tomoyuki matsuba - Academia.edu (original) (raw)
Papers by tomoyuki matsuba
Frontiers in Pediatrics, Mar 8, 2021
Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of de... more Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18 F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18 F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18 F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.
Nihon Shūchū Chiryō Igakukai zasshi, Jul 1, 2018
Japanese Journal of Cardiovascular Surgery, May 15, 2022
A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was bro... more A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was brought to our hospital as an emergency case. In Japan, endovascular treatment is unsuitable for the treatment of mycotic aneurysms, but findings from a Swedish national database showed that there was no difference in the long-term prognosis lasting over 10 years. Therefore, we performed endovascular aortic repair (EVAR) and saved the patient's life. The diameter of the proxymal sealing zone was larger than that of the distal zone. We used the Gore Excluder leg, which was inverted and implanted to match the caliber. Percutaneous abscess drainage was also performed on postoperative day 7 when hemostasis was confirmed for early infection control. The patient was discharged at 8 weeks postoperatively. After discharge from the hospital, oral antibiotics were continued until 6 months after the surgery. Six months postoperatively, contrast-enhanced computed tomography showed that the abscesses have disappeared. Blood samples that were taken at one month after the completion of antibiotics showed no evidence of the recurrence of infection and a curative course was achieved.
Japanese Journal of Cardiovascular Surgery, 2018
Due to the increasing number of patients with repaired tetralogy of Fallot TOF , the amount of su... more Due to the increasing number of patients with repaired tetralogy of Fallot TOF , the amount of subsequent sequelae has also increased along with the need for further surgical interventions. This case report described a patient who underwent multiple reoperations for late sequelae over a period of 48 years after repair of TOF. The patient was a 58-year-old man who underwent a reparative operation for TOF at the age of 9 years. At the age of 30, he underwent patch closure of residual VSD and reconstruction of right ventricular outflow tract RVOT with a mono-cusped trans-annular patch combined with aortic valve replacement. At the age of 47, he underwent aortic root replacement for aneurysmal dilatation of the Valsalva sinus, and he was implanted with a pacemaker for bradycardia atrial fibrillation at the age of 51. By the age of 58, he required pulmonary valve replacement and tricuspid valve annuloplasty for right ventricular dysfunction resulting from regurgitation of the pulmonary and tricuspid valves as 4th midline sternotomy surgery. His status improved to NYHA functional class III to II after the most recent procedures, although he still needed strict medical control. A proactive approach during long-term follow-up after TOF repair is important for timely and appropriate surgical intervention in the event of late sequelae.
Adult Congenital Heart Disease, 2017
Reconstruction of the right ventricular outflow tract with extracardiac conduits facilitated the ... more Reconstruction of the right ventricular outflow tract with extracardiac conduits facilitated the complete repair of complex cardiac malformations such as pulmonary atresia with VSD, transposition of the great arteries with VSD and left ventricular outflow tract obstruction, and truncus arteriosus. Commonly used conduits now are the valved conduits with various materials and designs: homograft, stented xenograft, stentless xenograft, autologous tissue conduit, and expanded polytetrafluoroethylene conduit. Early results are excellent in these conduits; however, conduit reoperation is unavoidable in the mid or long term due to conduit obstruction, valve regurgitation, infectious endocarditis, formation of aneurysm or pseudoaneurysm, somatic outgrowth, and so on. Among all, conduit obstruction is the most frequent cause of conduit explantation. Operative indication for conduit obstruction is usually based on the pressure gradient across the conduit or right ventricular systolic pressure, but it is important to perform the reoperation before the development of right ventricular failure. Reoperation is performed under cardiopulmonary bypass; the old conduit is removed, and the distal and proximal ends of a new conduit are anastomosed to each position. There is a variety of conduit types used in reoperation as in the first implantation, but it still remains unclear which conduit should be appropriate. Relatively larger sized conduit can be used in the reoperation compared to the first operation, which may offer a longer durability. Percutaneous pulmonary valve implantation is a less invasive alternative for the treatment of conduit dysfunction and may avoid polysurgery and reoperative procedure-related complications, but it is not approved in Japan at this point of time.
Adult Congenital Heart Disease, 2017
Japanese Journal of Cardiovascular Surgery, 2021
We experienced successful surgical treatment of a pseudoaneurysm of a RV-PA conduit in a 15-month... more We experienced successful surgical treatment of a pseudoaneurysm of a RV-PA conduit in a 15-monthold female patient whose original diagnosis was pulmonary atresia with ventricular septal defect. Her first operation was a central shunt at the age of 25 days. She underwent a palliative Rastelli procedure valved conduit of 10 mm e-PTFE graft when she was 10 months old, but bacterial mediastinitis occurred Pseudomonas aeruginosa on the 8th postoperative day, and drainage and negative pressure wound therapy were started combined with administration of antibiotics. It took one month to close the wound when the bacterial culture from the wound became negative. Although she was discharged from hospital on the 49th postoperative day, she was re-hospitalized after 10 days because of high fever. Echocardiography and CT showed no sign of vegetation or breakdown of the conduit and conservative therapy with antibiotics were continued. Two months later, enhanced CT demonstrated a large pseudoaneurysm which originated from the RV-conduit anastomotic site and urgent surgery was performed. Cardiopulmonary bypass was established with the right common carotid artery and internal jugular vein and the infected conduit was replaced with larger-sized one under electrically-induced ventricular fibrillation. Delayed sternal closure with omental filling was performed after 6 days. Fifteen months have passed since conduit replacement and she is now in good condition without recurrence of
Japanese Journal of Cardiovascular Surgery, 2021
We sometimes encounter the case that we have to make an anastomosis between a prosthetic graft an... more We sometimes encounter the case that we have to make an anastomosis between a prosthetic graft and an autologous vein graft in revascularization of a lower extremity. However, it is said that the intimal hyperplasia in the anastomosis site of a prosthetic graft and autologous vein graft has a tendency to become severe in the long term postoperatively. We herein report a case in which a vein cuff St. Mary s boot technique was very useful to prevent recurrent stenosis due to intimal hyperplasia. No recurrence of stenosis in repair lesion has been detected for 7.5 years after operation.
Frontiers in Pediatrics, 2021
Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of de... more Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drain...
Japanese Journal of Cardiovascular Surgery, 2018
When mitral valve dysfunction occurs in infants and mitral valve repair is difficult, mitral valv... more When mitral valve dysfunction occurs in infants and mitral valve repair is difficult, mitral valve replacement MVR is required. However, commercially available prosthetic heart valves can be too large to implant in infants with a small annulus. In these children, the technique of supra-annular MVR is useful. Here we report two cases of supra-annular MVR, which were performed using an expanded polytetrafluoroethylene ePTFE graft as a skirt for a prosthetic valve. This method has been previously reported by Sung et al. The first case was a 16-month-old, 6.7-kg male infant who suffered from Shone syndrome, mitral stenosis MS with a parachute mitral valve, coarctation of the aorta CoA , and ventricular septal defect VSD. MS progressed after CoA repair and VSD closure and a supra-annular MVR was performed. The second case was a 5-month-old, 4.9-kg female infant who suffered from polysplenia, intermediate atrioventricular septal defect AVSD , and severe left atrioventricular valve regurgitation. AVSD repair was performed at the age of 3 months. However, valve stenosis and regurgitation gradually progressed postoperatively and consequently, a supra-annular MVR was performed. Postoperative prosthetic valve function was good in both cases. We believe that this method of performing supra-annular MVR is useful for infants with a small annulus.
Journal of the Japanese Society of Intensive Care Medicine, 2018
Japanese Journal of Cardiovascular Surgery, 2019
Nephrology, 2019
ABSTRACTAimWe aimed to validate the incidence of, risk factors for, and postoperative outcomes of... more ABSTRACTAimWe aimed to validate the incidence of, risk factors for, and postoperative outcomes of acute kidney injury (AKI) according to the modified Kidney Disease Improving Global Outcomes (m‐KDIGO) criteria and compare this criteria with both the paediatric Risk, Injury, Failure, Loss, End‐stage disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria in infants after cardiac surgery.MethodsWe retrospectively enrolled 145 consecutive infants who underwent open‐heart surgery at Kagoshima University Hospital.ResultsAcute kidney injury was present in 55 (37.9%), 111 (75.9%), and 95 (65.5%) patients according to the m‐KDIGO, pRIFLE, and AKIN criteria, respectively. Among these, 71.9% of patients pRIFLE Risk patients and 60.5% of AKIN 1 patients were categorized in the ‘no‐AKI’ group according to the m‐KDIGO criteria. Low body weight (m‐KDIGO odds ratio [OR], 0.73; P = 0.015; pRIFLE OR, 0.66; P = 0.001; AKIN OR 0.69, P = 0.002) and prolonged cross‐clamp time (m‐KDIGO OR, 1.02;
Japanese Journal of Cardiovascular Surgery, 2012
Japanese Journal of Cardiovascular Surgery, 2012
A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous orig... more A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous origin of the coronary artery are scarce. A 35-year-old male was admitted to our department with fatigue and cough. Multi-detector-row computer tomography(MDCT)revealed an isolated extracardiac right sinus of Valsalva aneurysm with an anomalous origin of the left circumflex artery(LCX)and total occlusion of the right coronary artery(RCA). Its diameter was about 70 mm. We performed a partial aortic root remodeling procedure with a trimmed J-graft because he had neither aortic regurgitation(AR)nor annuloaortic ectasia(AAE). Concomitantly, coronary artery bypass grafting to the RCA(Seg. 3)using a saphenous vein, and reconstruction of the LCX by Piehler's technique using a saphenous vein were added. The patient's postoperative course was uneventful, and he was discharged on the 28th postoperative day. Postoperative MDCT revealed that the aneurysm of the right sinus of Valsalva was not enhanced, and the RCA and LCX were patent. This procedure preserved the patient's own normal aortic valve and sinus of Valsalva and enables him to have more physiologically normal hemodynamics than aortic root reconstruction using a composite graft, e.g. Bentall procedure, Cabrol procedure, although the potential progression of the AR requires careful follow-up. Jpn. J. Cardiovasc. Surg. 41 : 70-75(2012) Keywords：right sinus of Valsalva aneurysm, extracardiac, anomalous origin of the coronary artery, aortic regurgitation, partial aortic root remodeling
Japanese Journal of Cardiovascular Surgery, 2012
症例は 69 歳，女性．10 代のときに腎結核で右腎摘出の既往があった．2011 年，1 月初旬から微熱・食欲不 振があり，呼吸苦が出現したため当院へ紹介入院となった．心エコーと単純 CT で上... more 症例は 69 歳，女性．10 代のときに腎結核で右腎摘出の既往があった．2011 年，1 月初旬から微熱・食欲不 振があり，呼吸苦が出現したため当院へ紹介入院となった．心エコーと単純 CT で上行大動脈の拡大と心嚢 液貯留を認め，心タンポナーデと診断し心嚢穿刺を行った．心嚢液の塗抹培養および polymerase chain reaction(PCR)で結核菌は検出されなかったが，adnosine deaminase(ADA)活性が高値であったため結 核性心膜炎として 4 剤併用抗結核療法を開始した．しかし加療中の第 32 病日，夜間突然の背部痛が出現し た．急性 A 型大動脈解離と診断し，緊急手術にて大動脈基部および上行置換術を施行した．病理検査の結 果，上行大動脈外膜に Langhans 型巨細胞を伴う肉芽腫性炎症所見が認められた．術後経過は良好で 4 剤併 用療法を 2 カ月間施行し，現在リファンピシン，イソニアジドの 2 剤併用療法を継続中である．術後 70 日 以上経過中で，グラフト感染などは合併していないが注意深いフォローが必要である．日心外会誌 41 巻 1 号：16-20(2012) キーワード：結核性心膜炎，結核性大動脈炎，急性大動脈解離，人工血管置換術 日本心臓血管外科学会雑誌 41 巻 1 号(2012) 20
Kyobu geka. The Japanese journal of thoracic surgery, 2015
The development of a fistula between the aorta and the right atrium is a relatively rare but well... more The development of a fistula between the aorta and the right atrium is a relatively rare but well-documented complication after cardiac surgery and proximal aortic dissection, and has a high mortality rate if it is not diagnosed adequately and surgically treated without delay. We report a rare case of extracardiac aorta-right atrial fistula. An 86-year-old woman underwent aortic valve replacement via median sternotomy. Two weeks after surgery, the upper median skin incision reopened, which exposed the sternum and revealed purulent discharge inside the wound. Wound and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The wound was treated, and healed in approximately 2 weeks. Six weeks after surgery, the patient suddenly presented with dyspnea because of heart failure.Extracardiac aorto-right atrial fistula was confirmed by computed tomography. During surgery, we found an extracardiac fistula formed in the hematoma between the sites where the aortic vent ...
World journal for pediatric & congenital heart surgery, 2015
Darling's classification for total anomalous pulmonary venous connection (TAPVC) is based onl... more Darling's classification for total anomalous pulmonary venous connection (TAPVC) is based only on the level of the site of drainage of the anomalous pulmonary veins (PVs) to the systemic venous circulation. Although it is a clinically useful classification, atypical course of the PVs is occasionally encountered as well. We report a case of infracardiac-type TAPVC in which the left upper PV traversed the posterior mediastinum and merged into the right PVs at the right hilum. The combined vein coursed medially and caudally, meeting the left lower PVs, and finally penetrated the diaphragm; the pulmonary venous drainage formed a shape of "C." Despite definitive diagnosis according to Darling's classification, sometimes atypical course of the PVs do exist. Echocardiography may not be adequate for atypical cases. Contrast-enhanced computed tomography may be recommended in stable patients where an atypical course is suspected.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 18, 2015
A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preope... more A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preoperative examination for coronary artery bypass grafting (CABG). Findings on computed tomography and magnetic resonance imaging suggested the differential diagnoses of myxoma, haemangioma and haemangiosarcoma, and it was difficult to identify whether the tumour was benign or malignant. (18)F-fluorodeoxyglucose-positron emission tomography strongly suggested a benign tumour. We enucleated the tumour, because an intraoperative frozen section also strongly suggested a benign origin. After resection, CABG under cardiopulmonary bypass was performed. Histopathological and immunohistochemical analysis indicated a cavernous haemangioma without evidence of malignant tissue. The patient has survived 20 months after surgery with no evidence of tumour recurrence.
Surgical Case Reports, 2016
A 28-day-old infant with D-transposition of the great arteries underwent arterial switch operatio... more A 28-day-old infant with D-transposition of the great arteries underwent arterial switch operation. The coronary pattern was Yacoub type A, in which coronary transfer is usually thought to be easy. However, a dominant conus branch diverged from the proximal portion of the left coronary artery (LCA). Moreover, the LCA ostium itself was near the remote commissure in sinus 1, very far from the target re-implantation point. All of these conditions made LCA transfer very difficult. We used a coronary elongation technique to solve this problem. An inverted U-shaped flap was made in the wall of the neoaorta, and the LCA cuff was anastomosed to this flap (the inferior half from the neoaortic flap and the superior half from the LCA cuff). To prevent compression of the LCA, the neopulmonary trunk was shifted rightward. Postoperative echocardiography showed good left ventricular wall motion, and the LCA was easily visualized on chest computed tomography, with no compression from the neopulmonary artery.
Frontiers in Pediatrics, Mar 8, 2021
Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of de... more Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18 F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18 F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18 F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.
Nihon Shūchū Chiryō Igakukai zasshi, Jul 1, 2018
Japanese Journal of Cardiovascular Surgery, May 15, 2022
A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was bro... more A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was brought to our hospital as an emergency case. In Japan, endovascular treatment is unsuitable for the treatment of mycotic aneurysms, but findings from a Swedish national database showed that there was no difference in the long-term prognosis lasting over 10 years. Therefore, we performed endovascular aortic repair (EVAR) and saved the patient's life. The diameter of the proxymal sealing zone was larger than that of the distal zone. We used the Gore Excluder leg, which was inverted and implanted to match the caliber. Percutaneous abscess drainage was also performed on postoperative day 7 when hemostasis was confirmed for early infection control. The patient was discharged at 8 weeks postoperatively. After discharge from the hospital, oral antibiotics were continued until 6 months after the surgery. Six months postoperatively, contrast-enhanced computed tomography showed that the abscesses have disappeared. Blood samples that were taken at one month after the completion of antibiotics showed no evidence of the recurrence of infection and a curative course was achieved.
Japanese Journal of Cardiovascular Surgery, 2018
Due to the increasing number of patients with repaired tetralogy of Fallot TOF , the amount of su... more Due to the increasing number of patients with repaired tetralogy of Fallot TOF , the amount of subsequent sequelae has also increased along with the need for further surgical interventions. This case report described a patient who underwent multiple reoperations for late sequelae over a period of 48 years after repair of TOF. The patient was a 58-year-old man who underwent a reparative operation for TOF at the age of 9 years. At the age of 30, he underwent patch closure of residual VSD and reconstruction of right ventricular outflow tract RVOT with a mono-cusped trans-annular patch combined with aortic valve replacement. At the age of 47, he underwent aortic root replacement for aneurysmal dilatation of the Valsalva sinus, and he was implanted with a pacemaker for bradycardia atrial fibrillation at the age of 51. By the age of 58, he required pulmonary valve replacement and tricuspid valve annuloplasty for right ventricular dysfunction resulting from regurgitation of the pulmonary and tricuspid valves as 4th midline sternotomy surgery. His status improved to NYHA functional class III to II after the most recent procedures, although he still needed strict medical control. A proactive approach during long-term follow-up after TOF repair is important for timely and appropriate surgical intervention in the event of late sequelae.
Adult Congenital Heart Disease, 2017
Reconstruction of the right ventricular outflow tract with extracardiac conduits facilitated the ... more Reconstruction of the right ventricular outflow tract with extracardiac conduits facilitated the complete repair of complex cardiac malformations such as pulmonary atresia with VSD, transposition of the great arteries with VSD and left ventricular outflow tract obstruction, and truncus arteriosus. Commonly used conduits now are the valved conduits with various materials and designs: homograft, stented xenograft, stentless xenograft, autologous tissue conduit, and expanded polytetrafluoroethylene conduit. Early results are excellent in these conduits; however, conduit reoperation is unavoidable in the mid or long term due to conduit obstruction, valve regurgitation, infectious endocarditis, formation of aneurysm or pseudoaneurysm, somatic outgrowth, and so on. Among all, conduit obstruction is the most frequent cause of conduit explantation. Operative indication for conduit obstruction is usually based on the pressure gradient across the conduit or right ventricular systolic pressure, but it is important to perform the reoperation before the development of right ventricular failure. Reoperation is performed under cardiopulmonary bypass; the old conduit is removed, and the distal and proximal ends of a new conduit are anastomosed to each position. There is a variety of conduit types used in reoperation as in the first implantation, but it still remains unclear which conduit should be appropriate. Relatively larger sized conduit can be used in the reoperation compared to the first operation, which may offer a longer durability. Percutaneous pulmonary valve implantation is a less invasive alternative for the treatment of conduit dysfunction and may avoid polysurgery and reoperative procedure-related complications, but it is not approved in Japan at this point of time.
Adult Congenital Heart Disease, 2017
Japanese Journal of Cardiovascular Surgery, 2021
We experienced successful surgical treatment of a pseudoaneurysm of a RV-PA conduit in a 15-month... more We experienced successful surgical treatment of a pseudoaneurysm of a RV-PA conduit in a 15-monthold female patient whose original diagnosis was pulmonary atresia with ventricular septal defect. Her first operation was a central shunt at the age of 25 days. She underwent a palliative Rastelli procedure valved conduit of 10 mm e-PTFE graft when she was 10 months old, but bacterial mediastinitis occurred Pseudomonas aeruginosa on the 8th postoperative day, and drainage and negative pressure wound therapy were started combined with administration of antibiotics. It took one month to close the wound when the bacterial culture from the wound became negative. Although she was discharged from hospital on the 49th postoperative day, she was re-hospitalized after 10 days because of high fever. Echocardiography and CT showed no sign of vegetation or breakdown of the conduit and conservative therapy with antibiotics were continued. Two months later, enhanced CT demonstrated a large pseudoaneurysm which originated from the RV-conduit anastomotic site and urgent surgery was performed. Cardiopulmonary bypass was established with the right common carotid artery and internal jugular vein and the infected conduit was replaced with larger-sized one under electrically-induced ventricular fibrillation. Delayed sternal closure with omental filling was performed after 6 days. Fifteen months have passed since conduit replacement and she is now in good condition without recurrence of
Japanese Journal of Cardiovascular Surgery, 2021
We sometimes encounter the case that we have to make an anastomosis between a prosthetic graft an... more We sometimes encounter the case that we have to make an anastomosis between a prosthetic graft and an autologous vein graft in revascularization of a lower extremity. However, it is said that the intimal hyperplasia in the anastomosis site of a prosthetic graft and autologous vein graft has a tendency to become severe in the long term postoperatively. We herein report a case in which a vein cuff St. Mary s boot technique was very useful to prevent recurrent stenosis due to intimal hyperplasia. No recurrence of stenosis in repair lesion has been detected for 7.5 years after operation.
Frontiers in Pediatrics, 2021
Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of de... more Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drain...
Japanese Journal of Cardiovascular Surgery, 2018
When mitral valve dysfunction occurs in infants and mitral valve repair is difficult, mitral valv... more When mitral valve dysfunction occurs in infants and mitral valve repair is difficult, mitral valve replacement MVR is required. However, commercially available prosthetic heart valves can be too large to implant in infants with a small annulus. In these children, the technique of supra-annular MVR is useful. Here we report two cases of supra-annular MVR, which were performed using an expanded polytetrafluoroethylene ePTFE graft as a skirt for a prosthetic valve. This method has been previously reported by Sung et al. The first case was a 16-month-old, 6.7-kg male infant who suffered from Shone syndrome, mitral stenosis MS with a parachute mitral valve, coarctation of the aorta CoA , and ventricular septal defect VSD. MS progressed after CoA repair and VSD closure and a supra-annular MVR was performed. The second case was a 5-month-old, 4.9-kg female infant who suffered from polysplenia, intermediate atrioventricular septal defect AVSD , and severe left atrioventricular valve regurgitation. AVSD repair was performed at the age of 3 months. However, valve stenosis and regurgitation gradually progressed postoperatively and consequently, a supra-annular MVR was performed. Postoperative prosthetic valve function was good in both cases. We believe that this method of performing supra-annular MVR is useful for infants with a small annulus.
Journal of the Japanese Society of Intensive Care Medicine, 2018
Japanese Journal of Cardiovascular Surgery, 2019
Nephrology, 2019
ABSTRACTAimWe aimed to validate the incidence of, risk factors for, and postoperative outcomes of... more ABSTRACTAimWe aimed to validate the incidence of, risk factors for, and postoperative outcomes of acute kidney injury (AKI) according to the modified Kidney Disease Improving Global Outcomes (m‐KDIGO) criteria and compare this criteria with both the paediatric Risk, Injury, Failure, Loss, End‐stage disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria in infants after cardiac surgery.MethodsWe retrospectively enrolled 145 consecutive infants who underwent open‐heart surgery at Kagoshima University Hospital.ResultsAcute kidney injury was present in 55 (37.9%), 111 (75.9%), and 95 (65.5%) patients according to the m‐KDIGO, pRIFLE, and AKIN criteria, respectively. Among these, 71.9% of patients pRIFLE Risk patients and 60.5% of AKIN 1 patients were categorized in the ‘no‐AKI’ group according to the m‐KDIGO criteria. Low body weight (m‐KDIGO odds ratio [OR], 0.73; P = 0.015; pRIFLE OR, 0.66; P = 0.001; AKIN OR 0.69, P = 0.002) and prolonged cross‐clamp time (m‐KDIGO OR, 1.02;
Japanese Journal of Cardiovascular Surgery, 2012
Japanese Journal of Cardiovascular Surgery, 2012
A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous orig... more A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous origin of the coronary artery are scarce. A 35-year-old male was admitted to our department with fatigue and cough. Multi-detector-row computer tomography(MDCT)revealed an isolated extracardiac right sinus of Valsalva aneurysm with an anomalous origin of the left circumflex artery(LCX)and total occlusion of the right coronary artery(RCA). Its diameter was about 70 mm. We performed a partial aortic root remodeling procedure with a trimmed J-graft because he had neither aortic regurgitation(AR)nor annuloaortic ectasia(AAE). Concomitantly, coronary artery bypass grafting to the RCA(Seg. 3)using a saphenous vein, and reconstruction of the LCX by Piehler's technique using a saphenous vein were added. The patient's postoperative course was uneventful, and he was discharged on the 28th postoperative day. Postoperative MDCT revealed that the aneurysm of the right sinus of Valsalva was not enhanced, and the RCA and LCX were patent. This procedure preserved the patient's own normal aortic valve and sinus of Valsalva and enables him to have more physiologically normal hemodynamics than aortic root reconstruction using a composite graft, e.g. Bentall procedure, Cabrol procedure, although the potential progression of the AR requires careful follow-up. Jpn. J. Cardiovasc. Surg. 41 : 70-75(2012) Keywords：right sinus of Valsalva aneurysm, extracardiac, anomalous origin of the coronary artery, aortic regurgitation, partial aortic root remodeling
Japanese Journal of Cardiovascular Surgery, 2012
症例は 69 歳，女性．10 代のときに腎結核で右腎摘出の既往があった．2011 年，1 月初旬から微熱・食欲不 振があり，呼吸苦が出現したため当院へ紹介入院となった．心エコーと単純 CT で上... more 症例は 69 歳，女性．10 代のときに腎結核で右腎摘出の既往があった．2011 年，1 月初旬から微熱・食欲不 振があり，呼吸苦が出現したため当院へ紹介入院となった．心エコーと単純 CT で上行大動脈の拡大と心嚢 液貯留を認め，心タンポナーデと診断し心嚢穿刺を行った．心嚢液の塗抹培養および polymerase chain reaction(PCR)で結核菌は検出されなかったが，adnosine deaminase(ADA)活性が高値であったため結 核性心膜炎として 4 剤併用抗結核療法を開始した．しかし加療中の第 32 病日，夜間突然の背部痛が出現し た．急性 A 型大動脈解離と診断し，緊急手術にて大動脈基部および上行置換術を施行した．病理検査の結 果，上行大動脈外膜に Langhans 型巨細胞を伴う肉芽腫性炎症所見が認められた．術後経過は良好で 4 剤併 用療法を 2 カ月間施行し，現在リファンピシン，イソニアジドの 2 剤併用療法を継続中である．術後 70 日 以上経過中で，グラフト感染などは合併していないが注意深いフォローが必要である．日心外会誌 41 巻 1 号：16-20(2012) キーワード：結核性心膜炎，結核性大動脈炎，急性大動脈解離，人工血管置換術 日本心臓血管外科学会雑誌 41 巻 1 号(2012) 20
Kyobu geka. The Japanese journal of thoracic surgery, 2015
The development of a fistula between the aorta and the right atrium is a relatively rare but well... more The development of a fistula between the aorta and the right atrium is a relatively rare but well-documented complication after cardiac surgery and proximal aortic dissection, and has a high mortality rate if it is not diagnosed adequately and surgically treated without delay. We report a rare case of extracardiac aorta-right atrial fistula. An 86-year-old woman underwent aortic valve replacement via median sternotomy. Two weeks after surgery, the upper median skin incision reopened, which exposed the sternum and revealed purulent discharge inside the wound. Wound and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The wound was treated, and healed in approximately 2 weeks. Six weeks after surgery, the patient suddenly presented with dyspnea because of heart failure.Extracardiac aorto-right atrial fistula was confirmed by computed tomography. During surgery, we found an extracardiac fistula formed in the hematoma between the sites where the aortic vent ...
World journal for pediatric & congenital heart surgery, 2015
Darling's classification for total anomalous pulmonary venous connection (TAPVC) is based onl... more Darling's classification for total anomalous pulmonary venous connection (TAPVC) is based only on the level of the site of drainage of the anomalous pulmonary veins (PVs) to the systemic venous circulation. Although it is a clinically useful classification, atypical course of the PVs is occasionally encountered as well. We report a case of infracardiac-type TAPVC in which the left upper PV traversed the posterior mediastinum and merged into the right PVs at the right hilum. The combined vein coursed medially and caudally, meeting the left lower PVs, and finally penetrated the diaphragm; the pulmonary venous drainage formed a shape of "C." Despite definitive diagnosis according to Darling's classification, sometimes atypical course of the PVs do exist. Echocardiography may not be adequate for atypical cases. Contrast-enhanced computed tomography may be recommended in stable patients where an atypical course is suspected.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 18, 2015
A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preope... more A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preoperative examination for coronary artery bypass grafting (CABG). Findings on computed tomography and magnetic resonance imaging suggested the differential diagnoses of myxoma, haemangioma and haemangiosarcoma, and it was difficult to identify whether the tumour was benign or malignant. (18)F-fluorodeoxyglucose-positron emission tomography strongly suggested a benign tumour. We enucleated the tumour, because an intraoperative frozen section also strongly suggested a benign origin. After resection, CABG under cardiopulmonary bypass was performed. Histopathological and immunohistochemical analysis indicated a cavernous haemangioma without evidence of malignant tissue. The patient has survived 20 months after surgery with no evidence of tumour recurrence.
Surgical Case Reports, 2016
A 28-day-old infant with D-transposition of the great arteries underwent arterial switch operatio... more A 28-day-old infant with D-transposition of the great arteries underwent arterial switch operation. The coronary pattern was Yacoub type A, in which coronary transfer is usually thought to be easy. However, a dominant conus branch diverged from the proximal portion of the left coronary artery (LCA). Moreover, the LCA ostium itself was near the remote commissure in sinus 1, very far from the target re-implantation point. All of these conditions made LCA transfer very difficult. We used a coronary elongation technique to solve this problem. An inverted U-shaped flap was made in the wall of the neoaorta, and the LCA cuff was anastomosed to this flap (the inferior half from the neoaortic flap and the superior half from the LCA cuff). To prevent compression of the LCA, the neopulmonary trunk was shifted rightward. Postoperative echocardiography showed good left ventricular wall motion, and the LCA was easily visualized on chest computed tomography, with no compression from the neopulmonary artery.