Publications by authors named "Manabu Shiraishi"

31 Publications

[Surgical Resection Papillary Fibroelastoma Arising from Left Atrium:Report of a Case].

Kyobu Geka 2021 Oct;74(11):967-971

Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.

A 75-year-old man was admitted for cerebral infarction. Magnetic resonance imaging revealed parietal lobe cerebral infarction. Transesophageal echo and contrast-enhanced computed tomography indicated mobile and speckled mass arising from left atrium. He was diagnosed with cardiogenic cerebral embolism. Under cardiopulmonary bypass, resection of the mass including endocardium tissue was per formed. The resected specimen showed multiple small fronds resembling a sea anemone. Microscopic examination showed multiple branching fronds of paucicellular and avascular fibroelastic tissue lined by a single layer of endocardium. Pathological diagnosis was papillary fibroelastoma. Three years passed without recurrence.
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October 2021

[Subacute Pseudoaneurysm Formation after Sutureless Repair for Postinfarction Left Ventricular Rupture:Report of a Case].

Kyobu Geka 2021 Sep;74(9):697-700

Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.

A 71-year-old woman was admitted for cardiac tamponade due to left ventricular free wall rupture after acute myocardial infarction. Sutureless repair was performed for bleeding from the inferior wall. Fifteen days later, computed tomography demonstrated enlargement of a left ventricular pseudoaneurysm. Patch closure using a vascular prosthesis was performed through left thoracotomy. No recurrence of the left ventricular aneurysm has been observed since.
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September 2021

Early cardiac contractility outcome of reoperative coronary artery bypass grafting using right gastroepiploic artery.

J Card Surg 2021 Nov 8;36(11):4103-4110. Epub 2021 Aug 8.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Background And Aim Of The Study: Reoperative coronary artery bypass grafting (redo CABG) still carries higher mortality and increased morbidity compared with primary CABG. In this study, we retrospectively reviewed our operative outcome of redo CABG to evaluate the impact of the left anterolateral thoracotomy approach using the right gastroepiploic artery (RGEA).

Methods: Between 1994 and 2020, 11 patients (mean age 60.3 ± 13.1 years; nine men, two women) underwent isolated redo CABG using the RGEA via the left anterolateral thoracotomy.

Results: The mean duration from the initial CABG was 128.3 ± 88.4 months. Redo CABG was performed because of graft occlusion in six patients (54.5%), graft stenosis in one patient (9.1%), and progressive disease of previously ungrafted vessels in four patients (36.4%). The total number of bypasses using RGEA (including Y-composite vein grafts) was 16 (four left anterior descending branches, two diagonal branches, five circumflex branches, five right coronary arteries). No residual graft injury, major comorbidity, or in-hospital death was observed. Changes in echocardiographic values before and after redo CABG were 210.9 ± 48.2 ml and 175.0 ± 41.4 ml in left ventricular end-diastolic volume, 130.2 ± 49.2 ml and 94.4 ± 33.0 ml in left ventricular end-systolic volume, and 45.6 ± 11.0% and 52.2 ± 10.7% in left ventricular ejection fraction, respectively. These parameters significantly improved after redo CABG.

Conclusions: Redo CABG with RGEA grafting via the left anterolateral thoracotomy approach is a safe and effective surgical procedure especially in improving cardiac contractility in patients who required revascularization.
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http://dx.doi.org/10.1111/jocs.15898DOI Listing
November 2021

[Rapid Growing Thoracic Aortic Aneurysm in a Patient with Relapsing Polychondritis].

Kyobu Geka 2021 Aug;74(8):583-586

Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.

A 26-year-old man with relapsing polychondritis was admitted for the treatment of multiple thoracic aortic aneurysms in the ascending and descending aorta. Descending thoracic aortic aneurysm showed rapid expansion, therefore, the patient underwent an extended thoracic aortic repair from the ascending aorta to the descending aorta via anterolateral thoracotomy and partial sternotomy. Although postoperative course was uneventful, aortic root enlargement and severe aortic insufficiency progressed over the next two years. He and his family refused redo surgical intervention and the patient died of heart failure. Careful perioperative follow-up may be mandatory in a patient with relapsing polychondritis complicated by cardiovascular disease.
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August 2021

Cell barrier function of resident peritoneal macrophages in post-operative adhesions.

Nat Commun 2021 04 14;12(1):2232. Epub 2021 Apr 14.

William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Post-operative adhesions are a leading cause of abdominal surgery-associated morbidity. Exposed fibrin clots on the damaged peritoneum, in which the mesothelial barrier is disrupted, readily adhere to surrounding tissues, resulting in adhesion formation. Here we show that resident F4/80CD206 peritoneal macrophages promptly accumulate on the lesion and form a 'macrophage barrier' to shield fibrin clots in place of the lost mesothelium in mice. Depletion of this macrophage subset or blockage of CD11b impairs the macrophage barrier and exacerbates adhesions. The macrophage barrier is usually insufficient to fully preclude the adhesion formation; however, it could be augmented by IL-4-based treatment or adoptive transfer of this macrophage subset, resulting in robust prevention of adhesions. By contrast, monocyte-derived recruited peritoneal macrophages are not involved in the macrophage barrier. These results highlight a previously unidentified cell barrier function of a specific macrophage subset, also proposing an innovative approach to prevent post-operative adhesions.
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http://dx.doi.org/10.1038/s41467-021-22536-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046819PMC
April 2021

Effects of Obesity on Outcomes of Acute Type A Aortic Dissection Repair in Japan.

Circ Rep 2020 Oct 23;2(11):639-647. Epub 2020 Oct 23.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University Saitama Japan.

The prevalence of obesity among Japanese acute type A aortic dissection (ATAAD) patients and its effect on repair outcomes remain to be elucidated. The prevalence of obesity (body mass index [BMI] ≥30.0 kg/m) among 1,059 patients (mean [±SD] age 64.3±12.7 years) who underwent ATAAD repair between 1990 and 2018 was compared with that among the general Japanese population (National Health and Nutrition Survey data). The prevalence of obesity among male patients (17.1% [6/35], 20.0% [18/90], and 14.4% [20/139] for those aged 20-39, 40-49, and 50-59 years, respectively) was significantly higher than that among the age- and sex-matched general population. The 1,059 patients were divided into groups according to weight (normal [BMI <25.0 kg/m; n=742], overweight [BMI 25.0-29.9 kg/m; n=248], or obese [BMI ≥30.0 kg/m; n=69]). Comparing the normal weight, overweight, and obese groups revealed significant differences among the 3 groups in median cardiopulmonary bypass time (143, 167, and 183 min, respectively), ventilation >48 h (44.5%, 60.1%, and 78.3%, respectively), and in-hospital mortality (7.0%, 7.3%, and 17.4%, respectively), but not in 30-day survival. Shock, visceral malperfusion, operation time >360 min, obesity, and coronary malperfusion were identified as predictors of in-hospital mortality. The prevalence of obesity is increased among Japanese male patients with ATAAD aged ≤59 years. Obesity may increase these patients' operative risk; overweight does not.
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http://dx.doi.org/10.1253/circrep.CR-20-0098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937495PMC
October 2020

Early superior mesenteric artery revascularization for acute type A aortic dissection with cardiac tamponade and mesenteric malperfusion.

J Card Surg 2020 Dec 9;35(12):3581-3584. Epub 2020 Sep 9.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

We report herein the successful treatment of a case of acute type A aortic dissection complicated by cardiac tamponade and mesenteric malperfusion. The patient was a 60-year-old man with back and abdominal pain and in shock, who was transported to our hospital 2 h after symptom onset. Computed tomography revealed DeBakey type I dissection with massive hemopericardium and obstruction of both the celiac artery and superior mesenteric artery. After emergency pericardiotomy and removal of the hematoma, superior mesenteric artery-external iliac artery bypass was constructed with a vein graft, and this restored mesenteric perfusion. Open distal hemiarch replacement was then performed. The postoperative course was uneventful. Superior mesenteric artery revascularization achieved immediately after release of the cardiac tamponade prevented further mesenteric ischemia and paved the way for the aortic repair.
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http://dx.doi.org/10.1111/jocs.15009DOI Listing
December 2020

[Bioprosthetic Mitral Valve Thrombosis in Patient with Antiphospholipid Antibody Syndrome;Report of a Case].

Kyobu Geka 2020 Aug;73(8):619-622

Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.

A 66-year-old woman with primary antiphospholipid antibody syndrome (APS) was admitted due to severe dyspnea. Eight months prior to admission, she underwent bioprosthetic mitral valve replacement for mitral valve stenosis and regurgitation. Transthoracic echocardiogram showed thickening bioprosthetic valve leaflets and severe valve stenosis. Emergency reoperation for artificial valve failure was performed. The explanted bioprosthetic valve showed massive thrombus formation. After the operation, she started strict anticoagulant and antiplatelet therapies and was discharged without recurrence of valve thrombosis.
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August 2020

[Successful Surgical Repair of the Aortic Annular Infective Endocarditis with Subvalvular Abscess;Report of a Case].

Kyobu Geka 2018 May;71(5):365-368

Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.

A 49-year-old female was admitted to our hospital with a history of fever for 2 weeks and consciousness disorder.Transthoracic echocardiography demonstrated aortic regurgitation with a mobile fibrous band adhering to the right cusp. Infective endocarditis was diagnosed by positive blood culture and echocardiographic findings. Emergent aortic valve surgery was performed because of uncontrollable infection. A destroyed aortic annulus and subvalvular abscess was found during the operation. Removal of abscess tissue and annuloplasty with self-pericardium were successfully performed.
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May 2018

[Hybrid Repair of Distal Arch Aortic Aneurysm:Total Aortic Arch Repair with the Lupiae Vascular Graft and Thoracic Endovascular Aortic Repair;Report of Two Cases].

Kyobu Geka 2018 May;71(5):357-360

Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.

Surgical treatment for distal arch aortic aneurysm is generally invasive, and there is no definitive approach for it. We report 2 cases of men who was admitted for the treatment of aortic aneurysm. First case is a 78-year-old man. Two saccular aneurysm were observed on distal aortic arch and descending aorta by contrast-enhanced computed tomography. Two staged-repair was performed with using the Lupiae vascular graft and thoracic endovascular aortic repair(TEVAR). The postoperative course was uneventful, and he was discharged on day 21 after 1st operation. Second case is a 68-yearold man. Dessecting aneurysm was observed on distal aortic arch and descending aorta 3 months after incidence of type B aortic dissection. Two staged-repair was performed with using the Lupiae vascular graft and TEVAR. However, additional TEVAR was performed for enlargement of descending aorta half a year after 1st operation. Two staged-repair using Lupiae vascular graft and TEVAR was useful for alleviating a burden of a patient and avoiding paraplegia.
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May 2018

IL-4 as a Repurposed Biological Drug for Myocardial Infarction through Augmentation of Reparative Cardiac Macrophages: Proof-of-Concept Data in Mice.

Sci Rep 2017 07 31;7(1):6877. Epub 2017 Jul 31.

William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.

Recent research has shown that reparative (alternatively activated or M2) macrophages play a role in repair of damaged tissues, including the infarcted hearts. Administration of IL-4 is known to augment M2 macrophages. This translational study thus aimed to investigate whether IL-4 administration is useful for the treatment of myocardial infarction. Long-acting IL-4 complex (IL-4c; recombinant IL-4 mixed with anti-IL-4 monoclonal antibody as a stabilizer) was administered after coronary artery ligation in mice. It was observed that IL-4c administration increased accumulation of CD206F4/80 M2-like macrophages predominantly in the injured myocardium, compared to the control. Sorted cardiac M2-like macrophages highly expressed wide-ranging tissue repair-related genes. Indeed, IL-4c administration enhanced cardiac function in association with reduced infarct size and enhanced tissue repair (strengthened connective tissue formation, improved microvascular formation and attenuated cardiomyocyte hypertrophy). Experiments using Trib1 mice that had a depleted ability to develop M2 macrophages and other in-vitro studies supported that these IL-4-mediated effects were induced via M2-like macrophages. On the other hand, when administered at Day 28 post-MI, the effects of IL-4c were diminished, suggesting a time-frame for IL-4 treatment to be effective. These data represent proof-of-concept of efficacy of IL-4 treatment for acute myocardial infarction, encouraging its further development.
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http://dx.doi.org/10.1038/s41598-017-07328-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537273PMC
July 2017

GFRA2 Identifies Cardiac Progenitors and Mediates Cardiomyocyte Differentiation in a RET-Independent Signaling Pathway.

Cell Rep 2016 07 7;16(4):1026-1038. Epub 2016 Jul 7.

Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK. Electronic address:

A surface marker that distinctly identifies cardiac progenitors (CPs) is essential for the robust isolation of these cells, circumventing the necessity of genetic modification. Here, we demonstrate that a Glycosylphosphatidylinositol-anchor containing neurotrophic factor receptor, Glial cell line-derived neurotrophic factor receptor alpha 2 (Gfra2), specifically marks CPs. GFRA2 expression facilitates the isolation of CPs by fluorescence activated cell sorting from differentiating mouse and human pluripotent stem cells. Gfra2 mutants reveal an important role for GFRA2 in cardiomyocyte differentiation and development both in vitro and in vivo. Mechanistically, the cardiac GFRA2 signaling pathway is distinct from the canonical pathway dependent on the RET tyrosine kinase and its established ligands. Collectively, our findings establish a platform for investigating the biology of CPs as a foundation for future development of CP transplantation for treating heart failure.
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http://dx.doi.org/10.1016/j.celrep.2016.06.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967477PMC
July 2016

[Total Aortic Arch Replacement by Minimally Invasive Approach in a Patient with Permanent Tracheostomy;Report of a Case].

Kyobu Geka 2016 Jun;69(6):481-4

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Standard full median sternotomy for total aortic arch replacement in patients with tracheostomy has higher risks for mediastinitis and graft infection. To avoid surgical site infection, it is necessary to keep a sufficient distance between the tracheostomy and the site of surgical skin incision. We herein report a case of a 74-year-old man with permanent tracheostomy after total laryngectomy, who underwent total aortic arch replacement for an aneurysm. Antero-lateral thoracotomy in the 2nd intercostal space with lower partial sternotomy( ALPS approach) provided an enough distance between the tracheostomy and the surgical field. It also provided a good view for surgical procedure and enabled the standard setup of cardiopulmonary bypass with ascending aortic cannulation, venous drainage from the right atrium and the left ventricular venting through the upper right pulmonary vein. The operation was completed in 345 minutes and the patient was discharged on the 11th postoperative day without any complications.
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June 2016

Alternatively activated macrophages determine repair of the infarcted adult murine heart.

J Clin Invest 2016 06 3;126(6):2151-66. Epub 2016 May 3.

Alternatively activated (also known as M2) macrophages are involved in the repair of various types of organs. However, the contribution of M2 macrophages to cardiac repair after myocardial infarction (MI) remains to be fully characterized. Here, we identified CD206+F4/80+CD11b+ M2-like macrophages in the murine heart and demonstrated that this cell population predominantly increases in the infarct area and exhibits strengthened reparative abilities after MI. We evaluated mice lacking the kinase TRIB1 (Trib1-/-), which exhibit a selective depletion of M2 macrophages after MI. Compared with control animals, Trib1-/- mice had a catastrophic prognosis, with frequent cardiac rupture, as the result of markedly reduced collagen fibril formation in the infarct area due to impaired fibroblast activation. The decreased tissue repair observed in Trib1-/- mice was entirely rescued by an external supply of M2-like macrophages. Furthermore, IL-1α and osteopontin were suggested to be mediators of M2-like macrophage-induced fibroblast activation. In addition, IL-4 administration achieved a targeted increase in the number of M2-like macrophages and enhanced the post-MI prognosis of WT mice, corresponding with amplified fibroblast activation and formation of more supportive fibrous tissues in the infarcts. Together, these data demonstrate that M2-like macrophages critically determine the repair of infarcted adult murine heart by regulating fibroblast activation and suggest that IL-4 is a potential biological drug for treating MI.
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http://dx.doi.org/10.1172/JCI85782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887176PMC
June 2016

Allogeneic Mesenchymal Stromal Cells Transplanted Onto the Heart Surface Achieve Therapeutic Myocardial Repair Despite Immunologic Responses in Rats.

J Am Heart Assoc 2016 Feb 18;5(2). Epub 2016 Feb 18.

William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom

Background: Transplantation of allogeneic mesenchymal stromal cells (MSCs) is a promising treatment for heart failure. We have shown that epicardial placement of cell sheets markedly increases donor cell survival and augments therapeutic effects compared with the current methods. Although immune rejection of intramyocardially injected allogeneic MSCs have been suggested, allogeneic MSCs transplanted on the heart surface (virtual space) may undergo different courses. This study aimed to elucidate immunologic response against epicardially placed allogeneic MSCs, rejection or acceptance of these cells, and their therapeutic effects for heart failure.

Methods And Results: At 4 weeks after coronary artery ligation, Lewis rats underwent epicardial placement of MSC sheets from syngeneic Lewis or allogeneic Fischer 344 rats or sham treatment. At days 3 and 10 after treatment, similar ratios (≈50% and 30%, respectively) of grafted MSCs survived on the heart surface in both MSC sheet groups. By day 28, survival of syngeneic MSCs was substantially reduced (8.9%); survival of allogeneic MSCs was more extensively reduced (0.2%), suggesting allorejection. Correspondingly, allogeneic MSCs were found to have evoked an immunologic response, albeit low level, as characterized by accumulation of CD4(+) T cells and upregulation of interleukin 6. Despite this alloimmune response, the allogeneic MSC sheet achieved myocardial upregulation of reparative factors, enhanced repair of the failing myocardium, and improved cardiac function to the equivalent degree observed for the syngeneic MSC sheet.

Conclusions: Allogeneic MSCs placed on the heart surface evoked an immunologic response; however, this allowed sufficient early phase donor cell survival to induce equivalent therapeutic benefits to syngeneic MSCs. Further development of this approach toward clinical application is warranted.
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http://dx.doi.org/10.1161/JAHA.115.002815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802488PMC
February 2016

Epicardial placement of mesenchymal stromal cell-sheets for the treatment of ischemic cardiomyopathy; in vivo proof-of-concept study.

Mol Ther 2014 Oct 16;22(10):1864-71. Epub 2014 Jun 16.

William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Transplantation of bone marrow mesenchymal stromal cells (MSCs) is an emerging treatment for heart failure. We have reported that epicardial placement of MSC-sheets generated using temperature-responsive dishes markedly increases donor MSC survival and augments therapeutic effects in an acute myocardial infarction (MI) model, compared to intramyocardial (IM) injection. This study aims to expand this knowledge for the treatment of ischemic cardiomyopathy, which is likely to be more difficult to treat due to mature fibrosis and chronically stressed myocardium. Four weeks after MI, rats underwent either epicardial MSC-sheet placement, IM MSC injection, or sham treatment. At day 28 after treatment, the cell-sheet group showed augmented cardiac function improvement, which was associated with over 11-fold increased donor cell survival at both days 3 and 28 compared to IM injection. Moreover, the cell-sheet group showed improved myocardial repair, in conjunction with amplified upregulation of a group of reparative factors. Furthermore, by comparing with our own previous data, this study highlighted similar dynamics and behavior of epicardially placed MSCs in acute and chronic stages after MI, while the acute-phase myocardium may be more responsive to the stimuli from donor MSCs. These proof-of-concept data encourage further development of the MSC-sheet therapy for ischemic cardiomyopathy toward clinical application.
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http://dx.doi.org/10.1038/mt.2014.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428395PMC
October 2014

Validation of Waffle procedure for constrictive pericarditis with epicardial thickening.

Gen Thorac Cardiovasc Surg 2015 Jan 13;63(1):30-7. Epub 2014 Jun 13.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-Ku, Saitama, 330-8503, Japan,

Objective: Waffle procedure, a small grid-like incision of epicardium, is a surgical technique for constrictive pericarditis with epicardial thickening. Yet evidences to endorse this approach for improved outcomes are lacking. The aim of this study is to elucidate better surgical treatment strategy for constrictive pericarditis with epicardial thickening.

Methods: Twenty-five patients (mean 64.1 years) who underwent pericardiectomy for constrictive pericarditis between January 1992 and July 2012 were included in this study and were classified into two groups according to the procedure they received; single total pericardiectomy (Group A, n = 17) and total pericardiectomy with the Waffle procedure (Group B, n = 8). Early and mid-term outcomes were analyzed for each group.

Results: No major postoperative complications or all-cause deaths at 30 days were observed in each group. Upon discharge, postoperative echocardiography showed statistically significant increase of left ventricular end-diastolic volume (from 76.6 ± 30.3 to 91.0 ± 27.3 ml; p < 0.02) and systolic volume (from 44.4 ± 19.1 to 54.5 ± 17.3 ml; p < 0.05) in Group B than those in Group A. The 5-year cardiac event-free rate was similar between groups [83.6 ± 10.8 % for group A and 83.3 ± 15.2 % for group B (p = NS)] as well as the mean value of NYHA classification for each at the mid-term periods (1.5 for Group A and 1.3 for Group B).

Conclusion: Waffle procedure improved echocardiographic elements of diastolic function of patients with epicardial thickening more than did total pericardiectomy without additional compromises.
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http://dx.doi.org/10.1007/s11748-014-0434-6DOI Listing
January 2015

Successful non-operative management of left atrioesophageal fistula following catheter ablation.

Surg Today 2014 Aug 3;44(8):1565-8. Epub 2013 Oct 3.

Division of Cardiovascular Surgery, Saitama Red-cross Hospital, 8-3-33 Kamiochiai, Chyuo-ku, Saitama, Saitama, 338-8553, Japan,

Atrioesophageal fistula (AEF) is a potentially lethal complication of catheter radiofrequency ablation for atrial fibrillation. A 49-year-old man with paroxysmal atrial fibrillation who underwent catheter ablation around the pulmonary vein was admitted 31 days after the procedure, suffering seizures and fever. Magnetic resonance imaging of the brain showed ischemia and multiple lesions of acute infarction in the right occipital lobe of the cerebrum. Computed tomography (CT) of the chest showed a small accumulation of air between the posterior left atrium and the esophagus, suggesting an AEF. Endoscopic snaring of the esophageal mucosa, repeated a few times, supported by nil by mouth and antibiotic therapy, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 45 days after admission with no neurological compromise.
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http://dx.doi.org/10.1007/s00595-013-0744-9DOI Listing
August 2014

Thrombus arising from the ascending aorta.

Asian Cardiovasc Thorac Ann 2012 Jun;20(3):351

Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan.

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http://dx.doi.org/10.1177/0218492311419767DOI Listing
June 2012

Successful surgical repair of the parachute mitral valve with mitral valve regurgitation.

Ann Thorac Cardiovasc Surg 2012 15;18(6):569-72. Epub 2012 May 15.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.
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http://dx.doi.org/10.5761/atcs.cr.11.01841DOI Listing
June 2013

Secondary aortoenteric fistula: a case report of acute aortic occlusion following cellulitis.

Ann Thorac Cardiovasc Surg 2012 27;18(6):557-9. Epub 2012 Apr 27.

Division of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan.

A secondary aortoenteric fistula is a relatively rare complication of abdominal aortic reconstruction. The clinical manifestation of aortoenteric fistula is usually upper gastrointestinal bleeding. We report a patient who developed acute aortic occlusion following chronic cellulitis, which is an uncommon finding. A 50-year-old man with a history of aortobifemoral bypass grafting was admitted for tiredness, fever and swelling of his right leg. On the 40th day of admission, he developed acute aortic occlusion. Computed tomography revealed right distal aortic graft occlusion and the presence of gas surrounding the graft. Gastroduodenoscopy showed an underlying Dacron graft consistent with an aortoenteric fistula in the third part of the duodenum. We excised the infected graft and reconstructed the abdominal aorta with a new prosthetic graft in situ, which was wrapped with the vascularized pedicle of the omentum. The duodenal defect was repaired with segmental duodenal resection and end-to-end anastomosis. The patient recovered well after surgical management and has remained in good condition for 2 years without developing any signs of recurrence of infection.
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http://dx.doi.org/10.5761/atcs.cr.11.01853DOI Listing
June 2013

Late-stage non-anastomotic rupture of axillo-bifemoral bypass graft.

Ann Thorac Cardiovasc Surg 2012 24;18(5):485-7. Epub 2012 Mar 24.

Division of Cardiovascular Surgery, Saitama Red-cross Hospital, Saitama, Japan.

An 82-year-old woman, who underwent axillo-bifemoral bypass for infrarenal aortic occlusion and peripheral arterial occlusive disease 9 years before, was admitted to our hospital for swelling in the left subclavicular region. Ultrasound examination revealed a leak in the wall of the bypass graft with the formation of a false aneurysm. No signs of infection, either locally or systemically, were observed. Resection of the aneurismal segment with interposition using a Dacron graft was performed. Macroscopic findings during surgery confirmed an intact anastomotic region of the left axillary artery and Dacron graft. Two possible mechanisms for the formation of this false aneurysm, either cumulative stress on the graft over the years or Dacron graft biodegradation, were hypothesized.
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http://dx.doi.org/10.5761/atcs.cr.11.01818DOI Listing
May 2013

Successful surgical repair of pulmonary artery aneurysm and regurgitation.

Ann Thorac Cardiovasc Surg 2012 24;18(5):491-3. Epub 2012 Mar 24.

Division of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Japan.

Pulmonary artery aneurysm (PAA) is generally a rare lesion, and there is no definitive approach for it. We report the case of a 45-year-old man who was admitted for the evaluation of dyspnea. In childhood, he had been diagnosed with PAA with congenital pulmonary valve stenosis and regurgitation, and he had a percutaneous transvenous pulmonary valve commissurotomy. Transthoracic echocardiogram showed dilatation of the right atrium and right ventricle, with right ventricular hypertrophy. There was severe pulmonary valve regurgitation, and the main pulmonary artery was dilated to 68 mm in diameter. From the surgical findings, the left leaflet of pulmonary valve was torn from commissure with failure to coapt with the other leaflet. After direct sutures of edges of the left leaflet, a nearly normal valvular competence was restored. The PAA was repaired with a Y-shaped 24 × 12 mm Dacron graft replacement. The postoperative course was uneventful, and the patient was discharged.
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http://dx.doi.org/10.5761/atcs.cr.11.01769DOI Listing
May 2013

Cardiac varix in the right atrium.

Interact Cardiovasc Thorac Surg 2012 May 7;14(5):686-8. Epub 2012 Feb 7.

Division of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Japan.

A 73-year old man underwent transthoracic and transoesophageal echocardiography and computed tomography, which revealed what appeared to be an asymptomatic primary mobile tumour located in the right atrium. During surgery, the mass was found to be associated with the right atrial septum and was subsequently resected. Histopathology of the mass revealed a cardiac varix with phleboliths. The patient had an uneventful postoperative course and no signs of recurrence at the 10-month follow-up.
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http://dx.doi.org/10.1093/icvts/ivs015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329297PMC
May 2012

Late disruption of axillo-bifemoral bypass graft.

Eur J Cardiothorac Surg 2012 Jul 18;42(1):188. Epub 2012 Jan 18.

Division of Cardiovascular Surgery, Saitama Red-Cross Hospital, Saitama, Japan.

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http://dx.doi.org/10.1093/ejcts/ezr309DOI Listing
July 2012

Hepatic artery pseudoaneurysm with extrahepatic biliary obstruction.

Ann Vasc Dis 2012 29;5(1):100-3. Epub 2012 Feb 29.

Division of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

Hepaticartery pseudoaneurysms are a rare complication of chronic pancreatitis. However, giant pseudoaneurysms (80 mm) and complicated biliary obstructions are extremely rare. This article reports a 75 year-old man with chronic pancreatitis that presented as upper abdominal pain and obstructive jaundice. Computed tomography revealed a hepatic artery pseudoaneurysm measuring 80 × 72 × 70 mm. We performed aneurysm resection and common hepatic artery bypass, using a great saphenous vein graft in the patient. The postoperative course was uneventful, and he was discharged on the 10th postoperative day. However, on the 135th postoperative day, he died of massive hemorrhage into the peritoneal cavity.
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http://dx.doi.org/10.3400/avd.cr.11.00080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595919PMC
April 2013

Surgical treatment for thoracic aneurysms: comparison of stent grafting and open surgery.

Ann Vasc Dis 2012 31;5(1):15-20. Epub 2012 Jan 31.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

Objectives: Early and mid-term results of stent graft (SG) treatment for thoracic aortic aneurysms (thoracic endovascular aneurysm repair: TEVAR) were retrospectively compared with open surgical treatment.

Methods: The records of 213 patients in whom single thoracic aortic aneurysm repairs had been performed in our department from January 2006 through August 31, 2009 were reviewed. Acute aortic dissection was excluded. Each case was reviewed for indications for TEVAR from an anatomical standpoint. Among 62 cases in which TEVAR was indicated, 30 (SG group) were treated by TEVAR and 32, by open surgery (OP group). Early and mid-term results were analyzed retrospectively in both groups.

Results: There were no operative deaths in either group. The SG group demonstrated significantly less operative bleeding, a shorter operative time, and shorter postoperative hospital stay compared with the OP group. There were 3 deaths in the SG group and 4 in the OP group, which occurred within an average of 656.4 days during the follow up period. The 3 year actuarial survival rate was 88.7% in the SG group and 87.1% in the OP group, and there were no significant differences between the groups.

Conclusion: Although early and mid-term results of TEVAR and open surgery were similar, TEVAR is generally less invasive and may be preferable for high-risk patients, compared with open surgical repair. (English Translation of Jpn J Vasc Surg 2010; 19: 51-56.).
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http://dx.doi.org/10.3400/avd.oa.11.00920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595911PMC
April 2013

Apico-aortic conduit for aortic stenosis in a patient with chronic thoracic wall infection.

Ann Thorac Cardiovasc Surg 2012 9;18(4):379-81. Epub 2011 Dec 9.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

We report a case of an apico-aortic bioprothesis-valved conduit for a 70-year-old-woman with symptomatic, severe aortic stenosis and severe calcification of the ascending aorta. She had a history of mastectomy and radiation therapy for breast cancer and was suffering from radiodermatitis and chronic thoracic wall infection. Transthoracic echocardiography showed severe aortic valve stenosis with heavy calcification and high aortic valve pressure gradients. In patients with a chronically infected thoracic wall, median sternotomy is considered to be a high risk procedure, resulting in postoperative mediastiniti; therefore, we applied a technique in which we used an apico-aortic conduit via posterolateral thoracotomy. We underwent apico-aortic bypass with a hand-made composite graft: 19-mm bioprosthetic valve and a 22-mm woven polyester vascular graft. The surgical intervention successfully decreased pressure gradient across the aortic valve, also separating an incision from chronic infection allowed us to avoid postoperative mediastinitis. The patient had remained in good condition for 15 months without developing any complications.
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http://dx.doi.org/10.5761/atcs.cr.11.01767DOI Listing
August 2013

[Emergency stent placement after descending aortic replacement with chronic aortic dissection].

Kyobu Geka 2011 Sep;64(10):887-93

Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan.

A 49-year-old man with asymptomatic chronic aneurysmal dissection was admitted to our hospital. He had undergone ascending aortic replacement for type A aortic dissection 7 months before. We performed descending aortic replacement for chronic aneurysmal dissection. Renal dysfunction appeared 1 day after the operation. Contrast-enhanced computed tomography indicated that the true lumen was severely compressed by a false lumen, and that the origins of the renal artery were occluded. We performed emergency endovascular stent placement to dilate the true lumen. Immediately after this procedure, renal ischemia improved. The postoperative course was uneventful. An endovascular approach using bare stent can be a treatment option that is less invasive and prompter for a patient with renal ischemia resulting from aortic dissection.
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September 2011

Thrombus arising from ascending aorta.

Eur J Cardiothorac Surg 2011 Sep 2;40(3):e133. Epub 2011 Jun 2.

Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan.

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http://dx.doi.org/10.1016/j.ejcts.2011.04.032DOI Listing
September 2011
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