6

Language：Japanese  

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Event date： 2000.6

Language：Japanese  

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Event date： 2000.5

Language：Japanese  

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Event date： 2000.2

Language：Japanese  

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