研究者詳細 - 黒子　洋介

論文 - 黒子　洋介

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日本において、controlled DCDからの心臓移植は実現可能か? 海外の現状からみた日本における今後の課題

小谷恭弘, 黒子洋介, 廣田真規, 小野稔, 笠原真悟

移植 59 ( 総会臨時 ) 317 - 317 2024年9月

重症成人先天性心疾患に対する移植適応基準の再考海外の報告からみた成人先天性心疾患患者の心移植におけるわが国の問題点

黒子洋介, 岩崎慶一朗, 小林純子, 角南春樹, 杜徳尚, 小谷恭弘, 中村一文, 赤木禎治, 湯浅慎介, 笠原真悟

移植 59 ( 総会臨時 ) 194 - 194 2024年9月

心停止後ドナーからの移植 DCD心臓移植のための心機能評価装置を搭載した体外式搬送システムの開発と多臓器獲得に向けての灌流方法

廣田真規, 井上善紀, 森岡慧, 黒子洋介, 小谷恭弘, 笠原慎吾

移植 59 ( 総会臨時 ) 159 - 159 2024年9月

Effects of dapagliflozin on myoglobin efflux from cardiomyocyte during myocardial ischemia/reperfusion in anesthetized rats 国際誌

Tomohiro Hayashida, Yosuke Kuroko, Shuji Shimizu, Tsuyoshi Akiyama, Takanori Suezawa, Yukio Kioka, Yasuhiro Kotani, Toshiaki Shishido, Shingo Kasahara

Scientific Reports 14 ( 1 ) 16337 - 16337 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

It has been suggested that sodium-glucose cotransporter 2 (SGLT2) inhibitors have cardioprotective effects during myocardial ischemia/reperfusion (I/R) independent of glucose-lowering action. However, the effects of SGLT2 inhibitors on structural damage to cardiomyocytes in the ischemic region during I/R remain unknown. We applied a microdialysis technique to the heart of anesthetized rats and investigated the effects of an SGLT2 inhibitor, dapagliflozin, on myocardial interstitial myoglobin levels in the ischemic region during coronary occlusion followed by reperfusion. Dapagliflozin was administered systemically (40 μg/body iv) or locally via a dialysis probe (100 μM and 1 mM) 30 min before coronary occlusion. In the vehicle group, coronary occlusion increased the dialysate myoglobin concentration in the ischemic region. Reperfusion further increased the dialysate myoglobin concentration. Intravenous administration of dapagliflozin reduced dialysate myoglobin concentration during ischemia and at 0–15 min after reperfusion, but local administration (100 μM and 1 mM) did not. Therefore, acute systemic administration of dapagliflozin prior to ischemia has cardioprotective effects on structural damage during I/R.

DOI： 10.1038/s41598-024-67195-3

その他リンク： https://www.nature.com/articles/s41598-024-67195-3

Initial trial of three‑lead wearable electrocardiogram monitoring in a full marathon.

Kenta Hirai, Noriko Sakano, Susumu Oozawa, Daiki Ousaka, Yosuke Kuroko, Shingo Kasahara

Journal of cardiology cases 30 ( 1 ) 24 - 28 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

UNLABELLED: Sudden cardiac arrest during exercise can occur without prior warning signs at rest, highlighting the importance of monitoring for its prevention. To detect the signs of ischemic heart disease, including coronary artery anomalies, ST changes must be detected using three‑lead electrocardiograms (ECGs) corresponding to each region of the three coronary artery branches. We conducted ECG monitoring of five runners during a marathon using a wearable three‑lead ECG device (e-skin ECG; Xenoma Inc., Tokyo, Japan). Data without noise or artifacts were successfully collected for one of five runners during the entire marathon. Within the initial hour of the marathon, poor electrode adhesion to the skin hindered the data collection for the remaining four runners, which resulted in significantly decreased acquisition rate compared with the first hour (86.7 ± 13.4 % to 37.3 ± 36.9 %, p = 0.028). Couplets of premature ventricular contractions with clear ECG waveforms in the three leads were detected in one runner during the marathon. Further device improvements are necessary to enable marathon runners to obtain ECGs efficiently without affecting their performance. This study also demonstrated the potential applications of three‑lead wearable ECG monitoring for other short-duration sports and remote home-based cardiac rehabilitation. LEARNING OBJECTIVE: This is an initial trial of a three‑lead wearable electrocardiogram (ECG) monitoring device during a full marathon. ECG data were obtained with low noise and artifacts during the first hour of the marathon; however, the data acquisition rate decreased in the middle and late stages owing to poor electrode adhesion. This study demonstrated the possibility of applying wearable ECG monitoring during short-term exercise and cardiac rehabilitation to detect warning signs and prevent sudden cardiac arrest.

DOI： 10.1016/j.jccase.2024.03.004

Initial trial of three‑lead wearable electrocardiogram monitoring in a full marathon

Kenta Hirai, Noriko Sakano, Susumu Oozawa, Daiki Ousaka, Yosuke Kuroko, Shingo Kasahara

Journal of Cardiology Cases 30 ( 1 ) 24 - 28 2024年7月

大学病院と市中病院における透析内シャント設置術の患者背景及び実施術式に関する比較と考察

藤井泰宏, 竹内英実, 加藤源太郎, 井上善紀, 倉田裕次, 黒子洋介, 田邊克幸, 岡本修吾, 小松弘明, 枝木大治, 徳田雄平, 大澤晋, 浅川知彦, 山本修三, 田蒔基行, 西岡聡, 田蒔昌憲, 和田淳, 田蒔正治, 笠原真悟

日本透析医学会雑誌 57 ( Suppl.1 ) 441 - 441 2024年5月

Long-term outcome and cardiac function after anatomic repair of congenitally corrected transposition

Fumi Yokohama, Norihisa Toh, Yasuhiro Kotani, Yoichi Takaya, Yosuke Kuroko, Kenji Baba, Teiji Akagi, Shingo Kasahara, Hiroshi Ito

Interdisciplinary CardioVascular and Thoracic Surgery 38 ( 3 ) 2024年3月

掲載種別：研究論文（学術雑誌）出版者・発行元：Oxford University Press (OUP)

Abstract

<p></p> OBJECTIVES

There is limited information on long-term outcomes and trajectories of ventricular and valvular functions in patients with congenitally corrected transposition of the great arteries after anatomic repair according to the operative strategy with a median follow-up period of more than 10 years.

METHODS

Twenty-nine patients who underwent anatomic repair in Okayama University Hospital between January 1994 and December 2020 were reviewed. Outcomes were compared between patients who underwent a double switch operation (DS group) and patients with an atrial switch with a Rastelli operation (Rastelli–Senning/Mustard group).

RESULTS

Fifteen (52%) were in the DS group and 14 (48%) were in the Rastelli–Senning/Mustard group. The median follow-up period after anatomic repair was 12.7 (interquartile range 4.2–18.8) years. There were 3 (10%) early deaths and 3 (10%) late deaths. Survival rates for the entire cohort at 10 and 20 years were 86% and 71%, respectively, and were not different between the 2 groups. Using competing risk analysis, risks of heart failure, cardiac rhythm device implantation and atrial arrhythmia showed no significant differences between the 2 groups, whereas risk of reoperation was higher in the Rastelli–Senning/Mustard group than that in the DS group. Four patients after a DS operation and 1 patient after a Rastelli technique developed more than moderate aortic regurgitation.

CONCLUSIONS

During a median follow-up period of more than 10 years, mortality rate and ventricular and valvular functions after anatomic repair were acceptable, though the incidences of late complications were relatively high, especially in the Rastelli–Senning/Mustard group.

DOI： 10.1093/icvts/ivae033

その他リンク： https://academic.oup.com/icvts/article-pdf/38/3/ivae033/57105371/ivae033.pdf

成人先天性心疾患領域における三尖弁形成術

徳田雄平, 小谷恭弘, 倉田裕次, 森岡慧, 成宮悠仁, 岸良匡, 鈴木浩之, 枝木大治, 小松弘明, 井上善紀, 小林純子, 藤井泰宏, 川畑拓也, 黒子洋介, 加藤源太郎, 笠原真悟

日本臨床外科学会雑誌 85 ( 3 ) 459 - 459 2024年3月

Y graft術後の人工血管感染に対して両腋窩-両大腿動脈人工血管バイパス施行後に人工血管除去を施行した1例

倉田裕次, 加藤源太郎, 笠原真悟, 小谷恭弘, 黒子洋介, 川畑拓也, 藤井泰宏, 小林純子, 小松弘明, 井上善紀, 枝木大治, 岸良匡, 成宮悠仁, 鈴木浩之, 森岡慧, 徳田雄平

日本臨床外科学会雑誌 85 ( 3 ) 459 - 459 2024年3月

海外の報告からみた心停止ドナーによる心臓移植の現状

黒子洋介, 小谷恭弘, 廣田真規, 笠原真悟, 小野稔

移植 58 ( 4 ) 412 - 412 2024年3月

移行期医療・ACHD診療の実践的方策移行期医療を断念せざるを得ない患者について考える

馬場健児, 近藤麻衣子, 栗田佳彦, 福嶋遥佑, 川本祐也, 原真佑子, 赤木禎治, 西井伸洋, 杜徳尚, 川畑拓也, 黒子洋介, 小谷恭弘, 笠原真悟

日本成人先天性心疾患学会雑誌 13 ( 1 ) 91 - 91 2024年1月

Cone手術時代の成人Ebstein病の管理成人Ebstein病でのCone手術前後における3D心エコーでの三尖弁輪サイズと開口部の評価

杜徳尚, 小谷恭弘, 中島充貴, 高谷陽一, 川畑拓也, 黒子洋介, 馬場健児, 赤木禎治, 笠原真悟, 中村一文

日本成人先天性心疾患学会雑誌 13 ( 1 ) 79 - 79 2024年1月

ヘパリン起因性血小板減少症患者に対する内シャント造設術の経験

藤井泰宏, 廣田真規, 加藤源太郎, 竹内英実, 黒子洋介, 川畑拓也, 小谷恭弘, 小林純子, 内田治仁, 小松弘明, 井上善紀, 枝木大治, 鈴木浩之, 岸良匡, 成宮悠仁, 森岡慧, 三浦望, 杭ノ瀬慶彦, 武田直人, 笠原真悟

脈管学 63 ( Suppl. ) S178 - S178 2023年10月

ヘパリン起因性血小板減少症患者に対する内シャント造設術の経験

藤井泰宏, 廣田真規, 加藤源太郎, 竹内英実, 黒子洋介, 川畑拓也, 小谷恭弘, 小林純子, 内田治仁, 小松弘明, 井上善紀, 枝木大治, 鈴木浩之, 岸良匡, 成宮悠仁, 森岡慧, 三浦望, 杭ノ瀬慶彦, 武田直人, 笠原真悟

脈管学 63 ( Suppl. ) S178 - S178 2023年10月

左心低形成症候群におけるFontan手術未到達例及びFailed Fontanからの考察左心低形成症候群におけるFontan未到達例およびFailed Fontan症例からみた予後因子

小谷恭弘, 小林純子, 杭ノ瀬慶彦, 武田直人, 三浦望, 森岡慧, 成宮悠仁, 鈴木浩之, 岸良匡, 井上善紀, 小松弘明, 枝木大治, 藤井泰宏, 黒子洋介, 川畑拓也, 廣田真規, 加藤源太郎, 笠原真悟

日本胸部外科学会定期学術集会 76回 CPD1 - 3 2023年10月

単心室における共通房室弁に対するAdjustable Annular Bridging Techniqueの短期成績

鈴木浩之, 小谷恭弘, 森岡慧, 成宮悠仁, 岸良匡, 井上善紀, 枝木大治, 小松弘明, 小林純子, 藤井泰宏, 川畑拓也, 廣田真規, 加藤源太郎, 黒子洋介, 笠原真悟

日本胸部外科学会定期学術集会 76回 CP23 - 4 2023年10月

When to intervene the pulmonary artery: Importance of anatomical assessment in the diagnosis of pulmonary artery coarctation. 国際誌

Eiri Kisamori, Yasuhiro Kotani, Hiroyuki Suzuki, Junko Kobayashi, Takuya Kawabata, Yosuke Kuroko, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 166 ( 3 ) 926 - 932 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Pulmonary artery coarctation (PACoA) is a major problem that increases the frequency of intervention. However, there is little evidence regarding the prediction of PACoA development. METHODS: A retrospective chart review was performed on 42 patients who underwent modified Blalock-Taussig shunt and preoperative contrast-enhanced computed tomography. An uneven PA branching was defined as an abnormal ductus arteriosus connection to the left PA distal to the PA branching on contrast-enhanced computed tomography. RESULTS: Nineteen (45.2%) of 42 patients were diagnosed with PACoA. The median diameters of the ductus on the aorta and PA sides were 4.1 mm and 3.6 mm in the PACoA group and 3.6 mm and 2.9 mm in the non-PACoA group, respectively (P = .07 and .28, respectively). Tortuous ductus was recognized in 7 (36.8%) patients in the PACoA group and 14 (60.8%) patients in the non-PACoA group (P = .12). PACoA was associated with pulmonary atresia (16 patients [84.2%] in the PACoA group and 12 patients [52.1%] in the non-PACoA group) (P = .02). All 19 patients had uneven PA branching in the PACoA group, whereas 5 of 23 (21.7%) patients had uneven PA branching in the non-PACoA group (P < .001). CONCLUSIONS: Uneven PA branching rather than the ductus arteriosus size was strongly associated with PACoA development; therefore, morphologic assessment by contrast-enhanced computed tomography should be considered in patients with pulmonary atresia.

DOI： 10.1016/j.jtcvs.2023.02.021

成人先天性心疾患の心不全に対する多剤併用療法の試み

杜徳尚, 中島充貴, 小谷恭弘, 馬場健児, 黒子洋介, 中村一文, 赤木禎治, 笠原真悟

日本小児循環器学会総会・学術集会抄録集 59回 [II - 06] 2023年7月

当院における1.5心室修復術後遠隔期成績

井上善紀, 岸良匡, 堀川優衣, 枝木大治, 小松弘明, 辻龍典, 小林純子, 川畑拓也, 黒子洋介, 小谷恭弘, 笠原真悟

日本小児循環器学会総会・学術集会抄録集 59回 [III - 08] 2023年7月

集中定数モデルを用いたフォンタン循環におけるフェネストレーションの効果の検討

堀尾直裕, 清水秀二, 小谷恭弘, 黒子洋介, 川畑拓也, 小林純子, 宮原義典, 佐野俊二, 笠原真悟

日本小児循環器学会総会・学術集会抄録集 59回 [I - 01] 2023年7月

TCPC conversion後のペースメーカ挿入回避のための術式の工夫

黒子洋介, 井上善紀, 岸良匡, 鈴木浩之, 枝木大治, 小松弘明, 横田豊, 辻龍典, 迫田直也, 村岡玄哉, 小林純子, 川畑拓也, 廣田真規, 小谷恭弘, 杜徳尚, 笠原真悟

日本成人先天性心疾患学会雑誌 12 ( 1 ) 146 - 146 2023年1月

竹内法が行われたALCAPA術後遠隔期LCA虚血に対する再血行再建術の経験

井上善紀, 黒子洋介, 高尾賢一朗, 岸良匡, 鈴木浩之, 枝木大治, 小松弘明, 横田豊, 辻龍典, 村岡玄哉, 迫田直也, 小林純子, 川畑拓也, 廣田真規, 小谷恭弘, 笠原真悟, 杜徳尚

日本成人先天性心疾患学会雑誌 12 ( 1 ) 191 - 191 2023年1月

特発性左外腸骨静脈破裂に対する治療経験例からの外科的術式の考察

森岡慧, 鈴木浩之, 枝木大治, 小松弘明, 辻龍典, 横田豊, 迫田直也, 村岡玄也, 小林純子, 川畑拓也, 黒子洋介, 小谷恭弘, 加藤源太郎, 廣田真規, 笠原真悟

日本血管外科学会雑誌 32 ( Suppl. ) P17 - 2 2023年

特発性左外腸骨静脈破裂に対する治療経験例からの外科的術式の考察

森岡慧, 鈴木浩之, 枝木大治, 小松弘明, 辻龍典, 横田豊, 迫田直也, 村岡玄也, 小林純子, 川畑拓也, 黒子洋介, 小谷恭弘, 加藤源太郎, 廣田真規, 笠原真悟

日本血管外科学会雑誌 32 ( Suppl. ) P17 - 2 2023年

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 2022年12月

Physiologic biventricular repair in a patient with unrepaired adult congenital heart disease with severe cyanosis. 国際誌

Hiroyuki Suzuki, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

JTCVS techniques 15 220 - 223 2022年10月

心停止ドナーにおける右室不全の機序の解明

小谷恭弘, 横田豊, 山崎悟, 清水秀二, 黒子洋介, 廣田真規, 宍戸稔聡, 新谷泰範, 笠原真悟

移植 57 ( 総会臨時 ) 334 - 334 2022年10月

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年10月

掲載種別：研究論文（学術雑誌）

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

A Ruptured Coronary Artery Aneurysm Secondary to Kawasaki Disease. 国際誌

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

JACC. Case reports 4 ( 13 ) 790 - 793 2022年7月

記述言語：英語

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

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年7月

Strategy of delayed repair of total anomalous pulmonary venous connection in right atrial isomerism and functional single ventricle. 国際誌

Eiri Kisamori, Yasuhiro Kotani, Fiza Komel Raja, Junko Kobayashi, Yosuke Kuroko, Takuya Kawabata, Shingo Kasahara

JTCVS open 10 308 - 319 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Repair of total anomalous pulmonary venous connection (TAPVC) in neonates with right atrial isomerism and functional single ventricle is challenging. In our novel strategy, primary draining vein stenting (DVS) was applied to patients with preoperative pulmonary vein obstruction to delay TAPVC repair. This study investigated our initial experience with a strategy of delayed TAPVC repair, incorporating DVS. METHODS: Twenty-nine patients with right atrial isomerism and functional single ventricle who had a severe obstruction in the course of draining veins, who required surgical or catheter intervention in their neonatal period were retrospectively reviewed (primary DVS: n = 11; primary TAPVC repair: n = 18). RESULTS: Patients in the primary DVS group had more mixed type TAPVC (primary DVS: n = 5, 45.5%; primary TAPVC repair: n = 2, 11.1%; P = .03) and required more systemic to pulmonary shunt surgeries during their lifetime (primary DVS: n = 9, 81.8%; primary TAPVC repair: n = 6, 33.3%; P = .047). Kaplan-Meier analysis showed that primary DVS repair was associated with improved survival compared with primary TAPVC repair (survival rates at 90 days, 1 year, 3 years and 5 years: primary DVS: 100%, 80%, 68.6%, and 54.9%; primary TAPVC repair: 55.6%, 38.9%, 38.9%, and 38.9%, respectively [P = .04]). Of the 4 patients who underwent stenting of the ductus venosus, 3 had elevated liver enzymes after surgical repair of TAPVC due to ductus venosus steal, which markedly improved after coil embolization of the stent. CONCLUSIONS: For neonates with obstructive TAPVC and functional single ventricle, our delayed TAPVC repair using primary DVS appeared to improve survival compared with the conventional strategy.

DOI： 10.1016/j.xjon.2021.11.012

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

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年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

Risk factors and outcomes of pediatric extracorporeal membrane oxygenation. 国際誌

Hiroshi Taka, Yasuhiro Kotani, Yosuke Kuroko, Susumu Iwadou, Tatsuo Iwasaki, Shingo Kasahara

Asian cardiovascular & thoracic annals 29 ( 9 ) 916 - 921 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD. METHODS: We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38-53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge. RESULTS: The median ECMO duration was 160 (91-286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min. CONCLUSIONS: Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.

DOI： 10.1177/0218492321997379

Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch? 国際誌

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

Interactive cardiovascular and thoracic surgery 33 ( 5 ) 765 - 772 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: This study aimed to evaluate whether recoarctation of the aorta (reCoA) after the Norwood procedure for hypoplastic left heart syndrome correlates with pre- and postoperative anatomic factors. METHODS: This retrospective study included 48 patients who underwent Norwood procedure with right ventricle-to-pulmonary artery conduit between 2009 and 2017. Anatomical factors such as preoperative length, diameter of the main pulmonary artery (MPA), and postoperative neoaortic arch angle stratified by arch reconstruction technique were analysed using the receiver operating characteristic analysis. RESULTS: Eleven patients needed surgical intervention for reCoA at stage 2. Out of the 30 patients who underwent direct anastomosis during arch reconstruction, 7 developed reCoA. Seven patients received the full patch augmentation (patch augmentation for both lesser and greater curvatures) and were all spared from reCoA. Among the patients who had direct anastomosis, the preoperative MPA length was correlated with the postoperative arch angle (P = 0.021) and was associated with the occurrence of reCoA (P = 0.002) and the best cutoff value for MPA length was 10 mm. The postoperative arch angle was also correlated with the incidence of reCoA (P < 0.001) and was larger in patients who underwent the full patch augmentation than in patients who had direct anastomosis (126° vs 112°, P = 0.005) despite comparable MPA length. CONCLUSIONS: ReCoA after the Norwood procedure correlates with MPA length when a direct anastomosis was used. Direct anastomosis can be considered in patients with a longer preoperative MPA. In other cases, the full patch augmentation should be considered for obtaining a large and smooth neoaortic arch.

DOI： 10.1093/icvts/ivab170

肺動脈弁狭窄の高度なファロー四徴症に対する右室流出路再建法 transannular patch vs右室流出路導管 Transannular patchを用いたファロー四徴症修復術の遠隔成績は良好である

小谷恭弘, 小林泰幸, 横山翔平, 鈴木浩之, 木佐森永理, 枝木大治, 小松弘明, 横田豊, 辻龍典, 迫田直也, 村岡玄哉, 衛藤弘城, 小林純子, 川畑拓也, 黒子洋介, 廣田真規, 笠原真悟

日本胸部外科学会定期学術集会 74回 CDB4 - 4 2021年10月

Successful Handmade Monobloc Aortomitral Valve Replacement for Extensive Aortic Root Abscess. 国際誌

Takanori Suezawa, Masanori Hirota, Naoya Sakoda, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

The Annals of thoracic surgery 112 ( 2 ) e131-e134 2021年8月

記述言語：英語

Aortic root abscess is one of the most catastrophic complications of aortic valve endocarditis. Complete débridement is recommended regardless of the kind of infected lesion. A 37-year-old man with extensive aortic root abscess due to prosthetic aortic valve endocarditis was surgically treated. The main lesion was the aortomitral continuity extending to the commissure between the left and right coronary cusps. After débridement, the aortic annulus underneath the left coronary artery was reconstructed using a handmade aortomitral monobloc valve without aortic annuloplasty. This valve was required for the extensive root abscess of the left and noncoronary sinus to achieve complete débridement.

DOI： 10.1016/j.athoracsur.2020.11.046

Anatomic Risk Factors for Reintervention After Arterial Switch Operation for Taussig-Bing Anomaly. 国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Atsushi Tateishi, Shunji Sano, Shingo Kasahara

The Annals of thoracic surgery 112 ( 1 ) 163 - 169 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: This study aimed to determine the factors related to reintervention, especially for pulmonary stenosis (PS), in patients with Taussig-Bing anomaly (TBA) after the arterial switch operation. METHODS: This retrospective study included 34 patients with TBA who underwent the arterial switch operation between 1993 and 2018. Preoperative anatomic and physiologic differences and long-term outcomes were determined using a case-matched control with transposition of the great arteries with ventricular septal defect and TBA with an anterior and rightward aorta. RESULTS: At arterial switch operation, median age was 43 days (range, 16 to 102) and median body weight was 3.6 kg (range, 2.8 to 3.8 kg). Aortic arch obstruction and coronary anomalies were present in 64% and 41% of patients, respectively. The hospital mortality rate was 11%, including one cardiac death, and the late mortality rate was 2.9%. Furthermore, 41% patients underwent 26 reinterventions for PS. Patients undergoing PS-related reintervention had a significantly larger native pulmonary artery to aortic annulus size ratio than patients not receiving reintervention (1.69 vs 1.41, P = .02). This ratio was the only predictor of PS-related reintervention; it was significantly higher in the TBA group than in the transposition of great arteries/ventricular septal defect group. The PS-related reintervention was required more in the TBA group than in the transposition of great arteries/ventricular septal defect group. CONCLUSIONS: Regardless of complex coronary anatomy and associated anomalies, early and late survival were acceptable. Postoperative PS was strongly associated with having a larger native pulmonary valve, suggesting that an optimal surgical reconstruction was required for achieving an appropriate aortopulmonary anatomic relationship during the arterial switch operation.

DOI： 10.1016/j.athoracsur.2020.06.016

Endocardial Hemangioma of the Right Ventricle: Complete Excision With Right Ventricular Restoration. 国際誌

Masanori Hirota, Takanori Suezawa, Yasuyuki Kobayashi, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Hiroshi Ito, Shingo Kasahara

The Annals of thoracic surgery 111 ( 6 ) e411-e413 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Primary cardiac tumor can arise from any location in the right and left cardiac chamber. Complete excision is generally recommended because of uncertainty regarding malignancy; however it is important to minimize the resultant functional deterioration after surgery. We report a case of endocardial hemangioma (4 × 3 × 3 cm) on the free wall of the right ventricle, located between the anterior and posterior papillary muscles. We describe details of the procedure to preserve the right ventricular volume and competence of the tricuspid valve.

DOI： 10.1016/j.athoracsur.2020.09.078

Corrigendum to 'Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience' [Eur J Cardiothorac Surg 2020;58:230-236]. 国際誌

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

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 59 ( 4 ) 931 - 931 2021年4月

Papillary-ventricular complex tugging for ischemic/functional mitral regurgitation. 国際誌

Masanori Hirota, Takanori Suezawa, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Fumi Yokohama, Yoichi Takaya, Hiroshi Ito, Shingo Kasahara

The Annals of thoracic surgery 113 ( 1 ) e71-e73 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Surgical restoration of subvalvular geometry is very important to prevent recurrence of ischemic/functional mitral regurgitation (MR). We evaluated an approach to the radical repair of left ventricular (LV) remodeling for three different cases with responsible coronary lesions. Leaflet tethering was corrected by tugging of the papillary-ventricular complex, which consists of the base of papillary muscles and posterior LV wall. The main lesion of the postinfarction scar was concomitantly excluded. Restoration of LV remodeling diminished MR with minimal leaflet tethering and improved systolic LV function. This technique may be an aggressive and encouraged approach for patients with ischemic/functional MR.

DOI： 10.1016/j.athoracsur.2021.03.095

Staged Repair of Tetralogy of Fallot: A Strategy for Optimizing Clinical and Functional Outcomes. 国際誌

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

The Annals of thoracic surgery 113 ( 5 ) 1575 - 1581 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

肥大したRVとは1.5または2心室修復が可能なくらい大きいのか? 岡山大学における純型肺動脈閉鎖症の段階的二心室治療戦略(How big RV is big enouh to go for biventricular repair or one and one half ventricular repair?)

笠原真悟, 小谷恭弘, 辻龍典, 木佐森永理, 小松弘明, 小林泰幸, 迫田直也, 横田豊, 堀尾直裕, 村岡玄弥, 小林純子, 川畑拓也, 黒子洋介, 末澤孝徳, 廣田正規

日本心臓血管外科学会学術総会抄録集 51回 PD2 - 2 2021年2月

The impact of pulmonary artery banding and cardiac resynchronization therapy for the adult patient with congenitally corrected transposition of the great arteries.

Sachiko Kadowaki, Yasuhiro Kotani, Norihisa Toh, Yosuke Kuroko, Atsushi Tateishi, Teiji Akagi, Hiroshi Ito, Shingo Kasahara

General thoracic and cardiovascular surgery 68 ( 9 ) 1024 - 1026 2020年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

It has been controversial how to manage severe dysfunction of the systemic right ventricle and severe tricuspid regurgitation for adult patients with congenitally corrected transposition of the great arteries. We reported a 43-year-old man with these disorders, who received pulmonary artery banding and cardiac resynchronization therapy without cardiopulmonary bypass. The degree of the tricuspid regurgitation was improved to mild-moderate and systemic right ventricular ejection fraction was improved from 28 to 45% after surgery. Cardiopulmonary exercise testing showed that the predictive value of anaerobic threshold and peak oxygen uptake improved from 65 to 99% and 59 to 92%, respectively. In conclusion, pulmonary artery banding and cardiac resynchronization therapy can be the first choice of surgery for severe tricuspid regurgitation with severely impaired systemic right ventricular function. After improving systemic right ventricular dysfunction tricuspid surgery could be the next choice as a surgical intervention in the future.

DOI： 10.1007/s11748-019-01171-x

Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience. 国際誌

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

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 58 ( 2 ) 230 - 236 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The aim of this study was to evaluate the long-term outcomes of the Norwood procedure with right ventricle-pulmonary artery (RV-PA) conduit for hypoplastic left heart complex. METHODS: A retrospective observational study was performed in 136 patients with hypoplastic left heart complex who underwent a Norwood procedure with RV-PA conduit between 1998 and 2017. The probabilities of survival, reintervention and Fontan completion were analysed. RESULTS: Stage 1 survival was 91.9% (125/136). Reintervention for PA stenosis was needed for 22% and 30% at stages 2 and 3, respectively, while 15% underwent reintervention for aortic arch recoarctation. Among 106 bidirectional Glenn survivors, 93 (68% of the total number of patients) had a Fontan completion, while 4 were not considered to be Fontan candidates. Risk factors for overall mortality included weighing <2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Overall survival was 80.9%, 72.3% and 62.8% at 1, 5 and 20 years, respectively. CONCLUSIONS: Probabilities of survival and Fontan completion were acceptable under the current surgical strategy incorporating RV-PA Norwood procedure as the first palliation. Incorporating a strategy to maintain PA growth and ventricular function through the staged repair is of prime importance. Further studies are necessary to observe changes in atrioventricular regurgitation as well as in right ventricular function, in patients who require atrioventricular valve interventions during the staged Fontan completion.

DOI： 10.1093/ejcts/ezaa041

Clinical impact of transcatheter atrial septal defect closure on new onset atrial fibrillation in adult patients: Comparison with surgical closure. 国際誌

Yasuhiro Fujii, Teiji Akagi, Koji Nakagawa, Yoichi Takaya, Koki Eto, Yosuke Kuroko, Yasuhiro Kotani, Kentaro Ejiri, Hiroshi Ito, Shingo Kasahara

Journal of cardiology 76 ( 1 ) 94 - 99 2020年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Previous studies demonstrated that the incidence of atrial fibrillation (AF) was significantly increased when patients aged ≥40 years had surgical atrial septal defect (ASD) closure (sASD). However, limited information is available on such findings in transcatheter ASD closure (tASD). The purpose of this study was to investigate the incidence of newly developed AF after tASD in patients aged ≥40 years in whom preoperative AF or atrial flutter (AFL) had not been detected and to compare with the incidence after sASD. METHODS: The medical records of patients aged ≥40 years without a history of AF or AFL who underwent tASD (n = 281) or sASD (n = 24) were reviewed. Patients who had catheter ablation before the ASD closure were excluded. Patients with a patent foramen ovale were also excluded. The incidence of newly developed AF after ASD closure and the risk factors for that were evaluated statistically. RESULTS: Eleven patients had newly developed AF (5 in tASD and 6 in sASD) postoperatively including 6 persistent AF (3 each after tASD and sASD). The cumulative incidence of newly developed AF was 0.7% in tASD and 16.7% in sASD, and 2.7% and 20.8% at 1 and 5 years, respectively (p < 0.001). ASD diameter ≥30 mm and sASD were potential risk factors for newly developed AF after ASD closure and postoperative persistent AF. CONCLUSIONS: In patients aged ≥40 years without a history of AF or AFL, the incidence of newly developed AF after tASD closure was lower than that after sASD. A large ASD more than 30 mm diameter was a potential risk factor for development of AF even if it is closed by transcatheter procedure. Further long-term evaluation after tASD is required to clarify preventive benefit for new onset AF in adult ASD population.

DOI： 10.1016/j.jjcc.2020.01.008

Outcomes of Patients with Pulmonary Atresia with Intact Ventricular Septum Reaching Adulthood

Norihisa Toh, Yasuhiro Kotani, Teiji Akagi, Yosuke Kuroko, Kenji Baba, Shin-ichi Otsuki, Shingo Kasahara, Hiroshi Ito

CONGENITAL HEART DISEASE 15 ( 1 ) 1 - 12 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：TECH SCIENCE PRESS

Background: There is limited information on outcomes of adult patients with pulmonary atresia with intact ventricular septum (PA-IVS) due to the low incidence of disease and the large variation of surgical histories. Methods: Among 58 patients with repaired PA-IVS, a total of 32 patients aged >= 16 years and who were followed at our institution between January 2003 and December 2018 were reviewed. Surgical history, clinical outcomes, and laboratory, echocardiographic and electrocardiographic data were obtained by chart review. Results: Follow-up was from the age of 16 years and the median age at the latest follow-up was 23.7 years. Twenty-four patients had undergone biventricular repair (BVR), 3 had undergone one-and-a half ventricular repair (1.5VR), and 5 had undergone univentricular repair. Over a median follow-up period of 7.7 years (interquartile range: 4.1-11.0 years), 1 BVR patient died suddenly and 7 patients had heart failure. Arrhythmias were present in 5 patients. Ten patients underwent surgical re-interventions, including 4 BVR take-downs with conversion to 1.5VR and 3 Fontan conversions. Overall survival, heart failure-free, arrhythmia-free, and surgical re-intervention-free rates at 5 years and 10 years from the age of 16 years were 96.2% (95% confidence interval [CI], 77.2-99.4) and 96.2% (95% CI, 77.2-99.4), 81.4% (95% CI, 62.1-92.1) and 74.6% (95%CI, 52.3-88.7), 88.7% (95% CI, 70.1-96.3) and 75.9% (95% CI, 51.7-90.2), and 80.7% (95% CI, 60.8-91.8) and 70.8% (95% CI, 49.7-85.7), respectively. Conclusion: Adults with PA-IVS have preserved long-term survival regardless of the early operative strategy, while they are at risk for heart failure, arrhythmia, and surgical re-intervention. Thus, detailed and continued follow-up is mandatory for all PA-IVS patients from childhood to adulthood.

DOI： 10.32604/CHD.2020.011579

Congenital left ventricular aneurysm diagnosed with atrial septal defect. 国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Sadahiko Arai, Shingo Kasahara

Asian cardiovascular & thoracic annals 27 ( 5 ) 404 - 406 2019年6月

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年6月

Homograft Replacement for Repeated Pseudoaneurysm after Aortic Valve Surgery in a Patient with Behçet Disease

Takuya Goto, Yosuke Kuroko, Takuya Kawabata, Koki Eto, Yasuyuki Kobayashi, Daiki Ousaka, Shingo Kasahara, Zenichi Masuda

Japanese Journal of Cardiovascular Surgery 47 ( 3 ) 133 - 137 2018年5月

[Subdural Hematoma after Open Heart Surgery for Infective Endocarditis Presenting with Pre-operative Intracranial Hemorrhage Infarction;Report of a Case].

Ryuta Tai, Yosuke Kuroko, Makoto Mohri, Masakazu Yamaoka

Kyobu geka. The Japanese journal of thoracic surgery 71 ( 5 ) 343 - 346 2018年5月

記述言語：日本語掲載種別：研究論文（学術雑誌）

A 47-year-old woman with a history of radiation enteritis and implantation of a central venous port was admitted to our intensive care unit(ICU) suffering from high fever. She was diagnosed with active infective endocarditis due to catheter-related blood stream infection. Although echocardiography showed a large vegetation on the mitral valve, surgical therapy was postponed for 5 weeks because of intracranial hemorrhage infarction. On the 3rd day after mitral valve repair, she developed consciousness disturbance and computed tomography(CT) revealed acute subdural hematoma of the posterior cranial fossa. Fortunately, she fully recovered from the neurological complication without surgical intervention.

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年9月

Fontan手術到達例から見たAsplenia syndromeの外科治療の成績査読

笠原真悟, 井上善紀, 川田幸子, 佐野俊和, 堀尾直裕, 小林純子, 石神修大, 藤井泰宏, 黒子洋介, 小谷恭弘, 新井禎彦

日本小児循環器学会雑誌 33 ( Suppl.1 ) s1 - 188 2017年7月

EVARにおける治療介入が必要であったtype 2エンドリークの検討 Dダイマーを中心に

大澤晋, 藤井泰宏, 増田善逸, 黒子洋介

日本血管外科学会雑誌 26 ( Suppl. ) O15 - 1 2017年6月

Decreased Serum Levels of High Mobility Group Box 1 (HMGB-1) after Graft Replacement or Stenting of Abdominal Aortic Aneurysm. 国際誌

Daiki Ousaka, Yasuhiro Fujii, Susumu Oozawa, Masahiro Nishibori, Yosuke Kuroko, Zenichi Masuda, Shunji Sano

Annals of vascular surgery 41 265 - 270 2017年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: High-mobility group box 1 (HMGB-1) is a key substance mediating inflammation and development of atherosclerotic lesions (ALs), including abdominal aortic aneurysms (AAA). Serum levels of HMGB-1 are increased in patients with AAA than those in normal controls because the ALs in AAAs secrete HMGB-1. We therefore postulate that the serum HMGB-1 level should decrease after endovascular aortic repair (EVAR) or open aortic repair (OAR). However, there is no evidence of this in the literature. The purpose of this study was to investigate the changes in HMGB-1 levels after surgical intervention for AAA. We also aimed to determine if the HMGB-1 levels varied between the two procedures. METHODS: Serum HMGB-1 levels were determined in 24 patients with AAA and 25 healthy controls. Twelve of the 24 AAA patients underwent EVAR, whereas the other half underwent OAR. The relationship between HMGB-1 levels and presence of AAA or influence of operative methods on the serum HMGB-1 level were prospectively investigated. RESULTS: Serum HMGB-1 levels in AAA patients were significantly higher than those in healthy controls (9.4 ± 5.7 vs. 4.1 ± 2.0 ng/mL, P < 0.01). The serum HMGB-1 levels in both the EVAR group and the OAR group were significantly decreased from baseline at both 3 mo and 1 y after surgery. CONCLUSIONS: Removal or isolation of AL via surgical intervention significantly decreases serum HMGB-1 levels. The significant postoperative reduction in HMGB-1 levels suggests that important endocrinological changes occur after surgical treatment of AAA.

DOI： 10.1016/j.avsg.2016.08.017

EVARにおけるtype 2エンドリークの検討術前塞栓の必要性を中心に

大澤晋, 藤井康宏, 増田善逸, 黒子洋介, 藤原寛康, 生口俊浩, 松井裕輔, 平木隆夫, 郷原英夫, 金澤右

IVR: Interventional Radiology 32 ( Suppl. ) 248 - 248 2017年4月

Intracoronary Cardiac Progenitor Cells in Single Ventricle Physiology: The PERSEUS (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) Randomized Phase 2 Trial. 国際誌

Shuta Ishigami, Shinichi Ohtsuki, Takahiro Eitoku, Daiki Ousaka, Maiko Kondo, Yoshihiko Kurita, Kenta Hirai, Yosuke Fukushima, Kenji Baba, Takuya Goto, Naohiro Horio, Junko Kobayashi, Yosuke Kuroko, Yasuhiro Kotani, Sadahiko Arai, Tatsuo Iwasaki, Shuhei Sato, Shingo Kasahara, Shunji Sano, Hidemasa Oh

Circulation research 120 ( 7 ) 1162 - 1173 2017年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

RATIONALE: Patients with single ventricle physiology are at high risk of mortality resulting from ventricular dysfunction. The preliminary results of the phase 1 trial showed that cardiosphere-derived cells (CDCs) may be effective against congenital heart failure. OBJECTIVE: To determine whether intracoronary delivery of autologous CDCs improves cardiac function in patients with single ventricle physiology. METHODS AND RESULTS: We conducted a phase 2 randomized controlled study to assign in a 1:1 ratio 41 patients who had single ventricle physiology undergoing stage 2 or 3 palliation to receive intracoronary infusion of CDCs 4 to 9 weeks after surgery or staged reconstruction alone (study A). The primary outcome measure was to assess improvement in cardiac function at 3-month follow-up. Four months after palliation, controls had an alternative option to receive late CDC infusion on request (study B). Secondary outcomes included ventricular function, heart failure status, somatic growth, and health-related quality of life after a 12-month observation. At 3 months, the absolute changes in ventricular function were significantly greater in the CDC-treated group than in the controls (+6.4% [SD, 5.5] versus +1.3% [SD, 3.7]; P=0.003). In study B, a late CDC infusion in 17 controls increased the ventricular function at 3 months compared with that at baseline (38.8% [SD, 7.7] versus 34.8% [SD, 7.4]; P<0.0001). At 1 year, overall CDC infusion was associated with improved ventricular function (41.4% [SD, 6.6] versus 35.0% [SD, 8.2]; P<0.0001) and volumes (P<0.001), somatic growth (P<0.0001) with increased trophic factors production, such as insulin-like growth factor-1 and hepatocyte growth factor, and quality of life, along with a reduced heart failure status (P<0.0001) and cardiac fibrosis (P=0.014) relative to baseline. CONCLUSIONS: Intracoronary infusion of CDCs after staged palliation favorably affected cardiac function by reverse remodeling in patients with single ventricle physiology. This impact may improve heart failure status, somatic growth, and quality of life in patients and reduce parenting stress for their families. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01829750.

DOI： 10.1161/CIRCRESAHA.116.310253

小児大動脈弁疾患の外科治療戦略新生児・乳児期の先天性大動脈弁狭窄症に対する治療戦略と遠隔期成績

笠原真悟, 佐野俊和, 堀尾直裕, 後藤拓弥, 小林純子, 衛藤弘城, 石神修大, 藤井泰宏, 黒子洋介, 大澤晋, 小谷恭弘, 増田善逸, 新井禎彦, 佐野俊二

日本心臓血管外科学会学術総会抄録集 47回 474 - 474 2017年2月

EVARにおけるtype 2エンドリークの検討腰動脈塞栓の必要性を中心に

大澤晋, 藤井泰宏, 増田善逸, 黒子洋介, 佐野俊二

日本心臓血管外科学会学術総会抄録集 47回 676 - 676 2017年2月

[Delayed Diagnosis of Aortic Dissection Following Thrombolytic Therapy in a Patient with Acute Ischemic Stroke;Report of a Case].

Yosuke Miyamoto, Zenichi Masuda, Yasuhiro Kotani, Suguru Tarui, Yosuke Kuroko, Yasuhiro Fujii, Susumu Ozawa, Shunji Sano

Kyobu geka. The Japanese journal of thoracic surgery 69 ( 12 ) 1037 - 1040 2016年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Diagnosis of aortic dissection complicating cerebral ischemic stroke is difficult. A 60-year-old patient presented at an emergency department of a hospital with a sudden development of left-sided weakness, but without chest pain. During administration of recombinant tissue plasminogen activator with diagnosis of cerebral infarction, he developed symptomatic hypotension and was transferred to our hospital. His chest computed tomography revealed Stanford type A aortic dissection. Replacement of the ascending aorta and aortic arch was successfully performed on the 4th day.

明らかなmigrationもなく複合エンドリークを合併し切迫破裂状態となった胸部大動脈瘤の一例

大澤晋, 藤井泰宏, 増田善逸, 黒子洋介, 佐野俊二

脈管学 56 ( Suppl. ) S193 - S193 2016年10月

A staged decompression of right ventricle allows growth of right ventricle and subsequent biventricular repair in patients with pulmonary atresia and intact ventricular septum. 国際誌

Yasuhiro Kotani, Shingo Kasahara, Yasuhiro Fujii, Takahiro Eitoku, Kenji Baba, Shin-Ichi Otsuki, Yosuke Kuroko, Sadahiko Arai, Shunji Sano

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 50 ( 2 ) 298 - 303 2016年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: To achieve the growth of right-sided heart structures, our choice of the first palliation for patients with pulmonary atresia and intact ventricular septum (PA-IVS) includes a modified Blalock-Taussig shunt (BTS) with pulmonary valvotomy. We sought to analyse the impact of the first palliation on the growth of right-sided heart structures and factors associated with a choice of definitive surgical procedure. METHODS: Fifty patients with PA-IVS who underwent a staged surgical approach from 1991 to 2012 were retrospectively reviewed. RESULTS: Right ventricular (RV)-coronary artery fistulas were seen in 42% of patients at the time of birth. All 50 patients had a modified BTS with pulmonary valvotomy. Six patients died after the first palliation or inter-stage. Thirty patients achieved a biventricular repair (BVR group), 6 patients had a 1 + 1/2 ventricular repair (1 + 1/2V group) and 5 patients had a Fontan completion (Fontan group). After modified BTS with pulmonary valvotomy, tricuspid valve z-score did not increase in any of the group (BVR: pre -2.79 vs post -2.24, 1 + 1/2V: pre -5.25 vs post -6.69, Fontan: pre -6.82 vs post -7.94). Normalized RV end-diastolic volume increased only in BVR group after modified BTS with pulmonary valvotomy (BVR: pre 32% vs post 64%, 1 + 1/2V: pre 43% vs post 42%, Fontan: pre 29% vs post 32%). Major RV-coronary artery fistula was a strong factor with proceeding single-ventricle palliation [BVR: 4/30 (13%) patients, 1 + 1/2V: 1/6 (17%) and Fontan: 4/5 (80%)]. CONCLUSIONS: Tricuspid valve growth was not obtained by modified BTS with pulmonary valvotomy; therefore, tricuspid valve size at birth appeared to be a predictor for achieving BVR. Proportionate RV growth was seen only in patients who achieved BVR. However, RV growth was not seen in patients having 1 + 1/2 ventricular repair. Major RV-coronary artery fistula was a strong predictor for proceeding single-ventricle palliation.

DOI： 10.1093/ejcts/ezw124

腸骨動脈・大腿動脈間人工血管バイパス術後10年目に吻合部破綻をきたした一例

小松弘明, 大澤晋, 藤井泰宏, 柚木靖弘, 増田善逸, 黒子洋介, 佐野俊二

日本臨床外科学会雑誌 77 ( 7 ) 1864 - 1864 2016年7月

左側房室弁の外科治療 AVSDに対するmodified single patch repair 査読

笠原真悟, 佐野俊和, 堀尾直裕, 小林純子, 石神修大, 藤井泰宏, 黒子洋介, 小谷恭弘, 新井禎彦, 佐野俊二

日本小児循環器学会雑誌 32 ( Suppl.1 ) s1 - 115 2016年7月

Type2 endoleak発生に対する予測因子の検討術前にエンドリークを予測できるか?

大澤晋, 藤井泰宏, 黒子洋介, 増田善逸, 佐野俊二

日本血管外科学会雑誌 25 ( Suppl. ) 247 - 247 2016年6月

血管術後のHMGB-1の変化の検討動脈硬化病変・アテローム性病変の除去・隔離によるHMGB-1抑制効果

藤井泰宏, 逢坂大樹, 大澤晋, 増田善逸, 黒子洋介, 佐野俊二

日本血管外科学会雑誌 25 ( Suppl. ) 378 - 378 2016年6月

膠原病はタバコ窩内シャント閉塞のリスクファクターである

藤井泰宏, 大澤晋, 奥山倫弘, 増田善逸, 黒子洋介, 竹内英実, 内田治仁, 佐野俊二, 後藤拓弥, 堀尾直裕, 枝木大治, 小松弘明, 木村紘爾

静脈学 27 ( 2 ) 235 - 235 2016年5月

腸骨動脈・大腿動脈間人工血管バイパス術後10年目に吻合部破綻をきたした一例

小松弘明, 大澤晋, 藤井泰宏, 柚木靖弘, 増田善逸, 黒子洋介, 佐野俊二

岡山医学会雑誌 128 ( 1 ) 81 - 81 2016年4月

成人先天性心疾患の外科治療成績と現在の問題点

小谷恭弘, 笠原真悟, 黒子洋介, 藤井泰宏, 小林純子, 大澤晋, 増田善逸, 佐野俊和, 衛藤弘樹, 枝木大治, 木村公爾, 堀尾直裕, 新井禎彦, 佐野俊二

日本外科学会定期学術集会抄録集 116回 OP - 5 2016年4月

HLHSの外科治療合併症回避のための治療戦略左心低形成症候群に対する連続135例のModified Norwood-Sano手術の治療成績

笠原真悟, 枝木大治, 佐野俊和, 木村紘爾, 堀尾直裕, 後藤拓弥, 小林純子, 石神修大, 藤井泰宏, 黒子洋介, 小谷恭弘, 大澤晋, 増田善逸, 新井禎彦, 佐野俊二

日本心臓血管外科学会学術総会抄録集 46回 PD2 - 1 2016年2月

タバコ窩内シャント設置術の開存率とシャント不全のリスクファクターの検討

藤井泰宏, 大澤晋, 小松弘明, 黒子洋介, 増田善逸, 奥山倫弘, 佐野俊二

日本心臓血管外科学会学術総会抄録集 46回 OP16 - 3 2016年2月

成人先天性心疾患心機能低下例の治療成人期Fontan手術およびTCPC conversionにおける低心機能例の検討

小谷恭弘, 笠原真悟, 黒子洋介, 枝木大治, 佐野俊和, 木村紘爾, 堀尾直裕, 小林純子, 藤井泰宏, 大澤晋, 増田善逸, 新井禎彦, 佐野俊二

日本心臓血管外科学会学術総会抄録集 46回 PR26 - 3 2016年2月

Surgical outcome of hypoplastic left heart syndrome with intact atrial septum. 国際誌

Sadahiko Arai, Yasuhiro Fujii, Yasuhiro Kotani, Yosuke Kuroko, Shingo Kasahara, Shunji Sano

Asian cardiovascular & thoracic annals 23 ( 9 ) 1034 - 8 2015年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The surgical outcomes of hypoplastic left heart syndrome with intact atrial septum remains very poor in spite of the introduction of prenatal diagnosis before the Norwood operation. The hybrid operation consisting of bilateral pulmonary artery banding and balloon atrioseptectomy is one of the treatment strategies to potentially improve this patient population, however, the long-term outcomes are unknown. METHODS: Six consecutive patients with hypoplastic left heart syndrome with intact atrial septum, who underwent the hybrid operation between October 2006 and July 2014, were retrospectively reviewed. Hypoplastic left heart syndrome with highly restrictive atrial communication was excluded. RESULTS: Three patients died after the hybrid operation, due to sepsis, cerebral bleeding, and heart failure. Three patients underwent the modified Norwood operation. One of these died due to severe hypoxia while awaiting the bidirectional Glenn operation. The others underwent a bidirectional Glenn operation and subsequent Fontan completion but died due to lung dysfunction and sudden hemoptysis. CONCLUSIONS: The hybrid operation for hypoplastic left heart syndrome with intact atrial septum may have improved the neonatal outcome and Fontan completion rate in this extremely high-risk group of patients, but the long-term outcome remains dismal. Considering the late mortality related to pulmonary complications, aggressive fetal intervention to create a nonrestrictive atrial septal communication to promote normal development of the pulmonary vessels may be the last resort to improve the long-term outcome.

DOI： 10.1177/0218492315606581

下大静脈フィルター閉塞が誘因となった症候性下肢動静脈瘻の2症例査読

大澤晋, 藤井泰宏, 藤原寛康, 増田善逸, 黒子洋介, 戸田洋伸, 内田治仁, 村上和敏, 江尻健太郎, 高樽由美, 料治三恵, 逢坂大樹, 竹内英実, 武本梨佳, 本田雅子, 三宅麻希, 佐野俊二

脈管学 55 ( Suppl. ) S212 - S212 2015年10月

日本人の体格を考慮した、タバコ窩内シャント設置術適応の検討

藤井泰宏, 大澤晋, 黒子洋介, 増田善逸, 佐野俊二, 内田治仁, 竹内英実, 戸田洋伸, 逢坂大樹, 武本梨佳

脈管学 55 ( Suppl. ) S179 - S179 2015年10月

Left Ventricular Myxoma Occluding the Suprarenal Abdominal Aorta in an Infant. 国際誌

Takuya Kawabata, Shingo Kasahara, Shin-ichi Ohtsuki, Yosuke Kuroko, Yasuhiro Kotani, Yasuhiro Fujii, Ko Yoshizumi, Sadahiko Arai, Shunji Sano

The Annals of thoracic surgery 100 ( 1 ) 309 - 11 2015年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Myxoma is the most common primary cardiac tumor in adults; however, it is extremely rare in infants. Acute occlusion of the abdominal aorta by a cardiac myxoma is also rare. We report the case of an infant with acute occlusion of the suprarenal abdominal aorta by a left ventricular myxoma. The patient underwent successful catheter embolectomy of the abdominal aorta and surgical resection of the cardiac myxoma. This is a very rare case report of the combination of infantile left ventricular myxoma and acute occlusion of the abdominal aorta.

DOI： 10.1016/j.athoracsur.2014.08.066

Current Management of Severe CHF by Mechanical Support and Cardiac Transplant 左心低形成症候群に対する心筋幹細胞を用いた再生医療

佐野俊二, 樽井俊, 石神修大, 小林純子, 後藤拓弥, 奥山倫弘, 逢坂大樹, 黒子洋介, 馬場健児, 大月審一, 新井禎彦, 笠原真悟, 王英正

日本小児循環器学会雑誌 31 ( Suppl.1 ) s1 - 147 2015年7月

Intracoronary autologous cardiac progenitor cell transfer in patients with hypoplastic left heart syndrome: the TICAP prospective phase 1 controlled trial. 国際誌

Shuta Ishigami, Shinichi Ohtsuki, Suguru Tarui, Daiki Ousaka, Takahiro Eitoku, Maiko Kondo, Michihiro Okuyama, Junko Kobayashi, Kenji Baba, Sadahiko Arai, Takuya Kawabata, Ko Yoshizumi, Atsushi Tateishi, Yosuke Kuroko, Tatsuo Iwasaki, Shuhei Sato, Shingo Kasahara, Shunji Sano, Hidemasa Oh

Circulation research 116 ( 4 ) 653 - 64 2015年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

RATIONALE: Hypoplastic left heart syndrome (HLHS) remains a lethal congenital cardiac defect. Recent studies have suggested that intracoronary administration of autologous cardiosphere-derived cells (CDCs) may improve ventricular function. OBJECTIVE: The aim of this study was to test whether intracoronary delivery of CDCs is feasible and safe in patients with hypoplastic left heart syndrome. METHODS AND RESULTS: Between January 5, 2011, and January 16, 2012, 14 patients (1.8±1.5 years) were prospectively assigned to receive intracoronary infusion of autologous CDCs 33.4±8.1 days after staged procedures (n=7), followed by 7 controls with standard palliation alone. The primary end point was to assess the safety, and the secondary end point included the preliminary efficacy to verify the right ventricular ejection fraction improvements between baseline and 3 months. Manufacturing and intracoronary delivery of CDCs were feasible, and no serious adverse events were reported within the 18-month follow-up. Patients treated with CDCs showed right ventricular ejection fraction improvement from baseline to 3-month follow-up (46.9%±4.6% to 52.1%±2.4%; P=0.008). Compared with controls at 18 months, cardiac MRI analysis of CDC-treated patients showed a higher right ventricular ejection fraction (31.5%±6.8% versus 40.4%±7.6%; P=0.049), improved somatic growth (P=0.0005), reduced heart failure status (P=0.003), and lower incidence of coil occlusion for collaterals (P=0.007). CONCLUSIONS: Intracoronary infusion of autologous CDCs seems to be feasible and safe in children with hypoplastic left heart syndrome after staged surgery. Large phase 2 trials are warranted to examine the potential effects of cardiac function improvements and the long-term benefits of clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01273857.

DOI： 10.1161/CIRCRESAHA.116.304671

先天性心疾患に合併した肺動脈瘤に対し外科治療を施行した成人の3例

樽井俊, 堀尾直裕, 石神修大, 後藤拓弥, 藤井泰宏, 大澤晋, 小谷恭弘, 黒子洋介, 川畑拓也, 吉積功, 増田善逸, 新井禎彦, 赤木禎治, 笠原真悟, 佐野俊二

日本心臓血管外科学会雑誌 44 ( Suppl. ) 361 - 361 2015年1月

Effects of intravenous cariporide on release of norepinephrine and myoglobin during myocardial ischemia/reperfusion in rabbits. 国際誌

Shigeru Sakurai, Yosuke Kuroko, Shuji Shimizu, Toru Kawada, Tsuyoshi Akiyama, Toji Yamazaki, Masaru Sugimachi, Shunji Sano

Life sciences 114 ( 2 ) 102 - 6 2014年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS: To examine the effects of cariporide, a Na(+)/H(+) exchanger-1 inhibitor, on cardiac norepinephrine (NE) and myoglobin release during myocardial ischemia/reperfusion by applying a microdialysis technique to the rabbit heart. MAIN METHODS: In anesthetized rabbits, two dialysis probes were implanted into the left ventricular myocardium and were perfused with Ringer's solution. Cariporide (0.3mg/kg) was injected intravenously, followed by occlusion of the left circumflex coronary artery. During 30-min coronary occlusion followed by 30-min reperfusion, four consecutive 15-min dialysate samples (two during ischemia and two during reperfusion) were collected in vehicle and cariporide-treated groups. Dialysate myoglobin and NE concentrations were measured by immunochemistry and high-performance liquid chromatography, respectively. KEY FINDINGS: Dialysate myoglobin and NE concentrations increased significantly during myocardial ischemia/reperfusion in both vehicle and cariporide-treated groups (P<0.01 vs. baseline). In cariporide-treated group, dialysate myoglobin concentrations were significantly lower than those in vehicle group throughout ischemia/reperfusion (P<0.01 at 0-15 min of ischemia, P<0.05 at 15-30 min of ischemia, P<0.01 at 0-15 min of reperfusion, and P<0.01 at 15-30 min of reperfusion). However, dialysate NE concentrations in cariporide-treated group were lower than those in vehicle group only during ischemia (P<0.01 at 0-15 min of ischemia, and P<0.05 at 15-30 min of ischemia). SIGNIFICANCE: When administered before ischemia, cariporide reduces myoglobin release during ischemia/reperfusion and decreases NE release during ischemia.

DOI： 10.1016/j.lfs.2014.08.008

Repair of Ebstein's anomaly in neonates and small infants: impact of right ventricular exclusion and its indications. 国際誌

Shunji Sano, Yasuhiro Fujii, Shingo Kasahara, Yosuke Kuroko, Atsushi Tateishi, Ko Yoshizumi, Sadahiko Arai

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 45 ( 3 ) 549 - 55 2014年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: In cases of severe Ebstein's anomaly, it is essential to determine whether biventricular repair (BVR) or single-ventricle palliation is feasible. Since 1999, in our institution, we have used the novel technique comprising tricuspid valve (TV) closure and right ventricular and right atrial (RV/RA) exclusion to reduce the deleterious effects of an enlarged RV in patients with severe Ebstein's anomaly. However, in cases with good RV function, primary BVR is performed. In the present study, we describe our surgical strategy in the treatment of severely symptomatic neonates with Ebstein's anomaly. METHODS: From June 1999 to October 2011, 12 neonates with a severely symptomatic Ebstein's anomaly underwent surgical repair. The mean age at the first operation was 29 ± 25 (range, 5-92) days; and the mean body weight was 2.8 ± 0.5 (range, 2.0-4.1) kg. The associated anomalies included pulmonary atresia with an intact ventricular septum in 7, critical pulmonary stenosis in 1, ventricular septal defect in 3 and coarctation of the aorta in 1 patient. The mean cardio-thoracic ratio (CTR) was 80 ± 14% (range, 57-98%). Preoperatively, 9 patients had grade IV tricuspid regurgitation (TR), as detected by echocardiography, and 6 required ventilator support. RESULTS: Five patients underwent primary BVR. Seven patients underwent staged palliation using a modified Blalock-Taussig shunt (BT shunt) with/without RV/RA exclusion. There was 1 case each of hospital death and late death. The median follow-up duration in the present study was 6.5 years. Among the 8 patients who underwent TV repair, postoperative TR was trivial or mild in 6 patients, moderate in 1 and absent in 1. After surgery, the mean CTR and serum B-type natriuretic peptide levels decreased to 59 ± 14% (range, 45-70%) and 46 ± 28 (range, 12-83) pg/dl, respectively. CONCLUSIONS: Critically ill neonates with Ebstein's anomaly can be successfully treated using RV/RA exclusion combined with a modified BT shunt in cases where RV function is poor. However, in cases of good RV function, we recommend the use of primary BVR.

DOI： 10.1093/ejcts/ezt465

The effect of pulmonary root translocation on the left ventricular outflow tract. 国際誌

Atsushi Tateishi, Shingo Kasahara, Takuya Kawabata, Yosuke Kuroko, Ko Yoshizumi, Masami Takagaki, Sadahiko Arai, Shunji Sano

The Annals of thoracic surgery 96 ( 4 ) 1469 - 1471 2013年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

We report the effect of pulmonary root translocation on the left ventricular outflow tract. A double switch operation with pulmonary root translocation was performed in a 6-year-old boy whose diagnosis was dextrocardia, congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. Postoperative magnetic resonance imaging showed more natural left ventricular outflow than preoperatively (19 mm vs 22 mm in length between the top of the interventricular septum and the aortic valve). This technique does not require coronary transfer and enables preservation of the aortic root structure. The long-term results, including left ventricular outflow tract morphology, should be evaluated.

DOI： 10.1016/j.athoracsur.2013.02.050

PA/VSD、MAPCAsに対する外科治療の中期成績

新井禎彦, 藤井泰宏, 黒子洋介, 川畑拓也, 立石篤志, 吉積功, 笠原真悟, 佐野俊二

日本小児循環器学会雑誌 28 ( Suppl. ) s173 - s173 2012年6月

画像診断 3T MRIの実際より低侵襲に、より速く、診断・治療に生きる画像を得る工夫

澤田まどか, 西岡貴弘, 松岡孝, 曽我恭司, 藤井隆成, 岩崎順弥, 富田英, 上村茂, 黒子洋介, 伊藤篤志, 石野幸三

日本小児循環器学会雑誌 26 ( Suppl. ) s158 - s158 2010年6月

Impact of miniaturization of cardiopulmonary bypass circuit on blood transfusion requirement in neonatal open-heart surgery

Yasuhiro Kotani, Osami Honjo, Mahito Nakakura, Shinya Ugaki, Takuya Kawabata, Yosuke Kuroko, Satoru Osaki, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Shunji Sano

ASAIO JOURNAL 53 ( 6 ) 662 - 665 2007年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

This study was undertaken to determine the impact of miniaturization of a cardiopulmonary bypass (CPB) circuit on blood transfusion and hemodynamics in neonatal open-heart surgery. Neonates (n = 102) undergoing open-heart surgery between 2002 and 2006 were included and divided into three groups: group 1 (n = 28), Dideco 902 oxygenator + 5/16 '' line; group 2 (n = 29), Dideco 901 oxygenator + 1/4 '' line; group3 (n = 45), Dideco 901 oxygenator + 3/16 '' arterial + 1/4 '' venous line. Amount of priming volume, blood and bicarbonate sodium use during CPB, and hemodynamics were compared. Priming volume in the groups 2 and 3 was significantly less compared with the group 1 (group 1, 575 37 ml; group 2, 328 +/- 12 ml, group 3, 326 +/- 5 ml, p < 0.05). Blood transfusion and bicarbonate sodium use during CPB in groups 2 and 3 were significantly less compared with group 1. Hemodynamics during CPB was comparable. There were no differences between groups 2 and 3 in any parameter. Miniaturization of the CPB circuit resulted in decrease in priming volume and subsequent reduction in blood and bicarbonate sodium use. Downsizing the lines had minimal impact on any of the parameters studied, and further efforts should be made to achieve neonatal open-heart surgery without blood transfusion.

DOI： 10.1097/MAT.0b013e318158ddf6

Cardiac epinephrine synthesis and ischemia-induced myocardial epinephrine release. 国際誌

Yosuke Kuroko, Toji Yamazaki, Noriyuki Tokunaga, Tsuyoshi Akiyama, Hirotoshi Kitagawa, Kozo Ishino, Shunji Sano, Hidezo Mori

Cardiovascular research 74 ( 3 ) 438 - 44 2007年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Phenylethanolamine-N-methyltransferase (PNMT), the enzyme that synthesizes epinephrine (EPI) from norepinephrine (NE) in the adrenal gland, is present in extra-adrenal tissues including heart. Ischemia evokes an excessive NE accumulation in the myocardial interstitial spaces. Therefore, cardiac PNMT activity with high NE levels may contribute to cardiac EPI synthesis and release evoked by ischemia. METHODS: We measured dialysate EPI levels in the left ventricle of anesthetized rabbits using a cardiac microdialysis technique. The dialysate EPI level served as an index of the myocardial interstitial EPI level. Locally administered NE-induced dialysate EPI responses were measured. The left circumflex coronary artery was occluded for 60 min and the dialysate EPI and NE levels in the ischemic region were measured. Coronary occlusion-induced EPI responses were compared with and without administration of a PNMT inhibitor (SKF29661) in the presence and absence of desipramine (catecholamine transport blocker). RESULTS: Local administration of NE (250, 2500 ng/ml) increased the EPI levels to 734+/-125 and 2088+/-367 pg/ml respectively. These increases in dialysate EPI were suppressed by the PNMT inhibitor. Acute myocardial ischemia significantly increased the EPI levels to 3607+/-1069 pg/ml in the ischemic region, and these were suppressed by the PNMT inhibitor (1417+/-581 pg/ml). The pretreatment with desipramine suppressed ischemia-induced EPI release, which did not differ with (725+/-155 pg/ml) and without administration of a PNMT inhibitor (743+/-172 pg/ml). CONCLUSION: The cardiac PNMT in the left ventricle is capable of synthesizing EPI with markedly elevated NE levels in the myocardial interstitial space.

Effect of sustained limb ischemia on norepinephrine release from skeletal muscle sympathetic nerve endings. 国際誌

Yosuke Kuroko, Noriyuki Tokunaga, Toji Yamazaki, Tsuyoshi Akiyama, Kozo Ishino, Shunji Sano, Hidezo Mori

Neurochemistry international 49 ( 5 ) 448 - 53 2006年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Acute ischemia has been reported to impair sympathetic outflow distal to the ischemic area in various organs, whereas relatively little is known about this phenomenon in skeletal muscle. We examined how acute ischemia affects norepinephrine (NE) release at skeletal muscle sympathetic nerve endings. We implanted a dialysis probe into the adductor muscle in anesthetized rabbits and measured dialysate NE levels as an index of skeletal muscle interstitial NE levels. Regional ischemia was introduced by microsphere injection and ligation of the common iliac artery. The time courses of dialysate NE levels were examined during prolonged ischemia. Ischemia induced a decrease in the dialysate NE level (from 19+/-4 to 2.0+/-0 pg/ml, mean+/-S.E.), and then a progressive increase in the dialysate NE level. The increment in the dialysate NE level was examined with local administration of desipramine (DMI, a membrane NE transport inhibitor), omega-conotoxin GVIA (CTX, an N-type Ca(2+) channel blocker), or TMB-8 (an intracellular Ca(2+) antagonist). At 4h ischemia, the increment in the dialysate NE level (vehicle group, 143+/-30 pg/ml) was suppressed by TMB-8 (25+/-5 pg/ml) but not by DMI (128+/-10 pg/ml) or CTX (122+/-18 pg/ml). At 6h ischemia, the increment in the dialysate NE level was not suppressed by the pretreatment. Ischemia induced biphasic responses in the skeletal muscle. Initial reduction of NE release may be mediated by an impairment of axonal conduction and/or NE release function, while in the later phase, the skeletal muscle ischemia-induced NE release was partly attributable to exocytosis via intracellular Ca(2+) overload rather than opening of calcium channels or carrier mediated outward transport of NE.

Advantages of temporary venoatrial shunt using centrifugal pump during bidirectional cavopulmonary shunt

Yasuhiro Kotani, Osami Honjo, Kozo Ishino, Satoru Osaki, Yosuke Kuroko, Takuya Kawabata, Shinya Ugaki, Ko Yoshizumi, Shingo Kasahara, Masaaki Kawada, Shunji Sano

ASAIO JOURNAL 52 ( 5 ) 549 - 551 2006年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Single-ventricle palliation without the use of cardiopulmonary bypass carries advantages that reduce systemic edema and inflammatory responses; however, simple clamping of the superior vena cava (SVC) without a temporary shunt leads to increase in cerebral venous pressure and subsequent decrease in cerebral blood flow during bidirectional cavopulmonary shunt (BCPS). We report our experience of BCPS, using a centrifugal pump-assisted temporary shunt.The criteria included an unrestrictive interatrial communication, the absence of atrioventricular valve regurgitation, and the existence of an antegrade pulmonary blood flow. From August 2000, 14 children with single-ventricle physiology met the criteria. The mean age was 1.0 +/- 0.9 years, and the mean weight was 8.4 +/- 2.6 kg. A temporary shunt was established between the SVC and the right atrium with right-angle cannulae, which were connected to a centrifugal pump to accelerate the blood flow from the SVC to the right atrium.All patients tolerated the procedure. Mean central venous pressure was 17 +/- 4 mm Hg, and transcutaneous oxygen saturation was maintained at 77 +/- 8% during anastomosis. No patients required blood transfusion. There were no postoperative neurological complications.The centrifugal pump-assisted temporary shunt offered safer and more effective circulatory support than other shunt systems, with excellent venous drainage in pediatric patients undergoing BCPS.

DOI： 10.1097/01.mat.0000235454.64316.f3

Protein-losing enteropathy seven years after total right ventricular exclusion procedure for arrhythmogenic right ventricular dysplasia.

Koki Nakamura, Masaaki Kawada, Yosuke Kuroko, Shuji Shimizu, Takuya Kawabata, Shunji Sano

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 12 ( 3 ) 207 - 9 2006年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 27-year-old man who was diagnosed with arrhythmogenic right ventricular dysplasia (ARVD) underwent the total right ventricular (RV) exclusion procedure: the RV free wall was resected and an extracardiac total cavopulmonary connection (TCPC) was created using a 24-mm-diameter polytetrafluoroethylene (PTFE) graft. After an uneventful period of 7 years, he began to develop protein-losing enteropathy (PLE), which was resistant to medical therapy, moderate mitral regurgitation (MR) and right femoral arteriovenous fistula due to heart catheterization. Therefore, fenestration of TCPC, mitral annuloplasty and ligation of arteriovenous fistula were performed. After the operation, symptoms and levels of total protein and albumin were immediately improved and normalized.

Contribution of catechol O-methyltransferase to the removal of accumulated interstitial catecholamines evoked by myocardial ischemia. 国際誌

Yosuke Kuroko, Takafumi Fujii, Toji Yamazaki, Tsuyoshi Akiyama, Kozo Ishino, Shunji Sano, Hidezo Mori

Neuroscience letters 388 ( 2 ) 61 - 4 2005年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Catechol O-methyltransferase (COMT) plays an important role for clearance of high catecholamine levels. Although myocardial ischemia evokes similar excessive catecholamine accumulation, it is uncertain whether COMT activity is involved in the removal of accumulated catecholamines evoked by myocardial ischemia. We examined how COMT activity affects myocardial catecholamine levels during myocardial ischemia and reperfusion. We implanted a dialysis probe into the left ventricular myocardial free wall and measured dialysate catecholamines levels in anesthetized rabbits. Dialysate catecholamine levels served as an index of myocardial interstitial catecholamine levels. We introduced myocardial ischemia by 60 min occlusion of the main coronary artery. The ischemia-induced dialysate catecholamines levels were compared with and without the pretreatment with entacapone (COMT inhibitor, 10 mg/kg, i.p.). Acute myocardial ischemia progressively increased dialysate catecholamine levels. Acute myocardial ischemia increased dialysate norepinephrine (NE) levels (20,453+/-7186 pg/ml), epinephrine (EPI) levels (1724+/-706 pg/ml), and dopamine (DA) levels (1807+/-800 pg/ml) at the last 15 min of coronary occlusion. Inhibition of COMT activity by entacapone augmented the ischemia-induced NE levels (54,306+/-6618 pg/ml), EPI levels (2681+/-567 pg/ml), and DA (3551+/-710 pg/ml) levels at the last 15 min of coronary occlusion. Myocardial ischemia evoked NE, EPI, and DA accumulation in the myocardial interstitial space. The inhibition of COMT activity augmented these increments in NE, EPI, and DA. These data suggest that cardiac COMT activity influences on the removal of accumulated catecholamine during myocardial ischemia.

Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia. 国際誌

Osami Honjo, Yukio Yamada, Yosuke Kuroko, Yoshio Kushida, Dai Une, Katsuyoshi Hioki

Journal of vascular surgery 40 ( 5 ) 1032 - 6 2004年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Spontaneous dissection and rupture of the iliac artery is an unusual finding in patients with fibromuscular dysplasia (FMD). We report the case of a patient with FMD who required emergent surgery because of rupture of an iliac artery dissection, and review 9 previously reported cases of iliac artery dissection associated with FMD. A 30-year-old man had abdominal pain, and went into shock. Angiograms revealed dissection of the left common iliac artery with extravasation. At emergent surgery the rupture site was in the proximal left common iliac artery and extended to the left external iliac artery. Interposition of the diseased artery with a Dacron graft was attempted, but cardiac arrest occurred, and resuscitation was unsuccessful. Pathologic examination showed typical characteristics of diffuse medial FMD. Ten cases (5 male and 5 female patients), including the present case, with dissection of iliac arteries associated with FMD have been reported. Median patient age was 45 years (range, 29-56 years). Three of the 10 patients had acute onset of symptoms, and the remainder had gradual development of intermittent claudication or groin pain. Only the present case had evidence of rupture. The site of dissection was in the external iliac artery in 8 patients and the common iliac artery in 2 patients. Anatomic bypass or interposition of the diseased artery was performed in 8 patients; the others received conservative treatment. There was no mortality in the 9 previously reported cases. Fatal acute dissection and rupture of the common iliac artery occurred in a patient with FMD, even though the clinical course of this disease is relatively benign. FMD should be considered the cause of dissection and rupture of the iliac artery in a patient with symptoms but of non-atherosclerotic age.

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