Orthotopic heart transplantation in patient with situs inversus and pectus excavatum: a case report.
Satoru Wakasa, Tomonori Ooka, Takuma Sato, Yasushige Shingu, Nobuyasu Kato, Toshiyuki Nagai, Toshihisa Anzai, Minoru Ono, Yoshiro Matsui
Surgical case reports, 10, 1, 202, 202, 2024年08月30日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Heart transplantation in patients with situs inversus is challenging, especially in terms of reconstruction of the systemic venous return. Several rerouting techniques have been presented but are associated with vulnerability to external compression, which might cause hemodynamic instability, especially in the presence of chest deformity. In this study, we report a rare case of successful heart transplantation in the presence of situs inversus and pectus excavatum. CASE PRESENTATION: A 55-year-old man, with a history of surgeries for corrected transposition of the great arteries with ventricular septal defect, was registered for heart transplantation owing to progression of heart failure. Subsequently, he had undergone a left ventricular assist device implantation; 14 years after registration, he underwent transplantation of the heart with normal anatomy. The inferior vena cava was reconstructed by anastomosing the left atria with a counterclockwise rotation of the donor heart and by lengthening the recipient inferior vena cava with a conduit made of the residual right atrial tissue. The superior vena cava was reconstructed using a donor innominate vein harvested with sufficient length. After successful weaning from cardiopulmonary bypass, the chest could not be closed because the heart was compressed owing to chest deformity, resulting in hemodynamic instability. Therefore, to exclude the left lung, a left pericardial screen was created using a bovine pericardium, allowing the chest to be closed with acceptable hemodynamics. The patient suffered postoperatively from a higher venous pressure, suggesting an obstruction of venous return early after surgery. The obstruction gradually resolved, and the patient was transferred for rehabilitation. CONCLUSIONS: Heart transplantation in the presence of situs inversus is challenging; moreover, the presence of pectus excavatum further complicates the procedure. The paradoxically larger left lung and chest deformity compressed and impaired reconstructed systemic venous return. Although intrathoracic exclusion of the left lung was effective, an intraoperative or early postoperative thoracoplasty for pectus excavatum was also a viable option. Patient-specific management is mandatory, depending on the anatomy.

重症金属アレルギーを有する僧帽弁位感染性心内膜炎に対する治療経験
松井双葉, 齊藤慈円, 加藤伸康, 阿部慎司, 加藤裕貴, 大岡智学, 新宮康栄, 若狭哲
北海道外科雑誌, 69, 1, 2024年

Reconstruction of right ventricular outflow tract with severe calcification: lantern procedure.
Takahiro Ishigaki, Satoru Wakasa, Koji Sato, Nobuyasu Kato, Yasuhiro Kamikubo
General thoracic and cardiovascular surgery, 72, 1, 58, 60, 2023年08月24日, ［国内誌］
英語, 研究論文（学術雑誌）, Right ventricular outflow tract reconstruction is repeatedly required after the Rastelli procedure. However, standard right ventricular outflow tract reconstruction using direct anastomosis on the posterior right ventricular outflow tract wall is unfeasible in cases with severe calcification. Herein, we present a novel technique called the "lantern procedure," which can fix the prosthetic pulmonary valve without anastomosis to the calcified right ventricular outflow tract wall.

A Noonan-like pediatric patient with a de novo CBL pathogenic variant and an RNF213 polymorphism p.R4810K presenting with cardiopulmonary arrest due to left main coronary artery ostial atresia.
Ayako Chida-Nagai, Hidefumi Tonoki, Naomasa Makita, Hiroyuki Ishiyama, Masafumi Ihara, Yuji Maruo, Takao Tsujioka, Daisuke Sasaki, Gaku Izumi, Hirokuni Yamazawa, Nobuyasu Kato, Masaki Ito, Miki Fujimura, Osamu Sasaki, Atsuhito Takeda
American journal of medical genetics. Part A, 191, 12, 2837, 2842, 2023年08月09日, ［国際誌］
英語, Left main coronary artery ostial atresia (LMCAOA) is an extremely rare condition. Here, we report the case of a 14-year-old boy with Noonan syndrome-like disorder in whom LMCAOA was detected following cardiopulmonary arrest. The patient had been diagnosed with Noonan syndrome-like disorder with a pathogenic splice site variant of CBL c.1228-2 A > G. He suddenly collapsed when he was running. After administering two electric shocks using an automated external defibrillator, the patient's heartbeat resumed. Cardiac catheterization confirmed the diagnosis of LMCAOA. Left main coronary artery angioplasty was performed. The patient was discharged without neurological sequelae. Brain magnetic resonance imaging revealed asymptomatic Moyamoya disease. In addition, RNF213 c.14429 G > A p.R4810K was identified. There are no reports on congenital coronary malformations of compound variations of RNF213 and CBL. In contrast, the RNF213 p.R4810K polymorphism has been established as a risk factor for angina pectoris and myocardial infarction in adults, and several congenital coronary malformations due to genetic abnormalities within the RAS/MAPK signaling pathway have been reported. This report aims to highlight the risk of sudden death in patients with RASopathy and RNF213 p.R4810K polymorphism and emphasize the significance of actively searching for coronary artery morphological abnormalities in these patients.

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, BioMed Central, 2023年08月, ［責任著者］
英語

Staged definitive repair for pulmonary atresia and ventricular septal defect 40 years after palliative surgery: a case report
Noriyoshi Ebuoka, Norihiro Ando, Hidetsugu Asai, Nobuyasu Kato, Tsuyoshi Tachibana, Satoru Wakasa
General Thoracic and Cardiovascular Surgery Cases, 2023年06月05日
研究論文（学術雑誌）

Usefulness of Prolonged PR Interval to Predict Atrial Tachyarrhythmia Development Following Surgical Repair of Tetralogy of Fallot.
Gaku Izumi, Atsuhito Takeda, Hirokuni Yamazawa, Ayako Nagai, Daisuke Sasaki, Itsumi Sato, Nobuyasu Kato, Tsuyoshi Tachibana
The American journal of cardiology, 184, 127, 132, 2022年09月17日, ［国際誌］
英語, 研究論文（学術雑誌）, Atrial tachyarrhythmias (ATAs), which may occur after tetralogy of Fallot (TOF) surgery, can cause sudden cardiac death. However, ATAs may also develop in response to electrical substrates. This study aims to examine the predictive factors for ATAs by identifying electrical substrates in the atrium obtained from 12-lead electrocardiogram in patients who underwent TOF repair. A total of 144 patients aged >15 years (median, 31.6 years) who underwent TOF repair at Hokkaido University were enrolled. We investigated the correlation between the development of ATAs with age, time interval after initial corrective surgery, brain natriuretic peptide levels, cardiac magnetic resonance parameters (right ventricular end-diastolic volume index, right ventricular end-systolic volume index, right ventricular ejection fraction, right atrial volume index, left ventricular end-diastolic volume index, left ventricular ejection fraction), and 12-lead electrocardiogram parameters (P wave maximum voltage, PR interval, QRS width, number of fragmented QRS). Of the 144 patients, 44 patients (30.6%) developed ATAs. Multivariate analysis revealed time interval after initial corrective surgery (odds ratio 6.7, 95% confidence interval 1.78 to 12.6) and PR interval (odds ratio 2.7, 95% confidence interval: 1.17 to 4.20) as independent risk factors for the development of ATAs. The receiver operating characteristic curve revealed a PR interval cut-off value of >200 milliseconds as predictive of the development of ATAs in patients more than 15 years after initial corrective surgery (area under the curve, 0.658; sensitivity, 71.4%; specificity, 66.4%). The present study demonstrated that a prolonged PR interval is a simple and convenient predictor for the development of ATAs in patients who underwent TOF repair.

Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease.
Yoshifumi Takeda, Masataka Yamamoto, Koji Hoshino, Yoichi M Ito, Nobuyasu Kato, Satoru Wakasa, Yuji Morimoto
Pediatric cardiology, 44, 3, 695, 701, 2022年09月01日, ［国際誌］
英語, 研究論文（学術雑誌）, Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-to-systemic blood flow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures. In the post hoc analysis of a previous prospective observational study, cerebral blood flow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery. Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no significant differences of the flow velocities between the start and end of surgery in either procedure. The pulsatility index significantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood flow. The cerebral oxygenation decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures. Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures.

Bronchial artery hypertrophy-associated perioperative pulmonary hemorrhage in cardiovascular surgery: a case report.
Shinji Abe, Yasuhiro Kamikubo, Nobuyasu Kato, Hiroki Kato, Tomonori Ooka, Yasushige Shingu, Satoru Wakasa
Surgical case reports, 8, 1, 80, 80, 2022年04月29日, ［国際誌］
英語, 研究論文（学術雑誌）, 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.

Perioperative junctional ectopic tachycardia associated with congenital heart disease: risk factors and appropriate interventions.
Gaku Izumi, Atsuhito Takeda, Hirokuni Yamazawa, Nobuyasu Kato, Hiroki Kato, Tsuyoshi Tachibana, Osamu Sagae, Ryogo Yahagi, Motoki Maeno, Koji Hoshino, Hitoshi Saito
Heart and vessels, 37, 10, 1792, 1800, 2022年04月25日, ［国内誌］
英語, 研究論文（学術雑誌）, The risk factors and the appropriate interventions for perioperative junctional ectopic tachycardia (JET) in congenital heart disease (CHD) surgery have not been sufficiently investigated despite the severity of this complication. This study aimed to examine the risk factors and interventions for perioperative JET. From 2013 to 2020, 1062 surgeries for CHD (median patient age: 4.3 years, range 0.0-53.0) with or without a cardiopulmonary bypass (CPB) were performed at Hokkaido University, Japan. We investigated the correlation between perioperative JET morbidity factors, such as age, genetic background, CPB/aortic cross-clamp (ACC) time, use of inotropes and dexmedetomidine, STAT score, and laboratory indices. The efficacy of JET therapies was also evaluated. Of the 1062 patients, 86 (8.1%) developed JET. The 30-day mortality was significantly high in JET groups (7% vs. 0.8%). The independent risk factors for JET included heterotaxy syndrome [odds ratio (OR) 4.83; 95% confidence interval (CI) 2.18-10.07], ACC time exceeding 90 min (OR 1.90; CI 1.27-2.39), and the use of 3 or more inotropes (OR 4.11; CI 3.02-5.60). The combination of anti-arrhythmic drugs and a temporary pacemaker was the most effective therapy for intractable JET. Perioperative JET after CHD surgery remains a common cause of mortality. Inotrope use was a risk factor for developing JET overall surgery risk. In short ACC surgeries, heterotaxy syndrome could increase the risk of JET, which could develop even without inotrope use in long ACC surgeries. It is crucial not to delay the treatment in cases with unstable hemodynamics caused by this arrhythmia. It is recommended to reduce numbers not dose of inotropes.

L-Carnitine supplementation for the prevention of postoperative atrial fibrillation in aortic valve surgery.
Yasushige Shingu, Nobuyasu Katoh, Tomonori Ooka, Hiroki Katoh, Satoru Wakasa
General thoracic and cardiovascular surgery, 69, 11, 1460, 1466, 2021年11月, ［国内誌］
英語, 研究論文（学術雑誌）, 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.

Intralobar pulmonary sequestration associated with left main coronary artery obstruction and mitral regurgitation.
Yusuke Motohashi, Tatsuya Kato, Nobuyasu Kato, Masato Aragaki, Aki Fujiwara-Kuroda, Tsuyoshi Tachibana, Yasuhiro Hida, Kichizo Kaga, Satoru Wakasa
General thoracic and cardiovascular surgery, 69, 12, 1575, 1579, 2021年09月21日, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, A 4-year-old boy with left intralobar pulmonary sequestration associated with left main coronary artery obstruction (LMCAO) and severe mitral regurgitation (MR) was admitted to our hospital. Since the patient presented with dyskinesia of the cardiac apex and increased left ventricular end-diastolic volume (LVEDV), left main coronary artery reconstruction and mitral annuloplasty were performed. The enlargement of the left ventricle was improved after sequential surgeries. There was a risk of deterioration of MR and regrowth of LVEDV due to shunt blood flow; therefore, left lower lobectomy and aberrant artery division were performed. This is a very rare case of a patient with pulmonary sequestration associated with LMCAO and severe MR.

Left ventricular inflow obstruction due to a coronary arteriovenous fistula: a paediatric case report.
Ayako Chida-Nagai, Hirokuni Yamazawa, Takao Tsujioka, Kota Taniguchi, Osamu Sasaki, Gaku Izumi, Nobuyasu Kato, Atsuhito Takeda
BMC cardiovascular disorders, 21, 1, 389, 389, 2021年08月11日, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: We report a rare case of left ventricular inflow obstruction from a branch of the left circumflex coronary artery to the right atrium caused by a coronary arteriovenous fistula (CAVF) in a young Japanese male child. CASE PRESENTATION: The patient was diagnosed with CAVF following a heart murmur shortly after birth. The left-to-right shunt caused right ventricular volume overload and pulmonary congestion. An emergency surgical intervention was performed for the CAVF on day 6 after birth. However, by 5 years of age, his left ventricular inflow obstruction worsened. We found an abnormal blood vessel originating from the proximal part of a branch of the left circumflex coronary artery, circling the outside of the mitral valve annulus along the medial side of the coronary sinus. As the child gets older, the blood inflow into the left ventricle might get restricted further, resulting in left-sided heart failure. CONCLUSION: Our findings suggest that even after CAVF closure surgery, it is essential to monitor for complications caused by progressive dilatation of a persistent CAVF.

心房内血流転換を併施し心内修復術を行った内臓錯位症候群・左側相同，鏡像型右胸心，完全型房室中隔欠損，単心房，下大静脈欠損，両側上大静脈の一例
加藤 伸康, 武田 充人, 新井 洋輔, 八田 英一郎, 八鍬 聡, 新宮 康栄, 大岡 智学, 若狭 哲
日本小児循環器学会雑誌, 37, 2, 126, 132, 特定非営利活動法人 日本小児循環器学会, 2021年08月01日
日本語, 内臓錯位症候群・左側相同に関連する心疾患では下大静脈欠損や両側上大静脈などの体静脈還流異常や単心房を合併することも多く，二心室修復の際には体静脈の再建も要する．今回我々は，内臓錯位症候群・左側相同，鏡像型右胸心，房室中隔欠損，単心房，両側上大静脈，下大静脈欠損，半奇静脈接続の4歳女児に対し，心房内血流転換を含めた心内修復術を行った．術前CTでは体静脈の心外再建には不向きな心大血管形態で，共通肺静脈腔の存在から心房内血流転換が適していると判断し，右上大静脈の血流を左側心房へ心房内血流転換しつつ，房室中隔欠損に対してmodified one patch法で共通房室弁の分割と心房中隔作成を行った．術後検査では体静脈や肺静脈の狭窄は認めず，経過良好で11日目に自宅退院となった．共通肺静脈腔を呈している場合は，心房内血流転換は体静脈還流異常に対して有用な術式となりうる．

About a definition of the persistent fifth aortic arch.
Nobuyasu Kato
The Annals of thoracic surgery, 112, 4, 1385, 1386, 2021年02月08日, ［国際誌］
英語

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, 51回, VS2, 4, (NPO)日本心臓血管外科学会, 2021年02月
日本語

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, 51回, OP28, 1, (NPO)日本心臓血管外科学会, 2021年02月
日本語

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, 51回, OP32, 4, (NPO)日本心臓血管外科学会, 2021年02月
日本語

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, 30, Suppl., O24, 1, (NPO)日本血管外科学会, 2021年
日本語

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, 30, Suppl., O37, 1, (NPO)日本血管外科学会, 2021年
日本語

Total Anomalous Pulmonary Venous Connection with Lethal Pulmonary Venous Obstruction Managed by Multidisciplinary Cooperation.
Kana Ito, Ayako Chida-Nagai, Osamu Sasaki, Nobuyasu Kato, Takeshi Umazume, Satoshi Kawaguchi, Kazutoshi Cho, Gaku Izumi, Hirokuni Yamazawa, Atsuhito Takeda
Case reports in pediatrics, 2021, 6619458, 6619458, 2021年, ［査読有り］, ［国際誌］
英語, Background: Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart disease for which emergency surgery is required after birth. In cases of no intervention, TAPVC is associated with a high mortality rate in the first year of life. Although foetal echocardiographic techniques for diagnosing TAPVC have improved, TAPVC remains one of the most difficult congenital heart diseases to diagnose via foetal echocardiography. Here, we report a case of TAPVC with pulmonary venous obstruction (PVO), which was diagnosed via foetal echocardiography. Case Presentation. On foetal echocardiography at 32 weeks' gestation, a large atrial septal defect, enlarged superior vena cava, and continuous flow pattern in the vertical vein from the common chamber were observed in the foetus. Paediatric cardiologists and cardiac surgeons, neonatologists, and obstetricians planned to perform a caesarean section and emergency heart surgery. The male infant was born at 37 weeks' gestation via caesarean section, and postnatal echocardiography revealed PVO at the confluence of the superior vena cava and common chamber. Similarly, chest computed tomography confirmed the foetal diagnosis. The postnatal diagnoses were TAPVC type Ib, PVO, atrial septal defect, and patent ductus arteriosus. Surgical repair of the TAPVC was initiated within the first 3 hours of life. Screening brain echocardiography and head computed tomography revealed intracranial haemorrhage and hydrocephalus. Therefore, the patient underwent emergency bilateral external drainage on day 13. On day 48, a ventriculoperitoneal shunt was inserted owing to progressive brain ventricular dilatation. The patient was discharged home on postoperative day 68. Conclusions: Although the prognosis of TAPVC with PVO remains poor, continuous observation through foetal echocardiography and early interdepartmental collaboration can result in good outcomes.

Persistent Fifth Aortic Arch with Left Ventricular Dysfunction and Left Bronchial Obstruction.
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年04月18日, ［査読有り］, ［筆頭著者］, ［国際誌］
英語, 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.

Forns Index is a predictor of cardiopulmonary bypass time and outcomes in Fontan conversion.
Gaku Izumi, Atsuhito Takeda, Hirokuni Yamazawa, Osamu Sasaki, Nobuyasu Kato, Hidetsugu Asai, Tsuyoshi Tachibana, Yoshiro Matsui
Heart and vessels, 35, 4, 586, 592, 2020年04月, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, Recent reports suggested that cardiopulmonary bypass (CPB) time is one of the risk factors for postoperative complications after Fontan conversion. Although Fontan conversion may be performed for the patients with hepatic fibrosis after initial Fontan procedure, there is no predictive indicator regarding the liver function associated with hemostasis which can affects CPB time. Thirty-one patients who underwent Fontan conversion using the same surgical procedure (extracardiac conduit conversion with right atrium exclusion) were enrolled. In multivariate analyses including age at Fontan conversion, interval from initial Fontan to conversion, hemodynamic data such as right atrial pressure, ventricular end-diastolic pressure, and cardiac index, hepatic data such as platelet count, prothrombin time international normalized ratios, serum total bilirubin, hyaluronic acid levels, five known indices for hepatic fibrosis (Forns Index, APRI, FIB4, FibroIndex, and MELD-XI), and liver stiffness measured by ultrasound elastography, only the Forns Index remained independently associated with the CPB time (P < 0.01) and blood transfusions (plasma transfusions and platelet concentrations: P < 0.01 for both). The cutoff level for Forns Index to predict the prolonged CPB time (exceeding 240 min) was 4.85 by receiver-operating characteristic curve (area under the curve 0.823, sensitivity 76.9%, and specificity 72.2%). Three patients with Forns Index > 7.0 had poor outcomes with long CPB time and massive blood transfusions in contrast with the other 28 patients. In conclusion, Forns Index could serve as a practical predictor of CPB time and is associated with blood transfusion volume in Fontan conversion.

Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy.
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, 2020年01月, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, 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.

肉眼的に乳頭状線維弾性腫と鑑別が困難であったvillous type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, 松居 喜郎
日本心臓血管外科学会雑誌, 48, 6, 405, 410, (NPO)日本心臓血管外科学会, 2019年11月, ［査読有り］
日本語, 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)

Risk factors for residual mitral regurgitation after aortic valve replacement in patients with severe aortic valve stenosis and moderate mitral regurgitation.
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, 2019年10月, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, 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.

Effects of blood flow dynamics on autologous pericardial degeneration in reconstructed pulmonary arteries.
Nobuyasu Kato, Masaaki Yamagishi, Keiichi Itatani, Takako Miyazaki, Yoshinobu Maeda, Satoshi Asada, Yoshiro Matsui, Hitoshi Yaku
Interactive cardiovascular and thoracic surgery, 26, 2, 293, 300, 2018年02月01日, ［査読有り］, ［筆頭著者］, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: To clarify the risk factors for abnormal degeneration of autologous pericardium, the mechanical stress on the endothelial tissue caused by turbulent blood flow in the pulmonary artery (PA) reconstructed with autologous pericardium and major aortopulmonary collateral arteries was assumed in pulmonary atresia and ventricular septal defect. METHODS: Patient-specific PA models were created for 6 patients based on their past computed tomography images taken after unifocalization of major aortopulmonary collateral arteries. Computational fluid dynamics models were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow streamline, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated from the simulated result. PA degeneration was evaluated with the computed tomography images before the intracardiac repair. RESULTS: Regions with physiological high WSS had fewer abnormal changes. Excessively high WSS was often detected at the anastomosis site of the reconstructed PA, and intimal thickening was found in these regions during intracardiac repair. Regions with high OSI and low WSS had dilated change within several months. In 1 patient, in particular, detached vortex flow occurred at the rectangular angle anastomosis site of the right PA in flow streamline, resulting in high OSI and low WSS with abnormal enlargement in the pericardium. CONCLUSIONS: Endothelial stress caused by blood flow would affect the degeneration of autologous pericardium and major aortopulmonary collateral arteries in the reconstructed PA. High OSI and low WSS might induce enlargement or dilatation, and excessively high WSS in the anastomosis site might induce intimal thickening.

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
佐藤 公治, 松居 喜郎, 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
日本心臓血管外科学会雑誌, 47, 6, 257, 262, 特定非営利活動法人 日本心臓血管外科学会, 2018年
日本語,

［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10 mm以上瘤径が拡大するか，最大短径65 mm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カ月であった．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±8 mmから術後47±5 mm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±7 mm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．

肺動脈閉鎖症兼心室中隔欠損症に対するWaterston手術40年後の巨大肺動脈瘤に対する1治験例
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, (NPO)日本心臓血管外科学会, 2018年01月, ［査読有り］
日本語, 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)

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, (NPO)日本小児循環器学会, 2017年07月
日本語

Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction.
Eijiro Yamashita, Masaaki Yamagishi, Takako Miyazaki, Yoshinobu Maeda, Yusuke Yamamoto, Nobuyasu Kato, Satoshi Asada, Hisayuki Hongu, Hitoshi Yaku
The Annals of thoracic surgery, 102, 4, 1336, 44, 2016年10月, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: One of the critical factors limiting conduit longevity in right ventricular outflow tract (RVOT) reconstruction with homografts and xenografts is the small size of the conduit. The aim of our study was to assess the outcome of using smaller-sized expanded polytetrafluoroethylene (ePTFE) conduits with a fan-shaped valve and bulging sinuses for RVOT reconstruction. METHODS: This retrospective review examined 303 patients who underwent RVOT reconstruction with ePTFE conduits at 63 Japanese hospitals between 2003 and 2014. Inclusion criteria were a conduit size less than or equal to 16 mm and the use of operative treatment as the primary correction for underlying heart disease. Patients undergoing palliative procedures were excluded. RESULTS: Median follow-up was 1.7 years. Freedom from conduit replacement and freedom from conduit reintervention were 90.1% ± 4.8% and 77.2% ± 5.6%, respectively. The most common indication for conduit reintervention was pulmonary artery (PA) bifurcation stenosis (82%). Modeling z-scores as a dichotomous variable revealed that freedom from conduit reintervention for PA bifurcation stenosis was significantly decreased for conduits with a z-score greater than or equal to 1.4 compared with z-scores less than 1.4 (p = 0.036). There were 30 patients (9.9%) who experienced at least moderate conduit stenosis and 21 patients (6.9%) with at least moderate conduit insufficiency. Univariate Cox regression analysis showed that conduit size was a significant factor for conduit stenosis (p = 0.006). CONCLUSIONS: Excellent midterm outcomes were achieved with ePTFE valved conduits, even when using smaller sizes. Conduit z-scores around 1.4 were optimal for RVOT reconstruction in younger patients.

First Successful Clinical Application of the In Vivo Tissue-Engineered Autologous Vascular Graft.
Nobuyasu Kato, Masaaki Yamagishi, Keiichi Kanda, Takako Miyazaki, Yoshinobu Maeda, Masashi Yamanami, Taiji Watanabe, Hitoshi Yaku
The Annals of thoracic surgery, 102, 4, 1387, 90, 2016年10月, ［査読有り］, ［筆頭著者］, ［国際誌］
英語, 研究論文（学術雑誌）, PURPOSE: The ideal material for pediatric pulmonary artery (PA) augmentation is autologous pericardium. However, its utility for multistaged operations is limited. In this study, we applied an in vivo tissue-engineered autologous Biotube graft to a patient with congenital heart disease for the first time. DESCRIPTION: For molds of the Biotubes, two silicone 19F drain tubes were embedded in the subcutaneous spaces of a 2-year-old girl with a diagnosis of pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries during palliative surgical procedures. When definitive repair was performed after 8 months, the implants were removed to prepare Biotubes, one of which was cut open and autologously implanted into the PA for patch augmentation. EVALUATION: Seven months after implantation, the Biotube patch-augmented PA tolerated balloon angioplasty (BAP) for residual stenosis of the peripheral PA. Computed tomography images after BAP showed the well-preserved shape of the Biotube patch-augmented PA. Neither aneurysm formation nor stenosis was observed. CONCLUSIONS: The safety and feasibility of Biotubes for pediatric PA patch augmentation are described. Because Biotubes are completely autologous, they may be ideal material for pediatric PA augmentation.

A Novel Surgical Technique for Right-Sided Interrupted Aortic Arch by Interposition of a Pulmonary Autograft Tube.
Nobuyasu Kato, Masaaki Yamagishi, Takako Miyazaki, Yoshinobu Maeda, Satoshi Asada, Hisayuki Hongu, Eijiro Yamashita, Hitoshi Yaku
The Annals of thoracic surgery, 102, 2, e125-7, 2016年08月, ［査読有り］, ［筆頭著者］, ［国際誌］
英語, 研究論文（学術雑誌）, Right-sided interrupted aortic arch (IAA) is a rare cardiac anomaly. In general, the right bronchus sits higher than the left bronchus, so aortic arch reconstruction with a direct anastomosis has a risk of tracheal and bronchial obstruction. This report describes the successful definitive repair of a right-sided IAA in a 2.5-kg neonate by aortic arch reconstruction with a pulmonary autograft tube (PA tube). Postoperative three-dimensional multidetector computed tomography showed the reconstructed aortic arch without airway obstruction or aortic stenosis. The use of a PA tube is a simple and useful technique for aortic arch reconstruction in patients with a high risk of tracheal andbronchial obstruction, such as right-sided IAA.

当科における感染性胸腹部大動脈瘤の外科治療
飯島 誠, 澁谷 千英子, 河合 昭浩, 加藤 伸康, 南田 大朗, 内藤 祐嗣, 夷岡 徳彦, 松井 欣哉, 若狭 哲, 杉木 宏司, 大岡 智学, 橘 剛, 久保田 卓, 松居 喜郎
北海道外科雑誌, 55, 2, 183, 183, 北海道外科学会, 2010年12月
日本語

特集 ファロー四徴症に対する外科治療 : 新生児期・幼少期から成人期まで—Surgery for tetralogy of Fallot from infancy to adulthood
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年06月
日本語

小児画像診断のコツ II.読影のコツ(マネージメントのコツ含む)4.心大血管におけるコツ 先天性心疾患
常田慧徳, 加藤伸康, 武田充人, 小児科診療, 85, 2022年