Faculty Profiles - MITSUI Takashi

最近当科で経験した有嚢性横隔膜ヘルニア(CDH)の2例を報告する。【症例1】初産、38週3日、胎児心奇形を疑い当科に紹介受診し、超音波精査でCDH、完全口唇口蓋裂、及び総肺静脈還流異常症(TAPVC)が疑われた。MRI検査では横隔膜の挙上が認められた。肺胸郭断面積比は0.22-0.28であり他科との相談の上、経腟分娩可能と判断、39週3日2,552g、女児、AP-s 3/3点自然分娩で出生。46XX、dup(5)q31.1-q33.1部分トリソミー、出生後大動脈離断症(IAA)、心室中隔欠損(VSD)、卵円孔開存(PFO)、動脈管開存症(PDA)と診断。Stabilization後、日齢1、開腹下で縫縮術を施行、術後診断は左有嚢性CDHであった。日齢20、心臓手術施行、術後経過良好。現在経過観察中である。【症例2】1経妊1経産。在胎9週3日多発性海綿状血管腫合併妊娠のため、当科紹介受診。その後FGR傾向が認められたが、明らかな胎児異常は認められず、38週3日母体適応による選択的帝王切開を施行。2,400g、女児、AP-s 8/8点、出生後呼吸状態が悪化し挿管となった。胸部CT検査で原因不明の左横隔膜挙上と左肺虚脱を認め、左横隔膜弛緩症が疑われ、日齢0、当院NICU入院。日齢2、胸腔鏡下で縫縮術を施行。術後診断は有嚢性CDHであった。経過良好で退院。【考察】高率で他の先天異常を合併し、出生後治療に向け画像検査で正確な評価が必要となるCDHに対し、予後判定に有用な指標が確立されつつある。症例1はその予後判定を行い、経腟分娩を選択し生児を得た後、CDH縫縮術及び心臓手術を無事施行できた。出生前診断が困難であったCDH単独発症の1例と併せ文献的考察を絡め報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05038&link_issn=&doc_id=20160624350010&doc_link_id=%2Fcv0mtrob%2F2015%2F006402%2F010%2F0193-0197%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcv0mtrob%2F2015%2F006402%2F010%2F0193-0197%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

除細動器植え込み術後の閉塞性肥大型心筋症患者の妊娠を継続し、生児を得た一例 Reviewed

光井崇, 増山寿, 江尻健太郎, 江口武志, 玉田祥子, 平野友美加, 衛藤英理子, 早田桂, 伊藤浩, 平松祐司

超音波医学 43 ( Suppl. ) S836 - S836 2016.4

有嚢性横隔膜ヘルニアの2例 Reviewed

牧尉太, 平野友美加, 玉田祥子, 江口武志, 光井崇, 延本悦子, 早田桂, 増山寿, 平松祐司

超音波医学 43 ( Suppl. ) S854 - S854 2016.4

NIPT陽性9例に施行した胎児超音波検査所見について

早田桂, 牧尉太, 江口武志, 玉田祥子, 光井崇, 平野友美加, 衛藤英理子, 延本悦子, 増山寿, 平松祐司

超音波医学 43 ( Suppl. ) S849 - S849 2016.4

診断に難渋した先天性サイトメガロウイルス感染症の一例

玉田祥子, 牧尉太, 江口武志, 光井崇, 平野友美加, 衛藤英理子, 延本悦子, 早田桂, 増山寿, 平松祐司

超音波医学 43 ( Suppl. ) S855 - S855 2016.4

胎児期に診断された心臓腫瘍の新生児経過と予後の検討

江口武志, 玉田祥子, 光井崇, 平野友美加, 衛藤英理子, 早田桂, 増山寿, 平松祐司, 近藤麻衣子, 馬場健児

超音波医学 43 ( Suppl. ) S702 - S702 2016.4

NIPT判定保留後の再検査で18トリソミー陽性を認め、出産後に胎盤のマイクロアレイ解析で胎盤性モザイクが判明した1例

早田桂, 岡本和浩, 柏原麻子, 牧尉太, 江口武志, 玉田祥子, 光井崇, 酒本あい, 衛藤英理子, 延本悦子, 小谷早葉子, 増山寿, 平松祐司, 吉本順子, 峠和美

日本遺伝カウンセリング学会誌 37 ( 1 ) 59 - 59 2016.3

A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after Surgery for an Implantable Cardioverter Defibrillator: A Case Report and Literature Review. Reviewed International journal

Takashi Mitsui, Hisashi Masuyama, Kentaro Ejiri, Kei Hayata, Hiroshi Ito, Yuji Hiramatsu

Case reports in obstetrics and gynecology 2016 4690790 - 4690790 2016

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

Hypertrophic obstructive cardiomyopathy (HOCM) is cardiac hypertrophy of ventricular myocardium with left ventricular outflow tract obstruction. We report a pregnancy with HOCM after defibrillator implantation surgery. The patient was a 33-year-old nulligravida and was categorized as New York Heart Association class II. Her brain natriuretic peptide (BNP) level was 724.6 pg/dL at preconception. She received careful pregnancy management. However, because frequent uterine contractions were observed at 25 weeks and 6 days of pregnancy, she was hospitalized, and magnesium sulfate was started as a tocolytic agent. At 27 weeks and 5 days of pregnancy, she had respiratory discomfort and orthopnea with a sudden decrease in peripheral oxygen saturation. Cardiac ultrasonography showed a worsened condition of HOCM and her BNP level was 1418.0 pg/mL. We performed an emergent cesarean section and she delivered a boy weighing 999 g. The Apgar score was 8 and 9 points at 1 and 5 minutes, respectively. The mother's heart failure quickly improved after birth and she was discharged at 10 days postoperatively. Fluctuations in circulatory dynamics during pregnancy may sometimes exacerbate heart disease. Therefore, the risks should be fully explained and careful assessment of cardiac function should be performed during pregnancy in patients with severe HOCM.

DOI： 10.1155/2016/4690790

PubMed

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Fetal cardiac tumor: a report of three cases

ETO Eriko, MAKI Jyota, TAMADA Syoko, EGUCHI Takeshi, MITSUI Takashi, HIRANO Yumika, TAKAHARA Etsuko, HAYATA Kei, MASUYAMA Hisashi, HIRAMATSU Yuji

Choonpa Igaku 43 ( 2 ) 311 - 315 2016

Language：Japanese Publisher：The Japan Society of Ultrasonics in Medicine

We present three rare cases of fetal cardiac tumor. Case 1: A 30-year-old multipara was referred to our hospital at 38 weeks pregnant. Fetal ultrasonographic examination revealed a homogeneous, hyperechogenic tumor in the left ventricle (13 mm in diameter). A part of the tumor protruded into the ascending aorta. A male neonate (gestational age 39 weeks and 1 day, weight 3,966 g) was born via vaginal delivery. Tumor resection was performed at the age of 1 day, and the histopathological diagnosis was rhabdomyoma. Brain MRI confirmed tuberous sclerosis at the age of two and a half months. He had epilepsy. The tumor has not recurred as of age 5 years. Case 2: A 30-year-old multipara was referred to our hospital at 29 weeks and 5 days pregnant because of three homogeneous, hyperechogenic tumors in the fetal left ventricle, right ventricle, and right atrium (14 mm, 17 mm, and 5 mm in diameter, respectively). A female neonate (gestational age 39 weeks and 5 days, weight 2,866 g) was born via vaginal delivery. She was diagnosed with tuberous sclerosis by brain CT at the age of 3 days. She had epilepsy. The sizes of the tumors have not changed as of age 3 years. Case 3: A 36-year-old primipara was referred to our hospital at 19 weeks and 5 days pregnant because of a homogeneous, hyperechogenic tumor in the fetal left ventricle (10 mm in diameter). A female neonate (gestational age 37 weeks 4 days, weight 3,006 g) was born via vaginal delivery. Ventricular tachycardia appeared at the age of 13 days. The size of the tumor has not changed as of age 9 months. Factors for poor prognosis of fetal cardiac tumor include tumor size of 20 mm or larger, fetal arrhythmia, and hydrops fetalis. This study contributes to the further investigation of prognostic factors.

DOI： 10.3179/jjmu.JJMU.A.52

CiNii Article

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Other Link： http://search.jamas.or.jp/link/ui/2016223168

妊婦の糖代謝異常の診断時期による臨床像の差異について Reviewed

平野友美加, 牧尉太, 玉田祥子, 江口武志, 光井崇, 衛藤英理子, 高原悦子, 早田桂, 瀬川友功, 増山寿, 平松祐司

糖尿病と妊娠 15 ( 2 ) S - 62 2015.10

妊娠初期診断GDMの特徴と診断における有用性と意義 JAGS trialによる検討 Reviewed

牧尉太, 平松祐司, 玉田祥子, 光井崇, 平野友美加, 延本悦子, 早田桂, 増山寿

糖尿病と妊娠 15 ( 2 ) S - 43 2015.10

胎児心疾患における染色疾患及び心外奇形合併について

平野友美加, 牧尉太, 玉田祥子, 江口武志, 光井崇, 衛藤英理子, 高原悦子, 早田桂, 瀬川友功, 増山寿, 平松祐司

現代産婦人科 64 ( Suppl. ) S45 - S45 2015.9

ALSO in Okayama開催から始まる地域の枠を超えた安心・安全な周産期医療実現を目指して受講者アンケートを通じて

牧尉太, 江口武志, 玉田祥子, 光井崇, 平野友美加, 衛藤英理子, 高原悦子, 早田桂, 増山寿, 平松祐司

現代産婦人科 64 ( Suppl. ) S52 - S52 2015.9

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