48 results on '"Fujii, Takeshiro"'
Search Results
2. Intracardiac Three-Dimensional Image as Surgical Decision-Making Tool of Congenital Heart Disease
- Author
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Isobe, Sho, Katayama, Yuzo, Ozawa, Tsukasa, and Fujii, Takeshiro
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- 2024
- Full Text
- View/download PDF
3. Three-dimensional-printed heart model can determine univentricular repair strategy in borderline double-outlet right ventricle
- Author
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Katayama, Yuzo, Isobe, Sho, Ozawa, Tsukasa, and Fujii, Takeshiro
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- 2023
- Full Text
- View/download PDF
4. Sex Differences in DeBakey Type I/II Acute Aortic Dissection Outcomes: The Tokyo Acute Aortic Super-network
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Takahashi, Toshiyuki, Yoshino, Hideaki, Shimokawa, Tomoki, Ogino, Hitoshi, Kunihara, Takashi, Akutsu, Koichi, Usui, Michio, Yamasaki, Manabu, Watanabe, Kazuhiro, Kawata, Mitsuhiro, Fujii, Takeshiro, Masuhara, Hiroshi, Takagi, Tomomitsu, Imazuru, Tomohiro, Yamamoto, Takeshi, Nagao, Ken, Kohsaka, Shun, and Takayama, Morimasa
- Published
- 2023
- Full Text
- View/download PDF
5. The prognostic impact of the controlling nutritional status (CONUT) score in patients undergoing cardiovascular surgery
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Hara, Masanori, Fujii, Takeshiro, Masuhara, Hiroshi, Kawasaki, Muneyasu, Tokuhiro, Keiichi, and Watanabe, Yoshinori
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- 2020
- Full Text
- View/download PDF
6. A case of constrictive pericarditis with a milk of calcium pericardial effusion undergoing surgical treatment.
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Hirano, Shojiro, Shinohara, Masaya, Nakanishi, Rine, Sano, Takahide, Yao, Shintaro, Hosono, Keisuke, Fujii, Takeshiro, and Ikeda, Takanori
- Abstract
Milk of calcium (MOC) pericardial effusion (PE) is extremely rare and has rarely been reported. A 78-year-old man was referred to our institution because of breathlessness and bilateral leg edema. Echocardiography revealed mild PE. In addition, abrupt posterior motion of the ventricular septum in early diastole was observed. A non-contrast chest computed tomography revealed a hyperdense PE, with Hounsfield units of 130, suggestive of MOC PE. Right heart catheterization (RHC) revealed that the right ventricular pressure had a dip and plateau pattern. We diagnosed the patient with constrictive pericarditis (CP) with MOC PE. As the right heart failure secondary to CP was refractory to medical therapy, we decided to perform surgical treatment. During pericardiectomy, a highly viscous PE, of which the color was pale and reddish brown, was aspirated. Chemical analysis of the PE revealed a very high calcium content of 39.2 mmol/L. The clinical symptoms secondary to CP improved. RHC performed postoperatively confirmed the disappearance of a dip and plateau pattern in the right ventricular pressure. In conclusion, we experienced a of CP with MOC PE and surgical treatment contributed to the improvement of the clinical symptoms and pericardial constriction secondary to CP. Because constrictive pericarditis (CP) with milk of calcium (MOC) pericardial effusion (PE) can cause severe morbidity and even mortality, the early diagnosis of CP is important in patients suspected of having MOC PE. MOC PE has hyperdensity on computed tomography, so its findings could be helpful in the diagnosis of MOC PE. Pericardiectomy for CP with MOC PE may contribute to the improvement of the clinical symptoms and pericardial constriction secondary to CP. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Untreated atrial septal defect after intracardiac repair for tetralogy of Fallot.
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Tanaka, Keisuke, Katayama, Yuzo, Isobe, Sho, Ozawa, Tsukasa, and Fujii, Takeshiro
- Abstract
Tetralogy of Fallot was repaired previously in a preschooler through right ventriculotomy, providing excellent exposure for ventricular septal defect closure and right ventricular outflow tract obstruction relief. Herein, we describe the preschooler as a 50-year-old man with untreated atrial septal defect found at pulmonary valve replacement in the remote period after tetralogy of Fallot repair. It was inferred intraoperatively that the previous tetralogy of Fallot was repaired only through right ventriculotomy, and atrial septal defect closure was performed together with pulmonary valve replacement. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Impact of preoperative nutritional status on postoperative dysphagia after elective cardiovascular surgery in older adults.
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Miyagi, Midori, Okuma, Shinnosuke, Nunoi, Yoshio, Kawada, Kota, Fujii, Takeshiro, and Ebihara, Satoru
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ELECTIVE surgery ,CARDIAC surgery ,TRACHEOTOMY ,ACADEMIC medical centers ,POSITIVE pressure ventilation ,CONTINUOUS arteriovenous hemofiltration ,PREOPERATIVE period ,TRANSESOPHAGEAL echocardiography ,INTUBATION ,DEGLUTITION disorders ,SURGICAL complications ,ACQUISITION of data ,RETROSPECTIVE studies ,ADULT respiratory distress syndrome ,MEDICAL records ,DEMENTIA ,DELIRIUM ,NUTRITIONAL status ,SEPTIC shock ,PARAPLEGIA ,OLD age - Published
- 2024
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9. Safety and effectiveness of tolvaptan for fluid management after pediatric cardiovascular surgery
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Katayama, Yuzo, Ozawa, Tsukasa, Shiono, Noritsugu, Masuhara, Hiroshi, Fujii, Takeshiro, and Watanabe, Yoshinori
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- 2017
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10. Removal of a leadless pacemaker using a 2.5cc syringe and silk thread during surgical treatment of infective endocarditis
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Yano, Kensuke, Shinohara, Masaya, Fujii, Takeshiro, and Ikeda, Takanori
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- 2023
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11. Outcomes of type A acute aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-network Registry.
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Yamasaki, Manabu, Yoshino, Hideaki, Kunihara, Takashi, Akutsu, Koichi, Shimokawa, Tomoki, Ogino, Hitoshi, Kawata, Mitsuhiro, Takahashi, Toshiyuki, Usui, Michio, Watanabe, Kazuhiro, Fujii, Takeshiro, Yamamoto, Takeshi, Nagao, Ken, and Takayama, Morimasa
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AORTIC dissection ,CARDIAC arrest ,AORTA ,EARLY death ,ODDS ratio ,HOSPITAL admission & discharge ,DISSECTION - Abstract
OBJECTIVES: Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS: Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS: A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008–0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012–8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065–5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056–0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045–0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940–0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025–1.228; P = 0.012) were significantly different. CONCLUSIONS: Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA. We previously reported a risk analysis for early death in emergency Stanford type A acute aortic dissection (AAD) surgery using the Tokyo Acute Aortic Super (TAAS)-network Registry. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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12. Radical Esophagectomy Combined with Resection of the Invaded Descending Aorta for T4 Barrett's Esophageal Carcinoma: A Case Report
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Yajima, Satoshi, Suzuki, Takashi, Okuma, Shinnosuke, Fujii, Takeshiro, Nanami, Tatsuki, Oshima, Yoko, Shiratori, Fumiaki, Funahashi, Kimihiko, Watanabe, Yoshinori, and Shimada, Hideaki
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Barrett's esophageal adenocarcinoma ,T4 aorta - Abstract
Case Report, A 58-year-old Japanese man was diagnosed with T4b (descending aorta) N2M1, stage IVB lower thoracic Barrett's esophageal adenocarcinoma. He was initially treated with definitive chemotherapy with cisplatin and 5-fluorouracil (FP therapy). After one course of FP therapy, he developed renal dysfunction complications. Computed tomography showed no remarkable change in the main tumor and metastatic lesion. Therefore, radical esophagectomy with resection of the invaded descending aorta and removal of the solitary metastatic lesion was performed. Superior mediastinal dissection, esophageal transection, and left adrenal gland removal were performed simultaneously. The patient underwent curative resection but died of multiple hematogenous metastases 116 days postoperatively. As aortic infiltrates were infected, artificial blood vessel replacement was selected. Although he underwent radical esophagectomy, hematogenous metastases have occurred in the early postoperative period.
- Published
- 2021
13. Novel Treatment for Atrial Septal Defect without an Inferior Septal Rim and Partial Anomalous Right Lower Pulmonary Venous Connection
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Kawada, Kota, Katayama, Yuzo, Ozawa, Tsukasa, Fujii, Takeshiro, Shiono, Noritsugu, and Watanabe, Yoshinori
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partial anomalous right lower pulmonary venous connection ,atrial septal defect without an inferior septal rim ,autologous tissue - Abstract
Case Report, There is no consensus regarding the ideal surgical procedure for treatment of combined atrial septal defect without an inferior septal rim and partial anomalous right lower pulmonary venous connection. A 41 year-old woman had previously undergone ineffective surgical closure of an ostium secundum-type atrial septal defect. Intraoperatively, we ascertained the correct diagnosis of partial anomalous right lower pulmonary venous connection combined with a residual defect. Incision of the atrial septal wall up to the superior margin along the previous suture line yielded a flap adequate for the atrial septal wall, and this flap was slid again into the entire opening. The spatially complex intracardiac lesion was repaired by using only autologous tissue.
- Published
- 2020
14. Antibacterial Effects of Vascular Grafts Treated with Rifampicin, Colistin, Vancomycin, or Daptomycin
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Okuma, Shinnosuke, Hamada, Masakaze, Hanai, Yuki, Fujii, Takeshiro, Tateda, Kazuhiro, and Watanabe, Yoshinori
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Staphylococcus aureus ,vancomycin ,Pseudomonas aeruginosa ,rifampicin-bonded vascular graft ,colistin - Abstract
Original Article, Introduction: Some reports suggest that rifampicin treatment of vascular grafts is useful when surgically treating vascular infections and mycotic aneurysms. However, the experimental evidence is limited, and the antibacterial effects of other antibiotic-treated vascular grafts are unknown. Methods: Vascular grafts were immersed in several antibiotic solutions (rifampicin, colistin, vancomycin, or daptomycin). After Pseudomonas aeruginosa PAO1 or Staphylococcus aureus N315 were inoculated into the graft exterior, the number of colony-forming units (CFU) inside and outside the grafts was measured over time. Moreover, bonding of colistin and vancomycin to the grafts was quantified. Results: For grafts immersed in rifampicin, the CFU values outside the grafts decreased over time and those inside the grafts did not increase when the grafts were exposed to a 106 CFU/mL concentration of PAO1 or N315. However, at 108 CFU/mL, the CFU values increased over time outside and inside the grafts. In PAO1 testing, grafts treated with colistin resisted pathogens in the tested area, and grafts treated with both colistin and rifampicin had even greater resistance. In N315 testing, vancomycin-treated grafts had some resistance to infection, but daptomycin-treated grafts did not. The bonding of colistin and vancomycin to the grafts depended on the immersion time. Conclusions: Rifampicin-bonded grafts have a strong antibacterial effect when the concentrations of pathogens are low. Colistin-bonded grafts are effective against P. aeruginosa infection, and vancomycin-bonded grafts are effective against S. aureus infection.
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- 2020
15. Impact of computed tomography on the diagnosis of Takayasu arteritis with acute coronary syndrome: A case series.
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Hosono, Keisuke, Nakanishi, Rine, Koike, Hideki, Matsumoto, Shingo, Oka, Yousuke, Fujii, Takeshiro, and Ikeda, Takanori
- Abstract
Both the diagnosis and treatment of coronary artery involvement with Takayasu arteritis (TA) are challenging. In this study, we report different clinical scenarios of two TA cases without Typical symptoms of TA that initially presented in the form of acute coronary syndrome (ACS). Patient 1 was a 24-year-old Japanese woman without coronary risk factors who presented with exertional chest pain, dyspnea, and syncope. Invasive coronary angiography (ICA) revealed a considerable lesion of the right coronary artery and the left main trunk. Ventricular fibrillation was observed immediately after the procedure. Despite conventional treatment, she died on day 16. Patient 2 was a 34-year-old Japanese woman without coronary risk factors who developed cardiogenic shock during a treadmill test for exertional chest pain. Coronary computed tomography angiography confirmed severe left main stenosis, presenting as ACS caused by TA. She was started on steroid therapy before coronary artery bypass grafting, resulting in a good postoperative course and no recurrence of chest pain. Therefore, coronary computed tomography angiography likely is useful for the early diagnosis of TA in young women with typical chest symptoms of ACS. It may help in avoiding complications associated with ICA. When young women with a low pre-test probability of coronary artery disease present with typical anginal symptoms, Takayasu arteritis (TA) should be suspected despite the absence of symptoms such as fever, fatigue, or myalgia. Coronary computed tomography angiography is safe for rapid diagnosis and decision-making when patients suspected of having TA initially manifest an unstable condition such as acute coronary syndrome. [ABSTRACT FROM AUTHOR]
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- 2022
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16. Successful Treatment of Infant Tricuspid Valve Dysplasia With Papillary Muscle-Splitting Technique
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Katayama, Yuzo, Isobe, Sho, Ozawa, Tsukasa, and Fujii, Takeshiro
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- 2023
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17. Fontan conversion with novel direct ablation after childbirth: Report of a case
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Ozawa, Tsukasa, Fujii, Takeshiro, Shiono, Noritsugu, Hamada, Satoshi, Masuhara, Hiroshi, Hara, Masanori, Sasaki, Yuki, Katayanagi, Tomoyuki, Yoshihara, Katsunori, Okano, Yoshifumi, Takatsuki, Shinichi, Saji, Tsutomu, Koyama, Nobuya, and Watanabe, Yoshinori
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- 2011
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18. Stent graft implantation combined with coil embolization and external-internal iliac artery bypass surgery: Report of a case
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Fujii, Takeshiro, Ozawa, Tsukasa, Hamada, Satoshi, Masuhara, Hiroshi, Teramoto, Chikao, Hara, Masanori, Katayanagi, Tomoyuki, Sasaki, Yuki, Koyama, Nobuya, and Watanabe, Yoshinori
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- 2010
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19. Study of coronary artery bypass using the PAS-Port device: assessment by multidetector computed tomography
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Fujii, Takeshiro, Watanabe, Yoshinori, Shiono, Noritsugu, Ozawa, Tsukasa, Hamada, Satoshi, Masuhara, Hiroshi, Teramoto, Chikao, Hara, Masanori, and Koyama, Nobuya
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- 2009
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20. Usefulness of perioperative blood glucose control in patients undergoing off-pump coronary artery bypass grafting
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Fujii, Takeshiro, Watanabe, Yoshinori, Shiono, Noritsugu, Kawasaki, Muneyasu, Yokomuro, Hiroki, Ozawa, Tsukasa, Hamada, Satoshi, Masuhara, Hiroshi, and Koyama, Nobuya
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- 2007
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21. Intravascular ultrasound imaging for detection of oseudoaneurysm with aortobronchopulmonary fistula after graft replacement of descending aorta
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Fujii, Takeshiro, Watanabe, Yoshinori, Shiono, Noritsugu, Kawasaki, Muneyasu, Yoshihara, Katsunori, and Koyama, Nobuya
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- 2004
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22. Increasing donor age adversely impacts beneficial effects of bone marrow but not smooth muscle myocardial cell therapy
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Zhang, Hao, Fazel, Shafie, Tian, Hai, Mickle, Donald A.G., Weisel, Richard D., Fujii, Takeshiro, and Li, Ren-Ke
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Myocardial ischemia -- Drug therapy ,Heart attack -- Demographic aspects ,Heart cells -- Research ,Heart cells -- Demographic aspects ,Aging -- Health aspects ,Biological sciences - Abstract
We evaluated the impact of donor age on the efficacy of myocardial cellular therapy for ischemic cardiomyopathy. Characteristics of smooth muscle cells (SMC), bone marrow stromal cells (MSCs), and skeletal muscle cells (SKMCs) from young, adult, and old rats were compared in vitro. Three weeks after coronary ligation, 3.5 million SMCs (n = 11) or MSCs (n = 9) from old syngenic rats or culture medium (n = 6) were injected into the ischemic region. Five weeks after implantation, cardiac function was assessed by echocardiography and the Langendorff apparatus. In the in vitro study, the numbers and proliferation of MSCs from fresh bone marrow and SKMCs from fresh tissue but not SMCs were markedly diminished in old animals (P < 0.05 both groups). SKMCs from old animals did not reach confluence. After treatment with 5-azacytidine (azacitidine), the myogenic potential of old MSCs was decreased compared with young MSCs. In the in vivo study, both SMC and MSC transplantation induced significant angiogenesis compared with media injections (P < 0.05 both groups). Transplantation of SMCs but not MSCs prevented scar thinning (P = 0.03) and improved ejection fraction and fractional shortening (P < 0.05). Load-independent indices of cardiac function in a Langendorff preparation confirmed improved function in the aged SMC group (P = 0.01) but not in the MSC group compared with the control group. In conclusion, donor age adversely impacts the efficacy of cellular therapy for myocardial regeneration and is cell-type dependent. SMCs from old donors retain their ability to improve cardiac function after implantation into ischemic myocardium. myocardial infarction; aging
- Published
- 2005
23. A case report of incomplete endocardial cushion defect with mitral stenosis in an elderly patient
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Fujii, Takeshiro, Koyama, Nobuya, Watanabe, Yoshinori, Shiono, Noritsugu, Yoshihara, Katsunori, and Takanashi, Yoshinori
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- 1998
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24. Ventricular septal defect repair in an infant with severe pulmonary hypertension and preoperatively diagnosed left ventricular noncompaction
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Sasaki, Yuki, Ozawa, Tsukasa, Matsuura, Hiroyuki, Saji, Tsutomu, Fujii, Takeshiro, Watanabe, Yoshinori, Shiono, Noritsugu, Takanashi, Yoshinori, and Koyama, Nobuya
- Published
- 2010
25. Myocardial Electrode Implantation by the Subxiphoid Approach Using a Heart Stabilizer
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Fujii, Takeshiro, Watanabe, Yoshinori, Shiono, Noritsugu, Yokomuro, Hiroki, Ozawa, Tsukasa, and Koyama, Nobuya
- Published
- 2005
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26. Transplantation of cryopreserved muscle cells in dilated cardiomyopathy: Effects on left ventricular geometry and function
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Ohno, Nobuhisa, Fedak, Paul W. M., Weisel, Richard D., Mickle, Donald A. G., Fujii, Takeshiro, and Li, Ren-Ke
- Published
- 2003
27. P22-5 - Tumor in Pulmonary Artery Diagnosed by Right Heart Failure: A Case Report
- Author
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Hamai, Asami, Kiuchi, Shunsuke, Hisatake, Shinji, Kabuki, Takayuki, Shinohara, Masaya, Fujii, Takahiro, Yamanaka, Kyoko, Fujii, Takeshiro, Watanabe, Yoshinori, and Ikeda, Takanori
- Published
- 2017
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28. Increasing donor age adversely impacts beneficial effects of bone marrow but not smooth muscle myocardial cell therapy.
- Author
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Hao Zhang, Fazel, Shafie, Hai Tian, Mickle, Donald A. G., Weisel, Richard D., Fujii, Takeshiro, and Ren-Ke Li
- Subjects
BONE marrow ,SMOOTH muscle ,CELLULAR therapy ,ORGAN donors ,CARDIOMYOPATHIES - Abstract
We evaluated the impact of donor age on the efficacy of myocardial cellular therapy for ischemic cardiomyopathy. Characteristics of smooth muscle cells (SMC), bone marrow stromal cells (MSCs), and skeletal muscle cells (SKMCs) from young, adult, and old rats were compared in vitro. Three weeks after coronary ligation, 3.5 million SMCs (n = 11) or MSCs (n = 9) from old syngenic rats or culture medium (n = 6) were injected into the ischemic region. Five weeks after implantation, cardiac function was assessed by echocardiography and the Langendorff apparatus. In the in vitro study, the numbers and proliferation of MSCs from fresh bone marrow and SKMCs from fresh tissue but not SMCs were markedly diminished in old animals (P < 0.05 both groups). SKMCs from old animals did not reach confluence. After treatment with 5-azacytidine (azacitidine), the myogenic potential of old MSCs was decreased compared with young MSCs. In the in vivo study, both SMC and MSC transplantation induced significant angiogenesis compared with media injections (P < 0.05 both groups). Transplantation of SMCs but not MSCs prevented scar thinning (P = 0.03) and improved ejection fraction and fractional shortening (P < 0.05). Load-independent indices of cardiac function in a Langendorff preparation confirmed improved function in the aged SMC group (P = 0.01) but not in the MSC group compared with the control group. In conclusion, donor age adversely impacts the efficacy of cellular therapy for myocardial regeneration and is cell-type dependent. SMCs from old donors retain their ability to improve cardiac function after implantation into ischemic myocardium. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
29. Cell transplantation to prevent heart failure: a comparison of cell types.
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Fujii, Takeshiro, Yau, Terrence M., Weisel, Richard D., Ohno, Nobuhisa, Mickle, Donald A. G., Shiono, Noritsugu, Ozawa, Tsukasa, Matsubayashi, Keiji, and Li, Ren-Ke
- Subjects
CELL transplantation ,MYOCARDIAL infarction ,ENZYMES - Abstract
: BackgroundAutologous cell transplantation may restore viable muscle after a myocardial infarction. We compared the effect of three cell types or an angiotensin-converting enzyme (ACE) inhibitor on preservation of ventricular function after cardiac injury.: MethodsA uniform transmural myocardial scar was created in adult rats by cryoinjury. Three weeks later the rats were randomly assigned to one of four blinded treatments: transplantation with 5 × 10
6 aortic smooth muscle cells (SMC, n = 12), ventricular heart cells (VHC, n = 13), skeletal muscle cells (SKC, n = 13) or culture medium alone (control, n = 11). The ACE inhibitor group (n = 8) received enalapril (1.0 mg/kg per day), also beginning 3 weeks after cryoinjury. Five and 12 weeks after transplantation, left ventricle (LV) function was assessed in a Langendorff apparatus, and histologic and immunohistological evaluation of the LV scars was performed.: ResultsAt 5 weeks, greater scar elastin content and better LV function was noted with cell transplantation or ACE inhibitor therapy compared with control rats (p < 0.05). Twelve weeks after transplantation, cell-transplanted rats still had greater elastin content and better LV function than control rats, although elastin content and LV function had declined in ACE inhibitor-treated animals to levels below those observed in control rats (p < 0.05).: ConclusionsTransplantation of SMC, VHC, and SKC preserved ventricular function equivalent to the effects of an ACE inhibitor. Muscle cell transplantation, but not ACE inhibitor therapy, continues to be effective later after cryoinjury. No differences were detected between the muscle cells. [Copyright &y& Elsevier]- Published
- 2003
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30. Non-bacterial Thrombotic Endocarditis Presenting as a Mass in the Right Atrium Diagnosed by Open Chest Surgery.
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Yamashita A, Hisatake S, Sakurai K, Murakami Y, Kinoshita T, Nunoi Y, Okuma S, Fujii T, Fukasawa Y, Tochigi N, and Ikeda T
- Subjects
- Humans, Male, Middle Aged, Diagnosis, Differential, Thrombosis etiology, Thrombosis diagnosis, Thrombosis surgery, Endocarditis, Non-Infective diagnosis, Endocarditis, Non-Infective etiology, Endocarditis, Non-Infective diagnostic imaging, Heart Atria diagnostic imaging, Heart Atria pathology
- Abstract
Non-bacterial thrombotic endocarditis (NBTE) is a condition that results in the development of vegetation on cardiac valves that are devoid of inflammation and bacteria. We herein report a 60-year-old man who transferred to our hospital because of a systemic embolism and heart failure. A mass in the right atrium and vegetation on the mitral valve were observed. He was first diagnosed with infectious endocarditis according to the Duke criteria. During treatment, however, the patient was diagnosed with antiphospholipid syndrome and cancer. After 4 weeks of antibacterial therapy, the patient underwent open chest surgery, and the postoperative histological diagnosis was NBTE.
- Published
- 2024
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31. Clinical Features of 544 Patients With Ruptured Aortic Aneurysm - A Report From the Tokyo Acute Aortic Super Network Database.
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Akutsu K, Yoshino H, Shimokawa T, Ogino H, Kunihara T, Takahashi T, Usui M, Watanabe K, Yamasaki M, Fujii T, Kawata M, Watanabe Y, Yamamoto T, Kohsaka S, Nagao K, and Takayama M
- Abstract
Background: Epidemiological data on ruptured aortic aneurysms from large-scale studies are scarce. The aims of this study were to: clarify the clinical course of ruptured aortic aneurysms; identify aneurysm site-specific therapies and outcomes; and determine the clinical course of patients receiving conservative therapy.Methods and Results: Using the Tokyo Acute Aortic Super Network database, we retrospectively analyzed 544 patients (mean [±SD] age 78±10 years; 70% male) with ruptured non-dissecting aortic aneurysms (AAs) after excluding those with impending rupture. Patient characteristics, status on admission, therapeutic strategy, and outcomes were evaluated. Shock or pulselessness on admission were observed in 45% of all patients. Conservative therapy, endovascular therapy (EVT), and open surgery (OS) accounted for 32%, 23%, and 42% of cases, respectively, with corresponding mortality rates of 93%, 30%, and 29%. The overall in-hospital mortality rate was 50%. The prevalence of pulselessness was highest (48%) in the ruptured ascending AA group, and in-hospital mortality was the highest (70%) in the ruptured thoracoabdominal AA group. Multivariable logistic regression analysis indicated in-hospital mortality was positively associated with pulselessness (odds ratio [OR] 10.12; 95% confidence interval [CI] 4.09-25.07), and negatively associated with invasive therapy (EVT and OS; OR 0.11; 95% CI 0.06-0.20)., Conclusions: The outcomes of ruptured AAs remain poor; emergency invasive therapy is essential to save lives, although it remains challenging to reduce the risk of death.
- Published
- 2024
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32. Endovascular Treatment for Kommerell's Diverticulum with a Right-Sided Aortic Arch.
- Author
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Hara M, Fujii T, Kawasaki M, Katayanagi T, Okuma S, Shiono N, Tokuhiro K, and Watanabe Y
- Abstract
We report a rare case of type A dissection involving a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell's diverticulum in a 76-year-old woman. Endovascular treatment for Kommerell's diverticulum including intimal tear of the dissection was performed. At the 5-year follow-up, the patient was doing well, with no endoleak or dilatation of the Kommerell's diverticulum.
- Published
- 2017
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33. A Case of an Aortic Abscess around the Elephant Trunk.
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Fujii T, Kawasaki M, Katayanagi T, Okuma S, Masuhara H, Shiono N, and Watanabe Y
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- Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Humans, Male, Middle Aged, Negative-Pressure Wound Therapy, Omentum transplantation, Postoperative Complications, Tomography, X-Ray Computed, Abscess etiology, Aorta, Thoracic surgery, Aortic Diseases etiology
- Abstract
A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.
- Published
- 2015
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34. Morphological Evaluation of Proximal Anastomosis by PAS-Port(®) System in Patients with Long-Term Patent Grafts.
- Author
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Kawasaki M, Fujii T, Hara M, Sasaki Y, Katayanagi T, Okuma S, and Watanabe Y
- Subjects
- Aged, Aorta physiopathology, Aorta surgery, Aortography methods, Coronary Artery Bypass, Off-Pump adverse effects, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease physiopathology, Coronary Restenosis etiology, Coronary Restenosis physiopathology, Equipment Design, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Male, Materials Testing, Phlebography methods, Saphenous Vein diagnostic imaging, Saphenous Vein physiopathology, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Coronary Artery Bypass, Off-Pump instrumentation, Coronary Artery Disease surgery, Saphenous Vein surgery, Vascular Patency
- Abstract
Purpose: We examined grafts employing for morphological analysis of early and long-term results on proximal anastomosis with the PAS-Port(®)., Methods: One hundred and four patients treated by OPCAB with PAS-Port(®) were performed postoperative MDCT. Morphological evaluation of the proximal anastomotic region was classified into three groups (A; graft was anastomosed almost perpendicularly to the aortic wall, B; graft was same type A, but subsequently curved to form an acute angle with the aortic wall, C; graft take off acute angle with the aortic wall) evaluated on planar and sagittal sections., Results: One hundred twenty-six PAS-Port(®) were used. Patency rate was 99.0% at discharge, 94.7% at 1 year, and no blockages were detected thereafter in patients examined. The morphology rate was A 50.6%, B 15.3% and C 34.1% on planar sections, and A 58.8%, B 10.6% and C 30.6% on sagittal sections., Conclusion: The morphological evaluation of grafts revealed the degree of freedom in graft design to be relatively high and long-term patency posed no particular problem even if the layout of the proximal anastomotic region involved a relatively acute angle. The PAS-Port(®) was considered to be a highly reliable device which performed appropriate proximal anastomosis and improved the patency of vein grafting to the aortic wall.
- Published
- 2015
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35. Multidisciplinary Treatment Approach for Prosthetic Vascular Graft Infection in the Thoracic Aortic Area.
- Author
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Fujii T and Watanabe Y
- Subjects
- Combined Modality Therapy, Humans, Aorta, Thoracic, Blood Vessel Prosthesis adverse effects, Blood Vessel Prosthesis Implantation adverse effects, Prosthesis-Related Infections diagnosis, Prosthesis-Related Infections therapy
- Abstract
Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition.
- Published
- 2015
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- View/download PDF
36. Interrupted aortic arch with massive saccular collateral aneurysm in an adult.
- Author
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Sasaki Y, Fujii T, Shiono N, Katayanagi T, Okuma S, Wakayama M, Shibuya K, and Watanabe Y
- Subjects
- Aorta, Abdominal diagnostic imaging, Aorta, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic physiopathology, Humans, Male, Middle Aged, Thoracotomy, Tomography, X-Ray Computed, Aorta, Abdominal physiopathology, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Collateral Circulation, Vascular Surgical Procedures methods
- Abstract
A 49-year-old man was diagnosed with an interrupted aortic arch (IAA), a massive saccular thoracic collateral aneurysm, ischemic renal insufficiency, and multiple abdominal collateral aneurysms. A bypass from the left subclavian artery to the descending aorta and thoracic collateral aneurysmectomy proceeded simultaneously through a posterolateral thoracotomy. The pressure gradient between upper and lower extremities disappeared and renal function was normalized. Thoracic collateral aneurysmectomy and a simultaneous bypass from the left subclavian artery to the descending aorta with postoperative normalization of ischemic renal insufficiency are extremely rare in adult patients with IAA, and the remaining abdominal collateral aneurysms require careful monitoring., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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- View/download PDF
37. Endovascular abdominal aortic aneurysm repair in patients with renal transplants: reports of two cases.
- Author
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Okuma S, Fujii T, Sasaki Y, Katayanagi T, Shiono N, Hara M, and Watanabe Y
- Subjects
- Aged, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal diagnosis, Humans, Male, Middle Aged, Renal Insufficiency complications, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Kidney Transplantation, Renal Insufficiency surgery
- Abstract
The artery and vein of the transplanted kidney are generally anastomosed to the external iliac artery and vein, respectively. Therefore, in open abdominal artery aneurysm (AAA) repair in renal transplant patients, kidney ischemia due to a proximal aortic clamp is a serious problem. We successfully performed endovascular aneurysm repair (EVAR) of AAA without aortic clamping in two renal transplant recipient cases. The two patients were diagnosed with large AAAs following the renal transplant, and EVAR was performed. To protect the renal function, we used N-acetylcysteine premedication and hydration before the operation, and we could then reduce the iodine contrast medium by using echography of the artery during the operation. In this report, a case where EVAR with renal function protection is a useful treatment for renal transplant recipients with AAA is described.
- Published
- 2014
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- View/download PDF
38. Novel infectious agent-free hemostatic material (TDM-621) in cardiovascular surgery.
- Author
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Masuhara H, Fujii T, Watanabe Y, Koyama N, and Tokuhiro K
- Subjects
- Aged, Aged, 80 and over, Animals, Disease Models, Animal, Female, Gels, Humans, Male, Middle Aged, Rabbits, Reoperation, Treatment Outcome, Vascular Surgical Procedures, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation, Chemistry Techniques, Synthetic, Coronary Artery Bypass, Hemostatics therapeutic use, Peptides therapeutic use, Peripheral Arterial Disease surgery
- Abstract
Subjects: Currently, hemostatic materials made from human blood components and animal-derived collagen is used for controlling operative hemorrhage in the cardiovascular surgery field. In this study, we focused on an entirely synthetic self-assembling peptide (development code: TDM-621) that gels when in contact with blood or other bodily fluids and stops bleeding upon contact with a wound site. We investigated its usefulness as a hemostatic material in animal and clinical studies., Methods: Before we began the clinical study, we demonstrated the hemostasis efficacy and safety of TDM-621 in animal experimental models. Twenty-five patients (22 men, 3 women) were enrolled in the clinical study, and the following procedures were performed: 1) coronary artery bypass graft (CABG) (n = 9), 2) abdominal aortic graft replacement (n = 4), and 3) peripheral artery bypass (n = 12). The TDM-621 material was applied to a total of 33 vascular anastomotic graft sites (some patients received material at more than one site). Both hemostatic efficacy and safety were examined., Results: A total of 33 anastomotic graft sites in 25 patients were evaluated, and the averaged primary and secondary efficacy rate was 94.5%. No postoperative bleeding or adverse events (including serious adverse events) with a causal relationship to treatment were observed., Conclusion: This study indicated that TDM-621 is a more effective and reliable hemostat than commonly-used general hemostatic agents and, therefore, will be very useful in several cardiovascular surgery applications.
- Published
- 2012
- Full Text
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39. Antibiotics and Drainage for Treating Stent-Graft Infection after EVAR.
- Author
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Masuhara H, Fujii T, Watanabe Y, Koyama N, and Tokuhiro K
- Abstract
The patient was a 64-year-old man. He developed fever and lumbago 6 months after the EVAR. Because CT showed an abscess in the aortic aneurysm surrounding the stent graft, stent-graft infection was diagnosed, and treatment with intravenous antibiotics was initiated. However, the fever and inflammatory markers persisted; therefore, CT-guided drainage catheter placement was performed. After all the pus had been discharged, the fever subsided, and the inflammatory reaction was also suppressed. One year has elapsed since the treatment, and the patient continues to visit with no complaints. We report that stent-graft infection was relieved with antibiotics and drainage.
- Published
- 2012
- Full Text
- View/download PDF
40. Redo CABG for ACS via the left thoracotomy using the PAS-port system to the descending thoracic aorta: a case report.
- Author
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Watanabe Y, Fujii T, Hara M, Sasaki Y, Katayanagi T, Shiono N, and Koyama N
- Subjects
- Aged, Female, Humans, Reoperation, Acute Coronary Syndrome surgery, Coronary Artery Bypass instrumentation, Coronary Artery Disease surgery, Saphenous Vein transplantation, Thoracotomy instrumentation
- Abstract
A 74-year-old female patient with left main trunk (LMT) and triple vessel disease underwent coronary artery bypass graft (CABG) surgery. The patient began to experience exertional dyspnea. A coronary artery angiogram confirmed a severe stenosis in the proximal side of the saphenous vein graft (SVG). The patient had impending infarction immediately after the unsuccessful attempt for percutaneous coronary intervention, which resulted in an emergent CABG procedure. A left thoracotomy at the 4th intercostal space was made with the patient in the right lateral position. We then interrupted the use of intra-aortic balloon pumping (IABP), confirmed on transesophageal echocardiography (TEE) that the balloon was in a position distal to the target anastomosis site, and made a proximal anastomosis using the PAS-Port system (Cardica, Redwood City, CA, USA). After its successful deployment, IABP was repositioned back and resumed. The distal anastomosis was made to the previously bypassed graft. The patient had no postoperative myocardial damage or complications and was discharged on postoperative day 21. A redo CABG for post-CABG acute coronary syndrome patient was thought to be an extreme high risk; however, the operative time could be minimized by using the PAS-Port system, which enabled a safe redo CABG with left thoracotomy.
- Published
- 2010
41. Successful surgical repair of an infectious thoracic aortic pseudoaneurysm accompanied by aortobronchopulmonary fistula and advanced hepatic dysfunction without assisted circulation.
- Author
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Masuhara H, Watanabe Y, Fujii T, Shiono N, Hamada S, Hara M, Teramoto C, Yoshihara K, and Koyama N
- Subjects
- Aneurysm, False complications, Aneurysm, False diagnostic imaging, Aneurysm, False microbiology, Aneurysm, Infected complications, Aneurysm, Infected diagnostic imaging, Aneurysm, Infected microbiology, Anti-Bacterial Agents therapeutic use, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic microbiology, Aortic Diseases diagnostic imaging, Aortography methods, Bronchial Fistula diagnostic imaging, Female, Hemoptysis etiology, Humans, Liver Diseases, Alcoholic physiopathology, Middle Aged, Severity of Illness Index, Streptococcus agalactiae isolation & purification, Tomography, X-Ray Computed, Treatment Outcome, Vascular Fistula diagnostic imaging, Aneurysm, False surgery, Aneurysm, Infected surgery, Aortic Aneurysm, Thoracic surgery, Aortic Diseases microbiology, Blood Vessel Prosthesis Implantation, Bronchial Fistula microbiology, Liver Diseases, Alcoholic complications, Vascular Fistula microbiology
- Abstract
The patient was a 59-year-old female. Because of massive hemoptysis, she was brought to our emergency center by ambulance. Thoracic computed tomography led to a diagnosis of an infectious thoracic aortic pseudoaneurysm accompanied by an aortobronchopulmonary fistula. Emergency surgery followed. Also noted was an advanced hepatic dysfunction, assessed as Child-Pugh score B, caused by an alcoholic liver disease. A localized affected area made it possible for us to perform an aneurysmectomy using a temporary bypass rather than assisted circulation. A patch plasty using expanded polytetrafluoroethylene completed the procedure. Streptococcus agalactiae (GBS) was detected in a sample obtained during the surgery from an abscess located in the aneurysm. The patient made satisfactory postoperative progress and left the hospital walking unaided on the 36th postoperative day.
- Published
- 2010
42. An aortic root pseudoaneurysm that developed after implantation of a rectus abdominis muscle flap to treat an MRSA mediastinitis: a case report.
- Author
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Fujii T, Watanabe Y, Shiono N, Ozawa T, Hamada S, Masuhara H, Teramoto C, Hara M, Katayanagi T, Sasaki Y, and Koyama N
- Subjects
- Aneurysm, False diagnostic imaging, Aneurysm, False surgery, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm surgery, Autopsy, Debridement, Fatal Outcome, Humans, Male, Mediastinitis microbiology, Reoperation, Tomography, X-Ray Computed, Treatment Outcome, Young Adult, Aneurysm, False etiology, Aortic Aneurysm etiology, Blood Vessel Prosthesis Implantation adverse effects, Mediastinitis surgery, Methicillin-Resistant Staphylococcus aureus isolation & purification, Rectus Abdominis transplantation, Surgical Flaps adverse effects
- Abstract
The occurrence of mediastinitis following synthetic vascular replacement surgery is still associated with an unfavorable prognosis in the treatment of thoracic aortic diseases. This time we report a Bentall procedure that we re-performed to treat an aortic root pseudoaneurysm, which developed after a postoperative mediastinitis. This followed the first Bentall procedure, which was treated by debridement of the focus of infection, continuous lavage, and a two-step rectus abdominis muscle flap implantation. Implantation of a rectus abdominis muscle flap is effective in controlling infection in the treatment of mediastinitis after heart surgery. However, after synthetic vascular replacement surgeries have been performed to treat aortic diseases, especially after aortic root reconstruction surgery, which puts stress on the anastomotic site, consideration should be given regarding the development of hemorrhages and pseudoaneurysms as a result of infection-induced tissue fragilization.
- Published
- 2010
43. Effect of cryopreservation on cell proliferation and immunogenicity of transplanted human heart cells.
- Author
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Yokomuro H, Shiono N, Ozawa T, Fujii T, Watanabe Y, Koyama N, and Okada M
- Subjects
- Animals, Cell Proliferation, Cells, Cultured, Heart Atria cytology, Humans, Male, Models, Animal, Myocytes, Cardiac immunology, Rats, Rats, Inbred Lew, Rats, Wistar, Cell Transplantation physiology, Cryopreservation, Myocytes, Cardiac transplantation
- Abstract
Background: Cell preservation is essential for successful cell transplantation and/or tissue engineering. We examined the effects of cryopreservation on the transplantation of human heart cells., Methods: Cells isolated from human atrial tissues were cultured for 15 days (control group), cryopreserved for 1 week, and rapidly thawed and cultured for 15 days. Proliferation was compared among control and cryopreserved cells or tissues by constructing growth curves. Growth factors, cytokines, biochemical features, and cell cycle phase were measured immediately before and after cryopreservation, and immunogenicity was evaluated from growth curves generated from heart cells after 7 days in mixed-lymphocyte culture. Control or cryopreserved cells were transplanted into rat connective tissues and evaluated histologically 2 weeks later., Results: Cryopreserved cells proliferated more effectively than control cells. Levels of basic fibroblast growth factor and transforming growth factor-β1 were significantly higher, and those of interleukin (IL)-6 and IL-8 were significantly lower after cryopreservation. Fewer peripheral blood lymphocytes were produced in cryopreserved cells than in noncryopreserved cells, and the cell cycle phase of cryopreserved heart cells shifted primarily to G2 + M from G1 + G0. Noncryopreserved and cryopreserved cells both survived in connective tissue., Conclusion: Human atrial cells can be cultured, cryopreserved, and transplanted. Cryopreservation might increase the proliferation of human cells and tissues and also reduce the immunogenicity of heart cells.
- Published
- 2010
44. Limitations of retrograde continuous tepid blood cardioplegia for myocardial remodeling.
- Author
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Fujii T, Watanabe Y, Shiono N, Kawasaki M, Yokomuro H, Ozawa T, Hamada S, Masuhara H, Teramoto C, Hara M, Katayanagi T, Sasaki Y, and Koyama N
- Subjects
- Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Creatine Kinase blood, Female, Humans, Male, Middle Aged, Stroke Volume physiology, Temperature, Aortic Valve surgery, Cardiopulmonary Bypass methods, Heart Arrest, Induced methods, Heart Valve Prosthesis Implantation methods, Myocardial Reperfusion methods, Ventricular Remodeling
- Abstract
Objective: We assessed potential limitations of retrograde continuous tepid blood cardioplegia (RCTBC) for myocardial remodeling, represented by hypertrophied and/or dilated myocardium in patients with severe cardiomyopathy following single aortic valve replacement., Methods: The study was conducted on 91 patients who underwent initial single aortic valve replacement with tepid cardiopulmonary bypass (CPB) and RCTBC. Based on the postoperative maximum creatine phosphokinase (max CPK)-MB level, the patients were allocated to Group H (>/=100 IU/mL) with severe cardiomyopathy or Group L (<100 IU/mL) to make intergroup comparisons of preoperative, intraoperative, and postoperative parameter values., Results: Preoperative measurements were as follows: pressure gradient between left ventricle and aorta (DeltaPG), 92.8+/-46.2 mmHg in Group H and 57.9+/-41.6 mmHg in Group L (p<0.01); implanted valve size, 21.0+/-2.2 mm in Group H and 22.8+/-2.2 mm in Group L (p<0.01); left ventricular end-diastolic volume (LVEDV), 155.7+/-73.3 mL in Group H and 224.3+/-101.5 mL in Group L (p<0.01). The rate of RCTBC flow rate increase did not differ between the groups (17.6% in Group H and 20.7% in Group L), while the rate of concomitant use of optional antegrade coronary perfusion was significantly lower in Group H (25%) than in Group L (37%) (p<0.05). Pre- and post-perfusion lactic acid levels in the myocardial protection solution measured every 30 min after aortic cross clamping were higher in Group H than in Group L., Conclusion: The study suggests preoperative high DeltaPG, small aortic root diameter, and low LVEDV, namely, concentrically hypertrophied myocardium, as risk factors for severe cardiomyopathy after RCTBC. RCTBC in patients with any risk factor should be accompanied by an increase in initial continuous perfusion flow and/or aggressive use of intermittent antegrade coronary perfusion.
- Published
- 2006
45. Assessment of on-pump beating coronary artery bypass surgery performed after introduction of off-pump approach.
- Author
-
Fujii T, Watanabe Y, Shiono N, Kawasaki M, Yokomuro H, Ozawa T, Hamada S, Masuhara H, Teramoto T, Hara M, Katayanagi T, Sasaki Y, and Koyama N
- Subjects
- Aged, Coronary Disease complications, Coronary Disease physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency physiopathology, Retrospective Studies, Stroke Volume, Treatment Outcome, Ventricular Dysfunction, Left complications, Ventricular Dysfunction, Left physiopathology, Coronary Artery Bypass methods, Coronary Disease surgery
- Abstract
Objective: To clarify the position of on-pump beating coronary artery bypass (CAB) and to define preoperative indicators of intentional conversion to the procedure in the era of advancement of off-pump CAB (OPCAB), we assessed on-pump beating CAB performed after the introduction of OPCAB., Subjects and Methods: We assessed 130 patients who underwent single CAB [117 (90%) with OPCAB and 13 (10%) with on-pump beating CAB] between August 1999 (when OPCAB was selected as the first-line surgical procedure) and December 2004., Results: No significant differences were seen between the groups in the number of coronary lesions or the prevalence of left main trunk (LMT) lesion. Reduced left cardiac function, cardiac dilatation, and mitral regurgitation (MR) were more remarkable in the on-pump beating CAB group. Preoperative ischemic condition was generally unstable in the both groups. A conversion to on-pump beating CAB occurred at anastomosis for the left anterior descending (LAD) branch in 61% and for the left circumflex (LCX) branch in 15%. LAD patients had more severe left cardiac dysfunction and cardiac dilatation than LCX patients., Conclusion: To perform safe and reliable CAB surgery, cardiovascular surgeons should define preoperative indicators of difficult OPCAB and convert OPCAB to on-pump beating CAB intentionally without hesitation when unstable hemodynamics is detected.
- Published
- 2006
46. A case report of emergency off-pump CABG in an aged patient with ACS renewing ventricular fibrillation.
- Author
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Masuhara H, Watanabe Y, Shiono N, Kawasaki M, Yokomuro H, Fujii T, and Koyama N
- Subjects
- Acute Disease, Aged, 80 and over, Coronary Angiography, Electrocardiography, Female, Heart Diseases diagnostic imaging, Heart Diseases physiopathology, Humans, Syndrome, Ventricular Fibrillation diagnostic imaging, Ventricular Fibrillation physiopathology, Coronary Artery Bypass, Off-Pump, Emergency Medical Services, Heart Diseases surgery, Ventricular Fibrillation surgery
- Abstract
An emergency off-pump coronary artery bypass (OPCAB) was performed successfully in an aged patient with acute coronary syndrome (ACS). The patient, an 80-year-old woman residing in a nursing home, suddenly lost consciousness during lunch. The electrocardiogram (ECG) showed ventricular fibrillation (Vf) but defibrillation successfully recovered the sinus rhythm. The patient was brought to our hospital as an emergency. She underwent emergency cardiac catheterization. Coronary angiography demonstrated severe three vessel disease with left main coronary trunk (LMT) stenosis. Even during intra-aortic balloon pumping (IABP), the hemodynamic state was unstable, with repeated development of ventricular tachycardia and fibrillation. An emergency coronary artery bypass without a cardiopulmonary bypass was performed. Saving her life was of primary importance and revascularization of the left anterior descending artery (LAD) branch, was performed. Thanks to the advances made in various devices, safe and reliable anastomoses have become possible in OPCAB applied to ACS. OPCAB for ACS have become safe and reliable anastomoses following development of various devices. We think that OPCAB is an effective surgical technique for coronary revascularization for emergency or serious cases involving elderly patients.
- Published
- 2006
47. Tissue-Engineered Grafts Matured in the Right Ventricular Outflow Tract.
- Author
-
Ozawa T, Mickle DAG, Weisel RD, Matsubayashi K, Fujii T, Fedak PWM, Koyama N, Ikada Y, and Li RK
- Abstract
Autologous smooth muscle cell (SMC)-seeded biodegradable scaffolds could be a suitable material to repair some pediatric right ventricular outflow tract (RVOT) cardiac anomalies. Adult syngenic Lewis rat SMCs (2 × 106) were seeded onto a new biodegradable copolymer sponge made of ∊-caprolactone-co-L-lactide reinforced with poly-L-lactide fabric (PCLA). Two weeks after seeding, the patch was used to repair a surgically created RVOT defect in an adult rat. At 8 weeks after implantation the spongy copolymer component was biodegraded, and SM tissue and extracellular matrices containing elastin fibers were present in the scaffolds. By 22 weeks more fibroblasts and collagen were present (p < 0.05). The number of capillaries in the grafts also increased (p < 0.001) between 8 and 22 weeks. The fibrous poly-L-lactide component of the PCLA scaffold remained. The 22-week grafts maintained their thickness and surface area in the RVOT. The SMCs prior to implantation were in a synthetic phenotype and developed in vivo into a more contractile phenotype. By 8 weeks the patches were endothelialized on their endocardial surfaces. Future work to increase the SM tissue and elastin content in the patch will be necessary before implantation into a pediatric large-animal model is tested.
- Published
- 2004
- Full Text
- View/download PDF
48. Smooth muscle cells transplantation is better than heart cells transplantation for improvement of heart function in dilated cardiomyopathy.
- Author
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Yoo KJ, Li RK, Weisel RD, Mickle DA, Tomita S, Ohno N, and Fujii T
- Subjects
- Animals, Cricetinae, Male, Vas Deferens cytology, Cardiomyopathy, Dilated physiopathology, Cardiomyopathy, Dilated surgery, Cell Transplantation, Heart physiopathology, Muscle, Smooth cytology, Myocardium cytology
- Abstract
Muscle cell transplantation may delay or prevent cardiac dilation in dilated cardiomyopathy. The present study was designed to compare the effects of the heart function of smooth muscle cell (SMCs) auto-transplantation and heart cell (CMs) allo-transplantation in dilated cardiomyopathic hamsters, and to determine which cells are better for cell transplantation. CMs and SMCs were isolated from BIO 53.58 hamsters, and cultured for transplantation. CMs, SMCs (4 X 10(6) cells each) or culture medium were transplanted into 17 weeks old BIO 53.58 hamsters to achieve CM transplantation (CMTx), SMC transplantation (SMCTx), and controls (Con) (N=10 each). Cyclosporine (5 mg/Kg) was administered subcutaneously to CMTx. Healthy hamsters (sham, N=6) were used to compare heart functions. Four weeks after transplantation, heart function was evaluated in all groups using a Langendorff perfusion apparatus. Histology demonstrated severe focal myocardial necrosis in the dilated cardiomyopathic hearts. CMTx and SMCTx formed huge muscle tissue in the dilated myocardium. Sham, SMCTx, and CMTx had a better heart function than Con (p < 0.01), and SMCTx had a better peak systolic pressure (p < 0.05) and developed pressure (p < 0.05) than CMTx at any balloon volume. However, sham and SMCTx were not statistically different. SMCTx and CMTx formed muscle tissue and produced better heart function in the cardiomyopathic hearts, and SMCTx showed better systolic and developed pressures than CMTx, even though they were similar in other functions. Significantly, SMCTx had heart functions, which were similar to those of healthy hamster's hearts.
- Published
- 2002
- Full Text
- View/download PDF
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