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Yasushige Shingu
Faculty of Medicine　Surgery　Surgery
Lecturer
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Last Updated :2024/05/09

Researcher Profile and Settings

Affiliation

  • Faculty of Medicine　Surgery　Surgery

Job Title

  • Lecturer

URL

Research funding number

  • 30617064

J-Global ID

Profile

  • 1995-2001 Hokkaido University (MD)
    2005-2009 Hokkaido University (PhD)
    2009-2011 Leipzig Heart Center (research and MICS fellowship program)
    2011- Hokkaido University Hospital

Research Interests

  • 臓器保存   the preload recruitable stroke work (PRSW) relationship   僧帽弁閉鎖不全症   ischemic reperfusion injury   autophagy   left ventriculoplasty   atrial fibrillation   minimally invasive surgery   heart valve disease   heart failure   cardiovascular surgery   

Research Areas

  • Life sciences / Cardiovascular surgery

Educational Organization

Academic & Professional Experience

  • 2022/04 - Today 北海道大学大学院医学研究院 心臓血管外科 講師
  • 2017/04 - 2022/03 北海道大学大学院医学研究院 循環器・呼吸器外科 講師
  • 2014/04 - 2017/03 Hokkaido University Hokkaido University Hospital
  • 2012/04 - 2014/03 Hokkaido University
  • 2011/03 - 2012/03 Hokkaido University Hokkaido University Hospital
  • 2009/05 - 2011/02 Heart Center Leipzig, Germany
  • 2005/04 - 2009/03 Hokkaido University Hokkaido University Hospital
  • 2003/10 - 2005/03 市立旭川病院 胸部外科 医員
  • 2002/08 - 2003/09 恵佑会札幌病院 外科 研修医
  • 2001/08 - 2002/07 国立がんセンター札幌 心臓血管外科 研修医
  • 2001/03 - 2001/07 Hokkaido University

Education

  • 2005/04 - 2009/03  北海道大学大学院
  • 1995/04 - 2001/03  Hokkaido University  School of Medicine
  • 1992/04 - 1995/03  函館ラ・サール高校

Association Memberships

  • 日本心不全学会   北海道外科学会   アジア心臓血管外科学会   THE JAPAN SOCIETY FOR TRANSPLANTATION   JAPANESE SOCIETY FOR VASCULAR SURGERY   The Japanese Circulation Society   THE JAPANESE SOCIETY FOR CARDIOVASCULAR SURGERY   THE JAPANESE ASSOCIATION FOR THORACIC SURGERY   JAPAN SURGICAL SOCIETY   

Research Activities

Published Papers

  • Hiroyuki Natsui, Masaya Watanabe, Takashi Yokota, Satonori Tsuneta, Yoshizuki Fumoto, Haruka Handa, Matsushima Shouji, Jiro Koya, Kotaro Nishino, Daishiro Tatsuta, Takuya Koizumi, Takahide Kadosaka, Motoki Nakao, Taro Koya, Taro Temma, Yoichi M. Ito, Hatanaka C. Kanako, Yutaka Hatanaka, Shingu Yasushige, Satoru Wakasa, Shuhei Miura, Takahiko Masuda, Naritomo Nishioka, Shuichi Naraoka, Kayoko Ochi, Tomoko Kudo, Tsugumine Ishikawa, Toshihisa Anzai
    Physiological Reports 12 (6) e15957  2051-817X 2024/03/28 [Refereed][Not invited]
     
    Abstract Epicardial adipose tissue (EAT) is an active endocrine organ that is closely associated with occurrence of atrial fibrillation (AF). However, the role of EAT in the development of postoperative AF (POAF) remains unclear. We aimed to investigate the association between EAT profile and POAF occurrence in patients who underwent cardiovascular surgery. We obtained EAT samples from 53 patients to evaluate gene expression, histological changes, mitochondrial oxidative phosphorylation (OXPHOS) capacity in the EAT, and protein secretion in EAT‐conditioned medium. EAT volume was measured using computed tomography scan. Eighteen patients (34%) experienced POAF within 7 days after surgery. Although no significant difference was observed in EAT profile between patients with and without POAF, logistic regression analysis identified that the mRNA expression levels of tumor necrosis factor‐alpha (TNF‐α) were positively correlated and adipocyte size in the EAT was inversely correlated with onset of POAF, respectively. Mitochondrial OXPHOS capacity in the EAT was not associated with POAF occurrence; however, it showed an inverse correlation with adipocyte size and a positive correlation with adiponectin secretion. In conclusion, changes in the secretory profile and adipocyte morphology of the EAT, which represent qualitative aspects of the adipose tissue, were present before the onset of AF.
  • Satoru Wakasa, Yasushige Shingu
    General thoracic and cardiovascular surgery 2023/11/02 
    Chordal preservation is recommended in mitral valve replacement for functional mitral regurgitation to preserve left ventricular function. In contrast, papillary muscle suspension toward the anterior mitral annulus can induce left ventricular reverse remodeling after mitral valve replacement for functional mitral regurgitation. However, the extent of suspension depends on the surgeon's experience. Therefore, we developed a new concept of chordal preservation, called rough-zone suspension, which not only spares the subvalvular structure but also suspends the papillary muscles toward the annulus. This procedure is simple and reproducible for determining the extent of suspension, and can increase the probability of left ventricular reverse remodeling after mitral valve replacement for functional mitral regurgitation.
  • Takahiro Ishigaki, Satoru Wakasa, Yasushige Shingu, Yohei Ohkawa, Akira Yamada
    General thoracic and cardiovascular surgery 71 (11) 674 - 680 2023/11 
    OBJECTIVE: To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection. METHODS: We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups. RESULTS: The median age was 84 years (interquartile range 82-87 years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97 cm2/m2. Except for sex, no significant differences were observed in patients' baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85 years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015). CONCLUSIONS: All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85 years or older.
  • Yuki Takahashi, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Takeshi Hamaya, Sho Kazui, Yutaro Yasui, Kohei Saiin, Seiichiro Naito, Yoshifumi Mizuguchi, Sakae Takenaka, Atsushi Tada, Suguru Ishizaka, Yuta Kobayashi, Kazunori Omote, Takuma Sato, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai
    Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 25 (1) 60 - 60 2023/10/26 
    BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR). METHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR. RESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups. CONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.
  • Takashi Kunihara, Yasushige Shingu, Satoru Wakasa, Hiroshi Sugiki, Yasuhiro Kamikubo, Norihiko Shiiya, Yoshiro Matsui
    General thoracic and cardiovascular surgery 71 (10) 552 - 560 2023/10 
    PURPOSE: There is controversy regarding which internal thoracic artery (ITA) should be anastomosed to the left anterior descending artery (LAD). Here, we propose an optimal graft design based on measurement of blood flow in the ITA. METHODS: Sixty-one patients (53 men, median age 68 [62-75] years) undergoing first elective coronary artery bypass grafting were enrolled. Fifty-seven left ITAs (LITAs) and 28 right ITAs (RITAs) were harvested in either a semi-skeletonized manner using a harmonic scalpel covered with papaverine-soaked gauze (group-A, n = 45) or a fully skeletonized manner using electrocautery with intraluminal papaverine injection (group-B, n = 41). Free flow of 33 ITAs was measured after pharmacological dilatation and in situ ITA-LAD flow was measured in 59 patients by transit-time flowmetry. RESULTS: RITA and LITA free flow were 147.0 [87.8-213.0] mL/min and 108.0 [90.0-144.0] mL/min, respectively (P = 0.199). The group-B had significantly higher ITA free flow (135.0 [102.0-171.0] mL/min) than group-A (63.0 [36.0-96.0] mL/min, P = 0.009). In 13 patients with bilateral ITA harvesting, free flow of the RITA (138.0 [79.5-204.0] mL/min) was also significantly higher than the LITA (102.0 [81.0-138.0] mL/min, P = 0.046). There was no significant difference between RITA and LITA flow anastomosed to the LAD. The group-B had significantly higher ITA-LAD flow (56.5 [32.3-73.6] mL/min) than group-A (40.9 [20.1-53.7] mL/min, P = 0.023). CONCLUSION: RITA provides significantly higher free flow than LITA but similar blood flow to the LAD. Full skeletonization with intraluminal papaverine injection maximizes both free flow and ITA-LAD flow.
  • Surgical repair of a residual lesion of mixed-type total anomalous pulmonary venous connection using a vertical vein as a free graft: a case report(タイトル和訳中)
    Watabe Yoshinobu, Kato Nobuyasu, Niwano Haruki, Shingu Yasushige, Ooka Tomonori, Kato Hiroki, Abe Shinji, Wakasa Satoru
    General Thoracic and Cardiovascular Surgery Cases 2 1 of 5 - 5 of 5 2023/08
  • 当科における冠動脈に対する外科介入
    加藤 伸康, 阿部 慎司, 新宮 康栄, 大岡 智学, 加藤 裕貴, 山澤 弘州, 武田 充人, 若狭 哲
    日本小児循環器学会総会・学術集会抄録集 (NPO)日本小児循環器学会 59回 [II - 03] 2023/07
  • Takashi Kunihara, Yasushige Shingu, Satoru Wakasa, Norihiko Shiiya, Satoshi Gando
    ASAIO journal (American Society for Artificial Internal Organs : 1992) 69 (4) 391 - 395 2023/04/01 
    Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine released in response to glucocorticoids, which counter-regulates the effects of glucocorticoids. This study was performed to determine the impact of steroids on the expression of MIF and other pro- and anti-inflammatory cytokines during and after cardiopulmonary bypass (CPB). Twenty adult patients (10 men, 64 ± 8 years old) who underwent elective cardiac surgery by CPB were given either 2000 mg (group-H, n = 10) or 500 mg of methylprednisolone (group-L, n = 10) during CPB. The serum concentrations of MIF, interleukin (IL)-1β, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) were measured at eight time points until 36 hours after skin closure. The early postoperative course was uneventful for all patients. There were no significant differences in duration of operation, CPB, or aortic cross-clamping (AXC) between the two groups. MIF and IL-10 levels peaked just after the conclusion of CPB and decreased gradually thereafter. IL-1β, IL-8, and TNF-α were undetectable throughout the study period. There were no significant differences in MIF or IL-10 levels between the two groups. Peak levels of MIF in all patients were significantly correlated with the duration of CPB and AXC, whereas no such correlation was observed for IL-10. MIF or IL-10 levels were significantly elevated during and after CPB, but there were no differences between the two doses of steroid administration. Both steroid doses sufficiently suppressed proinflammatory cytokines. MIF better reflected the invasiveness of the operation than IL-10.
  • Ryota Murase, Yasushige Shingu, Satoru Wakasa
    Surgery today 2022/08/05 
    A prolonged length of hospital stay (LOS) has become an important issue among patients undergoing cardiovascular surgery in our aging society. However, there are no established prediction models for a prolonged LOS. We therefore created a prediction model of a prolonged LOS using a deep learning software program (Prediction One; Sony Network Communications Inc., Tokyo, Japan) using preoperative data. Subjects were 157 patients (121 for training data, 36 for validation data). A prolonged LOS was defined as a more than 30-day postoperative stay due to physical inactivity. The area under the receiver operating characteristic curve and the accuracy of the model in the validation data were 0.806 and 67%, respectively. In conclusion, the preliminary model demonstrated acceptable performance for the prediction of a prolonged LOS after cardiovascular surgery.
  • Ryota Murase, Yasushige Shingu, Satoru Wakasa
    Molecular biology reports 2022/07/27 
    PURPOSE: Several therapeutic agents have been found to prevent myocardial ischemic and reperfusion (I/R) injury after cardiac surgery; however, no drug is routinely used to afford cardioprotective benefits in clinical settings. Herein, we aimed to determine whether chloroquine (CQ) pretreatment attenuates I/R injury after global ischemia in isolated rat hearts and elucidate mechanisms underlying the effects of CQ. METHODS: Isolated rat hearts were subjected to 30-min global ischemia, followed by 60-min reperfusion with Krebs-Henseleit buffer (KHB). Immediately before ischemia, 10 mL of pretreatment solutions (KHB, n = 4 or KHB + CQ [100 μM], n = 4) were injected through the aortic root. Cardiac function was examined based on the rate pressure product (RPP). Myocardial apoptosis was evaluated using TUNEL staining. To assess the reperfusion ischemia salvage kinase pathway, protein expression levels of AKT and extracellular signal-regulated kinase (ERK1/2) were determined using western blotting. To investigate the role of ERK1/2, an ERK1/2 selective inhibitor was used in eight additional rats. RESULTS: The recovery rate of the RPP was higher in the KHB + CQ group than in the KHB group 60 min after I/R (KHB, 44 ± 3% vs. KHB + CQ, 69 ± 7%; P = 0.019, d = 2.2). CQ pretreatment reduced apoptosis and enhanced the phosphorylation of ERK1/2; however, AKT phosphorylation was unaltered. In addition, the ERK1/2 inhibitor abolished CQ-mediated cardioprotective effects. CONCLUSIONS: CQ pretreatment showed protective effects on cardiac function after I/R by activating ERK1/2.
  • 当院の体肺動脈短絡手術の治療成績
    加藤 伸康, 阿部 慎司, 新宮 康栄, 加藤 裕貴, 大岡 智学, 泉 岳, 山澤 弘州, 武田 充人, 若狭 哲
    日本小児循環器学会総会・学術集会抄録集 (NPO)日本小児循環器学会 58回 [III - 04] 2022/07
  • 植込型補助人工心臓治療におけるunmet medical needsの考察
    渡部 克将, 大岡 智学, 松本 嶺, 東 亮太, 須野 賢一郎, 稗田 哲也, 石垣 隆弘, 村瀬 亮太, 阿部 慎司, 加藤 伸康, 加藤 裕貴, 新宮 康栄, 若狭 哲
    北海道外科雑誌 北海道外科学会 67 (1) 92 - 92 0288-7509 2022/06
  • Kenichiro Suno, Yasushige Shingu, Satoru Wakasa
    Molecular and cellular biochemistry 2022/05/17 
    Coronary endothelial dysfunction is a major cause of ischemia-reperfusion (I/R) injury. Trehalose, a natural disaccharide, has been reported to ameliorate endothelial dysfunction during aging by activating endothelial nitric oxide synthase (eNOS); however, its role in I/R injury is unknown. This study evaluated the effects of trehalose preconditioning on cardiac and coronary endothelial function after I/R. Langendorff-perfused rat hearts underwent 30 min of global ischemia followed by 80 min of reperfusion with or without trehalose preconditioning. Rate pressure product (RPP) and coronary flow (CF) were measured during reperfusion. Perivascular edema was assessed by hematoxylin and eosin staining. Myocardial oxidative stress and apoptosis were evaluated by immunohistochemistry and TUNEL staining, respectively. eNOS dimerization was determined by western blotting. An eNOS inhibitor was used to examine the role of eNOS. Trehalose preconditioning showed a higher recovery rate after I/R as indicated by high RPP (control vs. trehalose, 28 ± 6% vs. 46 ± 9%; P = 0.017, Cohen's d = 2.3) and CF values (35 ± 10% vs. 55 ± 9%; P = 0.025, d = 1.7). Furthermore, trehalose preconditioning reduced perivascular edema, myocardial oxidative stress, and apoptosis. The eNOS dimerization ratio was increased by trehalose (1.2 ± 0.2 vs. 1.6 ± 0.2; P = 0.023, d = 2.1), which was associated with the recovery of RPP and CF. These effects of trehalose were abolished by the eNOS inhibitor. Trehalose preconditioning showed protective effects on cardiac and coronary endothelial function after I/R through the eNOS signaling pathway.
  • Yasushige Shingu, Tetsuya Hieda, Satoshi Sugimoto, Hidetsugu Asai, Tomoji Yamakawa, Satoru Wakasa
    Molecular biology reports 49 (6) 4885 - 4892 2022/05/08 
    BACKGROUND: The change in myocardial protein degradation systems after ventricular unloading has been unknown. We aimed to evaluate the anti-hypertrophic protein adenosine monophosphate-activated protein kinase (AMPK) and two major protein degradation systems (ubiquitin proteasome system and autophagy) in a model of surgical ventricular reconstruction (SVR) in rats with ischemic cardiomyopathy. METHODS AND RESULTS: Rats were randomized into the following groups: sham/sham (control group), myocardial infarction (MI)/sham (sham group) and MI/SVR (SVR group), with an interval of 4 weeks. Two (early, n = 5 for each) and 28 days (late, n = 5 for each) after SVR, ventricular size, and wall stress were assessed. Myocyte area, protein expression of AMPKα and autophagy markers, and gene expression of ubiquitin ligases (Atrogin-1 and Murf-1) were evaluated in the late phase. In the early phase, left ventricular dimensions and wall stress were smaller in the SVR group than in the sham group, whereas they were comparable in the late period. Myocyte area in the SVR group was reduced to the value in the control group, while it was larger in the sham group than in the control group. Total-AMPKα, p-AMPKα, and AMPKα phosphorylation rates were higher, and Atrogin-1 and Murf-1 were lower in the SVR group than in the sham group, while the autophagy markers were not different between the groups. p-AMPKα had strong negative correlations with myocyte area, Atrogin-1, and Murf-1. CONCLUSIONS: In myocyte reverse remodeling after SVR, AMPKα phosphorylation increased in association with reduced gene expression of ubiquitin ligases.
  • Shinji Abe, Yasuhiro Kamikubo, Nobuyasu Kato, Hiroki Kato, Tomonori Ooka, Yasushige Shingu, Satoru Wakasa
    Surgical case reports 8 (1) 80 - 80 2022/04/29 
    BACKGROUND: Pulmonary hemorrhage is a life-threatening complication of cardiovascular surgery. Bronchial artery hypertrophy, a rare pathology associated with inflammatory and ischemic respiratory diseases, increases the risk of pulmonary hemorrhage; however, its involvement in cardiovascular surgery is not well known. We present two cardiovascular surgical cases in which embolization of the hypertrophied bronchial artery was effective in controlling perioperative pulmonary hemorrhage. CASE PRESENTATION: The first case was a 51-year-old man with chronic obstructive pulmonary disease who developed acute type A aortic dissection. After emergent surgery, his blood pressure suddenly dropped in the intensive care unit; computed tomography revealed a right hemothorax. Because a 4-mm dilated bronchial artery was identified on preoperative computed tomography, the hemothorax was suspected to be associated with bronchial artery hypertrophy. Selective bronchial arteriography was emergently performed and revealed a right pulmonary parenchymal blush. After subsequent coil embolization of the bronchial artery, the parenchymal blush disappeared, and his hemodynamic condition stabilized. The second case was a 66-year-old man with bronchiectasis who was referred for redo aortic valve replacement due to structural valve deterioration. A bioprosthesis was previously implanted to avoid permanent anticoagulation because the patient had repeated episodes of hemoptysis; however, he still had persistent hemosputum during admission for the redo aortic valve replacement. A dilated bronchial artery 3.7 mm in size was incidentally identified on preoperative computed tomography, and hence, the repeated hemosputum was suspected to be associated with bronchial artery hypertrophy. Bronchial arteriography revealed a right pulmonary parenchymal blush, and prophylactic embolization of the bronchial artery was performed. The hemosputum disappeared after the procedure, and redo aortic valve replacement was performed uneventfully 8 days later. CONCLUSION: In cardiovascular surgery, the risk of pulmonary hemorrhage associated with bronchial artery hypertrophy should be considered, especially in patients with inflammatory and ischemic respiratory diseases.
  • Takahiro Ishigaki, Satoru Wakasa, Yasushige Shingu, Yohei Ohkawa, Akira Yamada, Toshihisa Anzai, Yoshiro Matsui
    Journal of cardiology 79 (4) 530 - 536 2022/04 
    BACKGROUND: Functional mitral regurgitation (FMR) is caused by left ventricular (LV) remodeling and subsequent tethering of the mitral valve (MV). If LV remodeling is irreversibly advanced, it could not be attenuated by the MV procedure alone, although the additional subvalvular procedure could induce LV reverse remodeling by forcibly reducing MV tethering. This study aimed to assess the anti-tethering effect of papillary muscle tugging approximation (PMTA) on LV reverse remodeling after mitral valve replacement (MVR) for non-ischemic FMR. METHODS: The study subjects were 19 patients who underwent MVR with and without PMTA [MVR + PMTA (n = 11) and MVR alone (n = 8), respectively] for non-ischemic FMR. The tethering distance (TD) and LV end-systolic volume (ESV) at the preoperative, postoperative, and follow-up periods were assessed in terms of their correlation and time-dependent changes. The intra-LV energy efficiency was also evaluated through vector flow mapping analysis. RESULTS: TD and ESV were comparable between both procedures preoperatively and did not change after MVR alone. In MVR + PMTA, however, a significant decrease was identified in TD and ESV at the early postoperative and follow-up periods, respectively [TD = 48, 30, and 31 mm (p < 0.001) and ESV = 159, 133, and 82 mL (p < 0.001) at the preoperative, postoperative, and follow-up periods, respectively]. Finally, at follow-up, the extent of change from the preoperative value in ESV significantly correlated with that in TD (ρ = 0.81, p < 0.001 for overall; ρ = 0.93, p < 0.001 for MVR + PMTA; ρ = 0.86, p = 0.011 for MVR alone). The ratio of TD to ESV was also significantly correlated with systolic energy loss to LV stroke work after MVR + PMTA (ρ = 0.81, p = 0.015). CONCLUSIONS: PMTA for non-ischemic FMR could induce LV reverse remodeling depending on the extent of postoperative TD reduction. A smaller TD to ESV was associated with a higher intra-LV energy efficiency after PMTA + MVR.
  • 人工知能を用いた心大血管手術後長期リハビリ症例予測モデルの構築と検証
    村瀬 亮太, 新宮 康栄, 加藤 伸康, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本臨床外科学会雑誌 日本臨床外科学会 83 (3) 600 - 600 1345-2843 2022/03
  • Tetsuya Hieda, Yasushige Shingu, Satoshi Sugimoto, Hidetsugu Asai, Tomoji Yamakawa, Satoru Wakasa
    Heart and vessels 37 (3) 528 - 537 2022/03 
    Recurrence of left ventricular (LV) remodeling after surgical ventricular reconstruction (SVR) for ischemic cardiomyopathy has been reported to be partially attributed to autophagy. We aimed to examine the effects of trehalose, an autophagy inducer, on the recurrence of LV remodeling after SVR. After SVR in rats with ICM, trehalose was orally administered. The changes in LV end-diastolic dimension (LVEDD) and fractional shortening (FS) were evaluated. The activation of myocardial autophagy was also estimated by autophagy markers: microtubule-associated light chain 3 II (LC3-II) and p62; the former usually increases and the latter decreases if autophagy is activated. Significant LV reverse remodeling was observed early after SVR. On the other hand, the 28th postoperative day SVR + trehalose was associated with smaller LVEDD and better FS than SVR alone (LVEDD, P = 0.043; FS, P < 0.01). LC3-II increased comparably in both groups, while p62 was significantly lower in the SVR + trehalose group than in the SVR alone group (P < 0.01). In conclusion, trehalose attenuated the recurrence of LV remodeling and changed autophagy markers after SVR in rats with ICM. Trehalose may be a candidate for adjuvant therapy to retain the effects of SVR.
  • 幼少期に留置した肺動脈ステント内狭窄に対する外科治療の経験
    加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本成人先天性心疾患学会雑誌 日本成人先天性心疾患学会 11 (1) 195 - 195 2022/01
  • Sato Koji, Shingu Yasushige, Fusegawa Masato, Ishigaki Takahiro, Wakasa Satoru
    Annals of Vascular Diseases advpub 1881-641X 2022 
    Iatrogenic arteriovenous fistula (AVF) rarely develops around the proximal subclavian artery, although open surgical repair of this etiology is known to be complicated as deep dissection is required around the fistula surrounded by dilated veins. In this study, we present the case of a 64-year-old man, who was referred to our hospital, with AVF between the right subclavian artery and the right vertebral vein. He had a history of accidental puncture of the right subclavian artery. An endovascular repair using a covered stent was successfully performed, and the AVF disappeared. Thus, covered stent placement should be considered as the first-line treatment for a deeply developed AVF, if anatomically feasible.
  • Yoshiro Matsui, Suguru Kubota, Tatsuya Seki, Yasushige Shingu, Satoru Wakasa
    The Annals of thoracic surgery 114 (2) e141-e144  2021/12/09 
    Mitral valvuloplasty using Gore-Tex as the artificial chordae is often associated with difficulties in determining the length of the artificial chordae, achieving the correct artificial chordae length, and preventing knot slippage, especially for beginners. We describe a simple technique involving a novel device called the "Mitral Plate," which enables surgeons to automatically determine the correct length of the artificial chordae and tie slippery knots without performing excessive saline tests.
  • Yasushige Shingu, Nobuyasu Katoh, Tomonori Ooka, Hiroki Katoh, Satoru Wakasa
    General thoracic and cardiovascular surgery 69 (11) 1460 - 1466 2021/11 
    OBJECTIVES: L-Carnitine, a quaternary amine, improves fatty acid metabolism in the heart and has anti-inflammatory effects. Several studies have reported the efficacy of L-carnitine for the prophylaxis of arrhythmia. We assessed the clinical effectiveness of L-carnitine in preventing postoperative atrial fibrillation (POAF) in aortic valve surgery. METHODS: Thirty patients who underwent aortic valve surgery were included. Fifteen patients had no prophylaxis other than conventional measures (control), while 15 patients received oral L-carnitine for 9 days (daily dose of 3 g). The incidence of POAF during 1 week after surgery was compared between the two groups. The multivariable logistic regression analysis for POAF was performed using the pre- and intraoperative parameters. RESULTS: Preoperative characteristics and operative data were comparable between the groups. The POAF rate was significantly lower in the L-carnitine group than in the control (20% and 60%, respectively; P = 0.025). L-Carnitine use was an independently negative predictor for POAF (odds ratio 0.067; 95% confidence interval 0.006-0.768). CONCLUSIONS: L-Carnitine administration may have potential for the prevention of POAF in aortic valve surgery.
  • 低左心機能を伴う虚血性閉鎖不全症〜外科手術vs Mitraclip〜 虚血性僧帽弁閉鎖不全症に対する外科治療戦略
    若狭 哲, 新宮 康栄, 加藤 伸康, 阿部 慎司, 大岡 智学, 松居 喜郎
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 CWS2 - 3 2021/10
  • 混合型TAPVC術後の遺残病変修復に際して垂直静脈を遊離グラフトとして用いた1例
    渡部 克将, 加藤 伸康, 庭野 陽樹, 松本 嶺, 東 亮太, 須野 賢一郎, 石垣 隆弘, 稗田 哲也, 村瀬 亮太, 阿部 慎司, 新宮 康栄, 大岡 智学, 若狭 哲
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 CCPA3 - 8 2021/10
  • クロロキンの心筋虚血再灌流障害抑制効果の実験的検討
    村瀬 亮太, 新宮 康栄, 加藤 伸康, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 COP35 - 4 2021/10
  • 非虚血性機能性僧帽弁閉鎖不全症に対する僧帽弁置換術において僧帽弁下手技によるアンチテザリング効果の追加が術後左室リバースリモデリングを誘導する
    石垣 隆弘, 若狭 哲, 新宮 康栄, 大川 洋平, 山田 陽, 松居 喜郎
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 COP41 - 4 2021/10
  • ECMO運用に関わる院内ガイドラインの作成
    藤原 晶, 若狭 哲, 大岡 智学, 斉藤 仁志, 新宮 康栄, 加賀 基知三, 太田 稔, 南須原 康行
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 OD1 - 1 2021/10
  • ファロー四徴症に対するValve slicingを用いた肺動脈弁温存の検討
    稗田 哲也, 加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 74回 COD38 - 3 2021/10
  • Hidetsugu Asai, Yasushige Shingu, Jin Ikarashi, Yuchen Cao, Daisuke Takeyoshi, Yosuke Arai, Noriyoshi Ebuoka, Tsuyoshi Tachibana
    Journal of cardiac surgery 36 (9) 3078 - 3084 2021/09 
    BACKGROUND: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. METHODS: Eighteen patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the "vertebral-apex angle (V-A angle)." The ratio of postoperative and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. RESULTS: The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46° [45°-50°] vs. 36° [29°-38°], p = 0.001) and the ratio of postoperative and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], p = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cut-off values of the postoperative V-A angle and ratio were 41° and 1.17, respectively. CONCLUSION: A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.
  • Kato Nobuyasu, Takeda Atsuhito, Arai Yosuke, Hatta Eiichiro, Yakuwa Satoshi, Shingu Yasushige, Ooka Tomonori, Wakasa Satoru
    Pediatric Cardiology and Cardiac Surgery 特定非営利活動法人 日本小児循環器学会 37 (2) 126 - 132 0911-1794 2021/08/01 [Not refereed]
     
    Left isomerism is frequently associated with anomalous systemic venous connection and common atrium, requiring systemic venous abnormality correction and common-atrium septation in biventricular repair. Our case was a 4-year-old girl diagnosed with left isomerism, dextrocardia, complete atrioventricular septal defect, common atrium, bilateral superior vena cava, and interruption of the inferior vena cava with hemiazygos vein connection. She underwent intracardiac repair with intra-atrial rerouting. Preoperative computed tomography suggested that extracardiac reconstruction of the anomalous systemic vein was inappropriate, and showed that all the pulmonary veins drain to the common chamber in the common atrium. Thus, the blood flow from the right superior vena cava was diverted into the left side of the common atrium through an intra-atrial tunnel. Complete atrioventricular septal defect was repaired with modified one-patch method, and the patch divided the common atrium into the right and left atria. She was discharged on postoperative day 11 without obstruction in systemic and pulmonary venous return. Therefore, if all the pulmonary veins drain to the common chamber, intra-atrial rerouting may effectively correct anomalous systemic venous connection in the septation of the common atrium.
  • Hirokazu Komoriyama, Kiwamu Kamiya, Toshiyuki Nagai, Noriko Oyama-Manabe, Satonori Tsuneta, Yuta Kobayashi, Yoshiya Kato, Miwa Sarashina, Kazunori Omote, Takao Konishi, Takuma Sato, Shingo Tsujinaga, Hiroyuki Iwano, Yasushige Shingu, Satoru Wakasa, Toshihisa Anzai
    Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 23 (1) 81 - 81 2021/06/28 
    BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR. METHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR. RESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034). CONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
  • Norihiro Ando, Yasushige Shingu, Kenichiro Suno, Satoru Wakasa
    Biochemical and biophysical research communications 548 14 - 19 2021/04/09 
    Autophagy is an intracellular pathway that degrades unnecessary proteins and organelles and provides energy substrates during cellular ischemic conditions. Although pharmacological myocardial preconditioning with an autophagy inducer has been reported to protect cells against ischemic reperfusion (I/R), the effects of preconditioning using naturally occurring substances are still unknown. We aimed to examine whether autophagic preconditioning with trehalose improves cardiac function after myocardial stunning by global ischemia in rats. Rat hearts were perfused by oxygenized Krebs Henseleit (KH) solution in Langendorff system. Ten rats were randomized into the following two groups according to the perfusates during the preconditioning: control (KH solution only, n = 5) and trehalose (KH + 2% trehalose, n = 5). After the 35-min preconditioning period and subsequent 20 min of global ischemia, the hearts were reperfused for 60 min. Cardiac function was assessed during the reperfusion. To evaluate autophagy, myocardial protein expression of microtubule-associated protein light chain 3 (LC3) II was evaluated by western blotting. During I/R, a systolic functional parameter, maximum dP/dt was significantly higher; meanwhile, coronary flow tended to be higher in the trehalose group than in the control group. Myocardial LC3-II expression after preconditioning was higher in the trehalose group than in the control group and decreased to the control level after I/R. In conclusion, in a rat model of global myocardial ischemia, trehalose preconditioning improved cardiac function during I/R. Further studies would be needed to identify the mechanism and effects of trehalose preconditioning.
  • 心室拡大による機能性僧帽弁閉鎖不全症の外科治療 左室リモデリングを中心に考える機能性僧帽弁閉鎖不全症に対する外科治療
    若狭 哲, 新宮 康栄, 石垣 隆弘, 加藤 伸康, 加藤 裕貴, 大岡 智学
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 SY3 - 4 2021/02
  • ラット心筋虚血再灌流モデルにおけるトレハロース・プレコンディショニングの効果
    須野 賢一郎, 新宮 康栄, 安東 悟央, 若狭 哲
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 OP13 - 1 2021/02
  • 小児房室弁(単心室共通房室弁を含む)形成術 右側房室弁にEbstein病様の異形成を合併した共通房室弁閉鎖不全に対する弁形成
    加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 VS2 - 4 2021/02
  • 80歳以上高齢者の急性A型大動脈解離に対する外科手術のリスク因子解析
    石垣 隆弘, 新宮 康栄, 若狭 哲
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 OP19 - 4 2021/02
  • Arterial switch operation後の死亡・再介入関連因子の検討
    稗田 哲也, 加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 OP28 - 1 2021/02
  • Frozen elephant trunk術後早期SINE発生のリスク因子
    佐藤 公治, 加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 51回 OP32 - 4 2021/02
  • Shinji Abe, Yasuhiro Kamikubo, Yasushige Shingu, Ryo Matsumoto, Makoto Takahira
    General thoracic and cardiovascular surgery 69 (2) 340 - 342 2021/02 
    Although perigraft seroma (PGS) is a well-known complication of vascular surgery, optimal therapy has not yet been established. A 90-year-old patient underwent a bypass from the right subclavian artery to the left carotid and subclavian arteries for debranching thoracic endovascular aortic repair. Four years post-surgery, computed tomography revealed PGS at the anastomosis site. Percutaneous needle aspiration and surgical drainage were ineffective in treating PGS. We performed a relining procedure using covered stents for the bypass graft that resolved the PGS. This procedure is minimally invasive, avoids graft excision, and can be especially valuable for elderly patients.
  • Kubota Takehiro, Shingu Yasushige, Wakasa Satoru
    Japanese Journal of Cardiovascular Surgery 特定非営利活動法人 日本心臓血管外科学会 50 (4) 270 - 273 0285-1474 2021 

    We report a case of multiple papillary fibroelastoma (PFE) on the aortic valve. A healthy woman in her 60 s was referred to a nearby doctor with the chief complaint of palpitation and was admitted to our hospital for detailed examination. A mobile tumor was found by transthoracic echo, and she was introduced to us. We undertook excision surgery for her. Initially, it was thought to be a single tumor, and a pedunculated tumor adhering to the central aortic side of the left coronary cusp with a length of 7 mm was removed. After closing the aorta, we recognized a remaining mobile tumor by transesophageal echo. We decided to perform cardiac arrest again, and we recognized one tumor with 6 mm long string-like mobile mass on the right and non-coronary commissure of cardiac side, and a thorn-like mass of about 1.5 mm on the non-coronary cusp of the cardiac side. We removed both tumors from the aortic valve using shaving resection and preserved the aortic valve. All of these were found to be PFE pathologically as if they were three tumors that followed the developmental stage of PFE. After surgery, PFE recurrence is extremely rare. In the case of a pedunculated tumor, it is possible to remove the tumor and preserve the valve. However, as in this case, if both sides of the valve were not carefully inspected, it can be overlooked. In addition, small tumor resection could avoid the risk of new cerebral infarction and myocardial infarction due to recurrence and could avoid reoperation.

  • 80歳以上高齢者の急性A型大動脈解離に対する外科手術のリスク因子解析
    石垣 隆弘, 新宮 康栄, 若狭 哲, HOCARD members
    日本血管外科学会雑誌 (NPO)日本血管外科学会 30 (Suppl.) O11 - 1 0918-6778 2021
  • Frozen elephant trunk術後dSINEリスクの検討
    佐藤 公治, 加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲
    日本血管外科学会雑誌 (NPO)日本血管外科学会 30 (Suppl.) O24 - 1 0918-6778 2021
  • 止血デバイスを用いた経皮的腹部ステントグラフト内挿術の創合併症予防効果の検討
    鍋島 龍一, 石垣 隆弘, 加藤 伸康, 加藤 裕貴, 新宮 康栄, 大岡 智学, 若狭 哲
    日本血管外科学会雑誌 (NPO)日本血管外科学会 30 (Suppl.) O37 - 1 0918-6778 2021
  • 二心室修復可能な心疾患に対する姑息的右室流出路再建術8例の検討
    加藤 伸康, 橘 剛, 新宮 康栄, 若狭 哲, 加藤 裕貴, 大岡 智学, 山澤 弘州, 武田 充人
    日本小児循環器学会雑誌 (NPO)日本小児循環器学会 36 (Suppl.2) s2 - 383 0911-1794 2020/11
  • 感染症対策を見据えたVAD治療の進歩と臨床展開 VAD関連感染症の治療戦略 大網と局所閉鎖陰圧療法の適用と有効性
    大岡 智学, 布施川 真哲, 鍋島 龍二, 小市 裕太, 稗田 哲也, 石垣 隆弘, 佐藤 公治, 加藤 伸康, 新宮 康栄, 若狭 哲
    人工臓器 (一社)日本人工臓器学会 49 (2) S - 53 0300-0818 2020/10
  • Yasuyuki Chiba, Arata Fukushima, Motoki Nakao, Yuta Kobayashi, Takahiro Ishigaki, Taro Tenma, Kiwamu Kamiya, Yasushige Shingu, Tomonori Ooka, Yoshiro Matsui, Toshihisa Anzai
    Internal medicine (Tokyo, Japan) 59 (10) 1277 - 1281 2020/05/15 [Refereed][Not invited]
     
    A 23-year-old man had progressive muscle weakness and Emery-Dreifuss muscular dystrophy (EDMD) due to a LMNA (lamin A/C) mutation. Congestive heart failure diagnosed at 19 years of age. Maximal drug treatment/cardiac resynchronization failed to improve the cardiac function. He was therefore hospitalized due to heart failure. Despite extracorporeal membrane oxygenation, he developed severe right heart dysfunction and died (multiple organ failure). A cardiac lesion's presence determines the prognosis of EDMD. While there are many arrhythmia reports, few reports on heart failure (particularly severe heart failure requiring cardiac transplantation) have been published. Right heart function monitoring and early ventricular-assist device use plus right heart support considering heart transplantation are important.
  • Nobuyasu Kato, Tsuyoshi Tachibana, Hidetsugu Asai, Noriyoshi Ebuoka, Yasushige Shingu, Tomonori Ooka, Hiroki Kato, Satoru Wakasa
    The Annals of thoracic surgery 110 (5) e361-e363  2020/04/18 [Refereed][Not invited]
     
    Persistent fifth aortic arch is a rare anomaly in congenital heart disease, which is often associated with aortic obstructive diseases. We report a 7-month-old infant diagnosed persistent fifth aortic arch (AA) with left ventricular dysfunction along with left bronchial malacia due to compression from own heart. Surgical repair was performed including AA reconstruction using the 5th-AA as an in-situ flap to enlarge the 4th-AA with end-to-end anastomosis, and external stenting for the left bronchial malacia. Postoperative courses were uneventful. On computed tomography, a reconstructed aortic arch without obstruction and an expanded left bronchus were seen.
  • Type IIエンドリークに対する腰動脈結紮・ステントグラフト温存瘤縫縮術
    小市 裕太, 新宮 康栄, 新井 洋輔, 石垣 隆弘, 安東 悟央, 稗田 哲也, 佐藤 公治, 加藤 伸康, 関 達也, 加藤 裕貴, 若狭 哲, 大岡 智学
    日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 34 (4) 298 - 298 1340-4520 2020/04
  • 心筋症に対する外科的左室負荷軽減と「アジュバント治療」の可能性
    新宮 康栄, 稗田 哲也, 加藤 伸康, 若狭 哲, 大岡 智学
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 50回 PR20 - 1 2020/03
  • 機能性僧帽弁逆流に対する置換術式による左室内エネルギー損失の違い VFMによる検討
    石垣 隆弘, 新宮 康栄, 加藤 伸康, 若狭 哲, 大岡 智学, 大川 洋平, 山田 陽, 高橋 順一郎, 松居 喜郎
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 50回 O9 - 1 2020/03
  • 肺動脈血栓内膜摘除は慢性血栓塞栓性肺高血圧症に対する標準治療であり続けられるか?
    大岡 智学, 小市 裕太, 稗田 哲也, 荒木 大, 石垣 隆弘, 安東 悟央, 佐藤 公治, 加藤 伸康, 新宮 康栄, 若狭 哲, 加藤 裕貴
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 50回 O11 - 4 2020/03
  • 当院における完全型房室中隔欠損症に対する二心室修復の成績
    稗田 哲也, 加藤 伸康, 小市 裕太, 安東 悟央, 荒木 大, 石垣 隆弘, 佐藤 公治, 新宮 康栄, 若狭 哲, 加藤 裕貴, 大岡 智学, 橘 剛
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 50回 P2 - 3 2020/03
  • Satoshi Sugimoto, Yasushige Shingu, Torsten Doenst, Tomoji Yamakawa, Hidetsugu Asai, Satoru Wakasa, Yoshiro Matsui
    The Journal of thoracic and cardiovascular surgery 2020/02/19 [Refereed][Not invited]
     
    OBJECTIVES: Myocardial autophagy has been recognized as an important factor in heart failure. It is not known whether changes in ventricular geometry by left ventriculoplasty influence autophagy in ischemic cardiomyopathy. We hypothesized that myocardial autophagy plays an important role in left ventricular (LV) redilation after ventriculoplasty. METHODS: Four weeks after ligation of the left anterior descending artery, ventriculoplasty or sham operation was performed. The animals were euthanized at 2 days (early) or 28 days (late) after the second operation. Ventricular autophagy was evaluated by protein expression of microtubule-associated protein light chain 3 II, an autophagosome marker. Cardiomyocyte area was assessed by histologic examination. LV function was evaluated by echocardiography. To examine the implications of autophagy, an autophagy inhibitor (3-methyladenine) was injected intraperitoneally for 3 weeks before sacrifice. RESULTS: The LV was reduced in size early and redilated late after ventriculoplasty. LV systolic function was improved early and later worsened after ventriculoplasty. Light chain 3 II expression decreased early after ventriculoplasty and increased in the late period. Myocyte area increased from the early to late stage after ventriculoplasty. Autophagic inhibition exaggerated the increased myocyte hypertrophy and LV redilation. CONCLUSIONS: In a rat model of myocardial infarction, autophagy decreased early after ventriculoplasty and increased again during LV redilation. These results provide new insights into the mechanism underlying the late failure of ventriculoplasty.
  • Yasushige Shingu, Shingo Takada, Takashi Yokota, Ryosuke Shirakawa, Akira Yamada, Tomonori Ooka, Hiroki Katoh, Suguru Kubota, Yoshiro Matsui
    PloS one 15 (4) e0224713  2020 [Refereed][Not invited]
     
    Atrial metabolic disturbance contributes to the onset and development of atrial fibrillation (AF). Autophagy plays a role in maintaining the cellular energy balance. We examined whether atrial gene expressions related to fatty acid metabolism and autophagy are altered in chronic AF and whether they are related to each other. Right atrial tissue was obtained during heart surgery from 51 patients with sinus rhythm (SR, n = 38) or chronic AF (n = 13). Preoperative fasting serum free-fatty-acid levels were significantly higher in the AF patients. The atrial gene expression of fatty acid binding protein 3 (FABP3), which is involved in the cells' fatty acid uptake and intracellular fatty acid transport, was significantly increased in AF patients compared to SR patients; in the SR patients it was positively correlated with the right atrial diameter and intra-atrial electromechanical delay (EMD), parameters of structural and electrical atrial remodeling that were evaluated by an echocardiography. In contrast, the two groups' atrial contents of diacylglycerol (DAG), a toxic fatty acid metabolite, were comparable. Importantly, the atrial gene expression of microtubule-associated protein light chain 3 (LC3) was significantly increased in AF patients, and autophagy-related genes including LC3 were positively correlated with the atrial expression of FABP3. In conclusion, in chronic AF patients, the atrial expression of FABP3 was upregulated in association with autophagy-related genes without altered atrial DAG content. Our findings may support the hypothesis that dysregulated cardiac fatty acid metabolism contributes to the progression of AF and induction of autophagy has a cardioprotective effect against cardiac lipotoxicity in chronic AF.
  • Takahiro Ishigaki, Yasushige Shingu, Nobuyasu Katoh, Satoru Wakasa, Hiroki Katoh, Tomonori Ooka, Suguru Kubota, Yoshiro Matsui
    General thoracic and cardiovascular surgery 68 (1) 30 - 37 1863-6705 2020/01 [Refereed][Not invited]
     
    OBJECTIVES: The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels. METHODS: The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay. RESULTS: The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6 months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group. CONCLUSIONS: The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction.
  • 石垣 隆弘, 新宮 康栄, 加藤 伸康, 若狭 哲, 大岡 智学, 加藤 裕貴, 若林 健人, 三橋 智子, 松居 喜郎
    北海道外科雑誌 北海道外科学会 64 (2) 207 - 207 0288-7509 2019/12
  • 新宮 康栄, 小市 裕太, 稗田 哲也, 新井 洋輔, 安東 悟央, 石垣 隆弘, 佐藤 公治, 加藤 伸康, 若狭 哲, 大岡 智学
    北海道外科雑誌 北海道外科学会 64 (2) 209 - 209 0288-7509 2019/12
  • 長期(3年以上)VAD治療の課題と対策 長期植込型補助人工心臓治療の現状、課題、そして対策
    大岡 智学, 加藤 伸康, 新宮 康栄, 若狭 哲, 加藤 裕貴, 松居 喜朗, 寒河江 磨, 矢萩 亮児, 櫛引 勝年, 加藤 美香
    人工臓器 (一社)日本人工臓器学会 48 (2) S - 75 0300-0818 2019/10
  • Yasushige Shingu, Hiroyuki Iwano, Tatsuya Murakami, Nobuyasu Katoh, Tomonori Ooka, Hiroki Katoh, Suguru Kubota, Yoshiro Matsui
    General thoracic and cardiovascular surgery 67 (10) 849 - 854 1863-6705 2019/10 [Refereed][Not invited]
     
    OBJECTIVES: While it was reported that patients with residual moderate mitral regurgitation (MR) after surgical aortic valve replacement (SAVR) had a poorer prognosis than those without it, the risk factors for residual MR have not been fully elucidated. The aim of the study was to evaluate risk factors for residual MR after SAVR. METHODS: Of the 222 patients who underwent isolated SAVR from 2001 to 2018, 33 (11 men; age: 74 ± 7 years) had functional moderate MR before surgery. The risk factors for residual MR were evaluated by comparing patients with residual moderate MR (n = 11, 33%) with those who exhibited improved post-surgery MR (n = 22, 67%). RESULTS: The left atrial diameter was significantly larger in the residual MR group (51 ± 7 mm) than in the improved MR group (46 ± 5 mm; P = 0.049). The mean pressure gradient at the aortic valve was significantly smaller in the residual MR group (52 ± 18 mmHg) than in the improved MR group (69 ± 22 mmHg; P = 0.043). A ratio of left atrial diameter (mm) and mean aortic valve pressure gradient (mmHg) greater than 0.9 predicted residual MR with a sensitivity of 70% and a specificity of 74% (area under the ROC curve: 0.779; P = 0.015). CONCLUSIONS: In patients with severe aortic valve stenosis and moderate MR, a high ratio of preoperative left atrial diameter and mean aortic valve pressure gradient would be a parameter predicting residual moderate MR post-SAVR.
  • Yasuyuki Chiba, Kiwamu Kamiya, Tadao Aikawa, Hiroyuki Iwano, Toshiyuki Nagai, Takahiro Ishigaki, Yasushige Shingu, Ai Shimizu, Yoshiro Matsui, Toshihisa Anzai
    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (5) 1841 - 1843 1071-3581 2019/08/27 [Refereed][Not invited]
  • Asai H, Shingu Y, Ito N, Tachibana T
    The Annals of thoracic surgery 0003-4975 2019/06 [Refereed][Not invited]
  • Yoshiro Matsui, Yasushige Shingu, Satoru Wakasa, Tomonori Ooka, Suguru Kubota
    The Annals of thoracic surgery 107 (6) e427-e429  0003-4975 2019/06 [Refereed][Not invited]
     
    The surgical approach is challenging for patients with severe functional mitral regurgitation with nonischemic/ischemic dilated cardiomyopathy who are unsuitable for heart transplantation or ventricular assist device implantation. We developed a new surgical treatment named papillary muscle tugging approximation combined with mitral valve replacement. This technique is safe and feasible, with excellent midterm outcomes.
  • Tatsuya Seki, Katsuyoshi Jimuro, Yasushige Shingu, Satoru Wakasa, Hiroki Katoh, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Toshiro Ohashi, Yoshiro Matsui
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 22 (2) 126 - 133 1434-7229 2019/06 [Refereed][Not invited]
     
    Ideally, an annuloplasty ring's shape should be changed intraoperatively if mitral valve repair is unsuccessful because of a short coaptation length or systolic anterior motion. Several post-implantation adjustable rings have been developed, but they are not freely deformable and are unsuitable for asymmetric repair of the valvular annulus. We developed a novel thermally deformable mitral annuloplasty ring to address these problems and assessed the ring's mechanical properties and its effect on the mitral valve anatomy. This ring was made of polycaprolactone. Tensile and bending tests were performed to evaluate the ring's mechanical properties. The ratio of the transverse and septal-lateral length was determined as 4:3. Using 10 pig hearts, we measured the post-deformation coaptation length and minimum distance from the coaptation to the ventricular septum, which is a factor of abnormal systolic anterior motion of the mitral valve. In the mechanical tests, the ring's yield point was greater than the deformation force of the annulus in humans. In pigs with deformation from "4:3" to "4:2", the coaptation length was significantly increased in each mitral valve part. In pigs with deformation from "4:3" to "4:4", the minimum distance from the coaptation to the ventricular septum was significantly increased. Asymmetrical ring deformation increased the coaptation length only at the deformed area. In conclusion, this new thermally deformable mitral annuloplasty ring could be "order-made" to effectively change the coaptation length in all parts of the mitral valve and the distance from the coaptation to septum post-deformation via intraoperative heating.
  • Tatsuya Seki, Yasushige Shingu, Satoru Wakasa, Hiroki Katoh, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Yoshiro Matsui
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 22 (2) 177 - 180 1434-7229 2019/06 [Refereed][Not invited]
     
    Transvalvular leakage (TVL) of a prosthetic heart valve is not negligible regurgitant flow in patients with critically low contractile function. Although the opening function of prosthetic valves has been reported, its closing function is not well understood. A man in his 70 s had a history of mitral valve replacement (MVR) with a Magna Mitral® valve for ischemic mitral valve regurgitation. He presented with dyspnea 2 years postoperatively. Echocardiography showed moderate TVL. The pulmonary capillary wedge pressure and cardiac index were 37 mmHg and 1.65 L/min/m2, respectively. Because we considered his TVL relevant, we performed re-do MVR with a mechanical valve and papillary muscle approximation and suspension ("papillary muscle tugging approximation"). His cardiac function improved postoperatively; he was discharged with New York Heart Association class I. For MVR in patients with critically low contractile function, prosthetic valves, such as mechanical valves, with small TVL are recommended.
  • Segmental arterial mediolysis(SAM)による巨大脾動脈瘤に対する手術経験
    松木田 瞭, 岡村 圭祐, 水沼 謙一, 山村 喜之, 真木 健裕, 細井 勇人, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡, 杉本 聡, 新宮 康栄
    日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 RS - 10 2019/04
  • 心外導管型Fontan conversionの治療成績と中遠隔期の効果
    加藤 伸康, 橘 剛, 新宮 康栄, 大岡 智学, 加藤 裕貴, 久保田 卓, 泉 学, 山澤 弘州, 武田 充人, 松居 喜郎
    日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 PS - 5 2019/04 [Refereed][Not invited]
  • Takayuki Nakajima, Takashi Yokota, Yasushige Shingu, Akira Yamada, Yutaka Iba, Kosuke Ujihira, Satoru Wakasa, Tomonori Ooka, Shingo Takada, Ryosuke Shirakawa, Takashi Katayama, Takaaki Furihata, Arata Fukushima, Ryosuke Matsuoka, Hiroshi Nishihara, Flemming Dela, Katsuhiko Nakanishi, Yoshiro Matsui, Shintaro Kinugawa
    Scientific reports 9 (1) 3535 - 3535 2019/03/05 [Refereed][Not invited]
     
    Epicardial adipose tissue (EAT), a source of adipokines, is metabolically active, but the role of EAT mitochondria in coronary artery disease (CAD) has not been established. We investigated the association between EAT mitochondrial respiratory capacity, adiponectin concentration in the EAT, and coronary atherosclerosis. EAT samples were obtained from 25 patients who underwent elective cardiac surgery. Based on the coronary angiographycal findings, the patients were divided into two groups; coronary artery disease (CAD; n = 14) and non-CAD (n = 11) groups. The mitochondrial respiratory capacities including oxidative phosphorylation (OXPHOS) capacity with non-fatty acid (complex I and complex I + II-linked) substrates and fatty acids in the EAT were significantly lowered in CAD patients. The EAT mitochondrial OXPHOS capacities had a close and inverse correlation with the severity of coronary artery stenosis evaluated by the Gensini score. Intriguingly, the protein level of adiponectin, an anti-atherogenic adipokine, in the EAT was significantly reduced in CAD patients, and it was positively correlated with the mitochondrial OXPHOS capacities in the EAT and inversely correlated with the Gensini score. Our study showed that impaired mitochondrial OXPHOS capacity in the EAT was closely linked to decreased concentration of adiponectin in the EAT and severity of coronary atherosclerosis.
  • 乳児期・小児期に僧帽弁への手術介入を必要としたMarfan症候群4例の経験
    加藤 伸康, 橘 剛, 新宮 康栄, 大岡 智学, 加藤 裕貴, 久保田 卓, 山澤 弘州, 武田 充人, 松居 喜郎
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 49回 [PP - 011] 2019/02 [Refereed][Not invited]
  • 先天性左冠動脈開口部閉鎖に対して左冠動脈主幹部再建を施行した2例
    新井 洋輔, 加藤 伸康, 橘 剛, 新宮 康栄, 大岡 智学, 加藤 裕貴, 久保田 卓, 武田 充人, 山澤 弘州, 泉 岳, 佐々木 理, 松居 喜郎
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 49回 [PP - 024] 2019/02 [Refereed][Not invited]
  • 心外導管型フォンタンへの移行に加えて自己弁温存大動脈基部置換を併施した一例(A successful surgical case of extra-cardiac Fontan conversion combined with valve-sparing aortic root replacement for PA/IVS and aortic root aneurysm)
    加藤 伸康, 橘 剛, 新井 洋輔, 新宮 康栄, 加藤 裕貴, 大岡 智学, 久保田 卓, 泉 学, 山澤 弘州, 武田 充人, 松居 喜郎
    日本成人先天性心疾患学会雑誌 8 (1) 159 - 159 2019/01 [Refereed][Not invited]
  • Hidetsugu Asai, Tsuyoshi Tachibana, Yasushige Shingu, Hiroki Kato, Satoru Wakasa, Yoshiro Matsui
    Asian cardiovascular & thoracic annals 26 (9) 701 - 703 0218-4923 2018/11 [Refereed][Not invited]
     
    The left superior vena cava became occluded in an infant with hypoplastic left heart syndrome. After a bidirectional Glenn procedure, he presented with severe oxygen desaturation and right ventricular dysfunction; the left superior vena cava drained into the inferior vena cava through collateral veins. As salvage therapy, we created a modified total cavopulmonary shunt using only autologous tissue in which the right hepatic vein and inferior vena cava drained into the pulmonary artery via a lateral tunnel in the right atrium. Immediately after surgery, his oxygen saturation increased and right ventricular function improved.
  • Tatsuya Seki, Yasushige Shingu, Hiroshi Sugiki, Satoru Wakasa, Hiroki Katoh, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Yoshiro Matsui
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 21 (3) 363 - 366 1434-7229 2018/09 [Refereed][Not invited]
     
    Antiphospholipid syndrome (APS) is a complex autoimmune disease often related to systemic lupus erythematosus. Although adequate anticoagulation is important for APS patients during cardiopulmonary bypass, clotting tests can be potentially misleading due to antiphospholipid antibodies. We performed cardiac surgery safely in two APS patients under anticoagulation monitoring determined using preoperative heparin titration. We performed heparin titration for activated clotting time to determine the appropriate heparin concentration during cardiac surgery. We changed the targeted heparin concentration considering each patient's thrombotic risks: 3 U/ml of heparin for a normal-risk APS patient and 5 U/ml for a high-risk APS patient with a history of antiphospholipid-antibody-associated thrombocytopenia. A higher targeted heparin concentration might be necessary for patients with high thrombotic risks.
  • Shingu Y, Ooka T, Tachibana T, Kubota S, Matsui Y
    Kyobu geka. The Japanese journal of thoracic surgery 71 (7) 484 - 487 0021-5252 2018/07 [Refereed][Not invited]
  • T. Dung Nguyen, Yasushige Shingu, Paulo A. Amorim, Christina Schenkl, Michael Schwarzer, Torsten Doenst
    Journal of Cardiovascular Translational Research 11 (3) 259 - 267 1937-5395 2018/06/01 [Refereed][Not invited]
     
    Heart failure with preserved ejection fraction (HFpEF) has emerged as a public health burden with currently no effective medication. We assessed the treatment effects of the incretin hormone glucagon-like peptide-1 (GLP-1) on cardiac metabolism and function in a model of HFpEF. Following aortic banding, rats developed HFpEF characterized by diastolic dysfunction, pulmonary congestion, and poor survival (38%). A 4-week GLP-1 treatment via osmotic pumps significantly improved survival (70%) and reduced left ventricular stiffness, diastolic dysfunction, and pulmonary congestion. Isolated heart perfusion revealed preserved cardiac glucose oxidation (GO) and a shift in cardiac substrate utilization towards GO. While GLP-1 may boost insulin secretion and responsiveness, the protective effects were not related to cardiac insulin action. GLP-1 improves diastolic function and survival in rats with HFpEF, which was associated with a cardiac substrate switch towards GO. The therapeutic role of GLP-1 in HFpEF is new and warrants further investigation.
  • Yasushige Shingu, Hiroshi Sugiki, Tomonori Ooka, Hiroki Kato, Satoru Wakasa, Tsuyoshi Tachibana, Yoshiro Matsui
    The Thoracic and cardiovascular surgeon 66 (4) 307 - 312 0171-6425 2018/06 [Refereed][Not invited]
     
    BACKGROUND: To examine the results of myectomy and mitral valve surgery for systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) with a relatively thin interventricular septum. METHODS: The subjects were 12 patients with SAM and LVOTO. Eight had hypertrophic obstructive cardiomyopathy (HOCM) with a mean interventricular septal thickness of 16 mm. Three had sigmoid septum and one had an unknown etiology. For HOCM, isolated extended myectomy was performed when mitral regurgitation was mild (n = 1) and extended myectomy plus mitral valve surgery was performed when mitral regurgitation was more than mild (n = 4) or primary valve etiologies existed (n = 3). Myectomy was performed for the three cases with sigmoid septum. Myectomy plus height reduction of the posterior mitral leaflet was performed for the one case with the unknown etiology of SAM. RESULTS: In the patients with HOCM, the maximum LVOT pressure gradient significantly decreased from 140 ± 18 to 16 ± 6 and 3 ± 3 mm Hg, while mitral regurgitation significantly decreased from 2.3 ± 0.5 to 0.5 ± 0.3 and 0.4 ± 0.2 at pre-op, early post-op, and last follow-up (3 ± 1 years), respectively. In the other etiologies, the maximum LVOT pressure gradient changed from 56 ± 15 to 25 ± 15 and 5 ± 4 mm Hg; mitral regurgitation changed from 2.0 ± 0.6 to 1.3 ± 0.3 and 1.3 ± 0.8, at pre-op, early post-op, and the last follow-up (3 ± 2 years), respectively. CONCLUSION: Myectomy with mitral valve surgery is an option for SAM and LVOTO in patients with a relatively thin interventricular septum.
  • Yasushige Shingu, Tomonori Ooka, Hiroki Katoh, Tsuyoshi Tachibana, Suguru Kubota, Yoshiro Matsui
    Journal of Cardiology 71 (4) 329 - 335 1876-4738 2018/04/01 [Refereed][Not invited]
     
    Background: Although non-transplant surgical interventions for non-ischemic dilated cardiomyopathy (NIDCM) are relatively effective, their feasibility and limitations have not been fully elucidated. The aim of this study was to define the feasibility and limitations of mitral valve repair, with or without surgical ventricular reconstruction for patients with NIDCM in terms of postoperative low cardiac output syndrome (LOS). Methods: Twenty non-transplant candidates (aged 57 ± 13 years) with NIDCM and significant mitral regurgitation had undergone mitral valve repair combined with submitral procedures. Using a 72-mL plastic ellipsoidal sizer, left ventricular reconstruction was performed concomitantly in 14/20 (70%) patients with extremely large ventricles. Total stroke volume, deceleration time of early trans-mitral flow wave, and the slope (Mw) in the preload recruitable stroke-work relationship were assessed using transthoracic echocardiography. LOS was defined as in-hospital death due to heart failure or a cardiac index less than 2.2 L/min/m2 before discharge. Results: There were three in-hospital deaths and four patients with postoperative cardiac index less than 2.2 L/min/m2 [n = 7 (35%), LOS group]. Preoperative total stroke volume, deceleration time, and the Mw were significantly lower in the LOS group compared to those in the non-LOS group the predicted cut-off values for LOS were 84 mL/beat (p = 0.008), 133 ms (p = 0.015), and 45 erg cm−3 × 103 (p = 0.036), respectively. Preoperative left ventricular ejection fraction and ventricular size could not predict postoperative LOS. The one-year survival rate was 0% in the LOS group and 84% in the non-LOS group (p < 0.001). Conclusions: Mitral valve repair, with or without left ventricular reconstruction, could be contraindicated for NIDCM patients with low total stroke volume, deceleration time, and Mw in terms of high postoperative incidence of LOS. For high-risk patients, other therapeutic strategies might be necessary.
  • Takahiro Ishigaki, Yasushige Shingu, Yoshiro Matsui
    Journal of Cardiac Surgery 33 (4) 196 - 198 1540-8191 2018/04/01 [Refereed][Not invited]
  • 心外膜脂肪組織におけるミトコンドリア機能障害は冠動脈狭窄と関連している(Mitochondrial Dysfunction in Epicardial Adipose Tissue is Associated with Coronary Artery Stenosis)
    Nakajima Takayuki, Yokota Takashi, Shingu Yasushige, Yamada Akira, Iba Yutaka, Ujihira Kosuke, Wakasa Satoru, Ooka Tomonori, Takada Shingo, Shirakawa Ryosuke, Furihata Takaaki, Tsuda Masaya, Matsumoto Junichi, Katayama Takashi, Fukushima Arata, Saito Akimichi, Matsuoka Ryosuke, Nishihara Hiroshi, Matsui Yoshiro, Kinugawa Shintaro
    日本循環器学会学術集会抄録集 82回 YIA - 1 2018/03
  • Tochikubo A, Abe S, Yamakawa T, Yoshida M, Shingu Y, Matsui Y
    Annals of vascular diseases Annals of Vascular Diseases 編集委員会 11 (1) 120 - 122 1881-641X 2018/03 [Refereed][Not invited]
     

    A man in his 54 was admitted to our hospital owing to progressive postprandial pain for a month. Computed tomography (CT) scan and angiography revealed severe stenosis and calcification of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Based on the findings of CT scan and angiography, abdominal angina was established and retrograde revascularization was performed only to the superior mesenteric artery using an artificial graft. After the surgery, he remains free of postprandial abdominal pain.

  • 当院の心外導管型Fontan conversionの治療成績の検討
    加藤 伸康, 橘 剛, 浅井 英嗣, 新宮 康栄, 大岡 智学, 加藤 裕貴, 久保田 卓, 山澤 弘州, 武田 充人, 松居 喜郎
    日本心臓血管外科学会学術総会抄録集 (NPO)日本心臓血管外科学会 48回 716 - 716 2018/02 [Refereed][Not invited]
  • Hidetsugu Asai, Tsuyoshi Tachibana, Yasushige Shingu, Yoshiro Matsui
    Interactive Cardiovascular and Thoracic Surgery 26 (2) 353 - 354 1569-9285 2018/02/01 [Refereed][Not invited]
     
    Extracorporeal membrane oxygenation has been recently indicated as an ex utero intrapartum treatment procedure for placental support in patients with a large thoracic mass. In our case, a foetus with truncus arteriosus communis and hydrops with ventricular failure due to severe truncal valve stenosis was delivered under ex utero intrapartum treatment-to-extracorporeal membrane oxygenation at 34 weeks of gestation. The neonate underwent truncal valve plasty. He could be weaned off extracorporeal membrane oxygenation, but he died because of the infection on postnatal Day 24.
  • Yasushige Shingu, Takashi Yokota, Shingo Takada, Haruki Niwano, Tomonori Ooka, Hiroki Katoh, Tsuyoshi Tachibana, Suguru Kubota, Yoshiro Matsui
    Journal of Cardiology 71 (1) 65 - 70 1876-4738 2018/01/01 [Refereed][Not invited]
     
    Background Post-operative atrial fibrillation (POAF) frequently occurs after cardiac surgery. However, the mechanisms of POAF have not been fully elucidated. We aimed to examine whether pre-operative atrial gene expression related to cardiac metabolism is changed in patients with POAF. Methods Right atrial tissue was obtained during surgery from 38 patients who underwent cardiac surgery from 2013 to 2015. Atrial expression levels were determined by reverse transcription polymerase chain reaction for the following genes: glucose transporter type 4, peroxisome proliferator-activated receptor-α, fatty acid translocase, carnitine palmitoyltransferase 1B, and fatty acid binding protein 3 (FABP3). To investigate fatty acid β-oxidation and tricarboxylic acid cycle capacities in the mitochondria, β-hydroxyacyl CoA dehydrogenase and citrate synthase activity levels were spectrophotometrically determined. Results POAF within 7 days after surgery was observed in 18 (47%) patients. POAF patients were significantly older, had a larger left atrial diameter, and had reduced expression of FABP3, a fatty acids transport gene in the cytosol, compared to those in the non-POAF group. Reduced FABP3 expression predicted POAF independent of age and atrial size. In contrast, fatty acid β-oxidation enzymatic activity was comparable between the groups. Conclusions FABP3 gene expression in the atrium was reduced in patients with POAF. These findings suggest a potential link between altered fatty acid transport in the atrium and increased AF onset after cardiac surgery.
  • Naoya Asakawa, Keisuke Uchida, Mamoru Sakakibara, Kazunori Omote, Keiji Noguchi, Yusuke Tokuda, Kiwamu Kamiya, Kanako C. Hatanaka, Yoshihiro Matsuno, Shiro Yamada, Kyoko Asakawa, Yuichiro Fukasawa, Toshiyuki Nagai, Toshihisa Anzai, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Masanori Hirota, Makoto Orii, Takashi Akasaka, Kenta Uto, Yasushige Shingu, Yoshiro Matsui, Shin-Ichiro Morimoto, Hiroyuki Tsutsui, Yoshinobu Eishi
    PLOS ONE 12 (7) e0179980  1932-6203 2017/07 [Refereed][Not invited]
     
    Background Although rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients. Methods and results We examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (>= 14 inflammatory cells) and minimal (< 14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CMgroup samples. Conclusions Frequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.
  • 心外膜脂肪組織のミトコンドリア機能障害は冠動脈狭窄と関連する(Mitochondrial Dysfunction in Epicardial Adipose Tissue is Associated with Coronary Artery Stenosis)
    中島 孝之, 横田 卓, 新宮 康栄, 山田 陽, 伊庭 裕, 若狭 哲, 大岡 智学, 高田 真吾, 白川 亮介, 降旗 高明, 津田 正哉, 松本 純一, 片山 貴史, 福島 新, 松居 喜郎, 絹川 真太郎
    日本循環器学会学術集会抄録集 81回 PJ - 075 2017/03
  • Hidetsugu Asai, Yasushige Shingu, Tomoji Yamakawa, Haruki Niwano, Satoru Wakasa, Tomonori Ooka, Hiroki Kato, Tsuyoshi Tachibana, Yoshiro Matsui
    EUROPEAN SURGICAL RESEARCH 58 (1-2) 69 - 80 0014-312X 2017/02 [Refereed][Not invited]
     
    Background: The indications of left-ventricular plication (LVP) are controversial, although several studies have reported favorable outcomes in heart failure patients. The aim of this study was to assess left-ventricular (LV) wall stress and myocardial remodeling after LVP in a rat model of myocardial infarction (MI). Methods: Sixteen rats underwent LVP by excluding the LV anterior wall scar 4 weeks after ligation of the left anterior descending artery. After 4 weeks, LV wall stress was assessed using transthoracic echocardiography and an LV catheter. Gene expression of the wall stress markers, atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP), were evaluated via reverse transcription polymerase chain reaction. Cardiomyocyte area and myocardial fibrosis were also examined through histological examinations. These parameters were compared to those in 16 rats that underwent coronary artery ligation but not LVP. Results: We noted that the LV end-diastolic dimension was smaller (9.9 +/- 0.3 vs. 11.2 +/- 0.2 mm, p < 0.05) and fractional shortening was greater (25 +/- 2 vs. 15 +/- 1%, p < 0.05) in LVP rats than in sham rats. Moreover, systolic wall stress was lower in LVP rats (71 +/- 7 vs. 111 +/- 9 x 10(3) dyn/cm(2), p < 0.05). Myocardial ANF and BNP expression levels were lower in LVP rats (2.6 +/- 0.3 vs. 4.4 +/- 0.5 and 1.0 +/- 0.1 vs. 1.5 +/- 0.2 arbitrary units, respectively; p < 0.05). Cardiomyocyte area was significantly decreased in LVP rats (556 +/- 15 vs. 670 +/- 28 mu m(2), p = 0.003) and was correlated with LV wall stress (r = 0.669, p = 0.002). The reduction in myocardial fibrosis after LVP was not significant. Conclusion: LVP reduced LV wall stress and cardiomyocyte hypertrophy in a rat model of MI. (C)2016 S. Karger AG, Basel
  • Abe S, Yamakawa T, Kawashima H, Yoshida M, Takanashi S, Kashiyama M, Ishigooka M, Shingu Y, Matsui Y
    Surgical case reports Springer 2 (1) 146 - 146 2198-7793 2016/12 [Refereed][Not invited]
     
    Background: Chronic mesenteric ischemia (CMI) is a rare disease; however, symptomatic CMI has a risk of acute exacerbation without timely revascularization. Case presentation: A 54-year-old man who had had postprandial pain for 6 months was admitted to our hospital because of vomiting and diarrhea. Although the celiac and superior mesenteric arteries were occluded at the proximal portion, contrast enhancement of the bowel wall was good in contrast-enhanced computed tomography (CECT). Endoscopic examination revealed only a healed gastric ulcer and slight mucosal erosions in the colon. He was diagnosed as having acute enteritis or inflammatory digestive disease and observed with conservative therapy, which improved his acute symptoms. On hospitalization day 42, he suddenly complained of lower back pain. CECT showed abdominal free air, which indicated gastrointestinal perforation. Emergency surgery was performed for jejunum resection. Two days later, a second operation was performed for a leak in the anastomotic site of the jejunum. Necrotic change in the small intestinal serosa was also observed and required broad resection of the small intestine. He was diagnosed with acute exacerbation of CMI, and we performed surgical retrograde bypass to the gastroduodenal artery using a saphenous vein graft as the third operation. After the surgery, he was free from digestive symptoms and was discharged. Conclusions: When patients complain of chronic and gradual digestive symptoms, we should always consider symptomatic CMI. Timely mesenteric revascularization is important for symptomatic CMI before severe complications occur.
  • Takehiro Kubota, Satoru Wakasa, Yasushige Shingu, Yoshiro Matsui
    Kyobu geka. The Japanese journal of thoracic surgery 69 (6) 467 - 70 0021-5252 2016/06 [Refereed][Not invited]
     
    Unicuspid aortic valve in an adult is extremely rare. In addition, 90% of the patients with aortic coarctation are reported to die before the age 50. A 60-year-old woman was admitted to our hospital for further examination of exertional dyspnea which had begun one year before. She had been under medical treatment for hypertension since early thirties, and had been also diagnosed with moderate aortic stenosis at 50 years of age. She was at 1st diagnosed with aortic coarctation combined with bicuspid aortic valve stenosis. The aortic valve was then found unicuspid and was replaced under cardiopulmonary bypass with perfusion to both the ascending aorta and the femoral artery. Repair of aortic coarctation was performed 3 months later through left thoracotomy without extracorporeal circulation due to the rich collateral circulation. She had no postoperative complications, and hypertension as well as ankle-brachial index improved to the normal levels.
  • Hiroshi Sugiki, Kenji Sugiki, Tomonori Ooka, Satoru Wakasa, Yasushige Shingu, Tsuyoshi Tachibana, Yoshiro Matsui
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 19 (1) 62 - 9 1434-7229 2016/03 [Refereed][Not invited]
     
    The authors developed the wavelet analysis system which can detect the splitting of bileaflet mechanical heart valve (BLV) into two spikes on the scalogram, and reported that either consecutive single spike or the split behavior can detect malfunctioning BLV (MBV). The latest study on 12 BLVs suggested that the comparison between two spike areas showed higher potential to detect MBV than the split behavior. The aim of the current study is to review 226 files of BLV sound and to select the suitable scalographic property to differentiate the function of BLV with the split. Eight of 30 MBV files showed consecutive single spike, and the rest of 22 MBV files showed two spikes. Two spike areas can be compared by the following three ratios; the anterior spike area/posterior spike area (Aa/La), its reverse ratio (Pa/Aa) and the smaller spike area/the larger spike ratio (Sa/La). Therefore, the current study compared those three ratios to pursue the suitable ratio to compare two spike areas and its sensitivity to differentiate valve function by the ROC analysis. As a result, the Sa/La was suitable for comparing two spike areas, and only this ratio showed high accuracy to differentiate the function of BVL with the split, and its cutoff value was <0.665. Conclusively, the key for detecting MBV was either consecutive single spike or the mean of Sa/La < 0.665. However, this cutoff point is still tentative due to small number of malfunctioning valves, and other key might be available in future.
  • Yoshiro Matsui, Satoru Wakasa, Tomonori Ooka, Yasushige Shingu
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 105 (2) 238 - 44 0021-5384 2016/02/10 [Refereed][Not invited]
  • 新宮 康栄
    心臓 公益財団法人 日本心臓財団 48 (12) 1444 - 2-1444-2 2016
  • Matsui Yoshiro, Wakasa Satoru, Ooka Tomonori, Shingu Yasushige
    Nihon Naika Gakkai Zasshi 一般社団法人 日本内科学会 105 (2) 238 - 244 0021-5384 2016 

    活動期感染性心内膜炎（infective endocarditis：IE）に対する外科治療は，心不全や感染の制御，塞栓症の予防の観点から，適応，手術時期を判断し，感染組織の可及的切除により再感染を予防する．また，脳合併症を呈する場合には，梗塞後出血や新規発症のリスクを考慮に入れたうえで適切な手術時期を決定すべきである．大動脈弁位では弁周囲膿瘍が起こりやすく，周囲組織との解剖学的関係を十分理解し，郭清，再建を行う．僧帽弁位では弁形成の可能性を常に考慮すべきである．

  • T. Dung Nguyen, Yasushige Shingu, Paulo A. Amorim, Michael Schwarzer, Torsten Doenst
    JOURNAL OF CARDIAC FAILURE 21 (11) 906 - 915 1071-9164 2015/11 [Refereed][Not invited]
     
    Objective: Cardiac hypertrophy is characterized by changes in substrate utilization and activity of the Krebs cycle. We assessed the effects of triheptanoin, an odd-chain fat that might support the Krebs cycle, on cardiac metabolism and function in a model of cardiac hypertrophy. Methods and Results: Rats were subjected to aortic banding (AoB) to induce pressure overload (PO). Starting at 1 week after AoB, rats were blindly fed a control diet or a special diet containing triheptanoin at 7% (T7 group) or 30% (T30 group) of total energy value. Six weeks after AoB, echocardiography revealed attenuated hypertrophy and improved diastolic function of the left ventricle. Isolated working heart perfusion showed similar cardiac power, fatty acid oxidation, substrate preference, and insulin response among groups. However, cardiac glucose oxidation (GO) was increased in the T30 group compared with the T7 and control groups. Blood levels of the odd-chain ketone body beta-hydroxypentanoate confirmed adequate bioavailability of triheptanoin. Importantly, they were directly proportional to cardiac GO. Conclusions: Treatment with triheptanoin-enriched diet reduces ventricular hypertrophy and improves diastolic function in rats with PO, which is associated with enhanced cardiac GO. The results suggest targeting supplementation of the Krebs cycle to approach ventricular and metabolic remodeling in cardiac hypertrophy.
  • 腹部大動脈ステントグラフト内挿術後のタイプIIエンドリークに対し、Penumbra Coilを用い塞栓術を行った1例
    高橋 文也, 作原 祐介, 吉野 裕紀, 曽山 武士, 阿保 大介, 工藤 與亮, 新宮 康栄, 松居 喜郎
    IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 30 (3) 273 - 273 1340-4520 2015/09
  • Yasushige Shingu, Suguru Kubota, Satoru Wakasa, Tomonori Ooka, Hiroki Kato, Tsuyoshi Tachibana, Yoshiro Matsui
    Journal of cardiology 65 (2) 157 - 63 0914-5087 2015/02 [Refereed][Not invited]
     
    BACKGROUND: Left ventriculoplasty (LVP) and mitral valve plasty (MVP) are sometimes effective for patients with idiopathic dilated cardiomyopathy (DCM) who are not eligible for heart transplantation. Strict patient selection is warranted for these controversial procedures. METHODS AND RESULTS: The subjects were 18 patients with idiopathic DCM and mitral regurgitation who had not been indicated for heart transplantation due to either older age or patient refusal, and who underwent LVP and MVP. Their mean age was 57±14 years and 50% were dependent on catecholamine infusion. The preload recruitable stroke work (PRSW) relationship and its slope (Mw) were estimated by a single-beat technique using transthoracic echocardiography. There were one 30-day mortality and six (33%) hospital deaths due to heart failure. The one-year survival rate was 50%. Left ventricular end-diastolic dimension (LVDd) decreased from 77±11 to 68±11mm (p=0.001) whereas the ejection fraction did not change. Preoperative Mw was significantly higher in one-year survivors than that in non-survivors (54±17ergcm(-3)10(3) vs. 31±10ergcm(-3)10(3), p=0.005). Preoperative LVDd was not different between the groups. The cut-off value of 42ergcm(-3)10(3) for Mw predicted one-year survival with high sensitivity (100%) and specificity (77%). CONCLUSIONS: Mw, the slope in the PRSW relationship, may predict survival after LVP and MVP in patients with idiopathic DCM.
  • S字状心室中隔に伴う流出路狭窄による僧帽弁逆流と弁穿孔が溶血性貧血の原因となった僧帽弁形成術後の1例
    横山 しのぶ, 山田 聡, 新宮 康栄, 中鉢 雅大, 岩野 弘幸, 若狭 哲, 西田 睦, 渋谷 斉, 清水 力, 松居 喜郎
    超音波医学 (公社)日本超音波医学会 42 (1) 84 - 84 1346-1176 2015/01
  • Tatsuya Seki, Mamoru Sakakibara, Yasushige Shingu, Hiroki Katoh, Satoru Wakasa, Hiroyuki Tsutsui, Yoshiro Matsui
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 21 (2) 132 - 8 1341-1098 2015 [Refereed][Not invited]
     
    PURPOSE: Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic option for severe aortic valvular stenosis (AS). To determine the indication for TAVR, it is mandatory to clarify the characteristics of the patients who were judged as inoperable for conventional aortic valve replacement (cAVR). METHODS: Of 185 patients newly diagnosed as severe AS from March 2010 to April 2011, we studied the characteristics of 61 (33%) patients (mean age, 86 ± 8 years) who were judged as inoperable. RESULTS: Younger patients (<85 years old, n = 22) had more major comorbidities and lower left ventricular ejection fraction than older patients (≥85 years old, n = 39). Mean estimated mortality for cAVR by Japan score was 7.0% ± 7.4%. Japan score did not correlate to age and was calculated relatively low in the older age group (6.2% ± 7.0%) than the younger age group (8.3% ± 8.1%). CONCLUSION: One thirds of severe AS patients were judged as inoperable. In advanced age patients, age itself and other factors, which are not included in the conventional scoring systems, might have contributed to the decision making not to perform cAVR by cardiologists. Further study is necessary to define risk factors except for age.
  • Satoru Wakasa, Yasushige Shingu, Tomonori Ooka, Hiroki Katoh, Tsuyoshi Tachibana, Yoshiro Matsui
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 21 (4) 370 - 7 1341-1098 2015 [Refereed][Not invited]
     
    PURPOSE: The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). METHODS: We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). RESULTS: The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). CONCLUSION: Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering.
  • Satoru Wakasa, Suguru Kubota, Yasushige Shingu, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui
    JOURNAL OF CARDIOTHORACIC SURGERY 9 98  1749-8090 2014/06 [Refereed][Not invited]
     
    Background: Since reduction annuloplasty alone for ischemic mitral regurgitation (MR) cannot prevent late recurrence of MR or improve survival for those with left ventricular (LV) dysfunction, and the surgical approach to this etiology is still controversial, we conducted a study to assess the efficacy of the additional papillary muscle approximation (PMA) procedure for ischemic MR by comparing the different subtypes of PMA. Methods: We studied 45 patients who underwent mitral annuloplasty and papillary muscle approximation (PMA) for ischemic MR between 2003 and 2012. Papillary muscles were approximated entirely (cPMA: complete PMA, n = 32) through an LV incision or partially from the tips to mid-parts (iPMA: incomplete PMA, n = 13) through the mitral and aortic valves. Twenty-three patients with cPMA also underwent LV plasty (LVP). We assessed the outcomes after PMA by comparing cPMA and iPMA. Results: The baseline MR grade, NYHA class, LV end-diastolic diameter, and LV ejection fraction (LVEF) were 2.8 +/- 1.0, 3.2 +/- 0.6, 67 +/- 6 mm, and 30 +/- 10%, respectively. There were no significant differences in these parameters among those with iPMA, cPMA/LVP-, and cPMA/LVP+, though iPMA patients had better LVEF than others. Three patients died before discharge and 12 died during the follow-up. Recurrence of grade 2+ and 3+ MR occurred in 8 and 2 patients, respectively. Reoperation for recurrent MR was performed only for the 2 patients with recurrence of grade 3+ MR. The cPMA was associated with lower mortality (log-rank P = 0.020) and a lower rate of recurrence of MR >= 2+ (log-rank P = 0.005) than iPMA. In contrast, there were no significant differences in the mortality (log-rank P = 0.45) and rate of recurrence (log-rank P = 0.98) between those with cPMA/LVP- and cPMA/LVP+. The 4-year survival rate and rate of freedom from recurrence of MR >= 2+ were 83% and 85% for those with cPMA, repectively. In contrast, the rates were 48% and 48% for those with iPMA, respectively. Conclusions: Complete PMA could be associated with lower postoperative mortality and higher durability of mitral valve repair for ischemic MR.
  • Satoru Wakasa, Yuji Naito, Suguru Kubota, Makoto Iijima, Yasushige Shingu, Yoshiro Matsui
    ANNALS OF THORACIC SURGERY 97 (5) 1822 - 1823 0003-4975 2014/05 [Refereed][Not invited]
     
    Massive blood loss during thoracoabdominal aortic aneurysm repair may impair postoperative outcomes but can be reduced by a secure suture line. Our internal cuff reimplantation is a novel technique for the reconstruction of branch arteries with a cuff of the native aortic wall, which is anastomosed inside the prosthesis through a hole created in it. This technique can ensure hemostasis at the anastomosis by decompression of the suture line, improve patency of the reconstructed branches by leaving the diseased orifices untouched, and prevent future enlargement of the remnant native aortic wall by covering it with the prosthesis. (C) 2014 by The Society of Thoracic Surgeons
  • Satoru Wakasa, Suguru Kubota, Yasushige Shingu, Hiroki Kato, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui
    General Thoracic and Cardiovascular Surgery 62 (7) 428 - 433 1863-6713 2014 [Refereed][Not invited]
     
    Objective: Radiofrequency ablation (RFA) makes the Cox-Maze procedure less complicated but cannot always achieve transmural lesions. In this study, we assessed whether repeated application of RFA could improve histological transmurality even in thick lesions. Methods: Left atrial appendages (LAA) amputated from 20 consecutive patients (age 68 ± 9 years, 9 males) who underwent the Cox-Maze procedure using bipolar RFA devices were studied. Three different segments in the amputated LAA were ablated once, twice, or three times. Thereafter, cross sections made along each of the ablation lines were histologically assessed. Transmurality, which was defined as completion of transmural fibrotic changes, and wall thickness were investigated at an average of 3 different sites in each section. Results: A total of 177 sites were investigated and divided into groups with single, double, and triple RFA treatments for 56, 61, and 60 lesions, respectively. Transmural lesions were observed in 25 (45 %), 27 (44 %), and 41 (68 %) lesions, respectively (P = 0.011). The transmurality was 100 % for all lesions with a thickness of 1.0 mm or less. In the thicker lesions (> 1.0 mm), however, wall thickness impaired transmurality, though triple RFA was associated with significantly higher transmurality than single and double RFA (P = 0.005). Conclusions: Triple repetition of RFA was associated with higher transmurality of lesions than double RFA, especially for thicker lesions. Increasing the number of repetitions could improve the success rate of the Cox-Maze procedure using RFA devices. © 2014 The Japanese Association for Thoracic Surgery.
  • Yasushige Shingu, Paulo A. Amorim, T. Dung Nguyen, Moritz Osterholt, Michael Schwarzer, Torsten Doenst
    Thoracic and Cardiovascular Surgeon 61 (8) 718 - 725 0171-6425 2013/12 [Refereed][Not invited]
     
    Background There is currently no standard for the assessment of contractile function in animals. We aimed to determine whether transthoracic echocardiography in rats with chronic pressure overload allows determining the stage of hypertrophy and heart failure (HF). Methods Pressure overload was created by placement of a metal clip around the thoracic aorta at a weight of 40 to 50 g. After 1, 2, 6, 10, and 20 weeks, we performed echocardiography according to the American Heart Association guidelines (n = 26, four to six rats for each time point). We also obtained heart, lung, and body weights and regularly evaluated clinical signs of HF. Results Pressure overload caused significant hypertrophy within 1 week. Contractile function was normal until 6 weeks when diastolic dysfunction appeared. After 10 weeks of pressure overload, systolic function decreased. At 20 weeks, hearts were dilated and cardiac index was decreased. These findings correlated with increased lung-to-body weight ratio after 6 weeks and clinical signs of HF after 20 weeks. Conclusion Echocardiography alone allows the reproducible determination of HF stages after aortic constriction in rats. © 2013 Georg Thieme Verlag KG Stuttgart, New York.
  • Suguru Kubota, Satoru Wakasa, Yasushige Shingu, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui
    CIRCULATION JOURNAL 77 (12) 2936 - 2941 1346-9843 2013/12 [Refereed][Not invited]
     
    Background: This study aimed to elucidate whether regional left ventricular wall thickening (LVWT) determined by quantitative gated SPECT (QGS) is useful in predicting surgical outcomes for ischemic (ICM) and nonischemic cardiomyopathy (NICM). Methods and Results; The study group comprised 53 patients with either ICM (n=30, left ventricular ejection fraction (LVEF)=24.7 +/- 7.1%) or NICM (n=23, LVEF=24.0 +/- 6.3%) scheduled for surgical repair underwent preoperative QGS to evaluate regional LV function. LVWT of 20 segments derived from QGS was normalized by being divided by the normal value of each LV level. Normalized values of the segments were summed to be representative of each area. For 16 of the 30 patients with ICM and 17 of the 23 patients with NICM, surgical ventricular restoration and papillary muscle approximation (PMA) were performed for surgical repair and, for the rest, PMA alone was done for both ICM and NICM patients. Adjunctive coronary artery bypass grafting for ICM patients was added when necessary. Mean follow-up periods were 2.5 +/- 1.8 years for ICM and 2.2 +/- 2.4 years for NICM. Posterior regional LVWT in NICM (normalized sum value <0.61 n=7, ROC: AUC=0.80) predicted cardiac events (chronic heart failure and cardiac-caused death). The one-year cardiac event-free rates were 22.2% and 85.1% and the 2 years rates were 11.1% and 48.6% for the lower posterior WT group and higher posterior WT group respectively (P=0.003). Conclusions: Posterior LVWT can be a predictor for postoperative cardiac events in patients with NICM.
  • T. Dung Nguyen, Yasushige Shingu, Michael Schwarzer, Andrea Schrepper, Torsten Doenst
    PLOS ONE 8 (12) e82077  1932-6203 2013/12 [Refereed][Not invited]
     
    Background: Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF. Methods and Results: Rats underwent aortic banding (AoB) to induce pressure overload (PO). Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW), a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A) and the deceleration time of E (DT), but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'). In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<.0001), followed by E/A (r = 0.69; p<0.0001), DT (r = 20.62; p<0.0001) and finally E/e' (r = 0.51; p<0.001). Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98) and DT (AUC = 0.95), which are significantly higher than that of E/e' (AUC = 0.82). In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function. Conclusions: The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations.
  • Nguyen TD, Shingu Y, Amorim PA, Schwarzer M, Doenst T
    International journal of cardiology 4 168 (4) 4085 - 4092 0167-5273 2013/10 [Refereed][Not invited]
  • Suguru Kubota, Norihiko Shiiya, Yasushige Shingu, Satoru Wakasa, Tomonori Ooka, Tsuyoshi Tachibana, Hidetoshi Yamauchi, Yoshimitu Ishibashi, Jun-Ichi Oba, Yoshiro Matsui
    General Thoracic and Cardiovascular Surgery 61 (10) 560 - 564 1863-6705 2013 [Refereed][Not invited]
     
    Objective: Aortoesophageal fistula (AEF) is relatively rare and usually life-threatening. Lots of strategies have so far been discussed for this entity including the role of endovascular repair. The aim of this study is to review our experiences and reconsider the surgical strategy for aortoesophageal fistula in the endovascular era. Methods: This is a retrospective multicenter study. From 1995 to 2011, 10 aortoesophageal fistula cases were identified in four institutions. For all of these cases surgical procedures and results were retrieved from medical records. Results: Six patients underwent open aortic repair and four patients underwent thoracic endovascular aortic repair (TEVAR) as a primary intervention. Three patients who underwent open aortic repair with esophagectomy and omental coverage in early phase, either as a primary intervention or performed after bridging TEVAR, showed 100 % 1-year survival. On the other hand, three patients with TEVAR alone did not survive more than 1 year without recurrence. One patient with bridging TEVAR underwent concomitant esophageal resection and conventional aortic graft replacement 2 days later, and simultaneous gastric tube reconstruction was performed with intact whole omentum covering the aortic prosthesis. This patient is doing well with no sign of infection at 1-year follow-up. Conclusion: For AEF, TEVAR as a primary approach is quite useful to stabilize the patients' condition. However, definitive aortic repair with omental coverage should be performed as early as possible as a next step. It may be one of the strategies for the treatment of AEF that concomitant esophageal resection and aortic graft replacement is performed with simultaneous gastric tube reconstruction with intact whole omentum after removing the stent graft, so far as the patient's physical condition permits. © 2013 The Japanese Association for Thoracic Surgery.
  • Wakasa S, Shingu Y, Kubota S, Minamida T, Iijima M, Naito Y, Ooka T, Tachibana T, Matsui Y
    Kyobu geka. The Japanese journal of thoracic surgery 1 66 (1) 26 - 30 0021-5252 2013/01 [Refereed][Not invited]
  • Yasushige Shingu, Suguru Kubota, Satoru Wakasa, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui
    SURGERY TODAY 42 (9) 819 - 824 0941-1291 2012/09 [Refereed][Not invited]
     
    Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, despite improvements in anesthesia, surgical techniques, and medical therapies. Although beta-blockers have been proven to be effective, the incidence of POAF is around 20 % even with these agents. The mechanism of POAF is not fully elucidated and no optimal strategy has been established for POAF. There are two important elements of "structural" and "electrical" remodelling of the atrium in the mechanism of POAF. A patient's age and preoperative left atrial fibrosis can predict POAF associated with structural remodelling. Although inflammation and oxidative stress during cardiac surgery may be the underlying mechanisms for electrical remodelling causing POAF, there are no reliable clinical parameters for their detection. Nonetheless, postoperative P-wave dispersion and electromechanical delay, which reflects excitation-contraction coupling abnormalities, could be new parameters for POAF. In conclusion, despite the importance of prevention of POAF, there are only a few parameters for predicting POAF. It is therefore necessary to consider both disease-mediated structural remodeling before surgery and electrical remodeling caused by cardiac surgery.
  • Yasushige Shingu, Yoshiro Matsui
    CIRCULATION JOURNAL 76 (6) 1533 - 1534 1346-9843 2012/06 [Refereed][Not invited]
     
    Background: Total stroke work (TSW) is used for the estimation of cardiac efficiency in mitral regurgitation (MR). We should be cautious about the interpretation of this parameter, especially when it is assessed by non-invasive methods such as echocardiography. Methods and Results: For the calculation of regurgitant stroke work, regurgitant volume is usually multiplied by left atrial (LA) pressure. However, by considering the left ventricular (LV) pressure-volume loop, it would be more appropriate to multiply regurgitant volume and the LV pressure, not the atrial one. Conclusions: We might underestimate TSW when we use LA pressure for the estimation of regurgitant stroke work. (Circ J 2012; 76: 1533-1534)
  • Wakasa S, Shingu Y, Ooka T, Tachibana T, Kubota S, Matsui Y
    Kyobu geka. The Japanese journal of thoracic surgery 11 64 (11) 985 - 988 0021-5252 2011/10 [Refereed][Not invited]
  • Yasushige Shingu, Suguru Kubota, Satoru Wakasa, Noriyoshi Ebuoka, Daisuke Mori, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 39 (5) 684 - 688 1010-7940 2011/05 [Refereed][Not invited]
     
    Objective: Although several risk factors for postoperative atrial fibrillation (AF) have been proposed, it remains the most common complication after cardiac surgery, even in low-risk patients. There is still no single reliable and reproducible parameter for predicting AF, and no standardized recommendation exists for this issue. Electromechanical delay (excitation-contraction coupling delay) is the time delay from the electrical activation to the actual systolic motion, and it reflects abnormality in calcium-handling proteins, which is considered one mechanism of postoperative AF. We hypothesized that left-ventricular electromechanical delay (LVEMD) is correlated to postoperative AF and serially examined it by echocardiography. Methods: We prospectively included 16 patients with relatively low risk for AF, who underwent cardiac surgery. The inclusion criteria were younger than 80 years, an ejection fraction greater than 45%, a left-atrial dimension less than 50 mm, and a brain natriuretic peptide (BNP) value less than 250 pg ml(-1). Postoperative AF for 10 postoperative days was monitored by 24-h electrocardiogram. The LVEMD was assessed by pulse-wave tissue Doppler echocardiography before and 1, 3, and 7 days after the operation. Serum BNP, adrenalin, and noradrenalin levels were also examined at the same time. Results: Postoperative AF was detected in six (37.5%) patients. There was no significant difference in heart rate, QRS duration, and serum hormones between the non-AF (n = 10) and AF (n = 6) groups. Although the preoperative LVEMD was comparable, that on postoperative day 1 of the AF group was significantly longer than that of the non-AF group (in the septal wall, 174 +/- 50 vs 101 +/- 36 ms, p = 0.020; in the lateral wall, 195 +/- 71 and 111 +/- 37 ms, p = 0.029). A LVEMD on postoperative day 1 greater than 150 ms well predicted postoperative AF (sensitivity, 75% and 75%; specificity, 100% and 86%, in septal and lateral LVEMDs, respectively). Conclusions: LVEMD is prolonged in patients with postoperative AF. This could be a new predicting parameter for AF in low-risk patients. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved.
  • Yasushige Shingu, Paulo Amorim, T. Dung Nguyen, Friedrich W. Mohr, Michael Schwarzer, Torsten Doenst
    EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 11 (10) 829 - 833 1525-2167 2010/12 [Refereed][Not invited]
     
    Myocardial performance index (MPI), or Tei index, is a Doppler echocardiographic parameter defined as the sum of the isovolumic contraction and relaxation times divided by the ejection time. It is considered a reliable parameter for global left ventricular function. However, the interpretation of this index is not fully clear in diastolic dysfunction. We measured MPI in a pressure-overload model of rats with severe diastolic with or without systolic dysfunction and examined its usefulness as a parameter for cardiac function in a hypertensive heart failure model. Pressure overload was created by placement of a metal clip around the thoracic aorta [transverse aortic constriction (TAC)] at a weight of 40-50 g. Transthoracic echocardiography including Doppler analysis and invasive left ventricular catheter examination were performed 10 and 20 weeks after TAC (n = 6 for each time point). While left ventricular ejection fraction was over 50% in all TAC animals after 10 weeks (56.3 +/- 2.3%), it was below 50% in all TAC animals after 20 weeks (45.4 +/- 1.0%). E/E' was significantly larger in the TAC groups at both time points and the time constant tau by Millar catheter was also elevated in the TAC groups. On the other hand, MPI was not different compared with the control groups (10 weeks: 0.47 +/- 0.09 vs. 0.44 +/- 0.04; 20 weeks: 0.38 +/- 0.03 vs. 0.46 +/- 0.07). MPI is not a reliable parameter for the assessment of contractile function in pressure-overload heart failure. It is normal in diastolic dysfunction with or without preserved ejection fraction.
  • Paulo A. Amorim, T. Dung Nguyen, Yasushige Shingu, Michael Schwarzer, Friedrich W. Mohr, Andrea Schrepper, Torsten Doenst
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 140 (5) 1160 - 1167 0022-5223 2010/11 [Refereed][Not invited]
     
    Objective: Myocardial infarction leads to contractile dysfunction. In patients with diabetes, impaired contractility has been associated with the loss of insulin effects and mitochondrial dysfunction. We assessed cardiac insulin sensitivity and mitochondrial and contractile function in rats after ligation of the left coronary artery. Methods: At 2 weeks after left coronary artery ligation, we performed echocardiography in vivo and assessed the substrate use and insulin response in the isolated working heart and the regulation of insulin (Akt, glucose transporter type 4) and mitochondrial signaling (p38 mitogen-activated protein kinase, peroxisome proliferator-activated receptor-gamma coactivator 1 alpha, mitochondrial transcription factor A) using polymerase chain reaction and Western blotting. Results: The infarcted hearts were dilated and had a reduced ejection fraction (ejection fraction < 50%). The basal glucose oxidation was preserved, but the fatty acid oxidation was significantly reduced. Insulin's effect on substrate oxidation was significantly impaired for both the decrease in fatty acid oxidation and the increase in glucose oxidation. However, insulin-stimulated glucose uptake was normal in the infarcted hearts, consistent with normal insulin-induced phosphorylation of Akt and unchanged mRNA expression of glucose transporter type 4. The impaired oxidative response to insulin was associated with reduced mRNA expression of the genes regulating fatty acid oxidation (long-chain-acyl-coenzyme A dehydrogenase, carnitine palmitoyltransferase 1, peroxisome proliferator-activated receptor-alpha) and mitochondrial biogenesis (mitochondrial transcription factor A). Although mRNA expression of the mitochondrial master regulator peroxisome proliferator-activated receptor-gamma coactivator 1 alpha was normal in the infarcted hearts, the protein expression of its post-transcriptional activator, p38 mitogen-activated protein kinase, was significantly reduced. Conclusions: Myocardial infarction in rats caused partial insulin resistance at the level of substrate oxidation, which was associated with mitochondrial and cardiac contractile dysfunction. Mitochondrial dysfunction was characterized by a reduced capacity to oxidize fatty acids and might have resulted from impaired mitochondrial biogenesis through the lack of p38 mitogen-activated protein kinase. (J Thorac Cardiovasc Surg 2010; 140: 1160-7)
  • Yasushige Shingu, Yoshiro Matsui
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 140 (1) 251 - 252 0022-5223 2010/07 [Refereed][Not invited]
  • Torsten Doenst, Gracjan Pytel, Andrea Schrepper, Paulo Amorim, Gloria Faerber, Yasushige Shingu, Friedrich W. Mohr, Michael Schwarzer
    CARDIOVASCULAR RESEARCH 86 (3) 461 - 470 0008-6363 2010/06 [Refereed][Not invited]
     
    Left ventricular hypertrophy is a risk factor for heart failure. However, it also is a compensatory response to pressure overload, accommodating for increased workload. We tested whether the changes in energy substrate metabolism may be predictive for the development of contractile dysfunction. Chronic pressure overload was induced in Sprague-Dawley rats by aortic arch constriction for 2, 6, 10, or 20 weeks. Contractile function in vivo was assessed by echocardiography and by invasive pressure measurement. Glucose and fatty acid oxidation as well as contractile function ex vivo were assessed in the isolated working heart, and respiratory capacity was measured in isolated cardiac mitochondria. Pressure overload caused progressive hypertrophy with normal ejection fraction (EF) at 2, 6, and 10 weeks, and hypertrophy with dilation and impaired EF at 20 weeks. The lung-to-body weight ratio, as marker for pulmonary congestion, was normal at 2 weeks (indicative of compensated hypertrophy) but significantly increased already after 6 and up to 20 weeks, suggesting the presence of heart failure with normal EF at 6 and 10 weeks and impaired EF at 20 weeks. Invasive pressure measurements showed evidence for contractile dysfunction already after 6 weeks and ex vivo cardiac power was reduced even at 2 weeks. Importantly, there was impairment in fatty acid oxidation beginning at 2 weeks, which was associated with a progressive decrease in glucose oxidation. In contrast, respiratory capacity of isolated mitochondria was normal until 10 weeks and decreased only in hearts with impaired EF. Pressure overload-induced impairment in fatty acid oxidation precedes the onset of congestive heart failure but mitochondrial respiratory capacity is maintained until the EF decreases in vivo. These temporal relations suggest a tight link between impaired substrate oxidation capacity in the development of heart failure and contractile dysfunction and may imply therapeutic and prognostic value.
  • Yasushige Shingu, Takashi Sugiki, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Yoshiro Matsui
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 16 (2) 139 - 141 1341-1098 2010/04 [Refereed][Not invited]
     
    After isolated left ventriculoplasty, the mechanism of mitral regurgitation (MR) remains unclear. A 68-year-old male with ischemic cardiomyopathy presented with a new onset of severe MR after left ventriculoplasty without a mitral procedure. He needed a second operation for heart failure because of the MR. We speculate about its mechanism and express caution about the procedure. (Ann Thorac Cardiovasc Surg 2010; 16: 139-141)
  • Yasushige Shingu, Satoshi Yamada, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Hiroyuki Tsutsui, Yoshiro Matsui
    CIRCULATION JOURNAL 73 (11) 2061 - 2067 1346-9843 2009/11 [Refereed][Not invited]
     
    Background: Papillary muscle (PM) Suspension concomitant with mitral annuloplasty and PM approximation (PMA) has been developed for functional mitral regurgitation (MR). In the present study, the early effect of PM suspension (PMS) on the postoperative mitral geometry and diastolic mitral tethering was investigated Methods and Results: Subjects were 22 patients with left ventricular dysfunction and functional MR who underwent mitral annuloplasty and PMA with or without suspension from 2004 to 2008. The purpose of PMS is to maintain the mitral complex geometry and prevent future mitral tethering caused by left ventricular remodeling The mean a-e was 64 +/- 10 (range 39-85) years. The submitral apparatus geometry was measured by echocardiography PM and mitral inflow angles in the anterior-directional suspension group were significantly larger than those in the posterior-directional suspension group (57 +/- 7 degrees vs 46 +/- 9 degrees, P=0.017 and 78 +/- 9 degrees vs 60 +/- 6 degrees. P<0.001. respectively). which were comparable to the normal control. In the posterior-directional suspension group), file transmitral pressure gradient was higher and restrictive mitral filling pattern remained postoperatively in 2 cases of the group. Conclusions: Anterior-directional suspension is preferable to the posterior one in terms of diastolic mitral filling, (Circ J 2009, 73: 2061-2067)
  • Norihiko Shiiya, Satoru Wakasa, Kinya Matsui, Takashi Sugiki, Yasushige Shingu, Tomoshi Yamakawa, Yoshiro Matsui
    ANNALS OF THORACIC SURGERY 88 (3) 768 - 772 0003-4975 2009/09 [Refereed][Not invited]
     
    Background. We evaluated correlation between anatomical pattern of the spinal cord feeding artery, detected by preoperative multidetector row computed tomography, and the mechanism of spinal cord ischemia during aortic surgery. Methods. One hundred sixteen patients underwent multidetector row computed tomography before descending or thoracoabdominal replacement. Segmental arteries feeding the spinal cord were detected in 92 patients (79%), and were classified into "critical" (isolated hairpin shaped) or "supplemental" (confluence-shaped or multiple). Spinal cord ischemia was monitored together with distal aortic perfusion in 53 of them by motor-evoked potentials, evoked spinal cord potentials, or both. The relationship between monitoring results and operative management to the detected feeding arteries was analyzed. Results. When no feeding segmental artery was involved in the extent of replacement (n = 18), spinal cord ischemia was detected in 1 (6%), which was due to cross-clamping the subclavian artery. When a supplemental feeding artery was involved (n = 15), ischemia was detected in 7 patients (47%), and was reversed by stopping back-bleeding. When a critical feeding artery was involved (n = 20), ischemia was detected in 6 (30%). In 3 of them, ischemia was reversed by stopping back-bleeding, whereas it was reversed only after reconstruction of the critical feeder in the remaining 3. Paraparesis occurred in 1 of the latter 3, and the incidence of spinal cord injury was 2% (1 of 53). Conclusions. When the involved feeding artery is a supplemental one, the steal phenomenon is the predominant mechanism of ischemia. Conversely, blood flow interruption to the critical feeding artery may cause spinal cord ischemia without steal phenomenon.
  • 阿部 慎司, 夷岡 徳彦, 新宮 康栄, 杉木 孝司, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 山川 智士, 椎谷 紀彦, 村下 十志文, 松居 喜郎
    日本小児循環器学会雑誌 (NPO)日本小児循環器学会 25 (4) 638 - 639 0911-1794 2009/07
  • Yasushige Shingu, Norihiko Shiiya, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota, Satoshi Morita, Yoshiro Matsui
    ANNALS OF THORACIC SURGERY 87 (5) 1373 - 1378 0003-4975 2009/05 [Refereed][Not invited]
     
    Background. The augmentation index, the ratio of the ejection pressure from the heart to the reflection pressure from the arterial system, has recently been recognized as one of the indexes of left ventricular afterload. We studied it in patients with aortic aneurysm and dissection, using carotid artery diameter waveform obtained from an echo-tracking system. Methods. Forty-six patients were divided into the following three groups based on pathology: group A, 21 patients with thoracic aortic aneurysm; group B, 15 patients with chronic aortic dissection; and group C, 10 patients without any aortic diseases. Using an echo-tracking system on the carotid artery, we measured stiffness parameter beta, arterial compliance, and the augmentation index. Results. There was no significant difference in stiffness parameter beta and arterial compliance among the three groups. The augmentation index was significantly higher in groups A and B than group C (22 +/- 10%, 22 +/- 13% vs 8 +/- 17%; p = 0.012). Female (p = 0.028) and heart rate (p = 0.005) were significantly associated with the augmentation index and the significance of aortic diseases was marginal (p = 0.056). Conclusions. The carotid augmentation index is elevated in patients with aortic aneurysm and dissection.
  • Shinichiro Shimura, Yoshiro Matsui, Chikao Yutani, Yukio Suto, Okihiko Akashi, Kinya Matsui, Yasushige Shingu, Mamoru Sakakibara, Masaomi Yamaguchi, Yasuo Haruki, Kou Takigami, Takashi Minase, Toshihiko Ueda
    Tokai Journal of Experimental and Clinical Medicine 34 (1) 1 - 7 0385-0005 2009 [Refereed][Not invited]
     
    Objective: Pathological changes in the myocardium in idiopathic dilated cardiomyopathy (DCM) are usually studied using endomyocardial biopsy specimens, but the relationship between pathological changes in the myocardium and clinical findings is unclear. The goal of the study was to examine correlations between clinical findings and histopathological findings in specimens of the left ventricular myocardium collected during left ventriculoplasty in DCM patients. Methods: The subjects were 20 DCM patients (17 males and 3 females mean age: 59 ± 14 years old) who underwent left ventriculoplasty, including 16 cases of overlapping ventriculoplasty (OLVP) and 4 of papillary muscle approximation (PMA) with left ventricular incision. Preoperative age, sex, The New York Heart Association (NYHA) classification, the brain natriuretic peptide (BNP) level, cardiothoracic ratio (CTR), echocardiographic data, history of diabetes mellitus, drug history of spironolactone, ACE inhibitor, ARB, and β-blocker were used as clinical findings. Histopathological scores were determined for each patient and semi-quantitative data for hypertrophy, attenuation, vacuolation and fibrosis were obtained. Results: A significant correlation was found between age and interstitial fibrosis. A significant inverse correlation was found between left ventricular diastolic diameter (LVDd) in echocardiographic data and interstitial fibrosis. There were no other significant relation between histopathological scores and clinical findings. Conclusion: From this study, we found that interstitial fibrous increased with aging and more dilated LVDd had less interstitial fibrosis. It is concluded that the kinetics of myocardial fibrosis with remodeling might be variable and histopathological findings does not reflect the clinical and hemodynamic changes in DCM patients. Further morphological data are needed to verify this result.
  • Yasushige Shingu, Norihiko Shiiya, Suguru Kubota, Yuji Naito, Kinya Matsui, Satoru Wakasa, Hiroshi Sugiki, Tsuyoshi Tachibana, Tomoji Yamakawa, Toshifumi Murashita, Yoshiro Matsui
    ADVANCES IN UNDERSTANDING AORTIC DISEASES 187 - 187 2009 [Refereed][Not invited]
  • Shingu Y, Shiiya N, Matsuzaki K, Kunihara T, Murashita T, Matsui Y
    Kyobu geka. The Japanese journal of thoracic surgery 6 61 (6) 440 - 443 0021-5252 2008/06 [Refereed][Not invited]
  • 若狭 哲, 阿部 慎司, 夷岡 徳彦, 内藤 祐嗣, 新宮 康栄, 松井 欣哉, 杉木 孝司, 大岡 智学, 橘 剛, 久保田 卓, 山川 智士, 椎谷 紀彦, 村下 十志文, 松居 喜郎
    北海道外科雑誌 北海道外科学会 53 (1) 116 - 116 0288-7509 2008/06
  • Yasushige Shingu, Norihiko Shiiya, Takashi Sugiki, Satoru Wakasa, Kenji Matsuzaki, Takashi Kunihara, Yoshiro Matsui
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 14 (2) 126 - 128 1341-1098 2008/04 [Refereed][Not invited]
     
    A 66-year-old man with thoracic and abdominal aortic aneurysm suffered from microembolism in the lower extremities after total arch replacement. He presented with livedo reticularis with palpable peripheral pulses, and the serum creatinine kinase level elevated up to 7,695. The abdominal aortic aneurysm, but not the thoracic aorta, was the origin of this complication. The morphological change of thrombus in the abdominal aorta detected by ultrasonography was the key to the diagnosis. Graft replacement of the abdominal aorta finally resolved his problem. (Ann Thorac Cardiovasc Surg 2008; 14: 126-128)
  • 夷岡 徳彦, 阿部 慎司, 内藤 祐嗣, 新宮 康栄, 松井 欣哉, 杉木 孝司, 若狭 哲, 杉木 宏司, 橘 剛, 久保田 卓, 山川 智士, 椎谷 紀彦, 村下 十志文, 松居 喜郎
    北海道外科雑誌 北海道外科学会 52 (2) 209 - 209 0288-7509 2007/12
  • 内藤 祐嗣, 阿部 慎司, 夷岡 徳彦, 新宮 康栄, 杉木 孝司, 松井 欣哉, 若狭 哲, 杉木 宏司, 橘 剛, 山川 智士, 久保田 卓, 椎谷 紀彦, 村下 十志文, 松居 喜郎
    北海道外科雑誌 北海道外科学会 52 (2) 212 - 212 0288-7509 2007/12
  • 虚血性MRの病態と治療戦略 拡大心によるfunctional MRに対して僧帽弁輪形成にPapillary muscle approximationを加えた治療戦略
    久保田 卓, 松居 喜郎, 阿部 慎司, 夷岡 徳彦, 新宮 康栄, 杉木 孝司, 若狭 哲, 橘 剛, 山川 智士, 椎谷 紀彦, 村下 十志文
    日本冠疾患学会雑誌 (NPO)日本冠疾患学会 13 (4) 296 - 296 1341-7703 2007/11
  • Yasushige Shingu, Norihiko Shiiya, Taisei Mikami, Kenji Matsuzaki, Takashi Kunihara, Yoshiro Matsui
    ANNALS OF THORACIC SURGERY 83 (4) 1356 - 1360 0003-4975 2007/04 [Refereed][Not invited]
     
    Background. In chronic aortic dissection, compression of the true lumen by the expanded false lumen may be a cause of left ventricular afterload elevation, which may result in diastolic dysfunction. We compared the left ventricular diastolic function by echocardiography between those patients who had double-barrel descending aortic dissection and those who did not. Methods. Twelve patients (mean age, 61 +/- 12 years) with chronic type B aortic dissection were enrolled in this study. Patients in group I had double-barrel aortic dissection that had expanded the patent false lumen and narrowed the true lumen (n = 7, 58.3%), and patients in group II had a wider-caliber true lumen with a thrombosed false lumen (n = 5, 41.7%). We evaluated the left ventricular diastolic function with the transmitral flow pattern (E and A waves) with the pulsed Doppler method and flow propagation velocity (FPV) with color M-mode Doppler images, and classified its severity into grade I (abnormal relaxation), grade II (pseudonormalization) and grade III (restriction). Results. All patients in group II had grade I diastolic dysfunction, with an E/A of less than 1.0. By contrast, 4 of the 7 patients in group I had grade II diastolic dysfunction, with an FPV/E of less than 0.6 and a pseudonormalized (> 1.0) E/A ratio (p = 0.081). Consequently, the E/A ratio was higher in group I than in group II (1.16 +/- 0.39 versus 0.68 +/- 0.18; p < 0.05). Conclusions. It is suggested that left ventricular diastolic function is severely reduced in the patients having aortic dissection with a double-barrel and narrowed true lumen.
  • Shingu Y, Shiiya N, Matsuzaki K, Kunihara T, Matsui Y
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 2 13 (2) 132 - 134 1341-1098 2007/04 [Refereed][Not invited]
  • Shingu Y, Aoki H, Ebuoka N, Eya K, Takigami K, Oba J, Chiba K, Fukuhara T
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 6 11 (6) 416 - 418 1341-1098 2005/12 [Refereed][Not invited]
  • Shingu Y, Aoki H, Ebuoka N, Eya K, Takigami K, Oba J
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 5 11 (5) 343 - 345 1341-1098 2005/10 [Refereed][Not invited]
  • Shingu Y, Aoki H, Oba J, Takigami K, Eya K, Ebuoka N
    Kyobu geka. The Japanese journal of thoracic surgery 7 58 (7) 565 - 568 0021-5252 2005/07 [Refereed][Not invited]
  • Shingu Y, Aoki H, Ebuoka N, Eya K, Takigami K, Oba J, Fukuhara T
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 3 11 (3) 198 - 200 1341-1098 2005/06 [Refereed][Not invited]
  • Junichi Oba, Hidetoshi Aoki, Ko Takigami, Kazuhiro Eya, Suguru Kubota, Yasushige Shingu
    Journal of Cardiology 45 (2) 69 - 73 0914-5087 2005/02 [Refereed][Not invited]
     
    An 83-year-old woman was transferred to our hospital because of pacing failure and suspected ventricular perforation by a permanent pacing lead. She had undergone permanent pacemaker implantation 5 months previously. Chest radiography showed the pacing lead running out of the cardiac shadow. Computed tomography and echocardiography confirmed the diagnosis of ventricular perforation by the pacing lead. No evidence of cardiac tamponade was found. The lead was surgically removed through a median sternotomy. Intraoperatively, the lead was found perforating the ventricle and the pericardium, and reaching into the left pleural cavity but not injuring the left lung. A pacing lead may potentially injure the heart or the lung. Regular check-up of lead position and pacing status is recommended.
  • Yasushige Shingu, Kazuhiro Myojin, Yoshimitsu Ishibashi, Kouji Ishii, Masakazu Kawasaki, Genbu Yamaura
    Japanese Journal of Thoracic and Cardiovascular Surgery 51 (4) 154 - 157 1344-4964 2003 [Refereed][Not invited]
     
    Multichannel near-infrared spectroscopy (NIRS) could detect change in the regional cerebral oxygenation by following animated pictures of oxy-hemoglobin (OxyHb), deoxy-hemoglobin (DeoxyHb) and total hemoglobin in operations for three surgical cases of thoracic aortic aneurysm with selective cerebral perfusion (SCP). Simultaneously measured jugular venous oxygen saturation (SjO2) showed no change in parallel to OxyHb or DeoxyHb of NIRS. It was concluded that SjO2 represented the entire rather than the local findings of the cerebral oxidative metabolism. Assessment of the intra cranial oxidative metabolism using a multichannel NIRS provided real-time information about the efficacy of SCP, while SjO2 had a comprehensive limited value. The animation enabled the detection of regional hypoperfusion visually and instantly during SCP. This multichannel NIRS was a new real-time monitoring method and was useful to prevent cerebral neurological complication due to hypoperfusion during SCP.
  • Yasushige Shingu, Kazuhiro Myojin, Yoshimitsu Ishibashi, Koji Ishii, Masakazu Kawasaki, Keitaro Ijima
    Japanese Journal of Thoracic and Cardiovascular Surgery 51 (10) 496 - 499 1344-4964 2003 [Refereed][Not invited]
     
    Objectives: The surgical treatment for thrombosed type A dissection is controversial because it has a better prognosis than with conservative therapy. We discuss the validity of conservative therapy for thrombosed type A dissection and examine the relationship between the morphology of the dissecting aorta and its operative indications. Methods: Subjects were 28 patients with acute type A aortic dissection in which the false lumen was totally thrombosed who were transferred to our hospital in the acute phase between 1990 and 2002. We performed medical therapy on all of them at first. We calculated the ratio of the false lumen and the true lumen (F/T) by enhanced computed tomography scan at the onset. The maximum aneurysmal size was measured approximately every week. Results: Fifteen of them needed surgical repair six in the acute phase and nine in chronic. One-year and 5-year survival rate for the operative and the non-operative group are 93.3, 80.0 and 92.3, 92.3% respectively. The mean F/T was 30% in the operative group and 50% in the non-operative group (p = 0.04). There was almost no reduction in size in the operative group during the follow up (-0.5 ± 1.2 mm). Conclusions: Conservative therapy with frequent imaging follow-up can be a rational option for thrombosed type A acute aortic dissection. A low ratio of the false lumen and the true lumen at the onset and no reduction in the aneurysmal size are the predictive factors by which we should consider surgical repair.

Books etc

Conference Activities & Talks

  • Can mitral valve replacement be the first-line intervention? - LVAD implantation alone vs. chordal sparing mitral valve replacement with submitral procedures for end-stage heart failure  [Not invited]
    Yasushige Shingu
    THE HEART VALVE SOCIETY 2019 Annual Scientific Meeting ▪ April 11-13, 2019, Spain  2019/04
  • Left ventricular stoke work index predicts reverse remodelling after submitral procedures for ischemic dilated cardiomyopathy  [Not invited]
    Yasushige Shingu
    29th Annual Meeting of European Association For Cardio-Thoracic Surgery（EACTS）  2015
  • Misunderstanding about Total Stroke Work in Mitral Regurgitation  [Not invited]
    Yasushige Shingu
    Heart Valve Society 1st Annual Meeting  2015
  • A newly developed tatoal stoke work index predicts survivor after mitral valve repair in end-stage heart failure patients with idiopathic dilated cardiomyopathy  [Not invited]
    Yasushige Shingu
    7th Biennial Congress of the Society for Heart Valve Disease (SHVD 2013)  2013
  • How can we estimate left ventricular stroke work in functional mitral regurgitation? –As a predictor for survival after mitral repair-  [Not invited]
    Yasushige Shingu
    21st Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS 2013)  2013
  • A New “Stoke Work Index” Predicts Responder to Mitral Valve Repair in Patients with Idiopathic Dilated Cardiomyopathy and Mitral Regurgitation  [Not invited]
    Yasushige Shingu
    Asian Pacific Society of Cardiology 2013 Congress (APSC 2013)  2013
  • Myocardial performance (Tei) index is normal in diastolic and systolic heart failure induced by pressure overload in rats  [Not invited]
    Yasushige Shingu
    European Society of Cardiology  2010
  • Transthoracic Echocardiography According to Clinical Guidelines Reliably Predicts the Stage of Heart Failure in Rats with Pressure Overload  [Not invited]
    Yasushige Shingu
    8th Society for Heart and Vascular Metabolism  2010
  • Comprehensive Echocardiographic Assessment of a Rat Model for Pressure Overload-Induced Heart Failure  [Not invited]
    Yasushige Shingu
    1st Frontier of Cardiovascular Biology  2010
  • Oleate controls the Effect of GLP-1 and Exendin-4 on myocardial glucose utilization and contractile function  [Not invited]
    Yasushige Shingu
    39th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery  2010

MISC

  • 加藤 伸康, 阿部 慎司, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲  北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編  67-  (1)  2  -9  2022/06
  • Hirokazu Komoriyama, Kiwamu Kamiya, Toshiyuki Nagai, Noriko Oyama-Manabe, Satonori Tsuneta, Yuta Kobayashi, Yoshiya Kato, Kazunori Omote, Takao Konishi, Takuma Sato, Shingo Tsujinaga, Hiroyuki Iwano, Yasushige Shingu, Satoru Wakasa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  75-  (11)  1639  -1639  2020/03
  • 川崎病冠動脈障害に対する冠動脈バイパス術
    安東 悟央, 若狭 哲, 加藤 伸康, 新宮 康栄, 加藤 裕貴, 大岡 智学  日本冠疾患学会誌  (Suppl.2019)  179  -179  2019/12  [Not refereed][Not invited]
  • 肉眼的に乳頭状線維弾性腫と鑑別が困難であったvilloustype左房粘液腫の1例
    石垣 隆弘, 新宮 康栄, 加藤 伸康, 若狭 哲, 大岡 智学, 加藤 裕貴, 若林 健人, 三橋 智子, 松居 喜郎  北海道外科雑誌  64-  (2)  207  -207  2019/12  [Not refereed][Not invited]
  • カルニチンによる心臓弁膜症手術後の心房細動の予防(単群介入試験)
    新宮 康栄, 小市 裕太, 稗田 哲也, 新井 洋輔, 安東 悟央, 石垣 隆弘, 佐藤 公治, 加藤 伸康, 若狭 哲, 大岡 智学  北海道外科雑誌  64-  (2)  209  -209  2019/12  [Not refereed][Not invited]
  • 石垣 隆弘, 新宮 康栄, 加藤 伸康, 若狭 哲, 大岡 智学, 加藤 裕貴, 松居 喜郎  日本心臓血管外科学会雑誌  48-  (6)  405  -410  2019/11  [Not refereed][Not invited]
     
    症例は60代女性。冠攣縮性狭心症で他院に通院加療中であった。経胸壁心エコー検査で左房内に心房中隔からバルサルバ洞後方の左房壁に至る広基性の可動性に富む腫瘍を指摘され、当院に紹介となった。CT検査やMRI検査の結果からは粘液腫が疑われた。手術は胸骨正中切開で行い、経心房中隔アプローチで左房腫瘍に到達した。左房内には同一の基部をもつ20×12×10mm大と40×30×15mm大の2つの腫瘍を認めた。粘液腫を念頭に約5mmのマージンを確保して腫瘍を切除した。小さい腫瘍は充実性で粘液腫を疑った。大きい腫瘍は乳頭状で、生理食塩水に浸したところイソギンチャク様の特徴的な形態を示したことから乳頭状線維弾性腫を疑った。ウシ心膜パッチを用いて心房中隔欠損部を補填した。病理診断では、小さい腫瘍は索状、管腔様構造を形成する腫瘍細胞を認め典型的な粘液腫の像を認めた。大きい腫瘍の乳頭状構造部分にはcalretinin染色に陽性を示す腫瘍細胞を少数認め、villous typeの粘液腫と診断された。術前検査や肉眼所見で両者を鑑別することは困難であり、判断に迷う場合はマージンを設けて全層切除するべきである。(著者抄録)
  • 感染性大動脈瘤に対するウシ心膜ロールを用いた人工血管置換症例の検討
    関 達也, 松居 喜郎, 新宮 康栄, 大岡 智学, 若狭 哲  脈管学  59-  (Suppl.)  S231  -S231  2019/10  [Not refereed][Not invited]
  • 原発性肺動脈腫瘍に対する治療経験
    安東 悟央, 大岡 智学, 小市 裕太, 新井 洋輔, 稗田 哲也, 石垣 隆弘, 佐藤 公治, 関 達也, 新宮 康栄, 若狭 哲, 加藤 裕貴  脈管学  59-  (Suppl.)  S288  -S288  2019/10  [Not refereed][Not invited]
  • 長期(3年以上)VAD治療の課題と対策 長期植込型補助人工心臓治療の現状、課題、そして対策
    大岡 智学, 加藤 伸康, 新宮 康栄, 若狭 哲, 加藤 裕貴, 松居 喜朗, 寒河江 磨, 矢萩 亮児, 櫛引 勝年, 加藤 美香  人工臓器  48-  (2)  S  -75  2019/10  [Not refereed][Not invited]
  • 松居喜郎, 新宮康栄, 若狭哲, 久保田卓, 大岡智学, 加藤信康, 加藤裕貴  日本心臓血管外科学会学術総会(Web)  49回-  [Ex  -3]  2019/02  [Not refereed][Not invited]
  • 松居喜郎, 新宮康栄, 若狭哲, 大岡智学, 久保田卓  日本臨床  77-  (増刊1 心不全(中))  446  -451  2019/02  [Not refereed][Not invited]
  • 佐藤公治, 新宮康栄, 若狭哲, 加藤伸康, 関達也, 大岡智学, 加藤裕貴, 橘剛, 久保田卓, 松居喜郎  日本心臓血管外科学会雑誌  47-  (6)  257  -262  2018/11  [Not refereed][Not invited]
     
    [背景]腹部ステントグラフト内挿術後に持続するエンドリークは瘤径拡大や破裂の原因となる。特にType IIエンドリークに対する標準術式は存在しない。最近Type IIエンドリークによる瘤拡大に対し、開腹下に腰動脈を結紮しステントグラフトを温存しつつ瘤を縫縮する方法が報告されるようになってきた。[目的]Type IIエンドリークに対する腰動脈結紮・ステントグラフト温存瘤縫縮術を施行した5例の術後成績と瘤径変化を検討する。[方法]持続するType IIエンドリークを有し初回腹部ステントグラフト内挿術時から10mm以上瘤径が拡大するか、最大短径65mm以上となった症例を手術適応とした。腹部正中切開し、腎動脈下の近位側のランディングゾーンで大動脈をバンディングした。大動脈を遮断することなく大動脈瘤前壁を切開し、血種を除去してType IIエンドリークの原因となっている腰動脈や正中仙骨動脈を大動脈瘤の内腔もしくは瘤壁の外側で結紮した。最後にステントグラフトを被覆するように瘤壁を縫縮した。[結果]初回手術から今回の腰動脈結紮・ステントグラフト温存瘤縫縮術までの期間は平均47±17ヵ月であった。手術時間は215±76分、4例に他家輸血を要した。術後平均在院日数は26±20日で在院死亡を認めなかった。術後合併症として誤嚥性肺炎を1例に、創感染を1例に認めた。瘤径は術前68±8mmから術後47±5mmに減少した。さらに677±322日の最終フォローアップ時における瘤径は36±7mmであり早期の瘤縮小効果を認めた。[結語]持続するType IIエンドリークに対する腰動脈結紮・ステントグラフト温存瘤縫縮術は開腹の侵襲を考慮し、適応は慎重に検討すべきであり、長期成績については今後のフォローアップを要するが、比較的根治性と安全性が高く、標準術式となりうる。(著者抄録)
  • 成人期に診断された右冠動脈肺動脈起始症の1治験例
    安東 悟央, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓, 松居 喜郎  日本心臓血管外科学会雑誌  47-  (5)  215  -219  2018/09  [Not refereed][Not invited]
     
    冠動脈肺動脈起始症(ACAPA)は稀な先天性冠動脈異常であり、多くは幼少期に手術介入を要する。右冠動脈肺動脈起始症(ARCAPA)は左冠動脈肺動脈起始症(ALCAPA)よりもさらに稀である。われわれは成人期のARCAPAに対する手術症例を経験した。症例は60代女性、主訴は胸痛。冠動脈CTおよび冠動脈造影で、左前下行枝・中隔枝より発達した側副血行路が右冠動脈を逆行性に灌流し、主肺動脈に流入することを確認した。肺体血流比は1.21であった。心臓MRIで右冠動脈と左前下行枝の領域に虚血所見を認めた。手術は、右冠動脈の上行大動脈への再移植(reimplantation)と肺動脈パッチ形成を施行した。術翌日に抜管し一般病棟へ転棟、術後18日目に退院となった。術後15ヵ月が経過した現在、胸部症状なく外来通院中である。成人期のARCAPAに対し手術を施行し良好な結果を得たので報告する。(著者抄録)
  • 【重症心不全に対する最新の外科治療】 重症非虚血性拡張型心筋症に対する外科治療選択
    新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  胸部外科  71-  (7)  484  -487  2018/07  [Not refereed][Not invited]
     
    内科的治療に抵抗性の非虚血性心筋症(NIDCM)に対する外科的治療の成績を比較し、重症心不全患者の治療選択を考察した。対象はpapillary muscle tugging approximation法6例(PMTA群)、左室形成術・僧帽弁複合体形成術20例(LVP群)と中等度以上の僧帽弁逆流を認めるNIDCMで心臓移植適応の14例(HTx群)であった。PMTA群ではLVP群よりも術後1年生存率が有意に高く、HTx群の1年植え込み型補助人工心臓回避率は33%であった。Slope in the preload recruitable stroke work relationship(Mw)が低値のNIDCMで非移植適応患者や移植拒否例ではPMTAを考慮してもよいと考えられ、移植適応があり、Mwが極度に低値のNIDCM患者では速やかに移植登録を考慮すべきであることが示された。
  • 孤立性高度三尖弁逆流の実態調査
    岩野 弘幸, 山田 聡, 新宮 康栄, 更科 美羽, 辻永 真吾, 林 大知, 松居 喜郎, 安斉 俊久  超音波医学  45-  (Suppl.)  S616  -S616  2018/04  [Not refereed][Not invited]
  • 安東 悟央, 橘 剛, 加藤 伸康, 有村 聡士, 浅井 英嗣, 新宮 康栄, 若狭 哲, 加藤 裕貴, 大岡 智学, 松居 喜郎  日本心臓血管外科学会雑誌  47-  (1)  13  -17  2018/01  [Not refereed][Not invited]
     
    非常に稀で、手術施行例の耐術例はほとんど報告がない、先天性心疾患姑息術後の肺動脈瘤の合併症例を経験した。症例は40代男性。肺動脈閉鎖症兼心室中隔欠損症に対して一歳時にWaterston手術を施行されたが、その後当時としては根治手術が困難と判断され、NYHA class I度のため数十年間近医で経過観察されていた。労作時の呼吸苦増悪を認め他院を受診、肺炎と心不全の疑いで入院加療されたが、胸部CT検査で95mmの右肺動脈瘤を認め、切迫破裂も疑われたため外科的加療目的に当科紹介となった。入院時、右胸水と右肺の広範な無気肺を認めた。胸水ドレナージを施行(800ml)した。胸水は漿液性で胸背部痛など認めず血行動態は安定していた。切迫破裂は否定的であったものの95mmと巨大な瘤径であり、利尿薬および抗生剤治療を数日間先行し、準緊急的に右肺動脈瘤に対して瘤切除および人工血管置換を施行した。術前NYHA I度であったことから、もともとの吻合部径や末梢の肺動脈径にならい24×12mm Y-graft人工血管を用いてcentral shuntとして肺動脈を再建した。PCPS装着のままICU入室、翌日離脱した。術後4日目に人工呼吸器離脱、術後38日目に退院となった。現在術後一年になるが、NYHA class I度で経過している。Waterston術後約40年後に発症した巨大肺動脈瘤に対し手術を施行し良好な結果を得たので報告する。(著者抄録)
  • Takayuki Nakajima, Takashi Yokota, Yasushige Shingu, Akira Yamada, Yutaka Iba, Kosuke Ujihara, Shuhei Miura, Shingo Takada, Ryosuke Shirakawa, Takaaki Furihata, Masaya Tsuda, Junichi Matsumoto, Takashi Katayama, Arata Fukushima, Akimichi Saito, Yoshiro Matsui, Shintaro Kinugawa  CIRCULATION  136-  2017/11  
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  • 人工血管内血栓による消費性凝固障害に対してダビガトランが奏功した1例
    村瀬 亮太, 新宮 康栄, 家子 正裕, 大岡 智学, 橘 剛, 松居 喜郎  脈管学  57-  (Suppl.)  S201  -S201  2017/10  [Not refereed][Not invited]
  • 胸郭出口症候群に対する治療経験
    安東 悟央, 新宮 康栄, 石垣 隆弘, 村瀬 亮太, 杉本 聡, 関 達也, 加藤 伸康, 浅井 英嗣, 太安 孝允, 加藤 裕貴, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  脈管学  57-  (Suppl.)  S228  -S229  2017/10  [Not refereed][Not invited]
  • 慢性A型大動脈解離により大動脈弁上真腔狭窄を来した1例
    石垣 隆弘, 新宮 康栄, 加藤 裕貴, 大岡 智学, 久保田 卓, 橘 剛, 松居 喜郎  脈管学  57-  (Suppl.)  S265  -S265  2017/10  [Not refereed][Not invited]
  • ブタ心を用いた熱可塑性人工弁輪の変形にともなう僧帽弁接合様式の検討
    関 達也, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  人工臓器  46-  (2)  S  -101  2017/08  [Not refereed][Not invited]
  • 植込み型VADの進歩と装着・管理の秘訣 Cカーブ+ドライブライン貫通部大網充填は、Heartmate II装着後のドライブライン感染を減らせるか?
    大岡 智学, 新宮 康栄, 加藤 裕貴, 橘 剛, 久保田 卓, 櫛引 勝年, 加藤 美香, 寒河江 磨, 矢萩 亮児, 松居 喜郎  人工臓器  46-  (2)  S  -48  2017/08  [Not refereed][Not invited]
  • 大血管転位症3型に対する当院の治療戦略 体肺動脈短絡術+短周径肺動脈絞扼術(BT-shunt with tight PAB)の有効性
    加藤 伸康, 橘 剛, 佐々木 理, 泉 岳, 山澤 弘州, 武田 充人, 新宮 康栄, 若狭 哲, 加藤 裕貴, 大岡 智学, 松居 喜郎  日本小児循環器学会雑誌  33-  (Suppl.1)  s1  -224  2017/07  [Not refereed][Not invited]
  • 古川夕里香, 安東悟央, 村瀬亮太, 杉本聡, 佐藤公治, 加藤伸康, 新宮康栄, 加藤裕貴, 若狭哲, 大岡智学, 橘剛, 松居喜郎  北海道外科雑誌  62-  (1)  80  2017/06/20  [Not refereed][Not invited]
  • TypeIIエンドリークに対するステントグラフト温存直達手術
    佐藤 公治, 新宮 康栄, 太安 孝允, 加藤 伸康, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  26-  (Suppl.)  V4  -10  2017/06  [Not refereed][Not invited]
  • Frailtyからみた腹部大動脈瘤開腹手術の成績
    村瀬 亮太, 新宮 康栄, 大岡 智学, 若狭 哲, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  26-  (Suppl.)  O18  -3  2017/06  [Not refereed][Not invited]
  • 胸腹部動脈瘤術後脊髄障害予防を目的とした分節動脈再建法の工夫 再建動脈開存性の意義
    若狭 哲, 佐藤 公治, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  26-  (Suppl.)  P19  -8  2017/06  [Not refereed][Not invited]
  • 右冠動脈肺動脈起始症に対しreimplantation法、肺動脈欠損壁自己心膜パッチ形成術を施行した1例
    安東 悟央, 大岡 智学, 古川 夕里香, 村瀬 亮太, 杉本 聡, 佐藤 公治, 加藤 伸康, 浅井 英嗣, 太安 孝允, 新宮 康栄, 若狭 哲, 加藤 裕貴, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  26-  (Suppl.)  P37  -8  2017/06  [Not refereed][Not invited]
  • 安東 悟央, 大岡 智学, 古川 夕里香, 有村 聡士, 村瀬 亮太, 杉本 聡, 佐藤 公治, 加藤 伸康, 新宮 康栄, 若狭 哲, 橘 剛, 松居 喜郎, 太安 孝允, 加藤 裕貴  北海道外科雑誌  62-  (1)  80  -80  2017/06  [Not refereed][Not invited]
  • 急性期にタクロリムスが原因とされる横紋筋融解症・多臓器不全を呈した心移植の1例
    大岡 智学, 大安 孝允, 新宮 康栄, 若狭 哲, 加藤 裕貴, 橘 剛, 松居 喜郎, 小林 真梨子, 櫛引 勝年  移植  52-  (1)  90  -91  2017/04  [Not refereed][Not invited]
  • 我が国の人工心臓治療の現況と展望 Destination Therapy導入に向け、5年間の植込型補助人工心臓によるBridge to Transplantationから何を学んだか?
    大岡 智学, 佐藤 公治, 新宮 康栄, 加藤 裕貴, 若狭 哲, 橘 剛, 松居 喜郎  日本外科学会定期学術集会抄録集  117回-  SY  -5  2017/04  [Not refereed][Not invited]
  • 中島 孝之, 横田 卓, 新宮 康栄, 山田 陽, 伊庭 裕, 若狭 哲, 大岡 智学, 高田 真吾, 白川 亮介, 降旗 高明, 津田 正哉, 松本 純一, 片山 貴史, 福島 新, 松居 喜郎, 絹川 真太郎  日本循環器学会学術集会抄録集  81回-  PJ  -075  2017/03  [Not refereed][Not invited]
  • 加藤喜哉, 浅川直也, 表和徳, 徳田裕輔, 岩野弘幸, 山田聡, 森敏洋, 新宮康栄, 久保田卓, 松居喜郎, 安斉俊久  日本循環器学会北海道地方会(Web)  118th-  2017
  • 植込み型補助人工心臓装着患者の在宅管理 北海道大学病院における植込型補助人工心臓装着患者に対する在宅管理の現状と課題
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 櫛引 勝年, 加藤 美香, 鴇田 智久, 矢萩 亮児, 寒河江 磨, 松居 喜郎  人工臓器  45-  (2)  S  -57  2016/10  [Not refereed][Not invited]
  • Yasushige Shingu, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui  JOURNAL OF CARDIAC FAILURE  22-  (9)  S155  -S155  2016/09  [Not refereed][Not invited]
  • 窪田 武浩, 若狭 哲, 新宮 康栄, 松居 喜郎  日本心臓血管外科学会雑誌  45-  (4)  170  -175  2016/07  [Not refereed][Not invited]
     
    先天性冠動脈-肺動脈瘻は珍しい疾患で、心筋虚血症状や瘤化などさまざまな病態を呈する。さらに体血管との連続性をも合併することは非常に稀である。症例は75歳男性で、生来健康であったが、自宅で数10秒の意識消失発作があり近医の神経外科を受診し、異常所見なく、心原性失神を疑われ当院循環器科を受診し精査が行われた。ホルター心電図で洞不全症候群と診断された。冠動脈造影で肺動脈-左右両冠動脈瘻と冠動脈狭窄との診断となった。瘻血管の存在により、冠動脈バイパス手術の適応決定においては苦慮し、通常の冠動脈造影に加え、冠血流予備量比、冠動脈内超音波検査、負荷心筋シンチを用い総合的に判断し、三枝バイパスが必要であると判断した。術前のCTアンギオで左総頸動脈・気管支動脈-肺動脈瘻が存在し左右両冠動脈-肺動脈瘻と交通していた。冠動脈バイパス術に加え、冠動脈-肺動脈瘻結紮、肺動脈開口部閉鎖、左総頸動脈-肺動脈瘻と気管支動脈-肺動脈瘻閉鎖、ペースメーカー埋め込み術をあわせて行うこととした。瘻孔開口部を決定するうえで術前のCTアンギオ、術中の心表面エコーは有用であった。あらかじめ、左総頸動脈、気管支動脈から流入する異常血管と瘻血管開口部に流入する異常血管を結紮処理した。心筋保護液注入時、さらに瘻孔開口部を直接圧迫することで、心筋保護液は十分に心筋に行き渡り十分な心停止が得られた。術後CTアンギオでは肺動脈-左右両冠動脈瘻、左総頸動脈・気管支動脈-肺動脈瘻は消失していた。左総頸動脈・気管支動脈-肺動脈瘻と左右両冠動脈-肺動脈瘻の合併症例の手術報告は探しうる限りなく、非常に稀な症例と考え文献的考察を含め報告する。(著者抄録)
  • TEVAR後のtypeIIエンドリークによる瘤拡大に対して動脈瘤直接切開による肋間動脈結紮および瘤縫縮を施行した1例
    村瀬 亮太, 若狭 哲, 杉本 聡, 佐藤 公治, 浅井 英嗣, 太安 孝允, 小林 一哉, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  25-  (Suppl.)  228  -228  2016/06  [Not refereed][Not invited]
  • 感染性大動脈瘤手術における遠隔期再感染予防
    飯島 誠, 若狭 哲, 新宮 康栄, 加藤 裕貴, 大岡 智学, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  25-  (Suppl.)  251  -251  2016/06  [Not refereed][Not invited]
  • 鼠径部の人工血管感染に対して閉鎖孔バイパス術を施行した3例の経験
    須野 賢一郎, 新宮 康栄, 杉本 聡, 村瀬 亮太, 浅井 英嗣, 大安 孝允, 佐藤 公治, 飯島 誠, 小林 一哉, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本血管外科学会雑誌  25-  (Suppl.)  362  -362  2016/06  [Not refereed][Not invited]
  • 窪田 武浩, 若狭 哲, 新宮 康栄, 松居 喜郎  胸部外科  69-  (6)  467  -470  2016/06  [Not refereed][Not invited]
     
    60歳女性。50歳時より大動脈弁狭窄症の経過観察中であった。今回、坂道歩行時の息切れを自覚し受診、CTアンギオグラフィーにて大動脈縮窄症(CoA)の合併した大動脈一尖弁狭窄症と診断された。以後、左鎖骨下動脈分岐直後に高度のCoAがあり、多数の側副血行路が存在し、正常分娩していることから、大動脈弁置換術(AVR)を先行させ、2期的にCoAの修復を行う方針とした。その結果、AVR後27日目に患者は一時的に自宅退院となったが、3ヵ月を経て左鎖骨下-下行大動脈バイパス術が施行された。目下、術後2年で降圧薬を必要とせず、大動脈にも変化はみず、良好に経過している。
  • 突然死を来たす疾患の病態と治療
    澤村 淳, 方波見 謙一, 石森 直樹, 新宮 康栄, 中山 若樹  北海道医学雑誌  91-  (1)  27  -30  2016/05  [Not refereed][Not invited]
  • 【心臓弁膜症:治療の最前線、未来への展望】 心臓弁膜症治療の最前線 外科医vs.内科医それぞれの立場から 感染性心内膜炎編 感染性心内膜炎に対する外科手術
    松居 喜郎, 若狭 哲, 大岡 智学, 新宮 康栄  日本内科学会雑誌  105-  (2)  238  -244  2016/02  [Not refereed][Not invited]
  • Satoru Wakasa, Yasushige Shingu, Tomonori Ooka, Hiroki Katoh, Tsuyoshi Tachibana, Yoshiro Matsui  ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY  22-  (2)  125  -125  2016  [Not refereed][Not invited]
  • 小児先天性心疾患術後管理におけるトルバプタンの使用経験
    太安 孝允, 浅井 英嗣, 佐藤 公治, 新宮 康栄, 加藤 裕貴, 大岡 智学, 若狭 哲, 橘 剛, 松居 喜郎, 丸藤 哲  日本集中治療医学会雑誌  23-  (Suppl.)  514  -514  2016/01  [Not refereed][Not invited]
  • 浅井 英嗣, 橘 剛, 新宮 康栄, 若狭 哲, 大岡 智学, 松居 喜郎  日本心臓血管外科学会雑誌  45-  (1)  26  -31  2016/01  [Not refereed][Not invited]
     
    Fontan循環においては重症三尖弁逆流による右房・右室の拡大や、pulmonary atresia and intact ventricular septum(PA/IVS)などにおける著明な右室圧の上昇は右心系の機能障害だけでなく二次的な左心機能障害や肺低形成の一因となる。当科ではこのような無機能右室を内腔より縫縮(内腔縫縮術)することで血行動態より遮断する手術の工夫を行ってきたのでその有効性について検討した。対象は当施設で無機能右室に対し内腔縫縮術を施行した5例(6手術)。心臓郭比は71±10%から61±5%へ有意に減少(p=0.017)し左室短縮率は27±17%から37±5%へ変化した(p=0.071)。全例がFontan循環に到達し術後経過も良好である。新生児期に内腔縫縮術を施行した1例で経過中に右室の再拡大を認めたためFontan手術時に再度内腔縫縮を追加した。当科で施行した右室内腔縫縮術は無機能右室を有する機能的単心室において有効な手術方法であると考えられた。(著者抄録)
  • Yasushige Shingu, Satoru Wakasa, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui  JOURNAL OF CARDIAC FAILURE  21-  (10)  S157  -S157  2015/10  [Not refereed][Not invited]
  • Bridge to recoverとなったHeartmate II装着例に対する治療経験
    大岡 智学, 浅井 英嗣, 佐藤 公治, 小林 一哉, 新宮 康栄, 加藤 裕貴, 若狭 哲, 橘 剛, 松居 喜郎  人工臓器  44-  (2)  S  -156  2015/10  [Not refereed][Not invited]
  • 松居 喜郎, 若狭 哲, 新宮 康栄, 大岡 智学, 橘 剛  Heart View  19-  (10)  1146  -1152  2015/10  [Not refereed][Not invited]
  • 心移植直後に発症した、タクロリムスによると思われる横紋筋融解を呈した1例
    大岡 智学, 大安 孝允, 佐藤 公治, 小林 一哉, 新宮 康栄, 加藤 裕貴, 若狭 哲, 櫛引 勝年, 小林 真梨子, 松居 喜郎  移植  50-  (総会臨時)  383  -383  2015/09  [Not refereed][Not invited]
  • 【外科治療における心エコーの役割】 外科医が知りたいFMRのポイント なぜ?どうして?
    新宮 康栄, 松居 喜郎  心エコー  16-  (9)  918  -921  2015/09  [Not refereed][Not invited]
  • 心臓血管 small volume centerにおける慢性血栓性肺高血圧症に対する肺動脈血栓内膜摘除の成績
    大岡 智学, 関 達也, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 橘 剛, 松居 喜郎  日本外科学会定期学術集会抄録集  115回-  OP  -184  2015/04  [Not refereed][Not invited]
  • 北大関連病院データベース(HOCARD)を用いた腹部大動脈瘤破裂の検討
    佐藤 公治, 若狭 哲, 浅井 英嗣, 太安 孝允, 関 達也, 内藤 祐嗣, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  283  -283  2015/01  [Not refereed][Not invited]
  • 左室形態からみた虚血性心筋症に対する左室形成と乳頭筋接合術の意義
    若狭 哲, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  343  -343  2015/01  [Not refereed][Not invited]
  • 心大血管再手術138例の検討
    内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  376  -376  2015/01  [Not refereed][Not invited]
  • 僧帽弁収縮期前方運動と左室流出路狭窄に対する心室中隔切除術の検討
    新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 杉木 宏司, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  392  -392  2015/01  [Not refereed][Not invited]
  • 末梢吻合部位の深さからみた遠位弓部大動脈瘤に対するstaged repair選択基準の検討
    佐藤 公治, 若狭 哲, 浅井 英嗣, 太安 孝允, 関 達也, 内藤 祐嗣, 新宮 康栄, 大岡 智学, 加藤 裕貴, 橘 剛, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  438  -438  2015/01  [Not refereed][Not invited]
  • 遠隔成績を鑑みて、機能性三尖弁閉鎖不全に対する弁輪形成術単独は十分か?
    大岡 智学, 関 達也, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 橘 剛, 松居 喜郎  日本心臓血管外科学会雑誌  44-  (Suppl.)  236  -236  2015/01  [Not refereed][Not invited]
  • EVAHEART装着後のMRSA縦隔炎及びポンプポケット感染例に対するJarvik2000換装(左開胸)の経験
    大岡 智学, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 橘 剛, 松居 喜郎  人工臓器  43-  (2)  S  -149  2014/09  [Not refereed][Not invited]
  • 北海道における心臓移植報告
    大岡 智学, 新宮 康栄, 若狭 哲, 松居 喜郎, 榊原 守, 絹川 真太郎, 筒井 裕之, 小林 真梨子, 久保田 卓, 杉木 宏司  日本移植学会総会プログラム抄録集  50回-  431  -431  2014/08  [Not refereed][Not invited]
  • 胸部大動脈 食道瘻に対する治療法の推移とその成績
    荒木 大, 若狭 哲, 久保田 卓, 新宮 康栄, 大岡 智学, 橘 剛, 松居 喜郎  北海道外科雑誌  59-  (1)  37  -43  2014/06  [Not refereed][Not invited]
     
    大動脈食道瘻(AEF)は非常に稀であり救命率も未だ低い疾患である。感染源である食道抜去、感染動脈組織除去と人工血管による血行再建が根治的治療とされるが、侵襲が高く施行困難な例も少なくない。一方で、近年ステントグラフト内挿術(TEVAR)による瘻孔閉鎖で低侵襲に血行動態の安定化が図れるようになってきた。今回我々は、AEFに対する外科治療9自験例を後方視的に検討し、至適な外科治療戦略について考察した。自己大動脈食道瘻6例に対しては初回TEVAR等による瘻孔閉鎖術を5例に施行したが、最終的に根治的治療を施行しえた3例は全例生存退院したものの非施行例は全例在院死亡であった。人工血管食道瘻3例については全例食道抜去を施行したものの、人工血管再置換術は非施行で、人工血管置換術後遠隔期に発症した1例のみが生存可能であった。TEVARによる早期の血行動態安定化と可及的速やかな根治的治療が望ましいと考えられた。(著者抄録)
  • 北海道大学における植込型補助人工心臓治療及び心臓移植実施体制の現状
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎, 絹川 真太郎, 榊原 守, 筒井 裕之, 小林 真梨子, 浅野 恵子, 寒河江 磨, 法邑 まなみ, 矢萩 亮児, 加藤 伸彦  移植  49-  (1)  192  -193  2014/05  [Not refereed][Not invited]
  • 松居 喜郎, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓  日本外科学会雑誌  115-  (2)  171  -171  2014/03/05  [Not refereed][Not invited]
  • 松居 喜郎, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 裕貴 剛, 久保田 卓  日本外科学会雑誌  115-  (2)  241  -241  2014/03/05  [Not refereed][Not invited]
  • 若狭 哲, 内藤 祐嗣, 久保田 卓, 関 達也, 小林 一哉, 新宮 康栄, 大岡 智学, 橘 剛, 松居 喜郎  日本外科学会雑誌  115-  (2)  489  -489  2014/03/05  [Not refereed][Not invited]
  • 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  115-  (2)  612  -612  2014/03/05  [Not refereed][Not invited]
  • 心臓再手術のPitfalls 心大血管再手術のPitfalls
    松居 喜郎, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓  日本外科学会雑誌  115-  (臨増2)  171  -171  2014/03  [Not refereed][Not invited]
  • 大動脈弁形成術を伴うRemodeling法による弁温存大動脈塞部再建術
    松居 喜郎, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓  日本外科学会雑誌  115-  (臨増2)  241  -241  2014/03  [Not refereed][Not invited]
  • 当科におけるTOFの肺動脈二尖弁に対する自己弁温存の術式と変遷
    加藤 伸康, 橘 鹿, 浅井 英嗣, 安東 悟央, 関 達也, 小林 一哉, 内藤 裕嗣, 新宮 康栄, 若狭 哲, 加藤 裕貴, 大岡 智学, 久保田 卓, 武田 充人, 松居 喜郎  日本心臓血管外科学会雑誌  43-  (Suppl.)  443  -443  2014/01  [Not refereed][Not invited]
  • 新宮 康栄  上原記念生命科学財団研究報告集  27-  1  -5  2013/12  [Not refereed][Not invited]
     
    ラットの虚血性心筋症モデルを作製し、4週後に左室形成術施行のAMI/LVP群、左室形成術なしのAMI/sham群、なにもしないsham/sham群とし、左室形成4週後に心機能を評価し、心筋オートファジーとの関連について検討した。左室心筋重量/体重比は3群間で差はなく、肺重量/体重比はAMI/sham群で最も大きかった。左室駆出率はsham/sham群に比べAMI群は有意に低値で、AMI/sham群よりAMI/LVP群で大きかった。左室拡張末期径はsham/sham群に比べAMI群は有意に高値で、AMI群間に差はなかった。平均大動脈圧はAMI/LVP群でやや低値であった。左室拡張末期圧はAMI/sham群で他2群に比べ有意に高値で、他2群間に差はなかった。左心室の拡張・収縮能の指標dpdpとmax dpdpはsham/sham群に比べAMI群は低い傾向で、AMI群間に差はなかった。オートファジーの程度を示すLC3-II蛋白の発現はAMI/sham群で他2群に比べ有意に多く、他2群間に差はなかった。
  • 浅井 英嗣, 新宮 康栄, 内藤 佑嗣, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本心臓血管外科学会雑誌  42-  (6)  494  -498  2013/11  [Not refereed][Not invited]
     
    心臓悪性腫瘍は一般に予後不良で稀な疾患である。多様な画像検査によりその診断率は上昇しているが確定診断が得られず治療方針の決定に難渋する症例が多い。今回、局所麻酔下・剣状突起下アプローチによる心膜生検と心嚢液細胞診の心臓腫瘍、特に悪性リンパ腫の確定診断における安全性と有用性について検討した。対象は心臓腫瘍の確定診断が得られないため治療が開始できなかった5例。無症状が2例、有症状が3例であった。男性3例、女性2例で平均年齢74歳(60〜81歳)であった。局所麻酔下・剣状突起下アプローチ手術は全例で合併症なく短時間で安全に行えた。心嚢液細胞診の診断率は60%(5例中3例)であった。心膜生検は3例に施行したが陽性例はなかった。最終診断は4例で悪性リンパ腫、1例でリンパ腫であった。局所麻酔下・剣状突起下アプローチによる心嚢液細胞診は開胸を要さず安全かつ簡便に行え、診断に難渋する心臓悪性腫瘍、特に悪性リンパ腫において有効な一診断手段であると考えられた。また悪性リンパ腫の診断には心膜生検は必ずしも必要でないことが示唆された。(著者抄録)
  • Satoru Wakasa, Yasushige Shingu, Tomonori Ooka, Tsuyoshi Tachibana, Yoshiro Matsui  JOURNAL OF CARDIAC FAILURE  19-  (10)  S114  -S114  2013/10  [Not refereed][Not invited]
  • 植込型補助人工心臓装着後の課題
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  北海道外科雑誌  58-  (1)  70  -70  2013/06  [Not refereed][Not invited]
  • 若狭 哲, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 加藤 伸康, 橘 剛, 浅井 英嗣, 関 達也, 南田 太朗, 飯島 誠, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 関 達也, 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 南田 大朗, 若狭 哲, 加藤 伸康, 関 達也, 浅井 英嗣, 飯島 誠, 内藤 祐嗣, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  2013/03/05  [Not refereed][Not invited]
  • 若狭 哲, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  465  -465  2013/03/05  [Not refereed][Not invited]
  • 加藤 伸康, 橘 剛, 浅井 英嗣, 関 達也, 南田 太朗, 飯島 誠, 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  560  -560  2013/03/05  [Not refereed][Not invited]
  • 関 達也, 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  562  -562  2013/03/05  [Not refereed][Not invited]
  • 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  563  -563  2013/03/05  [Not refereed][Not invited]
  • 南田 大朗, 若狭 哲, 加藤 伸康, 関 達也, 浅井 英嗣, 飯島 誠, 内藤 祐嗣, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  564  -564  2013/03/05  [Not refereed][Not invited]
  • 内藤 祐嗣, 新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  114-  (2)  914  -914  2013/03/05  [Not refereed][Not invited]
  • 心臓・大血管手術における止血法の工夫 TFF(TachoSil-Fibrin-Felt)StripとTF Sheet
    松居 喜郎, 若狭 哲, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓  日本心臓血管外科学会雑誌  42-  (Suppl.)  193  -193  2013/02  [Not refereed][Not invited]
  • 機能性三尖弁閉鎖不全に対する弁輪形成術後中等度以上の遺残閉鎖不全は予測可能か?
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  日本心臓血管外科学会雑誌  42-  (Suppl.)  363  -363  2013/02  [Not refereed][Not invited]
  • KATO NOBUYASU, ASAI HIDETSUGU, SEKI TATSUYA, MINAMIDA TARO, IIJIMA MAKOTO, NAITO YUJI, SHINGU YASUSHIGE, WAKASA SATORU, OOKA TOMONORI, TACHIBANA TSUYOSHI, KUBOTA SUGURU, MATSUI YOSHIRO  日本成人先天性心疾患学会雑誌  2-  (1)  83  -83  2013/01  [Not refereed][Not invited]
  • 【重症心不全に対する外科治療】 左室形成術の適応と限界
    若狭 哲, 新宮 康栄, 久保田 卓, 南田 大朗, 飯島 誠, 内藤 祐嗣, 大岡 智学, 橘 剛, 松居 喜郎  胸部外科  66-  (1)  26  -30  2013/01  [Not refereed][Not invited]
     
    左室形成術(SVR)を行った左室駆出率(LVEF)≦35%の拡張型心筋症107例を、原疾患別に虚血性拡張型心筋症(ICM)57例(男性52例、女性5例、平均61歳)と非虚血性拡張型心筋症(DCM)50例(男性43例、女性7例、平均58歳)に分け、中期成績について検討した。ICM群/DCM群の術前New York Heart Association(NYHA)分類III・IV度の症例は49例(86%)/46例(92%)で、術前IV度以上の僧帽弁閉鎖不全症は21例(37%)/34例(68%)であった。両群とも術後に有意な左室縮小とLVEFの改善、左室収縮末期容積係数の30%以上の収縮を認め、MRは殆どがI度以下、NYHA分類がII度以下となったが、III度以上の心不全残存を5例/3例に認めた。術後30日死亡は2例(4%)/6例(12%)、在院死亡は8例(14%)/14例(28%)、遠隔死亡は11例/17例、術後平均追跡期間は35ヵ月/28ヵ月であった。1年、3年、5年生存率は82%、71%、60%/54%、40%、37%で、遠隔生存例の94%/95%がNYHA分類II度以下に保たれていた。
  • SHINGU YASUSHIGE, WAKASA SATORU, OOKA TOMONORI, TACHIBANA TSUYOSHI, KUBOTA SUGURU, MATSUI YOSHIRO  北海道外科雑誌  57-  (2)  26  -30  2012/12  [Not refereed][Not invited]
  • 機能的僧帽弁逆流に対する前方への乳頭筋つり上げ術は左室流入血流障害を軽減する
    新宮 康栄, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  北海道外科雑誌  57-  (2)  130  -134  2012/12  [Not refereed][Not invited]
     
    機能的僧帽弁逆流に対する単独の僧帽弁輪縫縮(MAP)では高頻度で逆流が再発するのみならず、拡張期に僧帽弁前尖が乳頭筋に牽引され左室流入血流障害を惹起するとも報告されている。我々は乳頭筋の前方へのつり上げが左室流入血流に及ぼす影響を検討した。対象は機能的僧帽弁逆流に対する手術症例38例。虚血性21例、非虚血性17例。全例に乳頭筋接合術とMAPを施行した。乳頭筋つり上げなしが6例、後方つり上げ8例、前方つり上げ24例。前方つり上げ群では他群に比較して左室流入血流角度が大きく(75±8度vs.63±17度vs.60±6度;p<0.001)、左房/左室の最大圧較差が小さかった(5.9±2.0vs.7.2±3.3vs.10±2.6mmHg;p<0.001)。機能的僧帽弁逆流に対する前方への乳頭筋つり上げは左室流入血流障害を軽減できる可能性がある点で有用な方法であると考えられる。(著者抄録)
  • 植込型補助人工心臓承認によって重症心不全治療はどう変わったか? 重症心不全患者に対する左室形成術の成績から見た植込型補助人工心臓装着を含む外科的重症心不全治療戦略
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  人工臓器  41-  (2)  S  -33  2012/11  [Not refereed][Not invited]
  • 新宮 康栄, 久保田 卓, 若狭 哲, 夷岡 徳彦, 森 大輔, 大岡 智学, 橘 剛, 松居 喜郎  北海道醫學雜誌 = Acta medica Hokkaidonensia  87-  (6)  268  -268  2012/11/01  [Not refereed][Not invited]
  • Yasushige Shingu, Yoshiro Matsui  JOURNAL OF CARDIAC FAILURE  18-  (10)  S160  -S160  2012/10  [Not refereed][Not invited]
  • Yoshiro Matsui, Yasushige Shingu, Satoru Wakasa, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota  JOURNAL OF CARDIAC FAILURE  18-  (10)  S134  -S134  2012/10  [Not refereed][Not invited]
  • 千葉知, 納谷昌直, 吉永恵一郎, 岩野弘幸, 山田聡, 若狭哲, 新宮康栄, 久保田卓, 松居喜郎, 筒井裕之, 玉木長良  核医学  49-  (3)  261  2012/08/31  [Not refereed][Not invited]
  • 松居 喜郎, 新宮 康栄, 内藤 祐嗣, 夷岡 徳彦, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓  日本外科学会雑誌  113-  (2)  261  -261  2012/03/05  [Not refereed][Not invited]
  • 内藤 祐嗣, 夷国 徳彦, 新宮 康栄, 若狭 哲, 大岡 智学, 加藤 裕貴, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  113-  (2)  392  -392  2012/03/05  [Not refereed][Not invited]
  • 関 達也, 新宮 康栄, 榊原 守, 若狭 哲, 大岡 智学, 橘 剛, 久保田 卓, 筒井 裕之, 松居 喜郎  日本外科学会雑誌  113-  (2)  428  -428  2012/03/05  [Not refereed][Not invited]
  • 若狭 哲, 久保田 卓, 新宮 康栄, 大岡 智学, 橘 剛, 松居 喜郎  日本外科学会雑誌  113-  (2)  706  -706  2012/03/05  [Not refereed][Not invited]
  • 浅井 英嗣, 松居 喜朗, 久保田 卓, 橘 剛, 大岡 智学, 若狭 哲, 夷岡 徳彦, 内藤 裕嗣, 新宮 康栄, 南田 太朗, 関 達也  日本外科学会雑誌  113-  (2)  797  -797  2012/03/05  [Not refereed][Not invited]
  • 久保田 卓, 関 達也, 浅井 英嗣, 新宮 康栄, 内藤 祐嗣, 夷岡 徳彦, 若狭 哲, 大岡 智学, 橘 剛, 松居 喜郎  日本外科学会雑誌  113-  (2)  798  -798  2012/03/05  [Not refereed][Not invited]
  • 大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  113-  (2)  798  -798  2012/03/05  [Not refereed][Not invited]
  • 新宮 康栄, 関 達也, 久保田 卓, 若狭 哲, 大岡 智学, 橘 剛, 松居 喜郎  日本外科学会雑誌  113-  (2)  799  -799  2012/03/05  [Not refereed][Not invited]
  • 新しい僧帽弁形成術 Measured Tube Techniqueによる人工腱策再建
    松居 喜郎, 新宮 康栄, 夷岡 徳彦, 若狭 哲, 杉木 宏司, 大岡 智学, 橘 剛, 久保田 卓  日本心臓血管外科学会雑誌  41-  (Suppl.)  345  -345  2012/03  [Not refereed][Not invited]
  • 大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  Journal of the Japanese Coronary Association  18-  (3)  265  -269  2012  [Not refereed][Not invited]
     
    虚血性心筋症(ICM)は、多様な病態を呈する虚血性心疾患である。その臨床像には、再灌流が得られなかったことによる貫壁性心筋梗塞後に生じやすい左室瘤や、速やかな再灌流療法により心内膜下側に心筋障害がとどまったものの、あたかも拡張型心筋症のごとく局在を持たない広範囲な左室壁運動低下を呈する、いわゆる狭義のICMが含まれる。ICMに対する外科治療の背景、ICMに対する左室形成術の考え方、虚血性僧帽弁閉鎖不全の外科的制御、北海道大学循環器呼吸器外科におけるICMに対する左室形成術の成績、ICMに対する心臓移植の日本と欧米の比較、ハイリスク症例に対する左室形成術後のBridge to Recoverを目指した周術期左室補助の可能性について述べた。
  • 大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  Journal of the Japanese Coronary Association  18-  (3)  265  -269  2012  [Not refereed][Not invited]
  • 飯島誠, 関達也, 浅井英嗣, 加藤伸康, 南田大朗, 夷岡徳彦, 内藤祐嗣, 新宮康栄, 若狭哲, 大岡智学, 橘剛, 久保田卓, 松居喜郎  北海道外科雑誌  56-  (2)  160  -161  2011/12/20  [Not refereed][Not invited]
  • 北海道初の植込型補助人工心臓を用いた重症心不全治療の経験 院内治療体制構築からHub-Satellite Hospital systemへ
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  北海道外科雑誌  56-  (2)  156  -156  2011/12  [Not refereed][Not invited]
  • 北海道初の植込型補助人工心臓を用いた重症心不全治療の経験 院内治療体制構築からHub-Satellite Hospital systemへ
    大岡 智学, 新宮 康栄, 若狭 哲, 橘 剛, 久保田 卓, 松居 喜郎  人工臓器  40-  (2)  S134  -S134  2011/10  [Not refereed][Not invited]
  • 若狭 哲, 新宮 康栄, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  The Japanese journal of thoracic surgery  64-  (11)  985  -988  2011/10  [Not refereed][Not invited]
     
    左室形成術を施行した虚血性心不全52例(男45例・女7例・平均62±11歳)を対象に、左心機能・左室形態を考慮して治療成績を検討した。その結果、周術期心機能は、New York Heart Association(NYHA)分類で術前II度7例、III度31例、IV度14例から術後I度34例、II度18例となり、左室収縮末期容積係数(LVESVI)、左室収縮率(LVEF)の平均値も有意に改善した。入院死亡は4例、遠隔期死亡は4例で、心関連死が各2例であった。Kaplan-Meier法による5年生存率は75%で、Cox回帰分析では僧帽弁不全症(MR)≧4+が有意な死亡予測因子であった。一方、LVESVI≧100ml/m2、LVEF<35%の高度リモデリング群(25例)でも5年生存率は72%であり、死亡予測因子は全体と同様であった。また同群の生存例19例の経過観察時(平均25ヵ月)の心不全コントロールは、79%がNYHA分類≦II度と良好であった。
  • 最新の弁膜症治療 外科治療からカテーテル治療まで 虚血性僧帽弁逆流の外科治療
    松居 喜郎, 久保田 卓, 橘 剛, 大岡 智学, 若狭 哲, 新宮 康栄  日本心臓病学会誌  6-  (Suppl.I)  160  -160  2011/08  [Not refereed][Not invited]
  • 心不全に対する外科治療 左室形成術と心臓移植、植込型補助人工心臓はどのようにすみ分けるか?
    松居 喜郎, 久保田 卓, 橘 剛, 大岡 智学, 若狭 哲, 新宮 康栄  日本心臓病学会誌  6-  (Suppl.I)  172  -172  2011/08  [Not refereed][Not invited]
  • 松居 喜郎, 若狭 哲, 新宮 康栄, 杉木 宏司, 大岡 智学, 久保田 卓  内科  108-  (1)  81  -86  2011/07  [Not refereed][Not invited]
     
    ●本邦における人工心臓治療は植込み型人工心臓の認可で新しい時代が期待される。●また本邦における心臓移植は絶対数は少ないものの、現在までのところすぐれた遠隔成績が得られている。●左室形成術、僧帽弁手術は、適応、さまざまな術式の比較評価、長期予後などいまだ検討の余地が多く残されている。しかし、著明な低心機能例でも術後症状が改善することが多く経験され、心拡大、とくに球形の左室拡張を伴った僧帽弁逆流を呈する虚血性心筋症あるいは非虚血性心筋症に対して、左室の容積減少、機能・形態の改善が得られる。そのため、少なくとも植込み型人工心臓、心臓移植の前段階の重症心不全に対する有効な外科的アプローチの一つと考えられる。(著者抄録)
  • Tien Nguyen, Yasushige Shingu, Paulo A. Amorim, Michael Schwarzer, Torsten Doenst  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  57-  (14)  E211  -E211  2011/04  [Not refereed][Not invited]
  • Yoshiro Matsui, Satoru Wakasa, Yasushige Shingu, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota  JOURNAL OF CARDIAC FAILURE  16-  (9)  S137  -S137  2010/09  [Not refereed][Not invited]
  • 若狭 哲, 新宮 康栄, 松井 欣哉, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎  日本外科学会雑誌  111-  (2)  557  -557  2010/03/05  [Not refereed][Not invited]
  • TACHIBANA TSUYOSHI, ABE SHINJI, NAITO YUJI, EBUOKA NORIYOSHI, SHINGU YASUSHIGE, MATSUI KIN'YA, SUGIKI TAKASHI, WAKASA SATOSHI, OOKA TOMONORI, YAMAKAWA SATOSHI, KUBOTA SUGURU, SHIIYA NORIHIKO, MURASHITA TOSHIFUMI, MATSUI YOSHIRO  Gen Thorac Cardiovasc Surg  57-  (8)  7  2009/08/10  [Not refereed][Not invited]
  • 杉木孝司, 納谷昌直, 新宮康栄, 松井欣也, 若狭哲, 久保田卓, 椎谷紀彦, 筒井裕之, 玉木長良, 松居喜郎  Gen Thorac Cardiovasc Surg  57-  (8)  15  2009/08/10  [Not refereed][Not invited]
  • 杉木孝司, 納谷昌直, 新宮康栄, 松井欣也, 若狭哲, 大岡智学, 久保田卓, 椎谷紀彦, 玉木長良, 筒井裕之, 松居喜郎  日本心臓血管外科学会雑誌  38-  (Supplement)  351  2009/03/20  [Not refereed][Not invited]
  • 当科における慢性血栓塞栓性肺高血圧症に対する肺動脈血栓内膜摘除症例の検討
    大岡 智学, 夷岡 徳彦, 新宮 康栄, 杉木 孝司, 松井 欣哉, 若狭 哲, 橘 剛, 久保田 卓, 山川 智士, 椎谷 紀彦, 松居 喜郎, 安藤 太三  日本心臓血管外科学会雑誌  38-  (Suppl.)  324  -324  2009/03  [Not refereed][Not invited]
  • 大岡 智学, 夷岡 徳彦, 新宮 康栄, 杉木 孝司, 松井 欣哉, 若狭 哲, 橘 剛, 久保田 卓, 椎谷 紀彦, 松居 喜郎  日本外科学会雑誌  110-  (2)  378  -378  2009/02/25  [Not refereed][Not invited]
  • 久保田 卓, 夷岡 徳彦, 新宮 康栄, 松井 欣哉, 杉木 孝司, 若狭 哲, 大岡 智学, 橘 剛, 山川 智士, 椎谷 紀彦, 村下 十志文, 松居 喜郎  Circulation journal : official journal of the Japanese Circulation Society  72-  (0)  1073  -1073  2008/10/20  [Not refereed][Not invited]
  • 新宮 康栄, 大山 徳子, 加藤 伸康, 夷岡 徳彦, 杉木 孝司, 若狭 哲, 大岡 智学, 橘 剛, 山川 智士, 久保田 卓, 椎谷 紀彦, 村下 十志文, 松居 喜郎  Circulation journal : official journal of the Japanese Circulation Society  72-  (0)  1073  -1073  2008/10/20  [Not refereed][Not invited]
  • 杉木 孝司, 納谷 昌直, 新宮 康栄, 松井 欣哉, 久保田 卓, 椎谷 紀彦, 村下 十志文, 松居 喜郎  Circulation journal : official journal of the Japanese Circulation Society  72-  (0)  1073  -1073  2008/10/20  [Not refereed][Not invited]
  • Yoshiro Matsui, Yasushige Shingu, Takasi Sugiki, Kinya Matsui, Matsul Suguru Kubota, Norihiko Shiiya  JOURNAL OF CARDIAC FAILURE  14-  (7)  S139  -S139  2008/09  [Not refereed][Not invited]
  • 上田 裕一, 新宮 康栄, 松居 喜郎, 高橋 利佳  ハートナーシング  21-  (9)  879  -883  2008/09  [Not refereed][Not invited]
  • 上田 裕一, 新宮 康栄, 松居 喜郎, 大塚 博明  ハートナーシング  21-  (8)  775  -779  2008/08  [Not refereed][Not invited]
  • 新宮 康栄, 椎谷 紀彦, 松崎 賢司, 国原 孝, 村下 十志文, 松居 喜郎  胸部外科  61-  (6)  440  -443  2008/06  [Not refereed][Not invited]
     
    当科にて初期保存的降圧療法を施行した急性大動脈解離患者23例(男12例・女11例・平均64歳)を対象に、発症48時間以内にsivelestat sodium hydrateを使用した11例(A群)と非使用の12例(B群)で経過を比較した。DeBakey分類はI型15例、IIIa型2例、IIIb型6例であった。保存療法中に肺酸素化能の増悪により気管挿管を要したのはA群0例、B群5例で有意差を認めた。発症から気管挿管までは平均39時間、挿管時間は140時間で、全例人工呼吸器から離脱でき、気管切開を行った例はなかった。最大WBC数、最大CRP数、最低PaO2/FiO2値は両群間で有意差はなかった。CTで心嚢液の貯留を11例に、軽度の胸水貯留を13例に、中等量以上の胸水貯留を6例に認め、1例に胸水穿刺を施行した。ICU滞在日数はA群2.3日、B群4.7日、入院日数はそれぞれ28日、30日で有意差はなかった。Sivelestat投与は、重篤な呼吸不全を回避できる可能性が示唆された。
  • 【やさしく学べる血小板・血栓止血の管理 研修医からの質問317】 抗血小板療法、抗凝固療法、線溶療法、抗線溶療法 開心・大血管術後管理(CABG、弁置換等)
    新宮 康栄, 松居 喜郎  救急・集中治療  20-  (5-6)  634  -635  2008/06  [Not refereed][Not invited]
  • 新宮 康栄, 夷岡 徳彦, 松井 欣哉, 杉木 孝司, 若狭 哲, 橘 剛, 山川 智士, 久保田 卓, 椎谷 紀彦, 村下 十志文, 松居 喜郎  日本外科学会雑誌  109-  (2)  123  -123  2008/04/25  [Not refereed][Not invited]
  • TACHIBANA TAKESHI, ABE SHINJI, NAITO HIROSHI, EBISUOKA NORIHIKO, SHINGU YASUSHIGE, MATSUI KIN'YA, SUGIKI KOJI, WAKASA SATOSHI, SUGIKI KOJI, YAMAKAWA SATOSHI, KUBOTA TAKASHI, SHIIYA NORIHIKO, MURASHITA TOSHIFUMI, MATSUI YOSHIRO  Gen Thorac Cardiovasc Surg  56-  (4)  16  2008/04/10  [Not refereed][Not invited]
  • 重症心不全に対する左室形成術による外科治療
    松居 喜郎, 新宮 康栄, 若狭 哲, 杉木 孝司, 松井 欣哉, 久保田 卓, 椎谷 紀彦, 村下 十志文, 志村 信一郎, 須藤 幸雄  適応医学  11-  (2)  50  -56  2008/01  [Not refereed][Not invited]
     
    拡張心に伴う重症心不全に対して、症例に応じOverlapping法あるいは乳頭筋接合術を加えた変法、さらに乳頭筋接合術単独施行を行った。今回これらの術式による中期遠隔成績を報告した。非虚血性拡張型心筋症(DCM)36例、虚血性拡張型心筋症(ICM)34例を対象とした。周術期は心臓関連死亡はなく、緊急手術の1例が脳障害、2例が肺炎で死亡した。中期成績では4例が心不全、1例が不整脈、5例が感染、2例が脳梗塞、1例が腎不全で死亡した。1年、3年生存率は順にDCM 59±5、59±5%、ICM 92±6、87±6%、total 75±6、72±6%であった。Overlapping法、乳頭筋接合術を組み合わせた左室形成術は短期的には比較的安全で、特に虚血性心筋症に対し心機能改善の意味で有効な術式であるが、中期成績では非心臓死が多く、術前状態の悪化する前の手術が重要であることが示唆された。
  • 新宮 康栄, 松居 喜郎, 内藤 祐嗣, 松井 欣哉, 若狭 哲, 杉木 宏司, 橘 剛, 山川 智士, 久保田 卓, 椎谷 紀彦, 村下 十志文  Circulation journal : official journal of the Japanese Circulation Society  71-  (0)  1010  -1010  2007/10/20  [Not refereed][Not invited]
  • 明神 一宏, 石橋 義光, 石井 浩二, 川崎 正和, 岡 潤一, 國重 英之, 新宮 康栄  胸部外科  60-  (4)  285  -289  2007/04  [Not refereed][Not invited]
     
    閉塞型大動脈解離に対する早期保存療法の成績を検討した。対象は早期保存療法を行った偽腔血栓閉塞型大動脈解離96例で、内訳はA型35例(男性15例、女性20例、平均70.5歳)、B型61例(男性45例、女性16例、平均69歳)、観察期間は中央値63.6ヵ月であった。1)A型の手術移行は18例(51.4%:急性期8例、慢性期10例)で、手術死2例、遠隔関連死2例、非手術17例(48.6%)では入院死1例、遠隔関連死1例、遠隔他病死5例であった。2)B型の手術移行は14例(23.0%:急性期3例、慢性期11例)で、遠隔他病死3例、非手術47例(77.0%)では入院死1例、遠隔関連死6例、遠隔他病死10例であった。3)入院死を含む1年、5年累積生存率は、A型手術例94.4%、82.6%、非手術例88.2%、75.5%、B型手術例100%、92.3%、非手術例91.5%、75.4%であった。4)A型手術例の偽腔比率(F/T比)は有意に小さく、B型手術例の発症時大動脈径は有意に大きかった。これらの症例では猶予手術を念頭に経過観察すべきと考えられた。
  • Shingu Yasushige, Kunihara Takashi, Shiiya Norihiko, Murashita Toshifumi, Yamada Satoshi, Onozuka Hisao, Tsutsui Hiroyuki, Matsui Yoshiro  Circulation journal : official journal of the Japanese Circulation Society  71-  76  -76  2007/03/01
  • 新宮 康栄, 明神 一宏, 石橋 義光, 石井 浩二, 川崎 正和  脈管学  45-  (11)  941  -944  2005/11  [Not refereed][Not invited]
     
    偽腔血栓閉塞型急性大動脈解離におけるStanford A型28例(男性14例,女性14例),B型49例(男性37例,女性12例)を対象に,全例早期保存療法を施行し,良好な結果が得られた.1)A型では全経過中に手術療法を必要とする例が多かったものの,手術成績は良好であり,発症早期の手術の必要性は少ないと考えられた.2)発症時の大動脈形態がその後の病態予測に有用であり,A型では偽腔比率が低いものの,B型では瘤径の大きいものに対しては,手術療法を念頭に置いた定期的検査による厳重な経過観察が必要であると考えられた
  • 新宮 康栄, 青木 秀俊, 大場 淳一, 瀧上 剛, 江屋 一洋, 夷岡 徳彦  胸部外科  58-  (9)  807  -811  2005/08  [Not refereed][Not invited]
     
    単独CABG施行の39症例(男性65例・女性28例,平均年齢66.4歳)を対象に術後の心房細動(af)の発生頻度とその関連因子について検討した.対象の術前NYHA分類はI度49例・II度29例・III度6例・IV度2例で,何らかのβ遮断薬が49例で投与されていた.基本的に手術は完全体外循環心停止下に動脈グラフトによるCABG(34例)を行い,低左心機能症例では人工心肺使用心拍動下(9例)で血行再建を行った.脳血管障害既往例・頸部血管狭窄例・上行大動脈高度石灰化例などの50例では心拍動下CABG(OPCAB)を行った.その結果,術前からの5例のaf例を除く88例中22例(25%)に術後afを認め,術式(CABG群9例・非CABG群13例,OPCAB群10例・非OPCAB群12例)や術前投薬(β遮断薬内服群14例・非内服群8例)との関連は認めなかった.術前の平均左房径はaf群43.4±6.1mmで,非af群40.6±5.4mmより大きい傾向がみられた.以上より,術前の左房径と高齢が危険因子である可能性が示唆された
  • 滝上 剛, 青木 秀俊, 大場 淳一, 江屋 一洋, 新宮 康栄, 夷岡 徳彦  日本心臓血管外科学会雑誌  34-  (4)  295  -299  2005/07  [Not refereed][Not invited]
     
    開心術後周術期の合併症として大動脈解離はまれであるが致死的な合併症の一つとして考えられている.開心術後周術期に新たに弓部大動脈以下より大動脈解離が発生した症例を3例報告する.当科では1994年から2003年までの10年間で開心術は1,647例で,術後大動脈解離の発生率は0.18%であった.3例の術式はannulo aortic ectasiaに対するmodified Bentall手術,虚血性心筋症,陳旧心筋梗塞に対する冠動脈バイパス術およびDor手術,急性II型解離,大動脈弁閉鎖不全症に対する上行置換および大動脈弁置換術で,3例とも術中,術直後の血行動態は安定していた.3例中2例は術後のCT検査およびエコー検査により下行大動脈の解離を指摘され大動脈解離の発症が判明した.ほかの1例は術後10日目に左胸腔内に出血をきたしショックとなり広範囲脳損傷のために失い,死亡後の剖検により大動脈解離の診断を得た.解離のentryは死亡例とほかの1例は下行大動脈近位に,もう1例は左鎖骨下動脈に認めた.生存例はAHAの大動脈解離診療ガイドラインに従い安静と降圧療法を行い,行動拡大,血圧コントロール後に退院,外来followを行っている.術後急性大動脈解離は開心術後の合併症の一つとして考慮し,術中に経食道エコーによる下行大動脈の観察や,症例によっては周術期の血圧コントロールを厳格にすべきである.また,発症例に対しては定期的な経過観察をしていく必要があると考えられる(著者抄録)
  • 新宮 康栄, 青木 秀俊, 大場 淳一, 瀧上 剛, 江屋 一洋, 夷岡 徳彦  胸部外科  58-  (7)  565  -568  2005/07  [Not refereed][Not invited]
     
    上行あるいは上行・弓部置換術を行った急性A型大動脈解離15例を対象に,術後の吻合末梢側解離腔の状態および中期成績について検討した.その結果,平均経過観察期間14±16ヵ月で,9例(60%)に吻合末梢側解離腔の血栓化を認めた.吻合末梢側解離腔の血栓化は,上行・弓部置換術例(A群)では3例全例(100%),上行置換術例(B群)では12例中6例(50%)に認められた.下行大動脈の最大径は,A群で42.3±8.7mm,B群で40.8±5.9mmと,B群で径の開大が軽度であった.下行残存解離腔破裂にて1例が病院死したが,瘤関連イベントにて再手術を要したものはなかった.以上より,急性A型大動脈解離に対する術式として,上行置換術は弓部分再建がなく,人工心肺時間の短縮,出血のコントロールの点からも有利であると思われた
  • 新宮 康栄, 明神 一宏, 石橋 義光, 石井 浩二, 川崎 正和, 飯島 啓太郎  Circulation journal : official journal of the Japanese Circulation Society  67-  760  -760  2003/04/20
  • 明神 一宏, 石橋 義光, 石井 浩二, 川崎 正和, 山浦 玄武, 新宮 康栄  胸部外科  55-  (4)  292  -298  2002/04  [Not refereed][Not invited]
     
    1985〜2001年に手術を行った真性弓部大動脈瘤66例の成績について,脳保護法・術式別の比較を含めて報告した.全体の成績は早期死亡率9%,1年生存率81%,5年生存率59%で,耐術者の原病生存は概ね良好であった.在院死亡の主な要因は術後の心不全・呼吸不全であった.術後の脳神経障害は男に多く発生し,長期予後に大きな影響を与えていた

Awards & Honors

  • 2021/10 北海道大・部局横断シンポジウム実行委員会 部局横断型若手研究助成事業 金賞
     冬眠動物と植物の低温耐性に学ぶ新たな心臓保存法の開発 
    受賞者: 新宮 康栄;山口 良文
  • 2020/10 北海道大・部局横断シンポジウム実行委員会 Grants-in-Aid for Cross-department Young Researcher Grants of Hokkaido University
     冬眠動物の低温耐性に学ぶ心臓保存法の開発 
    受賞者: 新宮 康栄;山口 良文
  • 2013/02 日本心臓血管外科学会 優秀演題
     
    受賞者: 新宮康栄

Research Grants & Projects

  • 心房細動の病態進行における心臓周囲脂肪ミトコンドリア機能の役割
    科研 基盤研究(C)：
    Date (from‐to) : 2022/04 -2027/03 
    Author : 渡邉 昌也 新宮 康栄
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research
    Date (from‐to) : 2022/04 -2027/03 
    Author : 新宮 康栄
  • 秋山記念生命科学振興財団：研究助成（一般）
    Date (from‐to) : 2023/09 -2024/03 
    Author : 新宮康栄
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2020/04 -2023/03 
    Author : 深井 原, 新宮 康栄, 暮地本 宙己, 木村 太一, 藤好 真人
     
    心移植のドナー不足解消のためには、心臓グラフトの冷保存許容時間の延長、虚血再灌流傷害の軽減が必要である。本課題では心臓の冷保存状態の改善、冠選択的灌流の至適条件、薬剤性コンディショニング、再灌流時治療の効果を明らかにし、移植前グラフト機能評価法の確立を目指す。われわれはラット心の24-36時間冷保存後・移植において、グラフト生存、心機能を比較し、UW液に対する自作液の優位性を示すことに成功した (Wakayama et al 2012 Transplant Int)。今回は自作液とCelsior液で24時間冷保存しその効果をLangendorf灌流による再灌流で比較した。しかし、異所性心移植と異なり自作液の有効性を示し得なかった。そこで、心筋細胞株を用いて自作液の冷保存傷害軽減効果を検討すると共に、各種薬物による保護効果、ミトコンドリア機能保護、細胞質Ca2+ overload阻害の有効性等を検討した。また、心臓のproteomics, metabolomics解析のために抽出法を詳細に検討した。多くの方法を検討した中で、トリクロロ酢酸 (TCA) による除タンパク(沈殿) と代謝物の抽出 (上層)が有用であった。TCA抽出液はジエチルエーテルとの混和・分液によってTCAが除去され、pHが安定した試料が得られるようになった。これらの試料はNMR解析、LC-MS/MS解析、ラマン分光解析に使用できる。一方、ミトコンドリア傷害に先んじて放出される、電子伝達系Complex1の構成分子であるフラビンモノヌクレオチド (FMN) をHPLC蛍光検出により他のビタミンＢ２群と区別する方法を確立した。また、オスミウム浸軟SEM法により心筋細胞内のアクチンやミトコンドリア膜構造を超微形態比較する方法を確立した。
  • 心臓手術後の心房細動を抑え患者さんの負担を減らしたい！
    academist：研究クラウドファンディング
    Date (from‐to) : 2019/04 -2022/03 
    Author : 新宮康栄
  • カルニチンを用いた心臓弁膜症・肺癌・食道癌術後の心房細動予防
    胸部外科学会：JATS award for transitional clinical research
    Date (from‐to) : 2019/04 -2022/03 
    Author : 新宮康栄
  • 重症機能性僧帽弁逆流症を伴う非虚血性拡張型心筋症に対する僧帽弁手術の遠隔期成績―全国データベース研究
    第45回日本心臓財団研究奨励
    Date (from‐to) : 2020/04 
    Author : 石垣隆弘
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research
    Date (from‐to) : 2017/04 -2020/03 
    Author : Matsui Yoshiro
     
    We developed a novel thermally deformable mitral annuloplasty ring to address the problems in mitral valve surgery. We assessed the ring's mechanical properties and its effect on the mitral valve anatomy. This ring was made of polycaprolactone. In the mechanical tests, the ring's yield point was greater than the deformation force of the annulus in humans. In pigs with deformation from "4:3" to "4:2", the coaptation length was significantly increased in each mitral valve part. Asymmetrical ring deformation increased the coaptation length only at the deformed area. In conclusion, this new thermally deformable mitral annuloplasty ring could be "order-made" to effectively change the coaptation length in all parts of the mitral valve post-deformation via intraoperative heating.
  • 可塑性人工弁輪の開発
    文部科学省：科学研究費補助金(基盤研究(C))
    Date (from‐to) : 2017/04 -2019/03 
    Author : 松居喜郎
  • カルニチンによる心臓弁膜症手術後の心房細動の予防法の開発
    楡刀会外科医学研究助成基金：
    Date (from‐to) : 2017/12 -2018/12 
    Author : 新宮康栄
  • Autophagic preconditioningによる新たな心筋保護法の開発
    北海道心臓協会：
    Date (from‐to) : 2016/10 -2017/10 
    Author : 新宮康栄
  • 左室縮小術後のオートファジー制御による新たなアジュバント療法の開発
    持田記念財団研究助成：
    Date (from‐to) : 2016/10 -2017/10 
    Author : 新宮康栄
  • 心筋オートファジー活性化による左室縮小術後の心筋肥大抑制
    日本心臓財団研究奨励：
    Date (from‐to) : 2015/04 -2016/03 
    Author : 新宮康栄
  • 血中遊離脂肪酸と心筋オートファジーからみた新たな不整脈治療の開発
    三井住友循環器学研究振興基金：
    Date (from‐to) : 2015/04 -2016/03 
    Author : 新宮康栄
  • 文部科学省：科学研究費補助金(若手研究(B))
    Date (from‐to) : 2012/04 -2015/03 
    Author : 新宮 康栄
  • 術後心房細動患者における心筋興奮—収縮連関時間の延長
    フラテ研究奨励賞：同窓会研究助成
    Date (from‐to) : 2012/04 -2013/03 
    Author : 新宮康栄
  • オートファジーからみた重症心不全に対する左室形成術の効果
    上原財団：研究奨励金
    Date (from‐to) : 2011/04 -2012/03 
    Author : 新宮康栄
  • 心不全モデルにおけるGLP-1、エネルギー基質の心筋組織呼吸に及ぼす影響
    上原財団：海外留学助成
    Date (from‐to) : 2009/04 -2011/03 
    Author : 新宮康栄

Educational Activities

Teaching Experience

  • Basic Principles of Medicine
    開講年度 : 2021
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 先天性心疾患、後天性心疾患、大血管疾患、末梢血管疾患の病態評価と手術計画 Perioperative assessment and surgical planning for patients with cardiovascular diseases.
  • Master's Thesis Research in Medical Sciences
    開講年度 : 2021
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : ①心不全に対する外科治療；補助循環、左室形成、心臓移植 ②腫瘍外科，感染症の外科治療，外傷 1.Severe heart failure, mechanical circulatory support, left ventriculoplasty, heart transplantation 2.Oncologic surgery, surgical treatment of infectious diseases and trauma
  • Principles of Medicine
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 先天性心疾患、後天性心疾患、血管疾患 Congenital heart disease, acquired heart disease, and vascular disease
  • Dissertation Research in Medical Sciences
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : ①循環補助法の改良と開発 ②腫瘍外科，感染症の外科治療，外傷，肺移植 1.Mechanical circulatory support. 2.Oncology Surgery, Surgical treatment of infectious disease, trauma, lung transplantation
  • Dissertation Research in Clinical Medicine
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : ①心不全に対する外科治療；補助循環、左室形成、心臓移植 ②肺悪性腫瘍の診断、外科治療、補助療法 1.Severe heart failure, mechanical ciraulatory support, left ventriculoplasty, heart transplantation 2.Diagnosis, surgery, adjuvant therapy of malignant lung tumors
  • Surgical Disorders in Nursing Ⅱ
    開講年度 : 2021
    課程区分 : 学士課程
    開講学部 : 医学部
    キーワード : 血液疾患、呼吸器疾患、循環器疾患、消化器疾患 代謝・免疫学的疾患、感染症、腎・泌尿器疾患、神経疾患
  • Surgical Property
    開講年度 : 2021
    課程区分 : 学士課程
    開講学部 : 医学部
    キーワード : 外科総論，消化器外科，心臓血管外科，呼吸器外科，乳腺外科，小児外科，移植外科

Social Contribution

Social Contribution

Media Coverage

  • Date : 2023/11
    Publisher, broadcasting station: 秋山記念生命科学振興財団
    Program, newspaper magazine: アウトリーチ活動
    https://www.akiyama-foundation.org/news/6316.html Internet
  • プレスリリース_トレハロースによる虚血後の心機能改善にはじめて成功
    Date : 2021/02
    Publisher, broadcasting station: 北海道大学
    Program, newspaper magazine: プレスリリース
    https://www.hokudai.ac.jp/news/2021/02/post-797.html Internet
  • クラウドファンディングに成功した研究者・新宮康栄さんのサイエンスカフェ
    Date : 2018/11/07
    Publisher, broadcasting station: 北海道大学
    Program, newspaper magazine: いいね！Hokudai
    Internet
  • 心臓手術後の合併症「心房細動」をカルニチンで予防
    Date : 2018/07/13
    Publisher, broadcasting station: 北海道大学
    Program, newspaper magazine: いいね！Hokudai
    Internet

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