Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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大型動物の下大静脈絞扼モデルを用いた腹部臓器うっ血による臓器障害評価

後藤拓弥, 逢坂大樹, 佐野俊和, 平井健太, 笠原真悟, 王英正

日本小児循環器学会雑誌 34 ( Suppl.1 ) s1 - 269 2018.7

下大静脈絞扼を用いたプレコンディショニング戦略は大動物フォンタンモデル作成時の急激な循環変動を抑制する

逢坂大樹, 後藤拓弥, 佐野俊和, 平井健太, 笠原真悟, 王英正

日本小児循環器学会雑誌 34 ( Suppl.1 ) s1 - 385 2018.7

Treat-and-repair strategy is a feasible therapeutic choice in adult patients with severe pulmonary arterial hypertension associated with a ventricular septal defect: case series. International journal

Satoshi Akagi, Shingo Kasahara, Toshihiro Sarashina, Kazufumi Nakamura, Hiroshi Ito

European heart journal. Case reports 2 ( 2 ) yty033 2018.6

Language：English

Introduction: Recent advances in pulmonary arterial hypertension (PAH)-specific drugs have dramatically changed the therapeutic strategy for PAH. A strategy that includes 'treatment' with PAH-specific drugs initially and then 'repair' by closure of the cardiac defect (i.e. 'treat and repair') was devised, and has been attempted, in patients with PAH associated with a cardiac defect. Case presentation: We present three cases of severe PAH associated with a ventricular septal defect (VSD) in adult patients who were initially treated with PAH-specific drugs followed by VSD closure. Two of the patients were treated with a combination of an endothelin receptor antagonist (ERA), phosphodiesterase type 5 inhibitor, and intravenous prostacyclin before VSD closure. The third patient was treated with an ERA and pulmonary artery banding before VSD closure. After 12 months of anti-PAH treatment, the pulmonary vascular resistance index and the ratio of the pulmonary vascular index to the systemic vascular resistance index decreased to levels that allowed VSD closure. At the mid- and long-term follow-up measurements after surgical closure of the VSD, the mean pulmonary artery pressure had markedly decreased. Discussion: Our case series suggests that the treat-and-repair strategy is a promising approach for adult patients with severe PAH associated with VSD.

DOI： 10.1093/ehjcr/yty033

PubMed

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EVAR時代の開腹手術の現状

大澤晋, 藤井泰宏, 奥山倫弘, 黒子洋介, 小林泰幸, 村岡玄哉, 笠原真悟

日本血管外科学会雑誌 27 ( Suppl. ) P11 - 1 2018.6

Progression of pulmonary artery dilatation in patients with pulmonary hypertension coexisting with a pulmonary artery aneurysm. International journal

Satoshi Akagi, Kazufumi Nakamura, Toshihiro Sarashina, Kentaro Ejiri, Shingo Kasahara, Hiroshi Ito

Journal of cardiology 71 ( 5 ) 517 - 522 2018.5

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

BACKGROUND: Pulmonary artery (PA) dilatation is usually observed in patients with pulmonary hypertension (PH), but a PA aneurysm (PA diameter > 40mm) is rare. The difference between characteristics of patients with and those without progression of PA diameter remains poorly understood. We assessed the changes in PA diameter in patients with PH coexisting with and without a PA aneurysm. METHODS: We investigated the changes in PA diameter by multi-detector computed tomography performed twice with an interval of more than one year in 44 patients with PH. Seventeen patients had a PA aneurysm and 27 patients did not have a PA aneurysm at baseline. RESULTS: The median follow-up period was 3.6 years. All patients received medical or invasive treatment for PH. At baseline, main PA diameters were 52±15mm in patients with a PA aneurysm and 33±3mm in patients without a PA aneurysm. Mean PA pressure was higher in patients with a PA aneurysm than in those without a PA aneurysm (61±15mmHg vs. 51±16mmHg, p=0.04). At follow-up, mean PA pressure significantly decreased in both patients with a PA aneurysm (44±11mmHg) and patients without a PA aneurysm (41±18mmHg). Main PA diameter significantly increased in patients with a PA aneurysm (65±28mm, change ratio: 23.3%), while it did not increase in patients without a PA aneurysm (32±3mm, change ratio: -3.1%). CONCLUSIONS: PA dilatation progressed in patients with a PA aneurysm despite treatment of PH. The progression of PA dilatation is independent of reduction of PA pressure by PH treatment.

DOI： 10.1016/j.jjcc.2017.11.005

PubMed

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A case of conservative management for left ventricular giant pseudoaneurysm without ST segment changes.

Daiki Ousaka, Naruki Obara, Megumi Fujiwara, Koushi Nakagawa, Akira Teraoka, Shingo Kasahara, Susumu Oozawa

Journal of cardiology cases 17 ( 5 ) 167 - 170 2018.5

Language：English

Left ventricular (LV) rupture after myocardial infarction (MI) occasionally results in formation of LV pseudoaneurysm (LVPA) which is prone to rupture because of its thin wall. However, cases of LVPA without ST changes including segment elevation in electrocardiogram (ECG) are rare. In this case, we describe a patient who had relatively mild symptoms and giant LVPA with no specific ECG changes following MI with a confirmed diagnosis via transthoracic echocardiography. Although surgical treatment options are often recommended, conservative therapy was adopted, following which the patient had been well-medicated using antihypertensive drugs and anticoagulants. <Leaning objectives: Left ventricular pseudoaneurysm (LVPA) is usually accompanied by ST segment changes on electrocardiogram (ECG) due to myocardial damage. However, we should take into account a LVPA without ECG specific changes, so echocardiography is better to be considered for an identification. Although many LVPA patients undergo surgery because of risk for rupture, some cases with stable hemodynamic status can have long-term survival with conservative therapy such as anti-hypertension and coagulation.>.

DOI： 10.1016/j.jccase.2018.01.006

PubMed

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不全型ベーチェット病患者における大動脈基部置換術後の吻合部仮性瘤、感染性心内膜炎に対するホモグラフトを用いた大動脈基部置換術

後藤拓弥, 黒子洋介, 川畑拓也, 衛藤弘城, 小林泰幸, 逢坂大樹, 笠原真悟, 増田善逸

日本心臓血管外科学会雑誌 47 ( 3 ) 133 - 137 2018.5

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

ベーチェット病を基礎疾患に持つ患者の大動脈弁手術は、術後高率に弁周囲逆流、弁動揺、そして吻合部仮性瘤を合併することが知られている。患者は37歳の男性で、大動脈弁置換術直後に高度な弁周囲逆流により基部置換術が行われ、その後も吻合部仮性瘤を繰り返し、経過中に不全型ベーチェット病と診断されステロイドによる加療が開始された。その後、ベーチェット病に対する免疫抑制療法導入中にStaphylococcus epidermidisによる菌血症をきたし、大動脈基部に吻合部仮性瘤が再燃した。6週間の抗生剤加療の後にホモグラフトによる大動脈基部置換術を施行し5年間、問題なく経過しているため報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01122&link_issn=&doc_id=20180531170009&doc_link_id=10.4326%2Fjjcvs.47.133&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.47.133&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Impact of Cardiac Progenitor Cells on Heart Failure and Survival in Single Ventricle Congenital Heart Disease. International journal

Toshikazu Sano, Daiki Ousaka, Takuya Goto, Shuta Ishigami, Kenta Hirai, Shingo Kasahara, Shinichi Ohtsuki, Shunji Sano, Hidemasa Oh

Circulation research 122 ( 7 ) 994 - 1005 2018.3

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

RATIONALE: Intracoronary administration of cardiosphere-derived cells (CDCs) in patients with single ventricles resulted in a short-term improvement in cardiac function. OBJECTIVE: To test the hypothesis that CDC infusion is associated with improved cardiac function and reduced mortality in patients with heart failure. METHODS AND RESULTS: We evaluated the effectiveness of CDCs using an integrated cohort study in 101 patients with single ventricles, including 41 patients who received CDC infusion and 60 controls treated with staged palliation alone. Heart failure with preserved ejection fraction (EF) or reduced EF was stratified by the cardiac function after surgical reconstruction. The main outcome measure was to evaluate the magnitude of improvement in cardiac function and all-cause mortality at 2 years. Animal studies were conducted to clarify the underlying mechanisms of heart failure with preserved EF and heart failure with reduced EF phenotypes. At 2 years, CDC infusion increased ventricular function (stage 2: +8.4±10.0% versus +1.6±6.4%, P=0.03; stage 3: +7.9±7.5% versus -1.1±5.5%, P<0.001) compared with controls. In all available follow-up data, survival did not differ between the 2 groups (log-rank P=0.225), whereas overall patients treated by CDCs had lower incidences of late failure (P=0.022), adverse events (P=0.013), and catheter intervention (P=0.005) compared with controls. CDC infusion was associated with a lower risk of adverse events (hazard ratio, 0.411; 95% CI, 0.179-0.942; P=0.036). Notably, CDC infusion reduced mortality (P=0.038) and late complications (P<0.05) in patients with heart failure with reduced EF but not with heart failure with preserved EF. CDC-treated rats significantly reversed myocardial fibrosis with differential collagen deposition and inflammatory responses between the heart failure phenotypes. CONCLUSIONS: CDC administration in patients with single ventricles showed favorable effects on ventricular function and was associated with reduced late complications except for all-cause mortality after staged procedures. Patients with heart failure with reduced EF but not heart failure with preserved EF treated by CDCs resulted in significant improvement in clinical outcome. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01273857 and NCT01829750.

DOI： 10.1161/CIRCRESAHA.117.312311

PubMed

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Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery

Yasuhiro Kotani, Shunji Sano, Shingo Kasahara

Operative Techniques in Thoracic and Cardiovascular Surgery 23 ( 1 ) 40 - 48 2018.3

Language：English Publishing type：Research paper (scientific journal) Publisher：W.B. Saunders

It has become increasingly evident that anomalous aortic origin of a coronary artery is considered as an important anatomic anomaly in adolescents and adults. The question is whether or not surgical repair should be performed in asymptomatic patients. Previous reports showed that the numbers of asymptomatic patients who result in a sudden cardiac death are not negligible. Another reason to proceed to surgical intervention is the improvement in understanding this unique anatomy and the refinement of surgical techniques that brought the satisfied outcomes. Physiologic repair, that is, coronary artery bypass grafting was used to be the first choice of surgery
however, anatomic repair, such as coronary implantation and repair of intramural coronary artery is considered favorable in adolescents as “radical” oppose to “palliative” repair. We report our technique to relieve the intramural coronary artery based on the experience in arterial switch operation performed in neonates.

DOI： 10.1053/j.optechstcvs.2018.10.002

Scopus

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Surgery for tricuspid regurgitation in a case of anomalous systemic venous return. International journal

Koki Eto, Yasuhiro Kotani, Yasuyuki Kobayashi, Daichi Edaki, Shingo Kasahara, Zenichi Masuda

Asian cardiovascular & thoracic annals 26 ( 3 ) 227 - 230 2018.3

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

A 75-year-old woman presented with severe tricuspid regurgitation requiring surgical repair. She had extremely rare anomalies in systemic venous return in spite of situs solitus: persistent left superior vena cava with absent right superior vena cava, infrahepatic inferior vena cava interruption, and hemiazygos continuation to a persistent left superior vena cava. These unusual systemic venous anomalies had significantly enlarged the coronary sinus, and the stretched coronary sinus orifice changed the geometry of the tricuspid annulus and triggered tricuspid regurgitation. There were technical difficulties in establishing cardiopulmonary bypass and achieving successful tricuspid valve repair.

DOI： 10.1177/0218492318759153

PubMed

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大動物フォンタン循環モデル作成に向けた下大静脈絞扼によるプレコンディショニング戦略の検証

逢坂大樹, 後藤拓弥, 佐野俊和, 平井健太, 笠原真悟, 王英正

日本循環器学会学術集会抄録集 82回 CP11 - 2 2018.3

単心室における心臓前駆細胞投与後の臨床転帰駆出率の保たれた心不全が及ぼす影響(Clinical Outcome after Cardiac Progenitor Cell Application in Single Ventricles: Impact of Heart Failure with Preserved Ejection Fraction)

佐野俊和, 逢坂大樹, 平井健太, 後藤拓弥, 笠原真悟, 大月審一, 王英正

日本循環器学会学術集会抄録集 82回 OJ09 - 8 2018.3

Change Detection in Vital Signs Associated with Impending Death for Homecare Patients Using a Pressure-Sensing Mat Reviewed International journal

Takayuki Shuku, Noriko Sakano, Mizuki Morita, Shingo Kasahara

European Journal for Biomedical Informatics 14 ( 1 ) 52 - 57 2018.2

Aortopexy for left pulmonary vein obstruction. International journal

Yasuhiro Kotani, Toshikazu Sano, Sadahiko Arai, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 155 ( 2 ) e69-e70 2018.2

成人期のFontan症例に対するV-A Extracorporeal membrane oxygenation

高寛, 堂口琢磨, 西村まどか, 宮本綾子, 高浪大地, 笠原真悟

日本集中治療医学会雑誌 25 ( Suppl. ) [O39 - 6] 2018.2

Prenatal Diagnosis of a Huge Ventriculocoronary Fistula in Pulmonary Atresia with Intact Ventricular Septum Reviewed

Maiko Kondo, Kenji Baba, Yoshihiko Kurita, Takahiro Eitoku, Yusuke Shigemitsu, Yousuke Fukushima, Kenta Hirai, Shingo Kasahara, Tatsuo Iwasaki, Shin-ichi Ohtsuki

Journal of Pediatric Cardiology and Cardiac Surgery 2018

狭小な心房間交通を有する左心低形成症候群に対するBalloon Atrial Septostomyの検討

福嶋遥佑, 馬場健児, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 塚原宏一, 岩崎達雄, 佐野俊二, 笠原真悟, 小谷恭弘, 大月審一

日本小児循環器学会雑誌 33 ( 6 ) 423 - 430 2017.11

Language：Japanese Publisher：(NPO)日本小児循環器学会

背景:左心低形成症候群(HLHS)では左房容積が小さく、心房中隔の形態や心房中隔欠損(ASD)の大きさによってRashkind Balloon Atrial Septostomy(BAS)を行うことが困難な場合もある。目的:当院におけるHLHSに対するBASの有効性について検討した。対象と方法:2006年1月から2015年12月までの10年間にHLHSに対してカテーテル治療・手術を施行した患者におけるBASの有効性について検討した。またcatheter BASを施行した群についてASDの形態別に分けて有効性について両群比較検討した。結果:全HLHS70例中のGlenn手術到達は57例(81%)であり、BAS未施行群では86%(44/51)、catheter BAS群では91%(10/11)、open BAS群では25%(2/8)と統計学的有意差を認めたが(p=0.0002)、BAS未施行群とcatheter BAS群では同等の結果であった。(p=1.0)Glenn手術後にカテーテル検査を施行した56例について検討すると、BAS未施行群、catheter BAS施行群、open BAS施行群の平均肺動脈圧、肺血管抵抗、PAIいずれも3群間に差は認めなかった。次にCatheter BAS施行群をASDの位置・大きさ・atrial septumの厚さからstandard ASD(n=5)、complex ASD(n=5)に分類し、ASDの形態別にBAS施行方法を検討すると、standard ASD群では全例Rashkind BAS単独施行で効果を得たが、complex ASD群ではRashkind BAS単独施行症例は1例のみで、Static BASを先行させRashkind BASに到達した症例が4例であった(p=0.048)。BAS後のASD size、ASD flow、SpO2は2群間で統計学的有意差を認めなかった。結論:catheter BASは有効で、Glenn後のカテーテルデータではBAS未施行群と有意差は認めなかった。またcomplex ASD群の場合には、Static BASを先行し、Rashkind BASを追加することで、standard ASD群と同等の効果を得ることができた。(著者抄録)

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体格の小さな重症心不全患児に対する補助循環の現状

高寛, 堂口琢磨, 西村まどか, 宮本綾子, 高浪大地, 黒子洋介, 笠原真悟

体外循環技術 44 ( 3 ) 257 - 257 2017.9

Direct visualization of the laceration of a dissected pulmonary artery by transthoracic echocardiography: comparison with surgical findings. International journal

Hiroki Oe, Nobuhisa Watanabe, Shingo Kasahara, Hiroshi Ito

European heart journal 38 ( 32 ) 2512 - 2513 2017.8

重篤な低酸素血症のため緊急避難的に冠動脈用stentを留置した肺動脈低形成を伴うPA/VSD、MAPCAの2例

馬場健児, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 福嶋遙佑, 岩崎達雄, 笠原真悟, 佐野俊二, 大月審一

日本小児循環器学会雑誌 33 ( Suppl.1 ) s1 - 348 2017.7

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