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The Annals of thoracic surgery 06/2012; 93(6):2072. · 3.74 Impact Factor
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ABSTRACT: Objectives: The purpose of this study is to provide short- and mid-term results of open aortic valvotomy (OAV) for patients with critical
aortic stenosis (AS). Methods: Between December 1993 and June 1996, 6 patients with critical AS underwent an OAV in our unit. Their ages and body weights
at operation ranged from 1 to 65 days (median age, 9 days) and from 2.4 to 5.7 kg (median weight, 3.3 kg), respectively. Peak
pressure gradient and diameter of the aortic value ranged from 25 to 111 mmHg (mean value, 79 mmHg) and from 4.6 to 7.5 mm
(mean diameter, 6.1 mm), respectively. OAV comprised the valvular commissurotomy and excision of the myxomatous nodules with
cardiopulmonary bypass. Results: No early or late death occurred. Mean peak pressure gradient across the aortic valve was reduced to 33 mmHg (from 15 to
44 mmHg) with no aortic insufficiency in 2 patients and trivial insufficiency in 4. During the follow-up period of 6 to 9
years, 3 out of 6 patients required no reintervention. The other 3 patients required repeated valvotomy for recurrent stenosis
within 0.2 to 1.3 years after the operation. Of these, 2 patients required the Ross procedure at 7 years of age or older,
and another at 6 years of age awaits the Ross procedure. Conclusion: OAV for critical AS was effective without causing mortality or significant aortic insufficiency. Our current strategy comprising
the initial OAV and “delayed Ross procedure” for recurrent stenosis with or without insufficiency is a promising therapeutic
option for infants with critical AS.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 53(11):593-597.
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The Annals of thoracic surgery 03/2011; 91(3):929. · 3.74 Impact Factor
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ABSTRACT: We describe here successful palliative repair of tricuspid atresia, hypoplastic right ventricle, transposition of the great arteries, and hypoplastic aortic arch in a neonate. The repair consisted of the Norwood procedure with a rudimentary right ventricle to pulmonary artery shunt, which was located on the right side of a neo-aorta. This procedure could be a useful adjunct to avoid left ventriculotomy and its subsequent dysfunction.
General Thoracic and Cardiovascular Surgery 12/2010; 58(12):633-5.
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The Annals of thoracic surgery 10/2010; 90(4):1367. · 3.74 Impact Factor
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ABSTRACT: Surgical exposure and accurate closure of a ventricular septal defect with a membranous septal aneurysm beneath the septal tricuspid leaflet carries a risk of tricuspid valve dehiscence and conduction disturbances when the septal leaflet is detached along the tricuspid annulus. To avoid these problems, we use a radial incision to expose and close perimembranous ventricular septal defects. We reviewed recent cases to determine the risks and benefits of this technique. From January 2005 through September 2008, 30 patients underwent closure of a perimembranous ventricular septal defect through a right atrial approach at our institution. The operation included radial incision of the membranous septal aneurysm to improve visualization of the perimembranous ventricular septal defect in 9 patients. There was no perioperative or late death. The operative and postoperative courses were uneventful in all cases. A residual leak was detected in only one patient. No patient had more than mild postoperative tricuspid valve insufficiency, none underwent reoperation, and no new arrhythmia or conduction disturbance was detected during follow-up. The radial incision for closure of a ventricular septal defect with a membranous septal aneurysm provides satisfactory exposure of the defect through the right atriotomy, for safe and accurate closure.
Asian cardiovascular & thoracic annals 06/2010; 18(3):250-2.
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ABSTRACT: A large number of diverse signaling molecules in cell and animal models participate in the stimulus-response pathway through which the hypertrophic growth of the myocardium is controlled. However, the mechanisms of signaling pathway including the influence of lithium, which is known as an inhibitor of glycogen synthase kinase-3beta, in pressure overload hypertrophy remain unclear. The aim of our study was to determine whether glycogen synthase kinase-3beta inhibition by lithium has acute effects on the myocyte growth mechanism in a pressure overload rat model.
First, we created a rat model of acute pressure overload cardiac hypertrophy by abdominal aortic banding. Protein expression time courses for beta-catenin, glycogen synthase kinase-3beta, and phosphoserine9-glycogen synthase kinase-3beta were then examined. The rats were divided into four groups: normal rats with or without lithium administration and pressure-overloaded rats with or without lithium administration. Two days after surgery, Western blot analysis of beta-catenin, echo-cardiographic evaluation, left ventricular (LV) weight, and LV atrial natriuretic peptide mRNA levels were evaluated.
We observed an increase in the level of glycogen synthase kinase-3beta phosphorylation on Ser 9. A significant enhancement of LV heart weight (P < 0.05) and interventricular septum and posterior wall thickness (P < 0.05) with pressure-overloaded hypertrophy in animals treated with lithium were also observed. Atrial natriuretic peptide mRNA levels were significantly increased with pressure overload hypertrophy in animals treated with lithium.
We have shown in an animal model that inhibition of glycogen synthase kinase-3beta by lithium has an additive effect on pressure overload cardiac hypertrophy.
General Thoracic and Cardiovascular Surgery 06/2010; 58(6):265-70.
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ABSTRACT: 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 (FiO2 = 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, 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%, p0.01;8 weeks:40+/-5 vs. 92+/-4%, p0.01), 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. 96+/-7%, p0.01;8 weeks:31+/-6 vs. 92+/-7%, p0.01), 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.
Acta medica Okayama 10/2009; 63(5):237-42. · 0.84 Impact Factor
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ABSTRACT: We describe successful primary repair of 2 cases of transposition complex with aortic arch obstruction. A new aortic arch was reconstructed by direct anastomosis between the well-mobilized ascending aorta and the descending aorta. The neoaortic root with transferred coronary arteries was subsequently anastomosed to the undersurface of this new aortic arch. This technique deals with the significant size discrepancy between the 2 great arteries, and anomalous coronary artery patterns.
Asian cardiovascular & thoracic annals 09/2009; 17(4):422-4.
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European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2009; · 2.40 Impact Factor
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ABSTRACT: This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT).
The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed.
There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p < 0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO(2)/FiO(2;) 411 +/- 107 vs 272 +/- 107 mm Hg, p < 0.05) and the alveolar-arterial oxygen difference (a-aDO(2); 158 +/- 84 vs 315 +/- 127 mm Hg, p < 0.05) at 15 minutes after CPB. There were no differences in PaO(2)/FiO(2) and A-aDO(2) between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p < 0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups.
The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 05/2009; 28(4):340-6. · 3.54 Impact Factor
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The Annals of thoracic surgery 04/2009; 87(3):965. · 3.74 Impact Factor
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ABSTRACT: We present here an infant with an aortopulmonary window associated with an interrupted aortic arch. Single-stage repair with a pulmonary autograft patch for augmentation of the interrupted aortic arch repair was performed. Transpulmonary patch closure was used to repair the aortopulmonary window. A computed tomography scan at the 1-month follow-up demonstrated a reconstructed aortic arch without obstruction, kinking, or any sign of bronchial or branch pulmonary artery compression.
General Thoracic and Cardiovascular Surgery 02/2009; 57(1):37-9.
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ABSTRACT: We report an adult case of right aortic arch coarctation with a left descending aorta. Associated anomalies included dextrocardia, situs inversus, polysplenia, bilateral superior vena cava, and absent inferior vena cava with azygos connection. Extensive mobilization of the azygos vein was needed to obtain a good surgical field, including the left descending aorta via a right thoracotomy, and the lesion was anatomically repaired by resection and end-to-end anastomosis.
Asian cardiovascular & thoracic annals 02/2009; 17(1):76-8.
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ABSTRACT: We report a rare case of unguarded tricuspid orifice with pulmonary atresia, which is devoid of any guarding valvular tissue at tricuspid annulus. A left Blalock-Taussig shunt was constructed on the 17th day of life. At 4 years of age, a bidirectional Glenn's operation was performed for the further growth of the pulmonary bed and the volume reduction of the left ventricle. Finally, an extracardiac cavo-pulmonary connection was created using a ringed Gore-Tex graft at 6 years of age. Staged Fontan's strategy may contribute to a good surgical outcome for this highly lethal anomaly.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2008; 34(5):1111-2. · 2.40 Impact Factor
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ABSTRACT: A case of anomalous left coronary artery originating from the non-facing pulmonary sinus, located at the most distal position from the aorta, is described. An intrapulmonary tunnel was created without causing undue stenosis or kinking. The Takeuchi procedure is considered to be a useful surgical technique when the origin of the anomalous left coronary artery is far from the aorta.
Asian cardiovascular & thoracic annals 09/2008; 16(4):324-6.
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ABSTRACT: The present study analyzes a 15-year experience of repairing persistent truncus arteriosus (PTA) with a consistent policy of right ventricular outflow tract (RVOT) reconstruction (ie, direct anastomosis).
This retrospective study included 13 consecutive patients with PTA (8 type I PTA, 5 type II) who underwent primary repair from September 1992 to December 2006. Median age and body weight at surgery were 21 days and 2.9 kg, respectively. All but 1 patient underwent RVOT reconstruction by direct anastomosis with a monocusp patch. There were 2 operative deaths (12%). No patient had a pulmonary hypertensive crisis. The median duration of ventilation was 5 days. Another patient died from cardiogenic shock resulting from late cardiac tamponade 2 months after surgery. Four patients (40%) required balloon angioplasty and 5 (50%) required re-operation for branch pulmonary artery and/or conduit obstruction during the median follow-up period of 70 months (44-174 months). Freedom from all re-interventions and re-operation at 5 years was 50% (95% confidence limits, 19-81%) and 60% (95% confidence limits, 30-91%), respectively.
Reasonable early and long-term results can be achieved with direct anastomosis. Further reduction of the re-intervention rate could be attained by refining the surgical techniques and catheter intervention strategies.
Circulation Journal 12/2007; 71(11):1776-80. · 3.77 Impact Factor
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ABSTRACT: Left ventricular (LV) retraining followed by anatomical repair would be a superior alternative in patients with congenitally corrected transposition (ccTGA) having a deconditioned morphologically left ventricle (MLV); however, LV retraining in older children is a challenging task. A retraining process of the MLV in a teenage patient with ccTGA is reported here. Cardiac catheterization at 7 years of age revealed low pressure of the MLV (33/4 mm Hg) and a LV to right ventricular pressure ratio (LVp/RVp ratio) of 0.32. The first pulmonary artery banding (PAB) was performed at 10 years of age. Although the LVp/RVp ratio reached 0.68, there was no evidence of adequate LV hypertrophy. The second PAB was performed 2 years after the initial PAB, resulting in an increase in the LVp/RVp ratio to 0.93 and an adequate LV hypertrophy. The double switch procedure was successfully performed at 13 years of age. Although the ejection fraction of the MLV mildly decreased, the patient has been doing well during a follow-up period of 4 years. The MLV in the teenage patient with ccTGA was successfully trained using a retraining strategy and has sustained systemic circulation after anatomical repair.
Circulation Journal 05/2007; 71(4):613-6. · 3.77 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair.
Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months).
Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 +/- 0.8 versus 1.4 +/- 0.9; p < 0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 +/- 0.8 versus 1.1 +/- 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients.
There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.
The Annals of thoracic surgery 12/2006; 82(6):2240-6. · 3.74 Impact Factor
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ABSTRACT: We analyzed the midterm results of children undergoing mitral valve repair without the use of prosthetic materials focusing on mitral annulus growth. From 1991 to 2004, 17 children (median age: 11 months) underwent mitral valve repair (grade III=9, IV=8). Regurgitation was due to prolapsed leaflet in 8 patients, annular dilatation in 4, and restrictive leaflet motion in 5. Preoperative indexed mitral valve diameter and Z-value were compared with those obtained at follow-up. There were no early or late deaths. All patients had an improved regurgitation grade after surgery. MV repair resulted in reduction in the indexed mitral valve diameter (58.2+/-22.9 vs. 47.3+/-18.9 mm/m2, P<0.05) and Z-value (3.3+/-2.3 vs. 0.79+/-2.2, P<0.05). One patient underwent re-repair, but no patients required mitral valve replacement during the median follow-up period of 95 months. The latest regurgitation grade was absent or I in 4 patients, II in 10 patients, and III in 3 patients. Mitral valve annulus increased by 23% at 3 years and by 49% at 5 years compared with that at surgery. Mitral valve repair without the use of prosthetic materials is feasible for the majority of patients and carries an appropriate growth pattern of the mitral valve annulus after surgery.
Interactive cardiovascular and thoracic surgery 10/2006; 5(5):589-93.
