Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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新型インフルエンザA(H1N1 2009)に対するECMO治療の経験

伊藤英史, 市場晋吾, 笠原真悟, 堂口琢磨, 新井禎彦, 佐野俊二

膜型肺 ( 33 ) 50 - 55 2010.11

Language：Japanese Publisher：膜型人工肺研究会

新型インフルエンザ罹患によって急性呼吸窮迫症候群をきたした患者に対して、ECMOを導入し呼吸状態と循環動態の改善を図った結果、全身状態が劇的に回復し救命することができた症例を報告した。患者は11歳女児で、ECMOの早期導入によりLung Restが得られたことで、人工呼吸療法に起因する肺障害を回避できたと考えられた。

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小児心臓手術後の積極的ECMO導入の影響

伊藤英史, 市場晋吾, 笠原真悟, 新井禎彦, 佐野俊二

膜型肺 ( 33 ) 44 - 47 2010.11

Combination of continuous irrigation and vacuum-assisted closure is effective for mediastinitis after cardiac surgery in small children. International journal

Shinya Ugaki, Shingo Kasahara, Sadahiko Arai, Masami Takagaki, Shunji Sano

Interactive cardiovascular and thoracic surgery 11 ( 3 ) 247 - 51 2010.9

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

There is still no consensus on the optimal management to treat pediatric mediastinitis. We assessed the efficacy of continuous irrigation and vacuum-assisted closure (VAC) for mediastinitis in children. This study retrospectively reviewed 20 patients aged <5 years with mediastinitis from December 2002 to December 2009. The median age at the onset was 12 months (0.6-60 months), and the median body weight was 6.9 kg (3.1-15.3 kg). Continuous irrigation was applied for extensive mediastinitis or unstable hemodynamic cases and VAC for localized or ineffective cases after continuous irrigation. A 2-4-week course of intravenous antibiotics was administered after sternal closure. Continuous irrigation was initially applied in 19 patients and VAC in one patient. VAC was employed in six patients because of recurrent or prolonged mediastinitis after continuous irrigation. All patients underwent direct sternal closure without any flap. The median duration of the hospital stay was 49.5 days (15-158 days). Although two patients died of low cardiac output, 18 children survived and had no recurrence after the discharge during a median follow-up of 14 months (1-81 months). The combination of continuous irrigation and VAC is, therefore, considered to be a safe and effective option to minimize the morbidity and mortality in pediatric mediastinitis.

DOI： 10.1510/icvts.2010.235903

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Successful aortic reimplantation in a three-year-old child with Marfan syndrome. International journal

Yoshinori Miyahara, Shingo Kasahara, Masami Takagaki, Shunji Sano

Interactive cardiovascular and thoracic surgery 11 ( 2 ) 218 - 20 2010.8

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

Aortic root dilatation is rare in children, and is often secondary to Marfan syndrome (MFS). We experienced a case of a three-year-old boy (92 cm, 12 kg) with MFS presenting with progressive dilatation of aortic root. We electively performed a valve-sparing aortic root replacement using a 24-mm Gelweave Valsalva graft. Although the patient required a mitral valve repair due to infective endocarditis postoperatively, the recovery from the second surgery was uneventful. This case is one of the youngest children of valve-sparing aortic root replacement in the literature.

DOI： 10.1510/icvts.2010.234138

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Anatomical repair of a persistent left superior vena cava into the left atrium. International journal

Shinya Ugaki, Shingo Kasahara, Yasuhiro Fujii, Shunji Sano

Interactive cardiovascular and thoracic surgery 11 ( 2 ) 199 - 201 2010.8

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

The anatomy of a persistent left superior vena cava (SVC) to the left atrium (LA) without the innominate vein can make it challenging to complete intracardiac repair. We reviewed our five cases of the direct end-to-side anastomosis of SVCs to facilitate anatomical repair of SVC-right atrial connection for biventricular repair. Diagnoses were two partial atrioventricular septal defect with left isomerism, one complete atrioventricular septal defect (CAVSD) with left isomerism, one CAVSD without isomerism and one atrioventricular discordance and double outlet right ventricle with right isomerism. Mean age at the operation was 20+/-23 months (4-58 months) and body weight was 7.8+/-3.4 kg (4.8-12.7 kg). After completion of intracardiac repair, the SVC to LA was divided and end-to-side anastomosed to the SVC to the right atrium during cardiopulmonary bypass. No early or late death occurred during follow-up of 14.4+/-6.9 months (7-23 months). None of the patients developed an obstruction at the anastomosis site of the SVCs. The direct end-to-side anastomosis of SVCs achieved an excellent anatomical SVC-right atrium connection in complex congenital heart diseases.

DOI： 10.1510/icvts.2009.230581

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Growth of the lateral tunnel in patients who underwent a total cavopulmonary connection at less than 5 years of age. International journal

Yasuhiro Fujii, Yasuhiro Kotani, Masami Takagaki, Sadahiko Arai, Shingo Kasahara, Shin-ichi Otsuki, Shunji Sano

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 38 ( 1 ) 66 - 70 2010.7

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

OBJECTIVE: A lateral tunnel-total cavopulmonary connection (LT-TCPC) using a right atrial (RA) free wall is the first choice of treatment for patients with a small body weight in this institute. Whether the growth of the LT is appropriate or not according to the growth of the body remains controversial. In addition, the optimal initial diameter of an LT is unknown. The purpose of this study was to verify the growth of the LT. METHODS: Ninety-one patients of a total of 267 TCPC cases underwent an LT-TCPC at less than 5 years of age in this institute between March 1991 and June 2008. The data on 47 of the 91 patients, which were available to investigate the LT growth, were retrospectively reviewed. The mean age at LT-TCPC was 37+/-11 months (16-57 months). The mean body weight at TCPC was 12.4+/-2.4 kg (7.6-20.0 kg). The initial LT diameter was determined with Hegar's sizer of the estimated half-pulmonary arterial (PA) diameter, which is a diameter that results in half of the dimension of the normal pulmonary valve. The measured maximum LT diameter (mm) divided by the estimated half-PA diameter (mm) was considered as the LT index. The size of the LT was evaluated using either echocardiography or angiography. RESULTS: The mean follow-up period was 7.4+/-3.5 years (1.6-13.5 years). The LT index was initially 2.0+/-0.7 (1.3-4.5), 2.0+/-0.4 (1.3-3.2) at 1 year after operation, 2.1+/-0.5 (1.5-3.2) at 5 years after operation, 1.9+/-0.4 (1.5-2.8) at 10 years after operation and 2.1+/-0.5 (1.6-2.5) at 13 years after operation, respectively. CONCLUSIONS: LT growth suitable for the body growth can be expected. Although there was some variation in the initial LT diameter, the LT index tended to converge at 2.0 with growth.

DOI： 10.1016/j.ejcts.2010.01.014

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The impact of the length between the top of the interventricular septum and the aortic valve on the indications for a biventricular repair in patients with a transposition of the great arteries or a double outlet right ventricle. International journal

Yasuhiro Fujii, Yasuhiro Kotani, Masami Takagaki, Sadahiko Arai, Shingo Kasahara, Shin-ichi Otsuki, Shunji Sano

Interactive cardiovascular and thoracic surgery 10 ( 6 ) 900 - 5 2010.6

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

The purpose of this study was to establish a useful cut-off level for performing an original Rastelli-type operation in patients with transposition of the great arteries (TGA)/ventricular septal defect (VSD) or double outlet right ventricle (DORV). A total of 43 patients with TGA/VSD or DORV who underwent an original Rastelli-type operation in this institute between March 1993 and January 2009 were reviewed retrospectively. These patients were divided into two groups using the length between the top of the interventricular septum and the aortic valve (IVS-AV length); Group A; IVS-AV length <80% of normal left ventricular end-diastolic diameter (LVDd). Group B; IVS-AV length > or =80% of normal LVDd. Group A had a significantly better survival than Group B (100% vs. 56%, P=0.001). The cardiac event-free survival were 89.1% at 7.2 years in Group A and 26.3% at 8.4 years in Group B (P<0.0001). The Group B had a higher incidence of left ventricular outflow tract obstruction (LVOTO; 3% vs. 33%, P=0.02). The IVS-AV length was found to be a significant risk factor for mortality and LVOTO. The IVS-AV length should, therefore, be taken into consideration when selecting the optimal surgical procedures for these patients.

DOI： 10.1510/icvts.2009.223982

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Successful Fontan completion in a patient with noncompaction myocardium. International journal

Yoshinori Miyahara, Shingo Kasahara, Kozo Ishino, Shigeru Sakurai, Shunji Sano

The Journal of thoracic and cardiovascular surgery 139 ( 4 ) e85-7 2010.4

Three cases of Bland-White-Garland syndrome mimicking dilated cardiomyopathy in early infancy

Araki Tooru, Kodera Aya, Ohtsuki Shinichi, Sano Shunji, Kasahara Shingo, Takahashi Nobumasa, Kato Tetsuji, Hosogi Mizuho, Wada Tomoaki, Takasugi Mizue, Sakamoto Tomoko, Ikeda Masanori

Shinzo 42 ( 11 ) 1450 - 1457 2010

新生児・乳児体外循環における復温係数に関する考察

伊藤英史, 堂口琢磨, 海老島宏典, 桜井茂, 笠原真悟, 新井禎彦, 三井秀也, 佐野俊二, 黒光弘彦

体外循環技術 36 ( 4 ) 459 - 460 2009.12

The rewarming index formula for pediatric cardiopulmonary perfusion. International journal

Hideshi Itoh, Shingo Kasahara, Yasuhiro Fujii, Ysuhiro Kotani, Sadahiko Arai, Shunji Sano

Artificial organs 33 ( 11 ) 896 - 903 2009.11

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

Careful rewarming of perfusion blood following cardiopulmonary bypass surgery is critical to a successful outcome, but the optimal rewarming strategy is not clear. The purpose of this study was to derive a formula for a rewarming index (defined as [rewarming time x perfusion flow]/[body weight x body surface area]) that would enable the calculation of the ideal rewarming conditions for pediatric cardiopulmonary perfusion. We retrospectively investigated 220 pediatric cardiopulmonary bypass operations conducted from July 2005 to June 2008 in Okayama University Hospital, Japan. We determined the formula as Phi = (T x Q)/(R x S) = |0.9127P - 0.0152|, where Phi = rewarming index, T = rewarming time (min), Q = perfusion volume (L), R = body weight (kg), S = body surface area (m(2)), and P = temperature gap (right angle). The formula will help those who perform pediatric cardiopulmonary bypass surgery to establish ideal perfusion flow conditions and to control physiological temperature during rewarming.

DOI： 10.1111/j.1525-1594.2009.00945.x

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The potential of disproportionate growth of tricuspid valve after decompression of the right ventricle in patients with pulmonary atresia and intact ventricular septa. International journal

Shu-Chien Huang, Kozo Ishino, Shingo Kasahara, Ko Yoshizumi, Yasuhiro Kotani, Shunji Sano

The Journal of thoracic and cardiovascular surgery 138 ( 5 ) 1160 - 6 2009.11

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

OBJECTIVE: Tricuspid valve size is the major determinant of outcomes for patients with pulmonary atresia with intact ventricular septum. Lack of right ventricle-pulmonary artery continuity is associated with poor tricuspid valve growth (decrement in Z-value). However, most reports did not show evidence for disproportionate growth of the tricuspid valve after establishment of right ventricle-pulmonary artery continuity. METHODS: We studied 40 patients with pulmonary atresia with intact ventricular septum who underwent initial right ventricular decompression for planned staged repair. The initial Z-value of the tricuspid valve diameter (Zt1) was obtained from the echocardiography-derived normal value. The late Z-value (Zt2) was measured before definitive repair or the last available Z-value, if definitive repair was not yet reached. The factors associated with the changes of Z-values (Zt2 - Zt1) were analyzed. RESULTS: The mean initial tricuspid Z-value (Zt1) was -6.2 +/- 3.5. After treatment (Zt2), the mean Z-value was -6.0 +/- 3.4 (n = 34). Overall, the tricuspid Z-values did not change. Individually, the change in Z-value (Zt2 - Zt1) was larger than +2 in 11 (32%) patients and smaller than -2 in 6 (18%) patients. Increases in Z-value (Zt2 - Zt1) were significantly associated with right ventricular pressure/left ventricular pressure ratio measured after initial palliation (r = -0.54; P = .001) and the initial tricuspid valve Z-value (Zt1) (r = -0.40; P = .02). CONCLUSIONS: Disproportional growth of the tricuspid valve can occur, especially in patients with small tricuspid valves and lower right ventricular pressures after decompression. The findings support the possibility of neonates with small tricuspid valves undergoing biventricular repair after right ventricular decompression surgery.

DOI： 10.1016/j.jtcvs.2009.05.015

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The benefits of high-flow management in children with pulmonary atresia. International journal

Yasuhiro Fujii, Yasuhiro Kotani, Takuya Kawabata, Shinya Ugaki, Shigeru Sakurai, Hironori Ebishima, Hideshi Itoh, Mahito Nakakura, Sadahiko Arai, Shingo Kasahara, Shunji Sano, Tatsuo Iwasaki, Yuichiro Toda

Artificial organs 33 ( 11 ) 888 - 95 2009.11

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

The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.

DOI： 10.1111/j.1525-1594.2009.00895.x

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Effect of a miniaturized cardiopulmonary bypass system on the inflammatory response and cardiac function in neonatal piglets. International journal

Ko Yoshizumi, Kozo Ishino, Shinya Ugaki, Hironori Ebishima, Yasuhiro Kotani, Shingo Kasahara, Shunji Sano

Artificial organs 33 ( 11 ) 941 - 6 2009.11

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

The cognitive impairment and hemodynamic instability after neonatal cardiac surgery with cardiopulmonary bypass (CPB) might be exacerbated by hemodilution. Therefore, this study investigated the impact of different bloodless prime volumes on the hemodynamics and the inflammatory response by a miniaturized CPB system in neonatal piglets. The bypass circuit consisted of a Capiox RX05 (Capiox Baby RX, Terumo Corp., Tokyo, Japan) oxygenator and 3/16 internal diameter arterial and venous polyvinyl chloride tubing lines, with a minimum 75 mL prime volume. Twelve 1-week-old piglets were placed on a mild hypothermic CPB (32 degrees C) at 120 mL/kg/min for 2 h. The animals were divided into two groups, based on the volume of the prime solution. The priming volume was 75 mL in Group I and 175 mL in Group II. No blood transfusions were performed, and no inotropic or vasoactive drugs were used. The interleukin-6 (IL-6) and thrombin-antithrombin (TAT) complex levels, as well as right ventricular and pulmonary functions, were measured before and after CPB. Group I had low levels of IL-6 and TAT immediately after CPB (4370 +/- 2346 vs. 9058 +/- 2307 pg/mL, P < 0.01 and 9.9 +/- 7.7 vs. 25.1 +/- 8.8 ng/mL, P < 0.01, respectively). Group I had significantly improved cardiopulmonary function, cardiac index (0.22 +/- 0.03 vs. 0.11 +/- 0.05 L/kg/min, P < 0.001), and pulmonary vascular resistance index (7366 +/- 2860 vs. 28 620 +/- 15 552 dynes/cm(5)/kg, P < 0.01) compared with Group II. The miniaturized bloodless prime circuit for neonatal CPB demonstrated that the influence of hemodilution can reduce the subsequent inflammatory response. In addition, a low prime volume could therefore be particularly effective for attenuating pulmonary vascular resistance and right ventricular dysfunction in neonates.

DOI： 10.1111/j.1525-1594.2009.00922.x

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小児心臓ECMOにおける危険因子に関する検討

伊藤英史, 笠原真悟, 藤井泰宏, 川畑拓也, 小谷康弘, 桜井茂, 大澤晋, 堂口琢磨, 井上陽一, 大島祐, 吉積功, 新井禎彦, 三井秀也, 佐野俊二

膜型肺 ( 32 ) 43 - 46 2009.11

Language：Japanese Publisher：膜型人工肺研究会

1997年1月から2008年5月に実施された3100例の先天性心疾患手術症例の内、術後にExtracorporeal Membrane Oxygenation(ECMO)を導入した54例を生存群(20例)と非生存群(34例)に分け、月齢、身長、体重、体表面積、ECMO灌流量、ECMO補助期間、心臓手術中の体外循環時間、大動脈遮断時間を比較検討した。更に、ECMO補助期間についてNorwood手術後症例とその他の群、単心室形態症例群と両心室形態症例群において、生存群と非生存群に分けて多重比較による追加検討を行った。小児心臓ECMOに対する危険因子を分析した結果、低体重・低年齢の身体の小さな患者、ECMO導入期間、Norwood術後、単心室形態を持つ症例がECMO離脱困難症例であった。

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Clinical outcome of the Fontan operation in patients with impaired ventricular function. International journal

Yasuhiro Kotani, Shingo Kasahara, Yasuhiro Fujii, Ko Yoshizumi, Yu Oshima, Shin-Ichi Otsuki, Teiji Akagi, Shunji Sano

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 36 ( 4 ) 683 - 7 2009.10

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

OBJECTIVE: Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function. METHODS: A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991 and 2007. RESULTS: Twenty-nine (13%) of the 217 patients had an impaired ventricular function (ejection fraction (EF) <50%). The median age at the time of the operation was 3 (range: 1-31 years) years. There were five adult patients. The ventricular morphology was right in 20 patients (including five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) in nine patients. Heterotaxy syndrome was present in eight patients. Previous surgical interventions included bidirectional Glenn anastomoses in 24, modified Blalock-Taussig shunts in two and pulmonary artery banding in two. The preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular valve regurgitation was noted in four patients. The percutaneous oxygen saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 patients underwent the Fontan operation without any early mortality. There were two late mortalities and two re-operations. EF was maintained at 59+/-15% at a median follow-up of 7.5 (range: 1-19) years. The percent normal systemic ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 pgml(-1)), respectively. Three patients developed congestive heart failure, seven had arrhythmia and two developed protein-losing enteropathy. The New York Heart Association (NYHA) class functional class is I in 21 patients, II in five and III in one. CONCLUSIONS: Acceptable clinical outcomes were observed at an intermediate follow-up of the Fontan operation in patients with an impaired ventricular function.

DOI： 10.1016/j.ejcts.2009.04.042

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体外循環回路縮小化と体外循環の安全性は両立できるか?

伊藤英史, 堂口琢磨, 鵜垣伸也, 桜井茂, 笠原真悟, 新井禎彦, 三井秀也, 佐野俊二

日本臨床工学技士会会誌 ( 37 ) 132 - 134 2009.10

体外循環技士としての臨床工学技士臨床工学技士3年目の想い

堂口琢磨, 伊藤英史, 笠原真悟, 新井禎彦, 三井秀也, 佐野俊二

日本臨床工学技士会会誌 ( 37 ) 109 - 111 2009.10

Aortic relocation for transposition complex with aortic arch obstruction. International journal

Atsushi Tateishi, Masaaki Kawada, Hideki Morita, Shingo Kasahara, Shunji Sano

Asian cardiovascular & thoracic annals 17 ( 4 ) 422 - 4 2009.8

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

We describe successful primary repair of 2 cases of transposition complex with aortic arch obstruction. A new aortic arch was reconstructed by direct anastomosis between the well-mobilized ascending aorta and the descending aorta. The neoaortic root with transferred coronary arteries was subsequently anastomosed to the undersurface of this new aortic arch. This technique deals with the significant size discrepancy between the 2 great arteries, and anomalous coronary artery patterns.

DOI： 10.1177/0218492309338126

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Right but not left ventricular function recovers early after living-donor lobar lung transplantation in patients with pulmonary arterial hypertension. Reviewed International journal

Shinichi Toyooka, Kengo Fukushima Kusano, Keiji Goto, Yamane Masaomi, Takahiro Oto, Yoshifumi Sano, Soichiro Fuke, Megumi Okazaki, Toru Ohe, Shingo Kasahara, Shunji Sano, Hiroshi Date

The Journal of thoracic and cardiovascular surgery 138 ( 1 ) 222 - 6 2009.7

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

OBJECTIVE: The aim of this study was to evaluate right and left ventricular functions in patients with pulmonary arterial hypertension after living-donor lobar lung transplantation compared with those without hypertension. METHODS: Thirty-three recipients of living-donor lobar lung transplantation were divided into two groups: those with pulmonary arterial hypertension (PAH group; n = 12) and those without (non-PAH group; n = 21). Their systolic pulmonary artery pressure was 93.1 +/- 6.7 mm Hg versus 31.4 +/- 2.9 mm Hg, respectively. Right and left ventricular ejection fractions, systolic pulmonary artery pressure, and cardiac index were serially measured by radionuclide ventriculography and right heart catheterization, respectively. RESULTS: Pretransplant right and left ventricular ejection fractions were lower in the PAH group (29.8% +/- 7.0%, 49.9% +/- 6.6%) than in the non-PAH group (49.7% +/- 3.3%, 65.2% +/- 1.9%) (P = .010, .068). Two months after living-donor lobar lung transplantation, right ventricular ejection fraction and systolic pulmonary artery pressure in the PAH group (57.3% +/- 5.1%, 25.7 +/- 1.8 mm Hg) improved dramatically, equal to those in the non-PAH group. In contrast, left ventricular ejection fraction and cardiac index in the PAH group (50.9% +/- 3.7%, 2.66 +/- 0.12 L x min(-1) x m(-2)) were still significantly lower than in the non-PAH group (65.4% +/- 2.8%, 3.13 +/- 0.15 L x min(-1) x m(-2)) (P = .0038, .037). At 6 to 12 months, the PAH group demonstrated a significant rise in left ventricular ejection fraction and cardiac index that reached similar values in the non-PAH group measured at 2 months. These values were stable for up to 3 years. CONCLUSIONS: Right ventricular function recovered early after living-donor lobar lung transplantation in the PAH group. In contrast, recovery of left ventricular function required 6 to 12 months. Improved cardiac function was sustained for up to 3 years, suggesting long-term durability of cardiac function recovery after living-donor lobar lung transplantation.

DOI： 10.1016/j.jtcvs.2009.02.038

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