118 results on '"S. Wakasa"'
Search Results
2. (466) Clinical Utility of Near-Infrared Spectroscopy Intravascular Ultrasound in the Assessment of Rapidly Progressive Cardiac Allograft Vasculopathy
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S. Takenaka, T. Sato, S. Kazui, Y. Yasui, K. Saiin, S. Naito, Y. Takahashi, Y. Mizuguchi, A. Tada, Y. Kobayashi, K. Omote, T. Konishi, K. Kamiya, T. Ooka, T. Nagai, S. Wakasa, and T. Anzai
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
3. PARAMEDICAL - NURSING
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V. Izquierdo Manrique, C. L. Ramos Acosta, R. Garcia Sanchez, C. Gonzalez Canino, M. Martinez Romero, L. Cornago Delgado, L. Gonzalez Aleman, A. C. Santos Ruiz, M. R. Martin Guillada, A. Rodriguez Benitez, C. R. Garcia Guzman, J. Hernandez Hernandez, A. Palumbo, C. Meunier, G. Callender, S. Matey, A. Alvarez, V. Legidos, E. Lara, I. Cabanes, A. Requena, J. Boivin, L. Bunting, C. M. Verhaak, V. Rozee, C. Gallo, A. Ruiz Jorro, J. Remohi Gimenez, A. Pellicer Martinez, E. Kamisawa, N. Hirabayashi, S. Wakasa, K. Inoue, H. Yusa, S. Sahuquillo, M. Meseguer, A. Martinez, V. Fernandez, L. Jimenez, A. Borgonoz, A. Pellicer, P. Alama, S. Sahin, N. K. Beji, M. D. Bal, S. D. Yilmaz, S. Caliskan, B. Urman, L. Perl, E. Zwahlen, K. Gourounti, F. Anagnostopoulos, K. Stefanidis, S. Lone, G. Vaslamatzis, and K. Lykeridou
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Reproductive Medicine ,Rehabilitation ,Obstetrics and Gynecology - Published
- 2012
4. Permanent Magnet System for PET Cyclotron
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I. Bolhsakova, Yoshihisa Iwashita, E. Sugiyama, V. Erashok, Roman Holyaka, S. Matsumoto, Hirohiko M. Shimizu, T. Fujisawa, M. Kumada, E. Antokhin, and S. Wakasa
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Physics ,Electropermanent magnet ,Aperture ,Cyclotron ,System testing ,Mechanical engineering ,Condensed Matter Physics ,Electronic, Optical and Magnetic Materials ,law.invention ,Magnetic field ,Nuclear physics ,Dipole magnet ,law ,Magnet ,Electric power ,Electrical and Electronic Engineering - Abstract
The recent paper is devoted to design, manufacturing and testing the permanent magnet system to be used for Positron Emission Tomography (PET) cyclotron. The using permanent magnet material instead of copper coils allows essential electric power savings during PET cyclotron operation, though it comes to some increasing construction cost. The main problem why until now permanent magnets were not used for PET cyclotron magnet system is huge magnetic force, making cyclotron assembling/disassembling and isochronous magnetic field adjustment very difficult. For presented magnet system that problem is solved by applying rotating system providing the magnetic field switch-off (reduction to practically zero level inside working aperture). It makes assembling and adjustment easy at force free conditions. The main parameters of permanent magnet system are as follows: the average field is 1.4 T, pole radius is 375 mm and weight is 900 kg. As it shown in paper the magnetic properties of constructed permanent magnet system does satisfy to specification for magnet system of typical 10 MeV cyclotron for PET radioisotope production.
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- 2008
5. DESIGN OF AN ULTRA COMPACT CYCLOTRON FOR PARTICLE INDUCED X-RAY EMISSION
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T. Takagi, N. Nakanishi, S. Wakasa, and K. Fukuda
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Physics ,Proton ,Scattering ,Astrophysics::High Energy Astrophysical Phenomena ,Cyclotron ,Cyclotron resonance ,Particle-induced X-ray emission ,Fourier transform ion cyclotron resonance ,law.invention ,Nuclear physics ,Physics::Plasma Physics ,law ,Magnet ,Physics::Accelerator Physics ,Ion cyclotron resonance - Abstract
An ultra compact cyclotron was constructed for Particle Induced X-ray Emission (PIXE) and Rutherford Back Scattering (RBS) experiments. The cyclotron accelerates proton and alpha-particle beams to a constant energy of 3 MeV. The size of the magnet is 85 cm ×85 cm ×60 cm . Characteristics of the cyclotron are presented.
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- 1993
6. Exposure ages deduced from cosmogenic 10Be and 26Al produced in situ: application to granite domes and tors in Korea
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S WAKASA
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Nuclear and High Energy Physics ,Instrumentation - Published
- 2004
7. Bioprecipitation of copper from a leaching solution by a moderately thermophilic iron-oxidizing bacterium
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Tsuyoshi Sugio, M. Takai, Kazuo Kamimura, Keiko Matsumoto, T. Sogawa, and S. Wakasa
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inorganic chemicals ,Copper extraction techniques ,Bioprecipitation ,Chemistry ,Thermophile ,Inorganic chemistry ,Oxidizing agent ,chemistry.chemical_element ,Leaching (metallurgy) ,equipment and supplies ,Copper ,Sulfur ,Ferrous - Abstract
A moderately thermophilic iron-oxidizing bacterium strain TI-1 produced 74 μmol H2S extracellularly when grown at 45°C for 15 days in 20 mL of ferrous sulfate-5AAG medium (pH 4.0) containing 1.0 % elemental sulfur and 0.31 % L-glutamic acid. Precipitation of copper from a leaching solution by the H2S produced by strain TI-1 was investigated. A leaching solution containg Cu2+ was prepared by the cultivation of Thiobacillus ferrooxidans AP19-3 on a copper concentrate (5.0 %)-medium (pH 2.5) for 15 days. When strain TI-1 was grown for 8 days in a ferrous sulfate-5AAG medium (pH 4.0) containing 1.0 % elemental sulfur, 0.31 % L-glutamic acid and 5 mM Cu2+ from a leaching solution, the Cu2+ in the medium was completely precipitated by the H2S produced by strain TI-1. Growth of strain TI-1 in ferrous sulfate-5AAG medium was not inhibited by 10 mM Cu2+. A moderately thermophilic sulfate-reducing bacterium Desulfotomaculum nigrificans IFO 136987 produced 45 μmol H2S extracellularly when grown at 45°C for 15 days in 20 ml of lactate (0.35 %)-medium. The maximum productivity of H2S by D. nigrificans was observed in the medium with an initial pH of 7.2. The bacterium did not produce H2S in the lactatemedium with a pH less than 6.0. Growth of D. nigrificans in the lactate-medium was completely inhibited by 0.56 mM Cu2+. These results suggest that strain TI-1 is superior to D. nigrificans in the ability to precipitate copper from the acidic leaching solution containing Cu2+.
- Published
- 1999
8. Orthotopic heart transplantation in patient with situs inversus and pectus excavatum: a case report.
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Wakasa S, Ooka T, Sato T, Shingu Y, Kato N, Nagai T, Anzai T, Ono M, and Matsui Y
- Abstract
Background: Heart transplantation in patients with situs inversus is challenging, especially in terms of reconstruction of the systemic venous return. Several rerouting techniques have been presented but are associated with vulnerability to external compression, which might cause hemodynamic instability, especially in the presence of chest deformity. In this study, we report a rare case of successful heart transplantation in the presence of situs inversus and pectus excavatum., Case Presentation: A 55-year-old man, with a history of surgeries for corrected transposition of the great arteries with ventricular septal defect, was registered for heart transplantation owing to progression of heart failure. Subsequently, he had undergone a left ventricular assist device implantation; 14 years after registration, he underwent transplantation of the heart with normal anatomy. The inferior vena cava was reconstructed by anastomosing the left atria with a counterclockwise rotation of the donor heart and by lengthening the recipient inferior vena cava with a conduit made of the residual right atrial tissue. The superior vena cava was reconstructed using a donor innominate vein harvested with sufficient length. After successful weaning from cardiopulmonary bypass, the chest could not be closed because the heart was compressed owing to chest deformity, resulting in hemodynamic instability. Therefore, to exclude the left lung, a left pericardial screen was created using a bovine pericardium, allowing the chest to be closed with acceptable hemodynamics. The patient suffered postoperatively from a higher venous pressure, suggesting an obstruction of venous return early after surgery. The obstruction gradually resolved, and the patient was transferred for rehabilitation., Conclusions: Heart transplantation in the presence of situs inversus is challenging; moreover, the presence of pectus excavatum further complicates the procedure. The paradoxically larger left lung and chest deformity compressed and impaired reconstructed systemic venous return. Although intrathoracic exclusion of the left lung was effective, an intraoperative or early postoperative thoracoplasty for pectus excavatum was also a viable option. Patient-specific management is mandatory, depending on the anatomy., (© 2024. The Author(s).)
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- 2024
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9. Incidence of atrial fibrillation after esophageal cancer surgery with L-carnitine use: a preliminary single-group interventional study.
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Shingu Y, Yokota I, Shichinohe T, Murakami S, Ebihara Y, Kurashima Y, Hirano S, and Wakasa S
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- Humans, Incidence, Male, Female, Aged, Middle Aged, Esophagectomy adverse effects, Perioperative Care methods, Carnitine administration & dosage, Esophageal Neoplasms surgery, Atrial Fibrillation etiology, Atrial Fibrillation epidemiology, Atrial Fibrillation prevention & control, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Fatty Acid-Binding Proteins blood
- Abstract
Purpose: We aimed to investigate the POAF rate and blood FABP4 levels after perioperative L-carnitine administration in patients with esophageal cancer., Methods: L-carnitine (3 g in three divided doses) was administered to 15 patients 2 days before and 3 days after surgery. POAF during the study period and blood FABP4 levels (ELISA) before and after L-carnitine administration were evaluated. Accurate 95% confidence intervals (CI) for POAF incidence and changes in blood FABP4 levels were calculated. The preoperative predicted POAF rate was calculated using an application for esophageal cancer. The correlation between FABP4 levels and the predicted POAF rate was analyzed using Pearson's coefficient (r)., Results: Thirteen patients completed this study. The predicted POAF rate was 24% (17%, 34%) (median; interquartile range). The actual incidence of POAF was 7.7% (95% CI: 0.2-36%). Blood FABP4 levels changed from 10.3 to 7.0 ng/mL; the average change was - 3.3 (95% CI: - 6.6 to - 0.1). A positive correlation was found between preoperative FABP4 levels and the predicted POAF rates (r = 0.564)., Conclusions: The POAF rate after esophageal surgery was 7.7% for L-carnitine. L-carnitine may reduce blood FABP4 levels. This preliminary study will contribute to the planning of sample sizes in future randomized trials., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)
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- 2024
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10. Chronic Active Myocarditis After Transapical Transcatheter Aortic Valve Implantation.
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Kobayashi Y, Nagai T, Kamiya K, Tsuneta S, Shingu Y, Wakabayashi K, Kudo K, Matsuno Y, Wakasa S, and Anzai T
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- Humans, Chronic Disease, Aged, 80 and over, Male, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Female, Myocarditis etiology, Myocarditis diagnostic imaging, Transcatheter Aortic Valve Replacement adverse effects
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- 2024
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11. Effects of Trehalose Preconditioning on H9C2 Cell Viability and Autophagy Activation in a Model of Donation after Circulatory Death for Heart Transplantation.
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Gao J, Shingu Y, and Wakasa S
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Donation after circulatory death (DCD) is a promising strategy for alleviating donor shortage in heart transplantation. Trehalose, an autophagy inducer, has been shown to be cardioprotective in an ischemia-reperfusion (IR) model; however, its role in IR injury in DCD remains unknown. In the present study, we evaluated the effects of trehalose on cardiomyocyte viability and autophagy activation in a DCD model. In the DCD model, cardiomyocytes (H9C2) were exposed to 1 h warm ischemia, 1 h cold ischemia, and 1 h reperfusion. Trehalose was administered before cold ischemia (preconditioning), during cold ischemia, or during reperfusion. Cell viability was measured using the Cell Counting Kit-8 after treatment with trehalose. Autophagy activation was evaluated by measuring autophagy flux using an autophagy inhibitor, chloroquine, and microtubule-associated protein 1A/1B light chain 3 B (LC3)-II by western blotting. Trehalose administered before the ischemic period (trehalose preconditioning) increased cell viability. The protective effects of trehalose preconditioning on cell viability were negated by chloroquine treatment. Furthermore, trehalose preconditioning increased autophagy flux. Trehalose preconditioning increased cardiomyocyte viability through the activation of autophagy in a DCD model, which could be a promising strategy for the prevention of cardiomyocyte damage in DCD transplantation.
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- 2024
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12. Rough-zone suspension with mitral valve replacement for ventricular functional mitral regurgitation.
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Wakasa S and Shingu Y
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- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Ventricular Function, Left physiology, Heart Ventricles diagnostic imaging, Heart Ventricles surgery, Papillary Muscles diagnostic imaging, Papillary Muscles surgery, Ventricular Remodeling, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery
- Abstract
Chordal preservation is recommended in mitral valve replacement for functional mitral regurgitation to preserve left ventricular function. In contrast, papillary muscle suspension toward the anterior mitral annulus can induce left ventricular reverse remodeling after mitral valve replacement for functional mitral regurgitation. However, the extent of suspension depends on the surgeon's experience. Therefore, we developed a new concept of chordal preservation, called rough-zone suspension, which not only spares the subvalvular structure but also suspends the papillary muscles toward the annulus. This procedure is simple and reproducible for determining the extent of suspension, and can increase the probability of left ventricular reverse remodeling after mitral valve replacement for functional mitral regurgitation., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2024
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13. Interpapillary muscle distance independently predicts recurrent mitral regurgitation.
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Gambardella I, Spadaccio C, Singh SSA, Shingu Y, Kunihara T, Wakasa S, and Nappi F
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- Humans, Mitral Valve surgery, Echocardiography, Papillary Muscles diagnostic imaging, Papillary Muscles surgery, Heart Ventricles diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency complications, Mitral Valve Annuloplasty methods
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Objective: Ischaemic secondary mitral regurgitation (ISMR) after surgery is due to the displacement of papillary muscles resulting from progressive enlargement of the left ventricle end-diastolic diameter (LVEDD). Our aim was to prove that if the interpapillary muscle distance (IPMD) is surgically stabilized, an increase in LVEDD will not lead to a recurrence of ischaemic mitral regurgitation (MR)., Methods: Ninety-six patients with ISMR, who underwent surgical revascularisation and annuloplasty, were randomly assigned in a 1:1 ratio to undergo papillary muscle approximation (PMA). At the 5-year follow-up, we assessed the correlation between PMA and echocardiographic improvements, the effect size of PMA on echocardiographic improvements, and a prediction model for recurrent MR using inferential tree analysis., Results: There was a significant correlation between PMA and enhancements in both the α and β angles (Spearman's rho > 0.7, p < 0.01). The α angle represents the angle between the annular plane and either the A2 annular-coaptation line or the P2 annular-coaptation line. The β angle indicates the angle between the annular plane and either the A2 annular-leaflet tip line or the P2 annular-leaflet tip line. PMA led to substantial improvements in LVEDD, tenting area, α and β angles, with a large effect size (Hedge's g ≥ 8, 95% CI ORs ≠ 1). The most reliable predictor of recurrent MR grade was the interpapillary distance, as only patients with an interpapillary distance greater than 40 mm developed ≥ 3 + grade MR. For patients with an IPMD of 40 mm or less, the best predictor of recurrent MR grade was LVEDD. Among the patients, only those with LVEDD greater than 62 mm showed moderate (2+) MR, while only those with LVEDD less than or equal to 62 mm had absent to mild (1+) MR., Conclusion: Prediction of recurrent ischaemic MR is not independent of progressive LVEDD increase. PMA-based surgical procedure stabilises IPMD., (© 2024. The Author(s).)
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- 2024
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14. Leadless Pacemaker Implantation in Severe Kyphosis: Challenging Implantation for Tortuous IVC and Narrow RA.
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Sakamoto S, Tani T, Baba K, Wakasa S, Irishio M, Kataoka T, and Fukuda D
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Leadless pacemaker implantation is recognized as safe and effective for treating bradycardia. However, there are limited descriptions of its use in patients with complex anatomical considerations. Here, we present a case detailing the successful implantation of a leadless pacemaker with a tortuous inferior vena cava and a narrow right atrium., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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15. Influence of epicardial adipose tissue inflammation and adipocyte size on postoperative atrial fibrillation in patients after cardiovascular surgery.
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Natsui H, Watanabe M, Yokota T, Tsuneta S, Fumoto Y, Handa H, Shouji M, Koya J, Nishino K, Tatsuta D, Koizumi T, Kadosaka T, Nakao M, Koya T, Temma T, Ito YM, Kanako C H, Hatanaka Y, Yasushige S, Wakasa S, Miura S, Masuda T, Nishioka N, Naraoka S, Ochi K, Kudo T, Ishikawa T, and Anzai T
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- Humans, Epicardial Adipose Tissue, Adipocytes metabolism, Adipose Tissue metabolism, Inflammation metabolism, Pericardium metabolism, Atrial Fibrillation metabolism
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Epicardial adipose tissue (EAT) is an active endocrine organ that is closely associated with occurrence of atrial fibrillation (AF). However, the role of EAT in the development of postoperative AF (POAF) remains unclear. We aimed to investigate the association between EAT profile and POAF occurrence in patients who underwent cardiovascular surgery. We obtained EAT samples from 53 patients to evaluate gene expression, histological changes, mitochondrial oxidative phosphorylation (OXPHOS) capacity in the EAT, and protein secretion in EAT-conditioned medium. EAT volume was measured using computed tomography scan. Eighteen patients (34%) experienced POAF within 7 days after surgery. Although no significant difference was observed in EAT profile between patients with and without POAF, logistic regression analysis identified that the mRNA expression levels of tumor necrosis factor-alpha (TNF-α) were positively correlated and adipocyte size in the EAT was inversely correlated with onset of POAF, respectively. Mitochondrial OXPHOS capacity in the EAT was not associated with POAF occurrence; however, it showed an inverse correlation with adipocyte size and a positive correlation with adiponectin secretion. In conclusion, changes in the secretory profile and adipocyte morphology of the EAT, which represent qualitative aspects of the adipose tissue, were present before the onset of AF., (© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)
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- 2024
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16. Reconstruction of right ventricular outflow tract with severe calcification: lantern procedure.
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Ishigaki T, Wakasa S, Sato K, Kato N, and Kamikubo Y
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- Humans, Heart Ventricles, Treatment Outcome, Pulmonary Valve surgery, Calcinosis diagnostic imaging, Calcinosis surgery, Ventricular Outflow Obstruction diagnostic imaging, Ventricular Outflow Obstruction surgery
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Right ventricular outflow tract reconstruction is repeatedly required after the Rastelli procedure. However, standard right ventricular outflow tract reconstruction using direct anastomosis on the posterior right ventricular outflow tract wall is unfeasible in cases with severe calcification. Herein, we present a novel technique called the "lantern procedure," which can fix the prosthetic pulmonary valve without anastomosis to the calcified right ventricular outflow tract wall., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2024
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17. Posterior Papillary Muscle Suspension for Treating Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy.
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Ito T, Wakasa S, Sato K, Abe S, and Minamida T
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- Humans, Papillary Muscles diagnostic imaging, Papillary Muscles surgery, Echocardiography, Treatment Outcome, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery, Cardiomyopathy, Hypertrophic diagnostic imaging, Cardiomyopathy, Hypertrophic surgery
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Systolic anterior motion of the anterior mitral leaflet can persist after ventricular septal myectomy for obstructive hypertrophic cardiomyopathy, resulting in residual pressure gradients and mitral regurgitation. However, additional procedures for systolic anterior motion involving mitral valve leaflet suturing and resection may lead to future valve disease. Therefore, we adopted posterior papillary muscle suspension, a subvalvular procedure for functional mitral regurgitation, to treat systolic anterior motion without directly intervening in the mitral valve leaflets. Papillary muscle suspension toward the posterior mitral annulus moved the papillary muscles away from the interventricular septum and successfully eliminated the systolic anterior motion and midventricular pressure gradient. In terms of avoiding direct mitral interventions, this procedure is a viable option for systolic anterior motion, especially in cases of very mild mitral regurgitation.
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- 2024
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18. Multimodal Imaging of Constrictive Pericarditis Induced by Long-term Pergolide Treatment for Parkinson's Disease.
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Aoyagi H, Tsujinaga S, Takahashi Y, Naito S, Sato T, Otsuka T, Tamaki Y, Motoi K, Ishizaka S, Chiba Y, Kamiya K, Iwano H, Nagai T, Wakasa S, and Anzai T
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- Humans, Aged, Pergolide adverse effects, Pericardium diagnostic imaging, Pericardium pathology, Pericardiectomy, Multimodal Imaging, Pericarditis, Constrictive diagnostic imaging, Pericarditis, Constrictive drug therapy, Pericarditis, Constrictive etiology, Parkinson Disease complications, Parkinson Disease diagnostic imaging, Parkinson Disease drug therapy
- Abstract
We herein report the first case of constrictive pericarditis (CP) induced by long-term pergolide treatment for Parkinson's disease that was assessed using multimodal imaging in a 72-year-old patient with leg edema and dyspnea. The patient was correctly diagnosed with CP using multimodal imaging and successfully treated with pericardiectomy. The treatment history of Parkinson's disease and pathological findings of the removed pericardium suggested that long-term pergolide was the cause of CP. Properly recognizing pergolide as the cause of CP and accurately diagnosing CP using multimodal imaging may contribute to the early detection and treatment of pergolide-induced CP.
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- 2023
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19. Unique Extraction of a Fractured Pacemaker Lead Adhered to the Spermatic Vein.
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Sakamoto S, Baba K, Wakasa S, Yanagishita S, Irishio M, Yanagishita T, Yoshisako Y, Nakatani Y, Kataoka T, and Fukuda D
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Transvenous lead extraction has been increasingly recognized as a safe and effective method of lead extraction, but there are only few references for extracting leads migrating outside the heart. We present a successful extraction of a fractured pacemaker lead from the spermatic vein using several approaches and multiple tools., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2023
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20. Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians.
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Ishigaki T, Wakasa S, Shingu Y, Ohkawa Y, and Yamada A
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Objective: To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection., Methods: We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups., Results: The median age was 84 years (interquartile range 82-87 years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97 cm
2 /m2 . Except for sex, no significant differences were observed in patients' baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85 years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015)., Conclusions: All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85 years or older., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)- Published
- 2023
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21. Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement.
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Takahashi Y, Kamiya K, Nagai T, Tsuneta S, Oyama-Manabe N, Hamaya T, Kazui S, Yasui Y, Saiin K, Naito S, Mizuguchi Y, Takenaka S, Tada A, Ishizaka S, Kobayashi Y, Omote K, Sato T, Shingu Y, Kudo K, Wakasa S, and Anzai T
- Subjects
- Humans, Predictive Value of Tests, Hemodynamics, Aortic Valve diagnostic imaging, Aortic Valve surgery, Treatment Outcome, Prosthesis Design, Transcatheter Aortic Valve Replacement adverse effects, Heart Valve Prosthesis, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery
- Abstract
Background: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR)., Methods: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR., Results: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups., Conclusions: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients., (© 2023. Society for Cardiovascular Magnetic Resonance.)
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- 2023
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22. Blood flow characteristics of the bilateral internal thoracic artery: implications of optimal graft configuration for coronary artery bypass grafting to maximize blood supply.
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Kunihara T, Shingu Y, Wakasa S, Sugiki H, Kamikubo Y, Shiiya N, and Matsui Y
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- Male, Humans, Aged, Papaverine pharmacology, Vascular Patency physiology, Coronary Artery Bypass, Coronary Vessels, Mammary Arteries transplantation
- Abstract
Purpose: There is controversy regarding which internal thoracic artery (ITA) should be anastomosed to the left anterior descending artery (LAD). Here, we propose an optimal graft design based on measurement of blood flow in the ITA., Methods: Sixty-one patients (53 men, median age 68 [62-75] years) undergoing first elective coronary artery bypass grafting were enrolled. Fifty-seven left ITAs (LITAs) and 28 right ITAs (RITAs) were harvested in either a semi-skeletonized manner using a harmonic scalpel covered with papaverine-soaked gauze (group-A, n = 45) or a fully skeletonized manner using electrocautery with intraluminal papaverine injection (group-B, n = 41). Free flow of 33 ITAs was measured after pharmacological dilatation and in situ ITA-LAD flow was measured in 59 patients by transit-time flowmetry., Results: RITA and LITA free flow were 147.0 [87.8-213.0] mL/min and 108.0 [90.0-144.0] mL/min, respectively (P = 0.199). The group-B had significantly higher ITA free flow (135.0 [102.0-171.0] mL/min) than group-A (63.0 [36.0-96.0] mL/min, P = 0.009). In 13 patients with bilateral ITA harvesting, free flow of the RITA (138.0 [79.5-204.0] mL/min) was also significantly higher than the LITA (102.0 [81.0-138.0] mL/min, P = 0.046). There was no significant difference between RITA and LITA flow anastomosed to the LAD. The group-B had significantly higher ITA-LAD flow (56.5 [32.3-73.6] mL/min) than group-A (40.9 [20.1-53.7] mL/min, P = 0.023)., Conclusion: RITA provides significantly higher free flow than LITA but similar blood flow to the LAD. Full skeletonization with intraluminal papaverine injection maximizes both free flow and ITA-LAD flow., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2023
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23. Thrombus or tumor?
- Author
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Wakasa S, Hayashi H, Yamazaki T, Izumiya Y, and Fukuda D
- Abstract
Key Clinical Message: Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is difficult to differentiate between these using contrast-enhanced CT alone, but with angioscopy it is easy to visually distinguish between a benign and tumor thrombi., Abstract: Contrast-enhanced computer tomography (CT) performed on a male patient being treated for de-differentiated chondrosarcoma revealed contrast defects in the pulmonary artery and right femoral vein, and a diagnosis of pulmonary artery thromboembolism and venous thromboembolism was made, and oral anticoagulant therapy was started. However, a follow-up CT showed that the contrast defect had extended to the inferior vena cava. Observation using an angioscope revealed that it was not a benign thrombi but a tumor., Competing Interests: The authors declare that they have no conflict of interests., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2023
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24. 'Conventional' haemodynamics even in the quadricuspid aortic valve: clinical recognition using multimodality imaging.
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Wakasa S, Ito A, Kitada R, Takahashi Y, and Fukuda D
- Subjects
- Humans, Aortic Valve diagnostic imaging, Diagnostic Imaging, Hemodynamics, Quadricuspid Aortic Valve, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery
- Abstract
Competing Interests: Conflict of interest: None declared.
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- 2023
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25. Impact of Steroid on Macrophage Migration Inhibitory Factor During and After Cardiopulmonary Bypass.
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Kunihara T, Shingu Y, Wakasa S, Shiiya N, and Gando S
- Subjects
- Male, Adult, Humans, Middle Aged, Aged, Interleukin-10, Tumor Necrosis Factor-alpha, Interleukin-8, Cytokines, Methylprednisolone pharmacology, Cardiopulmonary Bypass adverse effects, Macrophage Migration-Inhibitory Factors
- Abstract
Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine released in response to glucocorticoids, which counter-regulates the effects of glucocorticoids. This study was performed to determine the impact of steroids on the expression of MIF and other pro- and anti-inflammatory cytokines during and after cardiopulmonary bypass (CPB). Twenty adult patients (10 men, 64 ± 8 years old) who underwent elective cardiac surgery by CPB were given either 2000 mg (group-H, n = 10) or 500 mg of methylprednisolone (group-L, n = 10) during CPB. The serum concentrations of MIF, interleukin (IL)-1β, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) were measured at eight time points until 36 hours after skin closure. The early postoperative course was uneventful for all patients. There were no significant differences in duration of operation, CPB, or aortic cross-clamping (AXC) between the two groups. MIF and IL-10 levels peaked just after the conclusion of CPB and decreased gradually thereafter. IL-1β, IL-8, and TNF-α were undetectable throughout the study period. There were no significant differences in MIF or IL-10 levels between the two groups. Peak levels of MIF in all patients were significantly correlated with the duration of CPB and AXC, whereas no such correlation was observed for IL-10. MIF or IL-10 levels were significantly elevated during and after CPB, but there were no differences between the two doses of steroid administration. Both steroid doses sufficiently suppressed proinflammatory cytokines. MIF better reflected the invasiveness of the operation than IL-10., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2022.)
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- 2023
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26. Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device.
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Takenaka S, Sato T, Nagai T, Omote K, Kobayashi Y, Kamiya K, Konishi T, Tada A, Mizuguchi Y, Takahashi Y, Naito S, Saiin K, Ishizaka S, Wakasa S, and Anzai T
- Subjects
- Humans, Quality of Life, Exercise Tolerance, Heart Ventricles, Ventricular Function, Right, Heart-Assist Devices, Stroke, Heart Failure
- Abstract
Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o
2 ) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d t than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( r = 0.59, P = 0.003) and peak V̇o2 ( r = 0.56, P = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( r = 0.44, P = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( r = -0.34, P = 0.88), peak V̇o2 ( r = 0.074, P = 0.74), or EQ-VAS ( r = 0.127, P = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. NEW & NOTEWORTHY The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.- Published
- 2023
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27. A preliminary prediction model using a deep learning software program for prolonged hospitalization after cardiovascular surgery.
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Murase R, Shingu Y, and Wakasa S
- Subjects
- Humans, Risk Factors, Software, Length of Stay, Aging, Deep Learning
- Abstract
A prolonged length of hospital stay (LOS) has become an important issue among patients undergoing cardiovascular surgery in our aging society. However, there are no established prediction models for a prolonged LOS. We therefore created a prediction model of a prolonged LOS using a deep learning software program (Prediction One; Sony Network Communications Inc., Tokyo, Japan) using preoperative data. Subjects were 157 patients (121 for training data, 36 for validation data). A prolonged LOS was defined as a more than 30-day postoperative stay due to physical inactivity. The area under the receiver operating characteristic curve and the accuracy of the model in the validation data were 0.806 and 67%, respectively. In conclusion, the preliminary model demonstrated acceptable performance for the prediction of a prolonged LOS after cardiovascular surgery., (© 2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)
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- 2023
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28. Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease.
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Takeda Y, Yamamoto M, Hoshino K, Ito YM, Kato N, Wakasa S, and Morimoto Y
- Subjects
- Infant, Humans, Hemodynamics, Prospective Studies, Vascular Surgical Procedures, Pulmonary Artery surgery, Heart Defects, Congenital surgery
- Abstract
Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-to-systemic blood flow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures. In the post hoc analysis of a previous prospective observational study, cerebral blood flow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery. Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no significant differences of the flow velocities between the start and end of surgery in either procedure. The pulsatility index significantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood flow. The cerebral oxygenation decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures. Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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29. Tacrolimus inhibits stress responses and hyphal formation via the calcineurin signaling pathway in Trichosporon asahii.
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Kurakado S, Matsumoto Y, Yamada T, Shimizu K, Wakasa S, and Sugita T
- Subjects
- Humans, Congo Red, Signal Transduction, Hyphae drug effects, Stress, Physiological drug effects, Calcineurin Inhibitors pharmacology, Calcineurin Inhibitors therapeutic use, Calcineurin metabolism, Tacrolimus pharmacology, Tacrolimus metabolism, Trichosporonosis drug therapy, Trichosporonosis virology
- Abstract
The pathogenic fungus Trichosporon asahii causes fatal deep-seated mycosis in immunocompromised patients. Calcineurin, which is widely conserved in eukaryotes, regulates cell growth and various stress responses in fungi. Tacrolimus (FK506), a calcineurin inhibitor, induces sensitivity to compounds that cause stress on the cell membrane and cell wall integrity. In this study, we demonstrated that FK506 affects stress responses and hyphal formation in T. asahii. In silico structural analysis revealed that amino acid residues in the binding site of the calcineurin-FKBP12 complex that interact with FK506 are conserved in T. asahii. The growth of T. asahii was delayed by FK506 in the presence of SDS or Congo red but not in the presence of calcium chloride. FK506 also inhibited hyphal formation in T. asahii. A mutant deficient of the cnb gene, which encodes the regulatory subunit B of calcineurin, exhibited stress sensitivities on exposure to SDS and Congo red and reduced the hyphal forming ability of T. asahii. In the cnb-deficient mutant, FK506 did not increase the stress sensitivity or reduce hyphal forming ability. These results suggest that FK506 affects stress responses and hyphal formation in T. asahii via the calcineurin signaling pathway., (© 2022 The Societies and John Wiley & Sons Australia, Ltd.)
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- 2023
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30. Thymoma-Related Stiff-Person Syndrome with Successfully Treated by Surgery.
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Sasaki A, Kato T, Ujiie H, Wakasa S, Otake S, Kikuchi K, and Ohno K
- Subjects
- Humans, Female, Adult, Treatment Outcome, Neoplasm Recurrence, Local complications, Thymoma complications, Thymoma diagnostic imaging, Thymoma surgery, Stiff-Person Syndrome diagnosis, Stiff-Person Syndrome diagnostic imaging, Thymus Neoplasms complications, Thymus Neoplasms diagnostic imaging, Thymus Neoplasms surgery
- Abstract
Introduction: Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder. Paraneoplastic SPS associated with malignant tumors such as thymoma occurs in approximately 5% of all SPS cases. We present a rare case of thymoma accompanied by SPS successfully treated using surgery., Presentation of Case: A 26-year-old woman presented with lower limbs convulsions and gait disturbance and complained of leg pain. Cerebrospinal fluid and blood test results showed a high level of anti-glutamic acid decarboxylase (GAD) antibodies. Computed tomography showed anterior mediastinal tumor suggestive of a thymoma. She underwent extended thymectomy, and her symptoms gradually improved after surgery. No evidence of recurrent thymoma and SPS has been observed over 44 months., Conclusion: Surgical treatment would be effective for patients with SPS and thymoma.
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- 2022
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31. Effect of Diabetes Mellitus on Outcomes in Patients With Left Ventricular Assist Device - Analysis of Data From a Japanese National Database.
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Yoshioka D, Toda K, Ono M, Fukushima N, Shiose A, Saiki Y, Usui A, Wakasa S, Niinami H, Matsumiya G, Arai H, Sawa Y, and Miyagawa S
- Subjects
- Humans, Japan epidemiology, Treatment Outcome, Retrospective Studies, Heart-Assist Devices adverse effects, Heart Failure, Diabetes Mellitus
- Abstract
Background: The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database., Methods and results: The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients' backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97-0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14-2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods., Conclusions: The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.
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- 2022
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32. Cardioprotective effects of chloroquine pretreatment on ischemic and reperfusion injury via activation of ERK1/2 in isolated rat hearts.
- Author
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Murase R, Shingu Y, and Wakasa S
- Subjects
- Animals, Chloroquine pharmacology, Extracellular Signal-Regulated MAP Kinases metabolism, MAP Kinase Signaling System physiology, Phosphorylation, Proto-Oncogene Proteins c-akt metabolism, Rats, Myocardial Reperfusion Injury metabolism, Reperfusion Injury
- Abstract
Purpose: Several therapeutic agents have been found to prevent myocardial ischemic and reperfusion (I/R) injury after cardiac surgery; however, no drug is routinely used to afford cardioprotective benefits in clinical settings. Herein, we aimed to determine whether chloroquine (CQ) pretreatment attenuates I/R injury after global ischemia in isolated rat hearts and elucidate mechanisms underlying the effects of CQ., Methods: Isolated rat hearts were subjected to 30-min global ischemia, followed by 60-min reperfusion with Krebs-Henseleit buffer (KHB). Immediately before ischemia, 10 mL of pretreatment solutions (KHB, n = 4 or KHB + CQ [100 μM], n = 4) were injected through the aortic root. Cardiac function was examined based on the rate pressure product (RPP). Myocardial apoptosis was evaluated using TUNEL staining. To assess the reperfusion ischemia salvage kinase pathway, protein expression levels of AKT and extracellular signal-regulated kinase (ERK1/2) were determined using western blotting. To investigate the role of ERK1/2, an ERK1/2 selective inhibitor was used in eight additional rats., Results: The recovery rate of the RPP was higher in the KHB + CQ group than in the KHB group 60 min after I/R (KHB, 44 ± 3% vs. KHB + CQ, 69 ± 7%; P = 0.019, d = 2.2). CQ pretreatment reduced apoptosis and enhanced the phosphorylation of ERK1/2; however, AKT phosphorylation was unaltered. In addition, the ERK1/2 inhibitor abolished CQ-mediated cardioprotective effects., Conclusions: CQ pretreatment showed protective effects on cardiac function after I/R by activating ERK1/2., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2022
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33. Protective effects of trehalose preconditioning on cardiac and coronary endothelial function through eNOS signaling pathway in a rat model of ischemia-reperfusion injury.
- Author
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Suno K, Shingu Y, and Wakasa S
- Subjects
- Animals, Eosine Yellowish-(YS), Hematoxylin, Ischemia, Nitric Oxide metabolism, Rats, Signal Transduction, Trehalose pharmacology, Nitric Oxide Synthase Type III metabolism, Reperfusion Injury
- Abstract
Coronary endothelial dysfunction is a major cause of ischemia-reperfusion (I/R) injury. Trehalose, a natural disaccharide, has been reported to ameliorate endothelial dysfunction during aging by activating endothelial nitric oxide synthase (eNOS); however, its role in I/R injury is unknown. This study evaluated the effects of trehalose preconditioning on cardiac and coronary endothelial function after I/R. Langendorff-perfused rat hearts underwent 30 min of global ischemia followed by 80 min of reperfusion with or without trehalose preconditioning. Rate pressure product (RPP) and coronary flow (CF) were measured during reperfusion. Perivascular edema was assessed by hematoxylin and eosin staining. Myocardial oxidative stress and apoptosis were evaluated by immunohistochemistry and TUNEL staining, respectively. eNOS dimerization was determined by western blotting. An eNOS inhibitor was used to examine the role of eNOS. Trehalose preconditioning showed a higher recovery rate after I/R as indicated by high RPP (control vs. trehalose, 28 ± 6% vs. 46 ± 9%; P = 0.017, Cohen's d = 2.3) and CF values (35 ± 10% vs. 55 ± 9%; P = 0.025, d = 1.7). Furthermore, trehalose preconditioning reduced perivascular edema, myocardial oxidative stress, and apoptosis. The eNOS dimerization ratio was increased by trehalose (1.2 ± 0.2 vs. 1.6 ± 0.2; P = 0.023, d = 2.1), which was associated with the recovery of RPP and CF. These effects of trehalose were abolished by the eNOS inhibitor. Trehalose preconditioning showed protective effects on cardiac and coronary endothelial function after I/R through the eNOS signaling pathway., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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34. Iatrogenic Arteriovenous Fistula of Subclavian Artery to Vertebral Vein with Perimedullary Vein Reflux.
- Author
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Sato K, Shingu Y, Fusegawa M, Ishigaki T, and Wakasa S
- Abstract
Iatrogenic arteriovenous fistula (AVF) rarely develops around the proximal subclavian artery, although open surgical repair of this etiology is known to be complicated as deep dissection is required around the fistula surrounded by dilated veins. In this study, we present the case of a 64-year-old man, who was referred to our hospital, with AVF between the right subclavian artery and the right vertebral vein. He had a history of accidental puncture of the right subclavian artery. An endovascular repair using a covered stent was successfully performed, and the AVF disappeared. Thus, covered stent placement should be considered as the first-line treatment for a deeply developed AVF, if anatomically feasible., Competing Interests: Disclosure StatementAll authors declare no conflict of interest., (© 2022 The Editorial Committee of Annals of Vascular Diseases.)
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- 2022
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35. Simple Chordal Replacement With a Newly Designed "Mitral Plate" in Mitral Valvuloplasty.
- Author
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Matsui Y, Kubota S, Seki T, Shingu Y, and Wakasa S
- Subjects
- Chordae Tendineae surgery, Humans, Polytetrafluoroethylene, Replantation, Cardiac Surgical Procedures methods, Mitral Valve Insufficiency surgery, Mitral Valve Prolapse surgery
- Abstract
Mitral valvuloplasty using GORE-TEX as the artificial chordae is often associated with difficulties in determining the length of the artificial chordae, achieving the correct artificial chordae length, and preventing knot slippage, especially for beginners. We describe a simple technique involving a novel device called the "Mitral Plate," which enables surgeons to automatically determine the correct length of the artificial chordae and tie slippery knots without performing excessive saline tests., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2022
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36. A novel system for analyzing indocyanine green (ICG) fluorescence spectra enables deeper lung tumor localization during thoracoscopic surgery.
- Author
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Chiba R, Ebihara Y, Shiiya H, Ujiie H, Fujiwara-Kuroda A, Kaga K, Li L, Wakasa S, Hirano S, and Kato T
- Abstract
Background: Palpation of tumors during thoracoscopic surgery remains difficult, and identification of deep-seated tumors may be impossible. This preclinical study investigated the usefulness of a novel indocyanine green (ICG) fluorescence spectroscopy system for tumor localization., Methods: ICG was diluted to 5.0×10
-2 mg/mL in fetal bovine serum (FBS) and mixed with silicone resin to prepare pseudo-tumors. Sponges of different densities and a porcine lung were placed on top of the pseudo-tumors, which were examined using a novel fluorescence spectroscopy system and a near-infrared (NIR) camera. Spectra were measured for different sponge and lung thicknesses, and the lung spectra were measured during both inflation and deflation., Results: The fluorescence spectroscopy system was able to identify tumors at depths ≥15 mm, while the NIR system was not. The spectroscopy system also detected tumors at greater depths when the density of the intervening material was lower. Depending on the density and thickness of the intervening material, the system could detect spectra as deep as 40 mm for sponges and 30 mm for lungs., Conclusions: This new fluorescence spectroscopy system can be used to identify lung tumors up to a depth of 30 mm in experiments using pseudo-tumors and a porcine lung, which may aid in tumor identification during thoracoscopic surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-244/coif). The authors have no conflicts of interest to declare., (2022 Journal of Thoracic Disease. All rights reserved.)- Published
- 2022
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37. Presurgical assessment of flow variability in an azygos vein aneurysm using 4D-flow MRI.
- Author
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Ikushima T, Ujiie H, Tsuneta S, Chiba R, Tabata Y, Fujiwara-Kuroda A, Hida Y, Kaga K, Wakasa S, and Kato T
- Subjects
- Hemodynamics, Humans, Imaging, Three-Dimensional methods, Magnetic Resonance Imaging, Vena Cava, Superior, Aneurysm, Azygos Vein diagnostic imaging, Azygos Vein surgery
- Abstract
Azygos vein aneurysm (AVA) is necessary to prevent pulmonary embolism due to the outflow of a thrombus or rupture of the aneurysm. However, there is no established modality to assess the properties of AVA. Time-resolved three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) has been used to examine the hemodynamics in various fields. We report a case of AVA to evaluate the flow variability and adhesions of surrounding tissues using 4D-flow MRI. The findings of the study suggested aneurysm turbulence and the absence of thrombi. The cine image, which showed a sliding wall synchronized to the heartbeat, indicated no adhesion to the superior vena cava. Based on these results, the thoracoscopic approach was deemed possible preoperatively. Thoracoscopic AVA resection was performed, and the postoperative course was uneventful. This study documented the utility of 4D-flow MRI for a detailed evaluation of AVA., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2022
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38. A simple closure method for a mechanical aortic valve in left ventricular assist device implantation.
- Author
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Ishigaki T and Wakasa S
- Subjects
- Aortic Valve surgery, Humans, Prosthesis Implantation, Treatment Outcome, Aortic Valve Insufficiency surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Heart-Assist Devices
- Abstract
Because a mechanical aortic valve is a contraindication for the implantation of left ventricular assist device, complicated additional procedures such as a replacement with a bioprosthesis and a closure of the left ventricular outflow tract are required to implant the device. Among such procedures, a sandwich plug technique using vascular clips is one of the simple and feasible procedures. However, this technique requires an off-label use of vascular clips within the aorta that could be associated with a risk of dislodgement and embolization. Thus, we developed a modified sandwich technique without using vascular clips, where the valve leaflets were fixed in the closed position using felt patches and sutures instead of vascular clips. This modified technique is a simple and secure method to close the mechanical aortic valve with the minimum use of artificial materials., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2022
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39. Chunnel debranching for hybrid repair of thoracoabdominal aortic aneurysm.
- Author
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Wakasa S, Sato K, Ishigaki T, Watabe Y, and Abe S
- Subjects
- Blood Vessel Prosthesis, Humans, Stents, Treatment Outcome, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic etiology, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures adverse effects, Endovascular Procedures methods
- Abstract
Hybrid repair of a thoracoabdominal aortic aneurysm comprising thoracic endovascular aortic repair and total renovisceral debranching is a feasible alternative to open repair, especially for high-risk patients. However, transperitoneal debranching is a relatively complicated procedure that requires deep dissection around vital abdominal organs. Therefore, we developed a new debranching technique called Chunnel debranching, which was characterized by transaortic tunneling using a covered stent between the target artery and the prosthetic graft anastomosed on the aneurysmal wall using an inclusion technique. This procedure increases the feasibility of renovisceral debranching with fewer dissections than conventional transperitoneal debranching., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2022
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40. Long-term preservation of functional capacity and quality of life in advanced heart failure patients with bridge to transplant therapy: A report from Japanese nationwide multicenter registry.
- Author
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Sato T, Kobayashi Y, Nagai T, Nakatani T, Kobashigawa J, Saiki Y, Ono M, Wakasa S, and Anzai T
- Subjects
- Humans, Japan epidemiology, Quality of Life, Registries, Retrospective Studies, Treatment Outcome, United States, Heart Failure diagnosis, Heart Failure surgery, Heart Transplantation, Heart-Assist Devices adverse effects
- Abstract
Background: Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients., Methods: We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO
2 ], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation., Results: During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO2 , 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively)., Conclusions: BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx., (Copyright © 2022 Elsevier B.V. All rights reserved.)- Published
- 2022
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41. Changes in AMPKα and Ubiquitin Ligases in Myocyte Reverse Remodeling after Surgical Ventricular Reconstruction in rats with ischemic cardiomyopathy.
- Author
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Shingu Y, Hieda T, Sugimoto S, Asai H, Yamakawa T, and Wakasa S
- Subjects
- AMP-Activated Protein Kinases, Animals, Heart Ventricles metabolism, Muscle Cells metabolism, Rats, Ubiquitin, Ubiquitin-Protein Ligases genetics, Ubiquitin-Protein Ligases metabolism, Ventricular Remodeling, Cardiomyopathies, Myocardial Infarction metabolism
- Abstract
Background: The change in myocardial protein degradation systems after ventricular unloading has been unknown. We aimed to evaluate the anti-hypertrophic protein adenosine monophosphate-activated protein kinase (AMPK) and two major protein degradation systems (ubiquitin proteasome system and autophagy) in a model of surgical ventricular reconstruction (SVR) in rats with ischemic cardiomyopathy., Methods and Results: Rats were randomized into the following groups: sham/sham (control group), myocardial infarction (MI)/sham (sham group) and MI/SVR (SVR group), with an interval of 4 weeks. Two (early, n = 5 for each) and 28 days (late, n = 5 for each) after SVR, ventricular size, and wall stress were assessed. Myocyte area, protein expression of AMPKα and autophagy markers, and gene expression of ubiquitin ligases (Atrogin-1 and Murf-1) were evaluated in the late phase. In the early phase, left ventricular dimensions and wall stress were smaller in the SVR group than in the sham group, whereas they were comparable in the late period. Myocyte area in the SVR group was reduced to the value in the control group, while it was larger in the sham group than in the control group. Total-AMPKα, p-AMPKα, and AMPKα phosphorylation rates were higher, and Atrogin-1 and Murf-1 were lower in the SVR group than in the sham group, while the autophagy markers were not different between the groups. p-AMPKα had strong negative correlations with myocyte area, Atrogin-1, and Murf-1., Conclusions: In myocyte reverse remodeling after SVR, AMPKα phosphorylation increased in association with reduced gene expression of ubiquitin ligases., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)
- Published
- 2022
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42. Bronchial artery hypertrophy-associated perioperative pulmonary hemorrhage in cardiovascular surgery: a case report.
- Author
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Abe S, Kamikubo Y, Kato N, Kato H, Ooka T, Shingu Y, and Wakasa S
- Abstract
Background: Pulmonary hemorrhage is a life-threatening complication of cardiovascular surgery. Bronchial artery hypertrophy, a rare pathology associated with inflammatory and ischemic respiratory diseases, increases the risk of pulmonary hemorrhage; however, its involvement in cardiovascular surgery is not well known. We present two cardiovascular surgical cases in which embolization of the hypertrophied bronchial artery was effective in controlling perioperative pulmonary hemorrhage., Case Presentation: The first case was a 51-year-old man with chronic obstructive pulmonary disease who developed acute type A aortic dissection. After emergent surgery, his blood pressure suddenly dropped in the intensive care unit; computed tomography revealed a right hemothorax. Because a 4-mm dilated bronchial artery was identified on preoperative computed tomography, the hemothorax was suspected to be associated with bronchial artery hypertrophy. Selective bronchial arteriography was emergently performed and revealed a right pulmonary parenchymal blush. After subsequent coil embolization of the bronchial artery, the parenchymal blush disappeared, and his hemodynamic condition stabilized. The second case was a 66-year-old man with bronchiectasis who was referred for redo aortic valve replacement due to structural valve deterioration. A bioprosthesis was previously implanted to avoid permanent anticoagulation because the patient had repeated episodes of hemoptysis; however, he still had persistent hemosputum during admission for the redo aortic valve replacement. A dilated bronchial artery 3.7 mm in size was incidentally identified on preoperative computed tomography, and hence, the repeated hemosputum was suspected to be associated with bronchial artery hypertrophy. Bronchial arteriography revealed a right pulmonary parenchymal blush, and prophylactic embolization of the bronchial artery was performed. The hemosputum disappeared after the procedure, and redo aortic valve replacement was performed uneventfully 8 days later., Conclusion: In cardiovascular surgery, the risk of pulmonary hemorrhage associated with bronchial artery hypertrophy should be considered, especially in patients with inflammatory and ischemic respiratory diseases., (© 2022. The Author(s).)
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- 2022
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43. Reduction of tethering distance by papillary muscle tugging approximation with mitral valve replacement for non-ischemic functional mitral regurgitation induces left ventricular reverse remodeling.
- Author
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Ishigaki T, Wakasa S, Shingu Y, Ohkawa Y, Yamada A, Anzai T, and Matsui Y
- Subjects
- Humans, Mitral Valve surgery, Papillary Muscles, Ventricular Function, Left physiology, Ventricular Remodeling, Mitral Valve Insufficiency
- Abstract
Background: Functional mitral regurgitation (FMR) is caused by left ventricular (LV) remodeling and subsequent tethering of the mitral valve (MV). If LV remodeling is irreversibly advanced, it could not be attenuated by the MV procedure alone, although the additional subvalvular procedure could induce LV reverse remodeling by forcibly reducing MV tethering. This study aimed to assess the anti-tethering effect of papillary muscle tugging approximation (PMTA) on LV reverse remodeling after mitral valve replacement (MVR) for non-ischemic FMR., Methods: The study subjects were 19 patients who underwent MVR with and without PMTA [MVR + PMTA (n = 11) and MVR alone (n = 8), respectively] for non-ischemic FMR. The tethering distance (TD) and LV end-systolic volume (ESV) at the preoperative, postoperative, and follow-up periods were assessed in terms of their correlation and time-dependent changes. The intra-LV energy efficiency was also evaluated through vector flow mapping analysis., Results: TD and ESV were comparable between both procedures preoperatively and did not change after MVR alone. In MVR + PMTA, however, a significant decrease was identified in TD and ESV at the early postoperative and follow-up periods, respectively [TD = 48, 30, and 31 mm (p < 0.001) and ESV = 159, 133, and 82 mL (p < 0.001) at the preoperative, postoperative, and follow-up periods, respectively]. Finally, at follow-up, the extent of change from the preoperative value in ESV significantly correlated with that in TD (ρ = 0.81, p < 0.001 for overall; ρ = 0.93, p < 0.001 for MVR + PMTA; ρ = 0.86, p = 0.011 for MVR alone). The ratio of TD to ESV was also significantly correlated with systolic energy loss to LV stroke work after MVR + PMTA (ρ = 0.81, p = 0.015)., Conclusions: PMTA for non-ischemic FMR could induce LV reverse remodeling depending on the extent of postoperative TD reduction. A smaller TD to ESV was associated with a higher intra-LV energy efficiency after PMTA + MVR., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2022
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44. Effects of trehalose on recurrence of remodeling after ventricular reconstruction in rats with ischemic cardiomyopathy.
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Hieda T, Shingu Y, Sugimoto S, Asai H, Yamakawa T, and Wakasa S
- Subjects
- Animals, Heart Ventricles, Humans, Rats, Trehalose pharmacology, Ventricular Remodeling, Cardiomyopathies complications, Cardiomyopathies etiology, Myocardial Ischemia
- Abstract
Recurrence of left ventricular (LV) remodeling after surgical ventricular reconstruction (SVR) for ischemic cardiomyopathy has been reported to be partially attributed to autophagy. We aimed to examine the effects of trehalose, an autophagy inducer, on the recurrence of LV remodeling after SVR. After SVR in rats with ICM, trehalose was orally administered. The changes in LV end-diastolic dimension (LVEDD) and fractional shortening (FS) were evaluated. The activation of myocardial autophagy was also estimated by autophagy markers: microtubule-associated light chain 3 II (LC3-II) and p62; the former usually increases and the latter decreases if autophagy is activated. Significant LV reverse remodeling was observed early after SVR. On the other hand, the 28th postoperative day SVR + trehalose was associated with smaller LVEDD and better FS than SVR alone (LVEDD, P = 0.043; FS, P < 0.01). LC3-II increased comparably in both groups, while p62 was significantly lower in the SVR + trehalose group than in the SVR alone group (P < 0.01). In conclusion, trehalose attenuated the recurrence of LV remodeling and changed autophagy markers after SVR in rats with ICM. Trehalose may be a candidate for adjuvant therapy to retain the effects of SVR., (© 2021. Springer Japan KK, part of Springer Nature.)
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- 2022
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45. JCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease.
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, and Tanemoto K
- Subjects
- Coronary Artery Bypass, Humans, Myocardial Revascularization, Treatment Outcome, Coronary Artery Disease surgery, Percutaneous Coronary Intervention
- Published
- 2022
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46. A Nationwide Survey of Surgical Treatment for Severe Ischemic Mitral Regurgitation.
- Author
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Masuzawa A, Takagi T, Arai H, Matsumiya G, Takanashi S, Yaku H, Komiya T, Matsui Y, Wakasa S, and Kunihara T
- Subjects
- Follow-Up Studies, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Surveys and Questionnaires, Treatment Outcome, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency epidemiology
- Abstract
Objective: Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of specific subvalvular repair in severe IMR have not been elucidated. This is the first nationwide survey regarding surgeons' attitudes toward IMR in Japan., Methods: A questionnaire was sent to 543 institutions. From 2015 to 2019, numbers of elective first-time mitral valve replacement (MVR) with/without complete chordal preservation (CCP)/papillary muscle approximation (PMA) and mitral valvuloplasty (MVP) with/without papillary muscle relocation (PMR)/PMA in patients with severe IMR were collected. Concomitant procedures for coronary artery, tricuspid valve, and arrhythmia could be included but left ventricular reconstruction was excluded., Results: Completed questionnaires were received from 286 institutions (52.7%). The majority (90%) had less than 20 cases within 5 years. The number of MVP (1413, 61.5%) surpassed MVR (886, 38.5%). CCP was performed in half of MVR (50.0%), while PMA was included in only 1.9% of MVR. PMA and PMR were also performed infrequently, in only 7.7% and 10.9% of MVP, respectively., Conclusion: Japanese surgeons aggressively perform MVP for severe IMR. Subvalvular repair was also aggressively performed in addition to MVR, but not to MVP. A multicenter registry study is in progress.
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- 2022
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47. Autophagy during left ventricular redilation after ventriculoplasty: Insights from a rat model of ischemic cardiomyopathy.
- Author
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Sugimoto S, Shingu Y, Doenst T, Yamakawa T, Asai H, Wakasa S, and Matsui Y
- Subjects
- Adenine pharmacology, Animals, Autophagy-Related Proteins metabolism, Cardiomyopathy, Dilated etiology, Cardiomyopathy, Dilated surgery, Cardiovascular Agents pharmacology, Echocardiography methods, Microtubule-Associated Proteins metabolism, Myocardial Ischemia complications, Myocardial Ischemia metabolism, Rats, Recurrence, Ventricular Function, Left, Ventricular Remodeling physiology, Adenine analogs & derivatives, Autophagy drug effects, Autophagy physiology, Cardiomyopathy, Dilated metabolism, Cardiomyoplasty adverse effects, Cardiomyoplasty methods, Myocytes, Cardiac metabolism, Myocytes, Cardiac pathology
- Abstract
Objectives: Myocardial autophagy has been recognized as an important factor in heart failure. It is not known whether changes in ventricular geometry by left ventriculoplasty influence autophagy in ischemic cardiomyopathy. We hypothesized that myocardial autophagy plays an important role in left ventricular (LV) redilation after ventriculoplasty., Methods: Four weeks after ligation of the left anterior descending artery, ventriculoplasty or sham operation was performed. The animals were euthanized at 2 days (early) or 28 days (late) after the second operation. Ventricular autophagy was evaluated by protein expression of microtubule-associated protein light chain 3 II, an autophagosome marker. Cardiomyocyte area was assessed by histologic examination. LV function was evaluated by echocardiography. To examine the implications of autophagy, an autophagy inhibitor (3-methyladenine) was injected intraperitoneally for 3 weeks before sacrifice., Results: The LV was reduced in size early and redilated late after ventriculoplasty. LV systolic function was improved early and later worsened after ventriculoplasty. Light chain 3 II expression decreased early after ventriculoplasty and increased in the late period. Myocyte area increased from the early to late stage after ventriculoplasty. Autophagic inhibition exaggerated the increased myocyte hypertrophy and LV redilation., Conclusions: In a rat model of myocardial infarction, autophagy decreased early after ventriculoplasty and increased again during LV redilation. These results provide new insights into the mechanism underlying the late failure of ventriculoplasty., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2022
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48. [A CASE OF URETEROARTERIAL FISTULA REQUIRING SURGICAL TREATMENT AFTER ENDOVASCULAR STENT PLACEMENT].
- Author
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Sugito Y, Hotta K, Yamada S, Chiba H, Matsumoto R, Osawa T, Abe T, Abo D, Sato K, Wakasa S, and Shinohara N
- Abstract
A 36-year-old woman was operated on at the age of 29 years for cervical cancer, and bilateral ureteral stents were inserted during radical hysterectomy. Subsequently, total pelvic irradiation and para-aortic lymph node irradiation were administered as postoperative radiation therapy. Four years following the surgery, the patient visited previous hospital for ureteral stent replacement; however, following this visit, there was no further contact with her. Seven years after the surgery, the patient presented with gross hematuria. Removal of right ureteral stent led to the observation of severe bleeding. The patient was, thus, transferred to our hospital because of suspected right ureteroarterial fistula. Angiography and intravascular ultrasonography showed a pseudoaneurysm at the distal end of the right common iliac artery. Thus, an endovascular stent graft was placed in the right common iliac artery, which led to resolution of the gross hematuria. One month after discharge, the patient developed right pyelonephritis and hydronephrosis; thus, she underwent right nephrostomy. Six months after undergoing right nephrostomy, the patient developed a fever of 39°C and started bleeding from the site of the right nephrostomy. A computerized tomography scan revealed a pseudoaneurysm in the right common iliac artery, and the endovascular stent graft was seen sliding into the artery. Thus, endovascular stent graft removal, pseudoaneurysm resection, and femoral-femoral artery bypass surgeries were performed. Thereafter, the patient showed no recurrence of infection or hematuria and no evidence of blood flow disorder to the lower extremities. In recent years, endovascular treatment for ureteroarterial fistulas is considered as the first-line treatment modality. However, in cases with infection, there is a possibility of vascular wall weakening, resulting in the formation of pseudoaneurysms, and sliding of the endovascular stent graft.
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- 2022
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49. Prediction of Pulmonary Embolism Following Resection of Pulmonary Infarction: A Case Series.
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Yamasaki H, Ujiie H, Kato T, Hida Y, Kaga K, Wakasa S, and Matsuno Y
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- Humans, Treatment Outcome, Postoperative Complications epidemiology, Pulmonary Embolism epidemiology, Pulmonary Infarction diagnosis, Pulmonary Infarction surgery
- Abstract
Purpose: Pulmonary nodules suspected to be cancerous are rarely diagnosed as pulmonary infarction (PI). This study examined the clinical, radiological, and laboratory data in cases diagnosed with PI to determine their potential utility as preoperative diagnostic markers. We also assessed factors affecting the postoperative course., Methods: A total of 603 cases of peripheral pulmonary nodules undiagnosed preoperatively were resected at Hokkaido University Hospital from 2012 to 2019. Of these, we reviewed cases with a postoperative diagnosis of PI. We investigated clinical symptoms, preoperative laboratory data, radiological characteristics, and postoperative complications., Results: Four patients (0.7%) were diagnosed with PI. All patients had a smoking history. One patient received systemic steroid administration, and none had predisposing factors for thrombosis. One case showed chronologically increased nodule size. Three cases showed weak uptake of
18 F-fluorodeoxyglucose. One patient with preoperative high D-dimer levels developed a massive pulmonary embolism (PE) in the postoperative chronic phase and was treated with anticoagulants., Conclusions: Preoperative diagnosis of PI is difficult, and we could not exclude lung cancer. However, if a patient diagnosed with PI has a high D-dimer level, we recommend postoperative physical examination for deep venous thrombosis. Prophylactic anticoagulation therapy should be considered to avoid fatal PE.- Published
- 2021
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50. Surgical treatment for tracheal stent prolapse in a patient with blunt tracheal trauma.
- Author
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Otsuka S, Kato T, Ujiie H, Fujiwara-Kuroda A, Hida Y, Kaga K, Wakasa S, Takashima Y, and Shinagawa N
- Subjects
- Humans, Prolapse, Stents, Trachea diagnostic imaging, Trachea injuries, Trachea surgery, Tracheal Stenosis etiology, Tracheal Stenosis surgery, Wounds, Nonpenetrating diagnostic imaging, Wounds, Nonpenetrating surgery
- Abstract
Blunt tracheal injury is a rare but life-threatening condition. Several indications for treatment have been reported. Conservative treatment (i.e., stenting) can be performed when the patient is clinically stable or has medical contraindications to surgical treatment. Although some studies have reported the use of tracheal stents as treatment for iatrogenic injury and blunt trauma, the efficacy of these stents is unknown. Herein, we report a case of emergency tracheoplasty for the management of tracheal stent prolapse in a patient with blunt tracheobronchial trauma. This report highlights the necessity of being cautious about the migration and prolapse of tracheal stents, which can more frequently occur in blunt trauma than in malignant stenosis or iatrogenic injury. Due to the limitations of non-surgical treatments, early surgical intervention may be lifesaving., (© 2021. The Japanese Association for Thoracic Surgery.)
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- 2021
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