Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. Reviewed International journal

Yasuyuki Kobayashi, Shingo Kasahara, Shunji Sano, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 165 ( 2 ) 411 - 421 2023.2

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

OBJECTIVES: We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes. METHODS: This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan-Meier method. RESULTS: The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor. CONCLUSIONS: Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth.

DOI： 10.1016/j.jtcvs.2022.07.041

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A case report of bacteremia caused by dental endodontic treatment in a patient with single ventricle Reviewed

Kazuhiro Omori, Norihisa Toh, Hidetaka Ideguchi, Kentaro Okamoto, Hidefumi Sako, Kanako Kodam, Tadashi Yamamoto, Teiji Akagi, Shingo Kasahara, Hiroshi Ito, Shogo Takashib

12 ( 2 ) 1 - 8 2023.2

Exercise-Induced Ischemic ST-Segment Elevation in Anomalous Origin of the Right Coronary Artery From the Left Sinus of Valsalva With an Intramural Course and Blocked Coronary Bypass

Kenta Hirai, Daiki Ousaka, Yosuke Kuroko, Shingo Kasahara

Cureus 14(12):e32418 2022.12

Repeated Syncope During Exercise as a Result of Anomalous Origin of Left Coronary Artery With Intramural Aortic Course in a Teenage Boy

Naofumi Amioka, Kazufumi Nakamura, Naoaki Matsuo, Atsuyuki Watanabe, Yasuhiro Kotani, Shingo Kasahara, Hiroshi Ito

Texas Heart Institute Journal 49 ( 6 ) e217677 2022.11

Publishing type：Research paper (scientific journal) Publisher：Texas Heart Institute Journal

Anomalous origin of the left coronary artery from the opposite sinus of Valsalva with an intramural aortic course (L-ACAOS-IM) can cause syncope, sometimes as a prodrome of lethal events, including sudden cardiac death, in young athletes. The detailed mechanism of syncope in patients with L-ACAOS-IM is still unclear. This case report describes a 17-year-old boy who presented to the hospital because of syncope following chest pain with increasing frequency during exercise, such as playing soccer and running. In a treadmill exercise test, a decrease in blood pressure was seen (from 99/56 mm Hg to 68/38 mm Hg); chest pain and faintness accompanied by ST-segment elevation in lead aVR and ST-segment depression at other leads on electrocardiography were noted. These findings and symptoms disappeared spontaneously within a few minutes while clinicians prepared for emergency medications. Coronary computed tomography angiography (CCTA) showed that the origin of the left coronary artery (LCA) was the opposite sinus of Valsalva, and the course of the LCA was through the aortic wall toward the left coronary sinus. He was diagnosed with L-ACAOS-IM. After surgical treatment by unroofing the intramural part of the LCA and reconstructing a neo-ostium, he no longer experienced syncope during exercise. This case suggests that low cardiac output caused by myocardial ischemia, not life-threatening arrythmia, is a main mechanism of syncope in patients with L-ACAOS-IM. Consideration should be given to performing CCTA before an exercise stress test for young patients with syncope and chest pain to avoid the risk of severe myocardial ischemia.

DOI： 10.14503/thij-21-7677

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Physiologic biventricular repair in a patient with unrepaired adult congenital heart disease with severe cyanosis. International journal

Hiroyuki Suzuki, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

JTCVS techniques 15 220 - 223 2022.10

Modified Konno procedure for structural valve deterioration of freestyle bioprosthesis

Naohiro Horio, Masanori Hirota, Takanori Suezawa, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

Chirurgia (Turin) 35 ( 5 ) 299 - 301 2022.10

Publishing type：Research paper (scientific journal)

Although the freestyle aortic root bioprosthesis offers excellent clinical outcomes, the surgical mortality after reoperation is extremely high compared to that after aortic valve replacement and Bentall operation. We have described a surgical technique for structural valve deterioration of the freestyle bioprosthesis with a small aortic annulus. Modified Konno procedure with anterior aortic annular enlargement was indicated to repair the tentative pseudoaneurysm. Postoperative image of the aortic root showed a successful reconstruction without stenosis. This approach was found to be safe and efficient in this complicated reintervention case.

DOI： 10.23736/S0394-9508.21.05376-6

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Sinus plication technique for neoaorta dilation and regurgitation in patients with repaired congenital heart diseases. International journal

Eiri Kisamori, Yasuhiro Kotani, Hiroyuki Suzuki, Shingo Kasahara

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 62 ( 4 ) ezac456 2022.9

男女を問わず外科医が輝き続けるためにステレオタイプ・スレットという問題とニュースレターの果たす役割

竹原裕子, 溝尾妙子, 小林純子, 坂本美咲, 新田薫, 工藤由里絵, 安井和也, 菊池覚次, 黒田新士, 吉田龍一, 岡崎幹生, 枝園忠彦, 山根正修, 小谷恭弘, 豊岡伸一, 笠原真悟, 土井原博義, 藤原俊義

日本外科学会雑誌 123 ( 5 ) 501 - 502 2022.9

Repair of common atrioventricular valve in univentricular circulation using adjustable annular bridging technique

Kasahara S, Kotani Y

Operative Techniques in Thoracic and Cardiovascular Surgery 27 ( 3 ) 302 - 308 2022.9

Right Vertical Infra-Axillary Thoracotomy Approach in Simple Congenital Heart Diseases

Kobayashi Y, Kasahara S, Kotani Y

Operative Techniques in Thoracic and Cardiovascular Surgery 27 ( 3 ) 294 - 301 2022.9

Journey Toward Improved Long-Term Outcomes After Norwood-Sano Procedure: Focus on the Aortic Arch Reconstruction

Sano S, Sano T, Kobayashi Y, Kotani Y, Couretas PC, Kasahara S

World Journal for Pediatric & Congenital Heart Surgery 13 ( 5 ) 581 - 587 2022.9

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Hideo Ohuchi, Masaaki Kawata, Hideki Uemura, Teiji Akagi, Atsushi Yao, Hideaki Senzaki, Shingo Kasahara, Hajime Ichikawa, Hirohiko Motoki, Morio Syoda, Hisashi Sugiyama, Hiroyuki Tsutsui, Kei Inai, Takaaki Suzuki, Kisaburo Sakamoto, Syunsuke Tatebe, Tomoko Ishizu, Yumi Shiina, Shigeru Tateno, Aya Miyazaki, Norihisa Toh, Ichiro Sakamoto, Chisato Izumi, Yoshiko Mizuno, Atsuko Kato, Koichi Sagawa, Ryota Ochiai, Fukiko Ichida, Takeshi Kimura, Hikaru Matsuda, Koichiro Niwa

Circulation Journal 86 ( 10 ) 1591 - 1690 2022.9

A Ruptured Coronary Artery Aneurysm Secondary to Kawasaki Disease. International journal

Hiroyuki Suzuki, Yosuke Kuroko, Yasuhiro Kotani, Naoya Sakoda, Shingo Kasahara

JACC. Case reports 4 ( 13 ) 790 - 793 2022.7

Language：English

Coronary artery aneurysm occurs in 0.3%-0.8% of patients with Kawasaki disease, and cases of rupture are extremely rare. Only 2 cases have been reported in which the patients survived. We report a case of ruptured coronary artery aneurysm that was treated with coronary artery bypass grafting and extracorporeal membrane oxygenation. (Level of Difficulty: Advanced.).

DOI： 10.1016/j.jaccas.2022.05.012

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成人に到達した二心室修復術後の純型肺動脈閉鎖における小児期の三尖弁サイズの推移と成人期心不全発症の関連について

杜徳尚, 小谷恭弘, 中島充貴, 黒子洋介, 馬場健児, 赤木禎治, 笠原真悟, 伊藤浩

日本小児循環器学会総会・学術集会抄録集 58回 [II - 04] 2022.7

Impact of decompression of the right ventricle on the sinusoidal communications in pulmonary atresia and intact ventricular septum International journal

Takahiro Eitoku, Shingo Kasahara, Kenji Baba, Yasuhiro Kotani

The Journal of Thoracic and Cardiovascular Surgery 163 ( 6 ) 2210 - 2215 2022.6

Vascular occlusion with 0.035-inch hydrogel expandable coils in congenital heart diseases and vascular anomalies. International journal

Kenji Baba, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Kenta Hirai, Shinichi Otsuki, Tomoyuki Kanazawa, Tatsuo Iwasaki, Toshihiro Iguchi, Norihisa Toh, Yasuhiro Kotani, Shingo Kasahara

Journal of cardiology 80 ( 3 ) 249 - 254 2022.5

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

BACKGROUND: We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields. METHODS: This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020. RESULTS: Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications. CONCLUSIONS: The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

DOI： 10.1016/j.jjcc.2022.04.005

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Staged Repair of Tetralogy of Fallot: A Strategy for Optimizing Clinical and Functional Outcomes. International journal

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Takuya Kawabata, Shunji Sano, Shingo Kasahara

The Annals of thoracic surgery 113 ( 5 ) 1575 - 1581 2022.5

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

BACKGROUND: This study evaluated the impact of a staged surgical strategy incorporating a modified Blalock-Taussig shunt (BTS) for tetralogy of Fallot on pulmonary valve annulus growth, the rate of valve-sparing repair at the time of intracardiac repair, and long-term functional outcomes. METHODS: This retrospective study involved 330 patients with tetralogy of Fallot who underwent intracardiac repair between 1991 and 2019 and included 57 patients (17%) who underwent BTS. The mean follow-up period was 15.0 ± 7.3 years. We compared the data of patients who underwent BTS and patients who did not undergo BTS before intracardiac repair. RESULTS: The median age before BTS was 71 days (range, 28 to 199) and the median body weight was 4.3 kg (range, 3.3 to 6.8 kg). There were no inhospital or interstage deaths after BTS. The pulmonary valve annulus Z scores of patients with BTS revealed significant growth after BTS (from -4.2 ± 1.8 to -3.0 ± 1.7, P < .001). Valve-sparing repair was eventually performed in 207 patients (63%), including 26 (46%) who underwent staged repair. The overall freedom from pulmonary regurgitation-related reintervention was 99.7%, 99.1%, and 95.8% at 1, 5, and 20 years, respectively. CONCLUSIONS: A staged surgical strategy incorporating BTS as the first palliation for symptomatic patients resulted in no mortality. Blalock-Taussig shunt may have contributed to the avoidance of primary transannular patch repair and facilitated pulmonary valve annulus growth; therefore, approximately half of the symptomatic neonates and infants were recruited for valve-sparing repair. Staged repair may have led to functionally reliable delayed transannular patch repair, thereby resulting in fewer surgical reinterventions.

DOI： 10.1016/j.athoracsur.2021.01.087

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Impact of pulmonary artery coarctation on pulmonary artery growth and definitive repair following modified Blalock-Taussig shunt. International journal

Yasuhiro Kotani, Yasuyuki Kobayashi, Sachiko Kadowaki, Eiri Kisamori, Junko Kobayashi, Takuya Kawabata, Yosuke Kuroko, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 163 ( 5 ) 1618 - 1626 2022.5

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

OBJECTIVE: Pulmonary artery coarctation may pose a risk for pulmonary stenosis and subsequent failure to achieve definitive repair. We sought to assess the impact of pulmonary artery coarctation on pulmonary artery growth. METHODS: A retrospective chart review was performed in 130 patients, including 37 single ventricles with a modified Blalock-Taussig shunt as first palliation. Pulmonary artery coarctation was defined as discrete stenosis of the pulmonary artery, with a diameter of less than 3 mm and with the ductus arteriosus connected. Preoperative echocardiography showed pulmonary artery coarctation in 29 patients (22%). Concomitant pulmonary artery plasty was performed in 14 patients with discrete stenosis having a diameter of less than 2 mm. RESULTS: Pre-modified Blalock-Taussig shunt left pulmonary artery z-scores were lower in patients with pulmonary artery coarctation than in those without (-4.0 [-5.8, -2.1] vs -1.7 [-2.6, -0.8], P < .001), and this remained the same even after modified Blalock-Taussig shunt (-2.5 [-5.1, -0.5] vs -0.5 [-2.4, 0.8], P = .010). Concomitant pulmonary artery plasty did not result in catch-up growth of the left pulmonary artery (post-modified Blalock-Taussig shunt left pulmonary artery z-score in patients with pulmonary artery plasty: -3.0 (-6.5, -2.0) versus those without: -1.8 (-3.3, -0.3), P = .279). Definitive repair/Fontan completion was achieved in 111 patients (85%), and this was not affected by the presence of pulmonary artery coarctation. CONCLUSIONS: Pulmonary artery coarctation affected disproportionate pulmonary artery growth throughout the staged repair, but did not result in failure of definitive repair/Fontan completion. Pulmonary artery plasty during the neonatal period did not contribute to catch-up growth of the left pulmonary artery; therefore, surgical indications and timing should be carefully considered.

DOI： 10.1016/j.jtcvs.2021.09.070

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A highly calcified conduit compressing the heart. International journal

Hiroyuki Suzuki, Eiri Kisamori, Yasuhiro Kotani, Shingo Kasahara

Asian cardiovascular & thoracic annals 30 ( 6 ) 2184923221094958 - 2184923221094958 2022.4

Stepwise Treatment for Heterotaxy Syndrome and Functional Single Ventricle Complicated by Infra-Cardiac Total Anomalous Pulmonary Venous Connection with Ductus Venosus Stent Placement and Subsequent Occlusion

Yuki Imai, Kenji Baba, Shinichi Otsuki, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Yosuke Fukushima, Kenta Hirai, Tatsuo Iwasaki, Tomoyuki Kanazawa, Yasuhiro Kotani, Shingo Kasahara

Pediatric Cardiology 43 ( 4 ) 756 - 763 2022.4

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