Faculty Profiles - FUJII Yasuhiro

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 Publisher：ELSEVIER SCIENCE BV

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 pg ml(-1) (range: 9-382 pg ml(-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, I I 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. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.ejcts.2009.04.042

Age-dependent vulnerability to ischemia-reperfusion injury of cyanotic myocardium in a chronic hypoxic rat model.

Yasufumi Fujita, Kozo Ishino, Koji Nakanishi, Yasuhiro Fujii, Masaaki Kawada, Shunji Sano

Acta medica Okayama 63 ( 5 ) 237 - 42 2009.10

Language：English Publisher：OKAYAMA UNIV MED SCHOOL

This study evaluated the effects of chronic hypoxia from birth on the resistance of rat hearts to global ischemia, with special emphasis on the duration of hypoxia. Male Wistar rats were housed from birth for 4 weeks or 8 weeks either in a hypoxic environment (FiO(2) = 0.12) or in ambient air (8 animals for each group). Isolated rat hearts were perfused for 40 min with oxygenated Krebs-Henseleit buffer, subjected to 20 min global no-flow ischemia at 37 degrees C, and then underwent 40 min of reperfusion. A non-elastic balloon was inserted into the left ventricle and inflated until the pre-ischemic LVEDP rose to 8 mmHg. Cardiac function was measured before and after ischemia. The post-ischemic percent recovery of LVDP in hypoxic hearts was worse than in normoxic hearts (4 weeks: 55 +/- 7 vs. 96 +/- 3%, p < 0.01; 8 weeks: 40 +/- 5 vs. 92 +/- 4 %, p < 0.01), and was worst in the 8-week-hypoxic hearts. Similarly, the percent recovery of +dP/dt in the hypoxic hearts was lower than in the normoxic hearts (4 weeks: 51 +/- 5 vs. %. 7 %, p < 0.01; 8 weeks: 31 +/- 6 vs. 92 +/- 7 %, p < 0.01), and was lowest in the 8-week-hypoxic hearts. In conclusion, cyanotic myocardium revealed an age-dependent vulnerability to ischemia-reperfusion injury in a chronic hypoxic rat model.

DOI： 10.18926/AMO/31840

Norwood+VSD creation―MS/AAを伴ったHLHSに対する新術式―

踵部潰瘍に対する踵骨部分切除術の経験

三井秀也, 櫻井茂, 藤井泰宏, 鵜垣伸也, 宮原義典, 川畑拓也, 高垣昌己, 新井禎彦, 笠原真悟, 佐野俊二, 土持茂之, 池田光則

日本血管外科学会雑誌 18 ( 6 ) 653 - 653 2009.10

海老島宏典, 佐野俊二, 笠原真悟, 新井禎彦, 高垣昌巳, 小谷恭弘, 藤井泰宏

日本小児循環器学会雑誌 25 ( 3 ) 437 - 437 2009.5

単心室患者における体循環流出路狭窄のmanagement―予防的Damns‐Kaye‐Stansel吻合は有用か?―

藤井泰宏, 井上陽一, 高垣昌巳, 新井禎彦, 笠原真悟, 赤木禎治, 小谷恭弘, 大野直幹, 岡本吉生, 大月審一, 佐野俊二

日本小児循環器学会雑誌 25 ( 3 ) 421 - 421 2009.5

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

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

ASAIO journal (American Society for Artificial Internal Organs : 1992) 55 ( 3 ) 296 - 9 2009.5

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

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 <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 <20% and/or mixed venous oxygen saturation of <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 < 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 <10 kg and/or with complex congenital heart disease. ASAIO Journal 2009; 55:296-299.

DOI： 10.1097/MAT.0b013e31819742f0

カテーテル治療のコントラバーシーカテーテル治療か手術か? 成人期心房中隔欠損に対するカテーテル閉鎖術と外科手術の臨床成績比較単一施設における後方視的非ランダマイズ化検討

藤井泰宏, 赤木禎治, 谷口学, 富井奉子, 新井禎彦, 笠原真悟, 戸田雄一郎, 岩崎達雄, 岡本吉生, 大月審一, 佐野俊二

日本小児循環器学会雑誌 25 ( 3 ) 329 - 329 2009.5

MAPCAを有する患者に対する治療戦略と中長期成績

藤井泰宏, 小谷恭弘, 井上陽一, 高垣昌巳, 吉積功, 笠原真悟, 三井秀也, 佐野俊二

日本心臓血管外科学会雑誌 38 ( Suppl. ) 192 - 192 2009.3

小児心臓手術後にextracorporeal membrane oxygenationを導入した55例の検討

笠原真悟, 伊藤英史, 藤井泰宏, 鵜垣伸也, 小谷恭弘, 吉積功, 高垣昌巳, 佐野俊二

日本心臓血管外科学会雑誌 38 ( Suppl. ) 270 - 270 2009.3

new hybrid strategy―HLHS/IAS及びHLHS/ristrictive ASに対する新しい治療戦略

海老島宏典, 笠原真悟, 吉積功, 高垣昌巳, 小谷恭弘, 藤井泰宏, 佐野俊二

日本心臓血管外科学会雑誌 38 ( Suppl. ) 276 - 276 2009.3

成長を考慮した異物を用いない手術術式の工夫―左心低形成症候群とFontan

佐野俊二, 笠原真悟, 吉積功, 小谷恭弘, 藤井泰宏, 徳永宣之, 川畑拓也, 宮原義典, 鵜垣伸也, 桜井茂, 大澤晋, 高垣昌巳, 三井秀也, 石野幸三, 河田政明

日本心臓血管外科学会雑誌 38 ( Suppl. ) 125 - 125 2009.3

Norwood手術後の肺・体血流比安定化のための戦略:クリップを用いた肺血流制御

小谷恭弘, 笠原真悟, 藤井泰宏, 吉積功, 高垣昌巳, 石野幸三, 河田政明, 佐野俊二

日本心臓血管外科学会雑誌 38 ( Suppl. ) 278 - 278 2009.3

新生児・乳児体外循環の復温技術に関する一考察

伊藤英史, 黒光弘幸, 川村宜寛, 堂口琢磨, 中倉真人, 藤井泰宏, 大島祐, 吉積功, 笠原真悟, 佐野俊二

体外循環技術 36 ( 1 ) 21 - 23 2009.3

Language：Japanese Publisher：(一社)日本体外循環技術医学会編集委員会

新生児・乳児体外循環の復温技術について考察した。岡山大学病院で2005年1月から2006年12月までに行われた新生児・乳児体外循環症例のうちSorin社製膜型人工肺D901を使用した151例について後方視研究を行った。その結果、Φ:復温係数(L/kg/m2)、T:復温時間(min)、P:温度較差(℃)、Q:灌流量(L/min)、R:体重(kg)、S:体表面積(m2)とすると、Φ=(T*Q)/(R*S)=1.2803P+3.8323の式が算出された。この復温係数とは復温時間に灌流量を乗じ、体重と体表面積で除したものと定義した。復温係数を用いることで、新生児・乳児体外循環の復温過程における適正な灌流量の維持と復温予測時間の算出が可能であり、理論的で科学的な復温操作が行える可能性が示唆された。(著者抄録)

J-GLOBAL

Other Link： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01893&link_issn=&doc_id=20090310150007&doc_link_id=%2Fcz4jsect%2F2009%2F003601%2F007%2F0021-0023%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcz4jsect%2F2009%2F003601%2F007%2F0021-0023%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Clinical outcome of Fontan operation in the patients with impaired cardiac function

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

JOURNAL OF CARDIAC FAILURE 14 ( 7 ) S151 - S151 2008.9

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 Publisher：JAPANESE CIRCULATION SOC

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 +/- 29h, 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.

DOI： 10.1253/circj.CJ-08-0065