Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. International journal

Shunji Sano, Kozo Ishino, Masaaki Kawada, Sadahiko Arai, Shingo Kasahara, Tomohiro Asai, Zen-ichi Masuda, Mamoru Takeuchi, Shin-ichi Ohtsuki

The Journal of thoracic and cardiovascular surgery 126 ( 2 ) 504 - 9 2003.8

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

OBJECTIVE: Pulmonary overcirculation through a systemic-pulmonary shunt has been one of the major causes of early death after the Norwood procedure. To avoid this lethal complication, we constructed a right ventricle-pulmonary shunt in first-stage palliation of hypoplastic left heart syndrome. METHODS: Between February 1998 and February 2002, 19 consecutive infants, aged 6 to 57 days (median, 9 days) and weighing 1.6 to 3.9 kg (median, 3.0 kg), underwent a modified Norwood operation with the right ventricle-pulmonary artery shunt. The procedure included aortic reconstruction by direct anastomosis of the proximal main pulmonary artery and a nonvalved polytetrafluoroethylene shunt between a small right ventriculotomy and a distal stump of the main pulmonary artery. The size of the shunt used was 4 mm in 5 patients and 5 mm in 14. RESULTS: All patients were managed without any particular manipulation to control pulmonary vascular resistance. There were 17 survivors (89%), including 3 patients weighing less than 2 kg. Two late deaths occurred due to obstruction of the right ventricle-pulmonary artery shunt. Thirteen patients underwent a stage II Glenn procedure after a mean interval of 6 months, with 2 hospital deaths. To date, a stage III Fontan procedure has been completed in 4 patients. Overall survival was 62% (13/19). Right ventricular fractional shortening at the last follow-up (3-48 months after stage I) ranged from 26% to 43% (n = 13, mean, 33%). CONCLUSION: Without delicate postoperative management to control pulmonary vascular resistance, the modified Norwood procedure using the right ventricle-pulmonary shunt provides a stable systemic circulation as well as adequate pulmonary blood flow. This novel operation may be particularly beneficial to low-birth-weight infants with hypoplastic left heart syndrome.

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Images in cardiovascular medicine. Incessant ventricular tachycardia in an infant treated with transmural radiofrequency ablation. International journal

Aravinda Thiagalingam, David Winlaw, Aarti Hejmadi, Shingo Kasahara, Sandra Biankin, Susan Arbuckle, David Ross, K C Lau, Graham Nunn

Circulation 105 ( 23 ) 2797 - 8 2002.6

Total right ventricular exclusion procedure: an operation for isolated congestive right ventricular failure. International journal

Shunji Sano, Kozo Ishino, Masaaki Kawada, Shingo Kasahara, Takushi Kohmoto, Mamoru Takeuchi, Shin-Ichi Ohtsuki

The Journal of thoracic and cardiovascular surgery 123 ( 4 ) 640 - 7 2002.4

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

OBJECTIVE: To prevent possible deleterious effects of right ventricular volume overload on cardiorespiratory function, we developed a total right ventricular exclusion procedure for the treatment of end-stage isolated congestive right ventricular failure. METHODS: Since 1996, this procedure has been performed in 5 patients in New York Heart Association functional class IV: 2 adults with arrhythmogenic right ventricular dysplasia and 3 children with Ebstein anomaly. The entire right ventricular free wall was resected along the atrioventricular groove and then parallel to the interventricular septum, sparing the pulmonary valve and a skeletonized right coronary artery. The orifice of the tricuspid valve was closed with either a polytetrafluoroethylene patch or with its leaflets. The defect of the right ventricular free wall was covered with a polytetrafluoroethylene patch in the 2 patients with arrhythmogenic right ventricular dysplasia and directly closed with the remnant of the free wall in the 3 children with Ebstein anomaly. After resection of a redundant right atrial wall, coronary sinus blood flow was rerouted into the left atrium through an atrial septal defect. A total cavopulmonary connection was constructed in 4 patients and a bidirectional superior cavopulmonary anastomosis in 1 infant. The heart was controlled with a DDD pacemaker in 3 patients. RESULTS: The patients were extubated at a mean of 14 hours postoperatively (range, 1-38 hours). There were no early or late deaths. At follow-up, ranging from 8 to 57 months, the mean cardiothoracic ratio had decreased from 74% +/- 7% before the operation to 52% +/- 6% (P <.01). All patients are in functional class I. Neither of the patients with arrhythmogenic right ventricular dysplasia have had attacks of ventricular tachycardia nor are they using antiarrhythmic medication. CONCLUSIONS: The total right ventricular exclusion procedure provides effective decompression of the lung, as well as the left ventricle, and may result in more effective volume loading of a surgically created single ventricle with increased systemic output. We believe that this new surgical option offers rescue treatment for isolated end-stage right ventricular failure in critically ill patients.

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Long-Term Follow Up of Ventricular Endocardial Pacing Leads. Complications, Electrical Performance, and Longevity of 561 Right Ventricular Leads.:Complications, Electrical Performance, and Longevity of 561 Right Ventricular Leads

KAZAMA Shigeru, NISHIYAMA Kiyotaka, MACHII Masato, TANAKA Katsuhiko, AMANO Takaomi, NOMURA Tomokiyo, OHUCHI Motofumi, KASAHARA Shingo, NIE Masaki, ISHIHARA Akira

International Heart Journal 34 ( 2 ) 193 - 200 1993

Language：English Publisher：International Heart Journal Association

Five hundred and sixty-one endocardial pacing leads implanted in the right ventricle of 502 patients between 1971 and 1990 were followed for up to 17 years regarding their complications, stimulation threshold behavior, and overall longevity.<br>Lead tip dislodgement occurred in 16 leads (2.9%), in 14 of which dislodgement occurred within 2 months after implantation. The incidence of dislodgement was significantly smaller in tined leads than in nontined leads. Lead conductor fracture occurred in 19 leads (3.4%), in 15 of which fracture occurred within 5 years after implantation. Two particular sites of lead fracture were identified; i.e., one within the pacemaker pocket and the other at a particular point in the subclavian vein between the clavicle and the first rib. Fixation ligature in the former site and the venopuncture point for lead insertion in the latter site are thought to be related to lead fracture.<br>Other complications included insulator break in 3 leads (0.5%), exit block in 7 leads (1.2%), and poor sensing in 2 leads (0.4%).<br>The cumulative survival of leads was 94.1±2.7% (mean±95% confidence interval) at 5 years, 86.3±6.3% at 10 years, and 74.2±14.0% at 15 years after implantation.<br>The minimal stimulation threshold, lead impedance and R wave amplitude were all found to be stable for up to 10 years, and there were no tendencies toward higher stimulation threshold during the observation period of this study.

DOI： 10.1536/ihj.34.193

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