Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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心室中隔欠損症に先天性副腎皮質機能不全を合併した乳児に対し周術期糖質コルチコイド補充療法を施行した1手術例

大澤晋, 笠原真悟, 小谷恭弘, 佐野俊二

日本心臓血管外科学会雑誌 38 ( 4 ) 276 - 279 2009.7

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

症例は5ヵ月女児。先天性副腎皮質機能不全にて近医で副腎皮質ホルモン補充療法を行っている。出生時より心雑音を指摘され近医転院、心室中隔欠損症の診断にて薬物療法を行っていた。生後4ヵ月までに心不全の状態は改善し、生後5ヵ月の時点で心カテーテル検査を施行した結果、肺体血流比2.9と高値であり、心不全の急性増悪をきたす恐れが強く、哺乳量が増えず体重増加があまり期待できないこと、易感染性であることから、早期に手術すべきと判断され、当院紹介となった。手術は心室中隔欠損症に対するパッチ閉鎖術を行った。周術期の糖質コルチコイド補充量は体表面積から投与ステロイド量を推定し、周術期の血中コルチゾール濃度の経時的変化を参考にしながら投与することで、良好な結果を得ることができた。乳幼児における開心術における糖質コルチコイド補充療法の報告は少なく、体表面積から投与量を推定することで良好な周術期管理を行うことができた。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J01122&link_issn=&doc_id=20090724250010&doc_link_id=10.4326%2Fjjcvs.38.276&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.38.276&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Large atrial septal defect visualized by real-time three-dimensional echocardiography.

Nobuhisa Watanabe, Manabu Taniguchi, Teiji Akagi, Takeshi Maruo, Yasuharu Tanabe, Shingo Kasahara, Kengo Kusano, Norio Koide, Shunji Sano

Journal of echocardiography 7 ( 2 ) 39 - 40 2009.6

Successful reconstruction of communicating bronchopulmonary foregut malformation associated with laryngotracheoesophageal cleft. International journal

Tatsuo Nakaoka, Sadashige Uemura, Tsunehiro Yano, Terutaka Tanimoto, Hiromu Miyake, Shingo Kasahara, Shunji Sano

Journal of pediatric surgery 44 ( 5 ) e29-32 2009.5

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

A full-term newborn male infant presented with dyspnea and cleft lip and palate. He was thought to have esophageal atresia with tracheoesophageal fistula. He underwent bronchoscopy before operation that showed a laryngotracheoesophageal cleft (LTEC) type III. The left main bronchus originated from the lower esophagus. His diagnosis was communicating bronchopulmonary foregut malformation (CBPFM) type IA associated with LTEC type III. Enhanced chest computed tomographic scan showed the left pulmonary artery originated from the descending aorta. Staged operations were indicated. At first, reconstruction of the left pulmonary artery was done at 3 months of age. Then at 6 months of age, operations for LTEC (tracheoplasty and esophagostomy) and CBPFM left bronchoplasty were performed. Reconstruction of esophagus was performed at age of 1 year. He is now 3 years old and doing well with a mild degree of bronchomalacia. This is the first report of total reconstruction of CBPFM type IA associated with LTEC.

DOI： 10.1016/j.jpedsurg.2009.02.061

Ultrafiltration of priming blood before cardiopulmonary bypass attenuates inflammatory response and maintains cardiopulmonary function in neonatal piglets

Shinya Ugaki, Osami Honjo, Yasuhiro Kotani, Mahito Nakakura, Takuma Douguchi, Yu Oshima, Ko Yoshizumi, Shingo Kasahara, Shunji Sano

ASAIO Journal 55 ( 3 ) 291 - 295 2009.5

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

Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution
however, transfusion-related inflammation affects postCPB outcomes in neonatal open-heart surgery. We hypothesized that ultrafiltration of priming blood before CPB may reduce inflammatory mediators in priming blood and postCPB inflammatory responses, thereby improving cardiopulmonary function. Twelve 1-week-old piglets (3.5 ± 0.2 kg) were divided into two groups. Group U (n = 6) employed the priming blood ultrafiltrated before CPB, but group N (n = 6) used the nonultrafiltrated blood. Cardiopulmonary bypass was performed for 2 hours and then modified ultrafiltration (MUF) was conducted. Data were acquired before CPB and after MUF. The values of K, serotonin, and IL-8 in priming blood was significantly decreased after ultrafiltration (8.2 ± 2.6 vs. 4.2 ± 0.8 mEq/L, p &lt
0.01, 234 ± 96 vs. 74 ± 42 ng/ml, p &lt
0.01, 78.4 ± 5.1 vs. 64.5 ± 59.1 pg/ml, p &lt
0.05). Group U after MUF had lower thrombin-antithrombin complex levels (23.9 ± 5.1 vs. 33.7 ± 4.6 ng/ml, p &lt
0.01) and lower IL-8 levels in airway fluid (925 ± 710 vs. 2495 ± 1207 pg/ml, p &lt
0.05) than group N. Cardiac output and arterial PO2 after MUF in group U were also higher (1.13 ± 0.21 vs. 0.69 ± 0.22, p &lt
0.01, 340 ± 190 vs. 149 ± 84 mm Hg, p &lt
0.05). The ultrafiltration of blood priming before CPB attenuated activation of the coagulation pathway and inflammatory responses and preserved cardiopulmonary function in neonatal piglets. ©2009Amercian Society of Artificial Internal Organs.

DOI： 10.1097/MAT.0b013e31819b00c2

Single center experience with a low volume priming cardiopulmonary bypass circuit for preventing blood transfusion in infants and small children

Yasuhiro Kotani, Osami Honjo, Mahito Nakakura, Yasuhiro Fujii, Shinya Ugaki, Yu Oshima, Ko Yoshizumi, Shingo Kasahara, Shunji Sano

ASAIO Journal 55 ( 3 ) 296 - 299 2009.5

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

This retrospective study analyzed the current practice of blood transfusion-free open-heart surgery in 536 children weighing 5-20 kg undergoing surgery between 2004 and 2007. A miniaturized cardiopulmonary bypass (CPB) circuit was used (priming volume
300 ml for the flow rate &lt
1,500 ml/min
550 ml for the flow rate of 1500-2300 ml/min). Modified ultrafiltration was routinely performed. Criteria for blood transfusion during CPB included a hematocrit of &lt
20% and/or mixed venous oxygen saturation of &lt
65%. Transfusion during CPB was avoided in 264 (49.3%) of the 536 patients (5-10 kg group, 29.0%
11-15 kg group, 67.4%
16-20 kg group, 80.8%). There was no neurological complication related to hemodilution. Multiple logistic regression analysis revealed that body weight, preoperative hematocrit, priming volume of CPB circuit, CPB time, and lowest hematocrit during CPB predict requirement of blood transfusion (p &lt
0.01). Transfusion rate was lowest in the atrial septal defect group (5.6%) and highest in tetralogy of Fallot group (78.7%), being associated with complexity of diagnosis and procedure required. Blood transfusion-free open-heart surgery may be achieved in the half of the patients weighing 5-20 kg, and further miniaturization of CPB circuit and refinement of perfusion strategy might reduce transfusion rate in patients &lt
10 kg and/or with complex congenital heart disease. ©2009Amercian Society of Artificial Internal Organs.

DOI： 10.1097/MAT.0b013e31819742f0

Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. International journal

Yasuhiro Fujii, Shunji Sano, Yasuhiro Kotani, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Teiji Akagi

The Annals of thoracic surgery 87 ( 2 ) 562 - 70 2009.2

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

BACKGROUND: Adult patients who do not fulfill the classical Fontan criteria now undergo total cavopulmonary connection (TCPC). However, limited information is available on the results for high-risk adult TCPC. METHODS: Twenty-five consecutive adult patients (aged 16 years or more) who underwent TCPC were retrospectively reviewed. The mean age at operation was 27 +/- 9 years (range, 16 to 52). The following items were considered as the potential risk factors according to previous reports: (1) aged more than 30 years (7 of 25); (2) heterotaxy (9 of 25); (3) systemic ventricular ejection fraction less than 50% (6 of 25); (4) atrioventricular valve regurgitation moderate or greater (6 of 25); (5) pulmonary arterial index less than 200 (7 of 25); (6) mean pulmonary arterial pressure 15 mm Hg or greater (3 of 25); (7) pulmonary arterial resistance 2.0 wood units or greater (11 of 25); (8) arrhythmias (13 of 25); (9) protein-losing enteropathy (3 of 25); (10) New York Heart Association (NYHA) functional class III or greater (9 of 25); (11) previous Fontan procedure (10 of 25); (12) systemic ventricular outflow obstruction (1 of 25); and (13) end-diastolic pressure of the systemic ventricle 11 mm Hg or higher (4 of 25). RESULTS: The mean follow-up period was 57 +/- 45 months (range, 0 to 154). All patients had at least 2 risk factors (range, 2 to 8). There was 1 early death and 2 late deaths. Comparing the late survivors and nonsurvivors, no statistical significance was identified in the above risk factors. However, the patients with 6 or more risk factors had a significantly higher mortality rate than patients with fewer than 6 risk risk factors (p < 0.01). Age (p = 0.08), NYHA class (p = 0.13), and protein-losing enteropathy (p = 0.08) may be risk factors for late death. CONCLUSIONS: The majority of the adult TCPC candidates tolerated the TCPC procedure in the early postoperative period. However, the accumulation of risk factors influences late mortality.

DOI： 10.1016/j.athoracsur.2008.10.040

Risk factors for mortality after the Norwood procedure using right ventricle to pulmonary artery shunt. International journal

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

The Annals of thoracic surgery 87 ( 1 ) 178 - 85 2009.1

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

BACKGROUND: The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. METHODS: Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). RESULTS: Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age <37 weeks), body weight less than 2.5 kg at stage 1 operation, and tricuspid regurgitation 2+ or more were associated with mortality. Using Cox regression analysis, body weight less than 2.5 kg and tricuspid regurgitation 2+ or more were two independent factors associated with midterm survival. CONCLUSIONS: From 9 years of experience, despite good early survival after Norwood stage 1 palliation, low body weight and tricuspid valve regurgitation were still associated with worse outcome. More efforts should be made to improve the late results for patients with hypoplastic left heart syndrome.

DOI： 10.1016/j.athoracsur.2008.08.027

Effect of modified ultrafiltration on postoperative course in neonates with complete transposition of the great arteries undergoing arterial switch operation.

Yasuhiro Kotani, Osami Honjo, Satoru Osaki, Takuya Kawabata, Shinya Ugaki, Yasuhiro Fujii, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Shunji Sano

Circulation journal : official journal of the Japanese Circulation Society 72 ( 9 ) 1476 - 80 2008.9

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

BACKGROUND: The purpose of the present study was to evaluate the effect of modified ultrafiltration (MUF) on neonates with transposition of the great arteries (TGA) undergoing arterial switch operation. METHODS AND RESULTS: The current study included 36 neonates who underwent an arterial switch operation between 1998 and 2006. Arterio-venous MUF was done in 15 patients (MUF-treated group) and the other 21 patients were controls. Parameters included hematocrit, hemodynamics, pulmonary function, drain loss, leak of peritoneal fluid, length of intubation, and intensive care unit (ICU) stay. The hematocrit increased from 34+/-2% to 47+/-4% in the MUF-treated group. Blood pressure in the MUF-treated group was significantly increased without any change of central venous or left atrial pressure. Post-operative oxygenation in the MUF-treated group was greater than that of the control group (P/F ratio: 258+/-92 vs 170+/-100 mmHg, p<0.05), which did not contribute to decrease in intubation time (54+/-33 vs 52+/-29 h, p=NS). Post-operative chest drain loss and peritoneal fluid leak were comparable. The ICU stay in the MUF-treated group was significantly shorter than that in the controls (101+/-34 vs 139+/-42 h, p<0.05). CONCLUSIONS: MUF brought improvement in blood pressure and gas exchange capacity and subsequent shorter ICU stay. MUF did not have significant impact on intubation time and capillary leak.

[Surgical treatment of transposition of great arteries: the coronary buttons transfer using medially based trapdoor flaps].

Shingo Kasahara, S Sano, K Yoshizumi, Y Oshima, K Ishino, M Kawada

Kyobu geka. The Japanese journal of thoracic surgery 61 ( 4 ) 287 - 92 2008.4

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

The arterial switch operation (ASO) has become the primary surgical approach used for correction of transposition of the great arteries. All the prerequisites for a successful ASO were recognized in time and dealt with, which allowed general acceptation of the technique. We report on our technique for the procedure and the result to date. From January 1991 to January 2008, a total of 100 patients underwent ASO at our unit using medially-based trapdoor flap method. The neo-pulmonary artery (PA) was reconstructed using a single rectangular pericardial patch. The initial patient having intramural coronary artery died due to ischemic event after Aubert procedure. Three patients had re-right ventricular out flow tract repair (RVOTR) in a long-term follow-up period. There was no significant aortic insufficiency, no ischemic event and no lethal arrhythmia.

不整脈源性右室心筋症に伴う難治性心室頻拍に対するtotal cavopulumonary connection術後、心不全を繰り返した1例

尾上豪, 福家聡一郎, 宮地晃平, 村上正人, 西井伸洋, 永瀬聡, 中村一文, 森田宏, 岡岳文, 草野研吾, 大江透, 大島祐, 笠原真悟, 佐野俊二

Journal of Arrhythmia 24 ( Suppl. ) 256 - 256 2008.4

Blunt cardiac rupture in a patient with a history of total correction of tetralogy of Fallot.

Yasuhiro Fujii, Teiji Akagi, Shingo Kasahara, Hideya Mitsui, Kozo Ishino, Shunji Sano

General thoracic and cardiovascular surgery 56 ( 3 ) 134 - 6 2008.3

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

A 35-year-old man with a history of total correction of tetralogy of Fallot (TOF) fell down while riding a bike and experienced blunt cardiac rupture. His vital signs were stable because the bleeding was limited by an adhesion caused by the previous operation. Chest computed tomography clearly displayed the ruptured points, and an emergency operation was performed. Because a pneumothorax was suspected, a cardiopulmonary bypass was established with a femorofemoral bypass while the patient was conscious before artificial ventilation was initiated. Two ruptured points were detected on the anterior wall of the right ventricle and were repaired by suturing. The patient recovered and was discharged without any major complications 40 days after the operation. This is the first published case of blunt cardiac rupture after total correction of TOF.

DOI： 10.1007/s11748-007-0206-7

Impact of miniaturization of cardiopulmonary bypass circuit on blood transfusion requirement in neonatal open-heart surgery

Yasuhiro Kotani, Osami Honjo, Mahito Nakakura, Shinya Ugaki, Takuya Kawabata, Yosuke Kuroko, Satoru Osaki, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Shunji Sano

ASAIO JOURNAL 53 ( 6 ) 662 - 665 2007.11

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

This study was undertaken to determine the impact of miniaturization of a cardiopulmonary bypass (CPB) circuit on blood transfusion and hemodynamics in neonatal open-heart surgery. Neonates (n = 102) undergoing open-heart surgery between 2002 and 2006 were included and divided into three groups: group 1 (n = 28), Dideco 902 oxygenator + 5/16 '' line; group 2 (n = 29), Dideco 901 oxygenator + 1/4 '' line; group3 (n = 45), Dideco 901 oxygenator + 3/16 '' arterial + 1/4 '' venous line. Amount of priming volume, blood and bicarbonate sodium use during CPB, and hemodynamics were compared. Priming volume in the groups 2 and 3 was significantly less compared with the group 1 (group 1, 575 37 ml; group 2, 328 +/- 12 ml, group 3, 326 +/- 5 ml, p < 0.05). Blood transfusion and bicarbonate sodium use during CPB in groups 2 and 3 were significantly less compared with group 1. Hemodynamics during CPB was comparable. There were no differences between groups 2 and 3 in any parameter. Miniaturization of the CPB circuit resulted in decrease in priming volume and subsequent reduction in blood and bicarbonate sodium use. Downsizing the lines had minimal impact on any of the parameters studied, and further efforts should be made to achieve neonatal open-heart surgery without blood transfusion.

DOI： 10.1097/MAT.0b013e318158ddf6

[Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) in adults].

Yu Oshima, Shingo Kasahara, Shunji Sano

Nihon rinsho. Japanese journal of clinical medicine Suppl 5 Pt 2 297 - 9 2007.9

Living-donor lobar lung transplantation for pulmonary arterial hypertension after failure of epoprostenol therapy. International journal

Hiroshi Date, Kengo Fukushima Kusano, Hiromi Matsubara, Aiko Ogawa, Hideki Fujio, Katsumasa Miyaji, Megumi Okazaki, Masaomi Yamane, Shinichi Toyooka, Motoi Aoe, Yoshifumi Sano, Motohiko Hanazaki, Keiji Goto, Shingo Kasahara, Shunji Sano, Tohru Ohe

Journal of the American College of Cardiology 50 ( 6 ) 523 - 7 2007.8

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

OBJECTIVES: The aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment. BACKGROUND: Although continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy. METHODS: From July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients. RESULTS: There was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 +/- 4 mm Hg to 15 +/- 2 mm Hg (p < 0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100% at 5 years for patients receiving LDLLT, and 80% at 1 year, 67% at 3 years, and 53% at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles. CONCLUSIONS: These follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.

Successful intra-postoperative extracorporeal circulatory support with atrial communication for treatment of anomalous left coronary artery from the pulmonary artery: a case report.

Yasuhiro Fujii, Shingo Kasahara, Kazushige Kanki, Hideya Mitsui, Kozo Ishino, Shunji Sano

Acta medica Okayama 61 ( 1 ) 41 - 5 2007.2

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

We describe a successful case of surgical treatment for anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome with severe left ventricular dysfunction. Because of the severe left ventricular dysfunction, we planned to use an extracorporeal membrane oxygenation for heart support until a satisfactory recovery had been established. The left ventricular function significantly recovered in a few days, and the patient could be discharged without any complications.

重症心不全を示すBland-White-Garland症候群の術後に機械的循環補助を用いて救命し得た1乳幼児例

中島真人, 笠原真悟, 大崎悟, 小谷恭弘, 川畑拓也, 黒子洋介, 鵜垣伸也, 藤井泰宏, 大澤晋, 桜井茂, 高橋研, 神吉和重, 三井秀也, 石野幸三, 泉本浩史, 佐野俊二

膜型肺 ( 29 ) 44 - 47 2006.10

Language：Japanese Publisher：膜型人工肺研究会

症例は3ヵ月女児で、高度左室機能低下・僧帽弁逆流を伴う左冠状動脈肺動脈起始異常症と診断された。胸部X線写真は、心胸比70%と右無気肺を示した。心電図で洞性頻脈、軽度ST低下、陰性T波、異常Q波、左室肥大を認めた。左冠状動脈は造影されなかった。経食道心臓超音波検査では、駆出率:測定不能、短縮率:10%、高度〜中等度僧帽弁逆流、左室中隔の壁運動低下がみられた。心房間交通を作成し、大動脈遮断解除後、約30分間の左心補助を行い、右房脱血、上行大動脈送血によるV-A extracorporeal membrane oxygenation(ECMO)へ移行継続した。カテコラミン・血管拡張剤の増量、ECMO補助流量の段階的減量により術後7日目に人工呼吸器から離脱し、短縮率・僧帽弁逆流は改善傾向となり、心胸比も縮小した。修復術後に肺うっ血や肺高血圧の可能性がある症例への心房間交通の作成とECMOを組み合わせた機械的循環補助は、有効であると思われた。

Calcifying fibrous tumor arising from the heart. International journal

Hisayuki Shigematsu, Yoshifumi Sano, Shingo Kasahara, Hiroyuki Yanai, Hiroshi Date

The Journal of thoracic and cardiovascular surgery 132 ( 3 ) e21-2 2006.9

Continuous cerebral and myocardial perfusion during aortic arch repair in neonates and infants

Yasuhiro Kotani, Kozo Ishino, Shingo Kasahara, Ko Yoshizumi, Osami Honjo, Masaaki Kawada, Shunji Sano

ASAIO JOURNAL 52 ( 5 ) 536 - 538 2006.9

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

To minimize myocardial ischemia, we repaired aortic arch obstruction with ventricular septal defect, using two different techniques of cerebral and myocardial perfusion.Seventy-one infants, ages 3 to 137 days, underwent primary repair of coarctation of the aorta (n = 49)/interruption of the aortic arch (n = 22) with ventricular septal defect. In 65 patients, an end-to-end arch anastomosis was performed with cerebral and myocardial perfusion through the innominate or the ascending arterial cannula (non-working beating heart: NWBH). In the remaining 6 patients, an arterial cannula was placed into the innominate artery. With partial cardiopulmonary bypass, the innominate artery was snared proximal to the cannulation site and the ascending aorta was cross-clamped. An extended arch anastomosis was carried out with cerebral perfusion and a working beating heart (WBH).Ten patients (15%) undergoing aortic arch repair with the NWBH technique required cardioplegic arrest to complete a proximal anastomosis, whereas in all 6 repairs with the WBH technique, the extended anastomoses were completed without myocardial ischemia. One hospital death and late death occurred, with an overall survival of 98%.End-to-end arch reconstruction is feasible without myocardial ischemia, using the NWBH technique in patients without hypoplastic arch and using the WBH technique in patients with hypoplastic arch.

DOI： 10.1097/01.mat.0000235276.77489.bb

Advantages of temporary venoatrial shunt using centrifugal pump during bidirectional cavopulmonary shunt

Yasuhiro Kotani, Osami Honjo, Kozo Ishino, Satoru Osaki, Yosuke Kuroko, Takuya Kawabata, Shinya Ugaki, Ko Yoshizumi, Shingo Kasahara, Masaaki Kawada, Shunji Sano

ASAIO JOURNAL 52 ( 5 ) 549 - 551 2006.9

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Single-ventricle palliation without the use of cardiopulmonary bypass carries advantages that reduce systemic edema and inflammatory responses; however, simple clamping of the superior vena cava (SVC) without a temporary shunt leads to increase in cerebral venous pressure and subsequent decrease in cerebral blood flow during bidirectional cavopulmonary shunt (BCPS). We report our experience of BCPS, using a centrifugal pump-assisted temporary shunt.The criteria included an unrestrictive interatrial communication, the absence of atrioventricular valve regurgitation, and the existence of an antegrade pulmonary blood flow. From August 2000, 14 children with single-ventricle physiology met the criteria. The mean age was 1.0 +/- 0.9 years, and the mean weight was 8.4 +/- 2.6 kg. A temporary shunt was established between the SVC and the right atrium with right-angle cannulae, which were connected to a centrifugal pump to accelerate the blood flow from the SVC to the right atrium.All patients tolerated the procedure. Mean central venous pressure was 17 +/- 4 mm Hg, and transcutaneous oxygen saturation was maintained at 77 +/- 8% during anastomosis. No patients required blood transfusion. There were no postoperative neurological complications.The centrifugal pump-assisted temporary shunt offered safer and more effective circulatory support than other shunt systems, with excellent venous drainage in pediatric patients undergoing BCPS.

DOI： 10.1097/01.mat.0000235454.64316.f3

Mid-term results for double inlet left ventricle and similar morphologies: timing of Damus-Kaye-Stansel. International journal

Andrew J B Clarke, Shingo Kasahara, David R Andrews, Stephen G Cooper, Ian A Nicholson, Richard B Chard, Graham R Nunn, David S Winlaw

The Annals of thoracic surgery 78 ( 2 ) 650 - 7 2004.8

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

BACKGROUND: Patients with double inlet left ventricle/l-transposition and similar morphologies have their systemic outflow traverse a bulboventricular foramen (BVF), which has a propensity to narrow over time. A Norwood procedure may be performed as the initial palliation. We prefer aortic arch repair and pulmonary artery banding, delaying Damus-Kaye-Stansel (DKS) or BVF resection until the second palliation. The aims of this study were to compare our results with those reported for Norwood strategy and examine the development of systemic outflow obstruction. METHODS: Retrospective study of patients with double inlet left ventricle, L-TGA or similar morphology presenting between 1990 and 2000. Follow-up with clinical assessment, echocardiography and catheter studies. RESULTS: Twenty-five patients had initial palliation with pulmonary artery banding with repair of any associated arch obstruction. Twelve patients had DKS performed as part of their second stage procedure, and 3 had DKS performed later for recurrent stenosis after prior enlargement of BVF. Six patients had BVF resection without later restenosis and 4 patients did not develop BVF stenosis. There was one early death (4%) and two late (8%). Fontan completion was achieved in 20 of the 22 survivors. There were no cases of DKS obstruction, no pulmonary valve had more than mild regurgitation. CONCLUSIONS: Our approach achieves low operative mortality and morbidity and compares favorably with reported results for Norwood palliation. The significant rate of systemic outflow obstruction in those who did not undergo DKS at the second stage confirms the utility of early DKS in children with this morphology.

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