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Shimizu Y, Yoshitani K, Kuriyama T, Mori K, Kujira K, Imai M, Fukuhara R, Taniguchi R, Toma M, Miyamoto T, Sato Y. The effect of an initial catheter ablation with an adjunctive ethanol infusion into the vein of Marshall on persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:453-460. [PMID: 38282242 DOI: 10.1111/jce.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Some previous studies have reported that a first-step ethanol infusion into the vein of Marshall (EIVOM) with touch-up radiofrequency (RF) ablation can facilitate mitral isthmus (MI) block and improves the ablation outcomes in persistent atrial fibrillation (PeAF) patients. However, the effect of an initial RF ablation with an adjunctive EIVOM has not been fully investigated. METHODS This study enrolled 233 PeAF patients undergoing pulmonary vein isolation and linear ablation including an MI, roof line, and cavotricuspid isthmus ablation. An EIVOM was performed when endocardial ablation with or without coronary sinus ablation failed to create MI block. RESULTS Bidirectional MI block was achieved in 224 patients (96.1%). Among them, MI block was obtained by only RF ablation in 174/224 patients (77.7%) (RF group) and an adjunctive EIVOM was needed in 50/224 (22.3%) (EIVOM group). During the follow-up, 113 (64.9%) RF group patients were free from AF/atrial tachycardia compared to 41 (82.0%) EIVOM group patients (log-rank p = .045). In a multivariate Cox regression analysis, an adjunctive EIVOM was associated with a lower recurrence rate (hazard ratio = 0.39, 95% confidence interval = 0.17-0.78, p = .006). CONCLUSION An initial RF ablation with an adjunctive EIVOM strategy improved MI ablation's acute success rate and was associated with better clinical outcomes.
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Affiliation(s)
- Yukiko Shimizu
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Tomoari Kuriyama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuki Mori
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuto Kujira
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Rei Fukuhara
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tadashi Miyamoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Miyazaki S, Kobori A, Jo H, Keida T, Yoshitani K, Mukai M, Sagawa Y, Asakawa T, Sato E, Yamao K, Horie T, Manita M, Fukaya H, Hayashi H, Tanimoto K, Iwayama T, Chiba S, Sato A, Sekiguchi Y, Sugiura K, Iwai S, Isonaga Y, Miwa N, Kato N, Inaba O, Hirota T, Nagata Y, Ono Y, Hachiya H, Yamauchi Y, Goya M, Nitta J, Tada H, Sasano T. Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation. Front Cardiovasc Med 2023; 10:1278603. [PMID: 37965084 PMCID: PMC10642562 DOI: 10.3389/fcvm.2023.1278603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Background Symptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce. Objective We compared the clinical course of SGH occurring with different energy sources. Methods This multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation. Results The data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1-4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5-5) days; the total hospitalization duration was 11 [7-19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for >1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set. Conclusions The clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hikari Jo
- Department of Cardiology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Kazuyasu Yoshitani
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Eiji Sato
- Department of Cardiovascular Medicine, Sendai City Hospital, Miyagi, Japan
| | - Kazuya Yamao
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Mamoru Manita
- Department of Cardiology, Naha City Hospital, Okinawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Suguru Chiba
- Department of Cardiology, Urasoe General Hospital, Okinawa, Japan
| | - Akinori Sato
- Cardiovascular Center, Tachikawa General Hospital, Niigata, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
| | - Shinsuke Iwai
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Yuhei Isonaga
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Naoyuki Miwa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Nobutaka Kato
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuichi Ono
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Miyazaki S, Kobori A, Jo H, Keida T, Yoshitani K, Mukai M, Sagawa Y, Asakawa T, Sato E, Yamao K, Horie T, Manita M, Fukaya H, Hayashi H, Tanimoto K, Iwayama T, Chiba S, Sato A, Sekiguchi Y, Sugiura K, Iwai S, Isonaga Y, Miwa N, Kato N, Inaba O, Hirota T, Nagata Y, Ono Y, Hachiya H, Yamauchi Y, Goya M, Nitta J, Tada H, Sasano T. Symptomatic Gastroparesis After Cryoballoon-Based Atrial Fibrillation Ablation: Results From a Large Multicenter Registry. Circ Arrhythm Electrophysiol 2023; 16:e011605. [PMID: 36745559 DOI: 10.1161/circep.122.011605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.)
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo (A.K.)
| | - Hikari Jo
- Department of Cardiology, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan (H.J.)
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan (T.K.)
| | - Kazuyasu Yoshitani
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (K.Y.)
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Japan (M. Mukai, H.T.)
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa (Y.S., Y.Y.)
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Japan (T.A.)
| | - Eiji Sato
- Department of Cardiovascular Medicine, Sendai City Hospital, Miyagi, Japan (E.S.)
| | - Kazuya Yamao
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan (K.Y., Y.O.)
| | | | - Mamoru Manita
- Department of Cardiology, Naha City Hospital, Okinawa (M. Manita)
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa (H.F.)
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan (H.H.)
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Japan (K.T.)
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan (T.I.)
| | - Suguru Chiba
- Department of Cardiology, Urasoe General Hospital, Okinawa (S.C.)
| | - Akinori Sato
- Cardiovascular Center, Tachikawa General Hospital, Niigata, Japan (A.S.)
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Y.S., J.N.)
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi University, Kerala, India (K.S., T. Hirota)
| | - Shinsuke Iwai
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa (S.I., N.K.)
| | - Yuhei Isonaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.)
| | - Naoyuki Miwa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (N.M., H.H.)
| | - Nobutaka Kato
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa (S.I., N.K.)
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.)
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi University, Kerala, India (K.S., T. Hirota)
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.)
| | - Yuichi Ono
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan (K.Y., Y.O.)
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (N.M., H.H.)
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa (Y.S., Y.Y.)
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.)
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Y.S., J.N.)
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Japan (M. Mukai, H.T.)
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.)
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Terashita K, Shimada Y, Yamanaka Y, Motohashi Y, Tonomura D, Yoshitani K, Yoshida M, Tsuchida T, Fukumoto H. Intraplaque wiring enables drug-coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries. Catheter Cardiovasc Interv 2023; 101:764-772. [PMID: 36786488 DOI: 10.1002/ccd.30596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES This study aimed to determine whether drug-coated balloon (DCB) angioplasty following intraplaque wiring and the use of modified balloons is safe and effective in the percutaneous treatment of coronary chronic total occlusions (CTOs). BACKGROUND DCB is an alternative therapeutic option without the limitations of permanent vascular implants. However, its efficacy in CTOs has yet to be confirmed. The combination of modified balloons and DCB can be effectively applied when the intraplaque passage of the guidewire is achieved in CTOs. METHODS Data from 124 consecutive CTO lesions (105 patients) treated at our hospital between February 2016 and December 2020 were screened for inclusion and retrospectively analyzed. Among the 118 lesions successfully recanalized, intraplaque wiring was achieved in 108, and 85 were treated by the DCB-only approach following cutting/scoring balloon dilatation. RESULTS Follow-up data were available for 82 lesions (71 patients). The median occlusion length was 18.5 mm, and the J-CTO score was 1.7 ± 0.9. No in-hospital major adverse cardiac events occurred, including abrupt vessel closure. During the median 29-month follow-up period, target lesion revascularization was performed for 10 lesions. Follow-up coronary angiography (8.7 ± 3.9 months after the index procedure) was performed for 64 lesions, demonstrating late lumen loss of -0.15 mm (interquartile range -0.4 to 0.23 mm), binary restenosis (diameter stenosis ≥50%) in 12 lesions (18.8%), and late lumen enlargement in 37 (57.8%). CONCLUSION The DCB-only approach following the use of modified balloons is a promising strategy for coronary CTOs when intraplaque wiring is achieved.
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Affiliation(s)
- Kazunori Terashita
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yoshihisa Shimada
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yuki Yamanaka
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yoshikazu Motohashi
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Daisuke Tonomura
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Kazuyasu Yoshitani
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Masataka Yoshida
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Takao Tsuchida
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Hitoshi Fukumoto
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
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Soejima K, Kondo Y, Sasaki S, Adachi K, Kato R, Hagiwara N, Harada T, Kusano K, Miura F, Morishima I, Yoshitani K, Yotsukura A, Fujimoto M, Nishii N, Shimeno K, Ohe M, Tasaka H, Sasaki H, Schrader J, Ando K. Intracardiac conduction time as a predictor of cardiac resynchronization therapy response: Results of the BIO|SELECT pilot study. Heart Rhythm O2 2022; 2:588-596. [PMID: 34988503 PMCID: PMC8703154 DOI: 10.1016/j.hroo.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Quadripolar left ventricular (LV) leads are capable of sensing and pacing the left ventricle from 4 different electrodes, which may potentially improve patient response to cardiac resynchronization therapy (CRT). Objective We measured 3 different time intervals: right ventricular (RV)-sensed to LV-sensed during intrinsic rhythm (RVs-LVs), RV-paced to LV-sensed (RVp-LVs), and LV-paced to LV-sensed (LVp-LVs, between distal [LV1] and proximal pole on a quadripolar LV lead), and assessed their association with CRT response in terms of LV end-systolic volume (LVESV) and a composite benefit index (CBI) comprising LVESV, LV ejection fraction (LVEF), brain natriuretic peptide level, and NYHA class. Methods A CRT-defibrillator system with quadripolar LV lead was implanted in 196 patients (mean age 69 years, mean LVEF 30%, left bundle-branch block [LBBB] 58%). Conduction intervals were measured before hospital discharge. At baseline and 7-month follow-up, echocardiographic and other components of CBI were determined. Results The mean RVs-LV1s, RVp-LV1s, and LVp-LVs delays were 68 ± 38 ms, 132 ± 34 ms, and 99 ± 31 ms, respectively. From baseline to 7 months, LVESV decreased by 17.3% ± 28.6%. The RVs-LV1s interval correlated stronger with CBI (R2 = 0.12, P < .00001) than with LVESV change (R2 = 0.05, P = .006). In contrast, RVp-LV1s did not correlate and LVp-LVs correlated only weakly with CRT response. The subgroup of patients (44%) with LBBB and RVs-LV1s above the lower quartile (≥34 ms) showed the greatest response to CRT. Conclusion The RVs-LVs interval during intrinsic rhythm is relevant for CRT success, whereas RVp-LVs and LVp-LVs intervals did not predict CRT response.
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Affiliation(s)
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | | | | | | | - Tomoo Harada
- St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Kenji Ando
- Kokura Memorial Hospital, Fukuoka, Japan
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Nakamura T, Takami M, Fukuzawa K, Kiuchi K, Kono H, Kobori A, Sakamoto Y, Watanabe R, Okumura Y, Yamashita S, Yamashiro K, Miyamoto K, Kusano K, Kanda T, Masuda M, Yoshitani K, Yoshida A, Hirayama Y, Adachi K, Mine T, Shimane A, Takeda M, Takei A, Okajima K, Fujiwara R, Hirata KI. Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures - Large-Scale Multicenter Analysis. Circ J 2021; 85:264-271. [PMID: 33431721 DOI: 10.1253/circj.cj-20-1096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.
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Affiliation(s)
- Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Kono
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital
| | | | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University of Medicine
| | | | | | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kazuyasu Yoshitani
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Akira Shimane
- Department of Cardiology, Himeji Cardiovascular Center
| | | | - Asumi Takei
- Department of Cardiology, Kobe Rosai Hospital
| | | | - Ryudo Fujiwara
- Cardiovascular Division, Osaka Saiseikai Nakatsu Hospital
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Yoshitani K, Fujii T, Ito S, Shimokawa A, Ohnishi Y. P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Department funding
Background
Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle.
Purpose
To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR.
Methods
This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months.
Results
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059).
Conclusions
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR.
Abstract P1409 Figure1
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Affiliation(s)
- K Yoshitani
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - T Fujii
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - S Ito
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - A Shimokawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Y Ohnishi
- National Cerebral and Cardiovascular Center, Suita, Japan
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Ito S, Yoshitani K, Yahagi M, Onishi Y. P1531 Changes in mitral annular dynamics with three different types of annuloplasty devices: measurement using three-dimensional transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
OnBehalf
National Cerebral and Cardiovascular Center, Japan
Background/Purpose
Mitral annuloplasty plays a crucial role during mitral valve (MV) repair. The dynamics of the mitral annulus (MA) may be variously affected by the annuloplasty device. Therefore, we investigated the differences in MA dynamics when using a semi-rigid ring, semi-rigid band, and flexible ring.
Methods
We retrospectively reviewed 61 patients with mitral regurgitation who underwent MV repair, which included annuloplasty. Semi-rigid rings were used in 33 patients, flexible bands in 21, and semi-rigid bands in seven. Three-dimensional transoesophageal echocardiography (3D-TEE) images of the MV were recorded before and after annuloplasty. The 3D-TEE image datasets were analysed using semi-automated analysis software. We measured anterolateral–posteromedial (AL–PM) and anteroposterior (AP) diameter and height of the MV. The sphericity index (AP diameter divided by AL-PM diameter) and annular height to commissural width ratio (AHCWR) were calculated as the circular and saddle-shaped geometries, respectively. The differences in these values between end diastole (ED) and end systole (ES) were compared by t-test before and after mitral annuloplasty to analyse the MA among the semi-rigid ring, semi-rigid band, and flexible ring.
Results
Before annuloplasty (n = 61), the AL–PM diameter was significantly larger (ED: 4.26 ± 0.08 vs. ES: 4.24 ± 0.07, p = 0.016) and the sphericity index was significantly smaller (ED: 0.93 ± 0.01 vs. ES: 0.94 ± 0.01, p = 0.017) at ED than at ES. Table 1 shows the analysis after annuloplasty for each device. After annuloplasty, not every group demonstrated significant differences in AL–PM diameter or sphericity index. MA dynamics were reduced equally with the three devices.
Conclusion
Mitral annuloplasty reduced MA dynamics equally when using a semi-rigid ring, semi-rigid band, and flexible ring. There were no distinctive differences among the three devices in terms of maintaining flexibility and a saddle-shaped geometry.
MV dynamics after mitral annuloplasty Semi-rigid ring (n = 33) Flexible band (n = 21) Semi-rigid band (n = 7) ES ED P value ES ED P value ES ED P value AP (cm) 2.61 ± 0.38 2.67 ± 0.44 0.15 2.61 ± 0.38 2.67 ± 0.44 0.15 2.79 ± 0.44 2.80 ± 0.43 0.75 AL-PM (cm) 2.85 ± 0.31 2.91 ± 0.39 0.20 2.85 ± 0.31 2.91 ± 0.39 0.20 2.70 ± 0.39 2.73 ± 0.42 0.15 Height (cm) 0.49 ± 0.20 0.51 ± 0.21 0.35 0.63 ± 0.17 0.62 ± 0.17 0.48 0.63 ± 0.13 0.63 ± 0.13 1.00 SI 0.92 ± 0.09 0.92 ± 0.09 0.45 0.91 ± 0.09 0.91 ± 0.08 0.85 0.95 ± 0.12 0.95 ± 0.11 0.34 AHCWR(%) 17.1 ± 6.65 17.4 ± 6.67 0.56 20.4 ± 5.00 20.2 ± 5.10 0.52 21.3 ± 4.49 21.3 ± 4.80 0.95 Data are expressed mean ± standard deviation. AP: anterior posterior; AL-PM: anterolateral-posteromedial; SI: Sphericity index; AHCWR: annular height to commissure width ratio; ES: endsystole; ED: enddiastole.
Abstract P1531 Figure
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Affiliation(s)
- S Ito
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - K Yoshitani
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - M Yahagi
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - Y Onishi
- National Cerebral & Cardiovascular Center, Suita, Japan
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Kuragaichi T, Hotta K, Miyata A, Nakayama H, Nishimoto Y, Kobayashi T, Saga S, Fukuhara R, Yoshitani K, Taniguchi R, Toma M, Miyamoto T, Sato Y. P1650Clinical significance of uNGAL, uKIM-1, and uL-FABP in patients with acute pulmonary edema. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Novel urinary biomarkers such as urinary neutrophil gelatinase-associated lipocalin (u-NGAL),urinary kidney injury molecule-1 (u-KIM-1), and urinary liver-type fatty acid-binding protein (uL-FABP) are proposed to be reliable markers for acute heart failure (AHF). Acute pulmonary edema (APE) is one of the vascular phenotypes of AHF, such as `vascular failure”, often with high blood pressure at admission. We aimed to investigate the differences in the clinical impact and prognostic utility of urinary biomarkers in AHF patients with and without APE.
Methods and results
This prospective observational study included 203 AHF patients (mean age: 77 years, 52% male). uL-FABP, u-NGAL, and u-KIM-1 were measured at admission and before discharge, with correction for urinary creatinine. APE was defined as acute-onset dyspnea and radiographic alveolar edema requiring non-invasive positive pressure ventilation. The primary outcome was a composite of all-cause death and AHF rehospitalization for 1 year. The median uL-FABP levels at admission were higher in APE (n=42) than in non-APE patients (n=161; 10.8 [4.5–23.7] vs. 20.7 [5.9–63.5] μg/gCr, p=0.017), whereas u-KIM-1, u-NGAL, and serum creatinine did not significantly differ between AHF patients with and without APE. The primary outcome did not differ between patients with and without APE. However, among patients with APE, Kaplan–Meier analysis showed that higher uL-FABP (≥median: 20.7 μg/gCr) was associated with adverse events (log-rank: p=0.019). After adjusting for age, sex, serum creatinine, and brain natriuretic peptide, multivariable Cox hazard analysis showed that higher uL-FABP is an independent predictor of adverse events (HR: 4.0 [1.2–18.2], p=0.023).
Conclusion
Unlike u-NGAL and u-KIM-1, uL-FABP was higher in APE patients than in non-APE patients. Further, among patients with APE, higher uL-FABP was predictive for poor prognosis.
Acknowledgement/Funding
None
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Affiliation(s)
- T Kuragaichi
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - K Hotta
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - A Miyata
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - H Nakayama
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - Y Nishimoto
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - T Kobayashi
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - S Saga
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - R Fukuhara
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - K Yoshitani
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - R Taniguchi
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - M Toma
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - T Miyamoto
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
| | - Y Sato
- Hyogo Prefectural Amagasaki General Medical Center, Cardiology, Amagasaki, Japan
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Shimizu Y, Yoshitani K, Murotani K, Kujira K, Kurozumi Y, Fukuhara R, Taniguchi R, Toma M, Miyamoto T, Kita Y, Takatsu Y, Sato Y. The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed-Cavotricuspid isthmus ablation using intracardiac echocardiography. J Arrhythm 2018; 34:410-417. [PMID: 30167012 PMCID: PMC6111476 DOI: 10.1002/joa3.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch-specified ablation strategy. METHODS This study included 94 atrial fibrillation (AF) patients (56 males, age 68 ± 8.0 years). With intracardiac echocardiography, the isthmus length and pouch depth were precisely measured. After a standard AF ablation, all patients underwent the CTI ablation along the lateral isthmus. If bidirectional block could not be achieved, the ablation catheter was deflected more than 90 degrees to ablate inside the pouch (knuckle-curve ablation). RESULTS Seventy-two patients (76.6%) had a sub-Eustachian pouch. Bidirectional block could be achieved in all patients. By a univariate logistic regression analysis, only the pouch depth was significantly correlated with the RF duration (P = .005) and RF energy (P = .006). A multivariate logistic regression analysis also revealed the pouch depth was the sole factor that influenced the RF duration (P = .001) and RF energy (P = .001). Among the 72 patients, 21 patients needed a knuckle-curve ablation. Using a receiver operating characteristic curve, the optimal cutoff value of the pouch depth for a knuckle-curve ablation was 3.7 mm with a sensitivity of 90% and specificity of 69%. CONCLUSIONS The sub-Eustachian pouch depth was the sole factor that influenced the RF duration and energy in the CTI ablation. If the pouch was deeper than 3.7 mm, a deep pouch-specified ablation strategy would be needed.
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Affiliation(s)
- Yukiko Shimizu
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Kazuyasu Yoshitani
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Kenta Murotani
- Center for Clinical ResearchAichi Medical UniversityNagakuteJapan
| | - Kazuto Kujira
- Department of Cardiovascular MedicineToyohashi Heart CenterToyohashiJapan
| | - Yuma Kurozumi
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Rei Fukuhara
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Ryoji Taniguchi
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Masanao Toma
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Tadashi Miyamoto
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Yoshio Kita
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Yoshiki Takatsu
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Yukihito Sato
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
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Miyazaki Y, Yoshitani K, Shimizu Y, Takatsu Y, Sato Y. 176-06: Vein of Marshall Ethanol Infusion Prevents Recovery of Mitral Isthmus Conduction. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i118b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kujira K, Yoshitani K, Futsuki A, Imai K, Hiraumi Y, Sakazaki H, Sato Y, Takatsu Y, Toyohara K, Fujiwara K. Ventricular Tachycardia Rotating a Scar of a Total Right Ventricular Exclusion. Ann Thorac Surg 2015; 100:1886-8. [PMID: 26522533 DOI: 10.1016/j.athoracsur.2014.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 10/22/2022]
Abstract
We describe a 15-year-old postoperative girl who underwent surgical 3-dimensional mapping and ablation of hemodynamically unstable ventricular tachycardia (VT) with an on-pump beating heart surgical technique. She had previously received a tricuspid valve closure, entire right ventricular free wall resection, and finally Fontan operation with an extracardiac conduit to treat a severe Ebstein's anomaly. Activation mapping revealed a VT rotating around a large right ventricular free wall incisional scar with a narrow conduction channel between the scar and a tricuspid annulus (TA). A linear radiofrequency ablation connecting the scar and the TA terminated the VT.
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Affiliation(s)
- Kazuto Kujira
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Kazuyasu Yoshitani
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
| | - Ayano Futsuki
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Kenta Imai
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Yoshimi Hiraumi
- Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan
| | - Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Yoshiki Takatsu
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Keiko Toyohara
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiichi Fujiwara
- Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan
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Suzuki K, Shiraishi K, Yoshitani K, Sugama K, Kometani T. Effect of a sports drink based on highly-branched cyclic dextrin on cytokine responses to exhaustive endurance exercise. J Sports Med Phys Fitness 2014; 54:622-630. [PMID: 25270782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Aim of the present study was to compare the effects of highly branched cyclic dextrin (HBCD) drink with a glucose-based control drink on immunoendocrine responses to endurance exercise. METHODS Using a randomized, double-blind placebo-controlled cross-over design, seven male triathletes participated in two duathlon races separated by one month, consisting of 5 km of running, 40 km of cycling and 5 km of running. In the first race, four athletes consumed the HBCD-based drink and three athletes consumed the glucose-based drink. In the second race, three athletes consumed the HBCD-based drink and four athletes consumed the glucose-based drink. We collected blood and urine samples before and after the races to analyze leukocyte count and concentrations of hormones and cytokines. RESULTS Lymphocyte and neutrophil counts increased significantly after exercise in both trials (P<0.05), but were not significantly different between the trials. Plasma noradrenalin concentration increased significantly (P<0.05) during exercise in the glucose trial, but not in the HBCD trial. Plasma concentrations of interleukin (IL)-8 and IL-10 increased significantly during exercise in both trials (P<0.05) but were not significantly different between the trials. Post-race urinary IL-8, IL-10 and IL-12p40 concentrations were significantly lower in the HBCD trial compared with the glucose trial (P<0.05), although the plasma concentrations of these cytokines were not significantly different between both trials. CONCLUSION These results suggest that the HBCD-based drink may attenuate the stress hormone response, and reduce the urinary cytokine levels following exhaustive exercise.
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Affiliation(s)
- K Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan -
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Yoshitani K, Kujira K, Okishige K. Simultaneous re-isolation of the left pulmonary veins and termination of peri-mitral flutter with only an ethanol infusion in the vein of Marshall: killing two birds with one stone. Europace 2014; 16:1180. [PMID: 24675022 DOI: 10.1093/europace/euu060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kazuyasu Yoshitani
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1-1 Higashidaimotsu, Amagasaki, Hyogo 660-0828, Japan
| | - Kazuto Kujira
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1-1 Higashidaimotsu, Amagasaki, Hyogo 660-0828, Japan
| | - Kaoru Okishige
- Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama, Japan
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Kamiya K, Sakakibara M, Yoshitani K, Yamada S, Asakawa N, Tsutsui H. Adaptive servo-ventilation has better acute effects on hemodynamics than continuous positive airway pressure in patients with heart failure. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yoshitani K, Sato Y. Prediction of Acute Heart Failure Decompensation. Circ J 2011; 75:55-6. [DOI: 10.1253/circj.cj-10-1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuyasu Yoshitani
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
| | - Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
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Yamanaka K, Sekine Y, Nonaka M, Iwakura A, Yoshitani K, Nakagawa Y, Fujita M. Left atrial appendage contributes to left atrial booster function after the maze procedure: quantitative assessment with multidetector computed tomography☆. Eur J Cardiothorac Surg 2010; 38:361-5. [DOI: 10.1016/j.ejcts.2010.01.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/24/2010] [Accepted: 01/26/2010] [Indexed: 11/17/2022] Open
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Izumi C, Takahashi S, Miyake M, Sakamoto J, Hanazawa K, Yoshitani K, Kaitani K, Izumi T, Gen H, Nakagawa Y. Impact of Aortic Plaque Morphology on Survival Rate and Incidence of a Subsequent Embolic Event. Circ J 2010; 74:2152-7. [DOI: 10.1253/circj.cj-10-0414] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abdelwahab A, Basta M, Parkash R, Gardner M, Sapp J, Nault I, Maury P, Sacher F, Deplagne A, Hocini M, Lellouche N, Haissaguerre M, Jais P, Konstantinidou M, Wissner E, Koektuerk B, Schmidt B, Zerm T, Ouyang F, Kuck KH, Chun JKR, Herrera Siklody C, Letsas K, Weber R, Schiebeling-Roemer J, Stockinger J, Astheimer K, Kalusche D, Arentz T, Nakamura K, Naito S, Kumagai K, Goto K, Iwamoto J, Ueda M, Oshima S, Komuro I, Vassilikos V, Dakos G, Chouvarda I, Maglaveras N, Paraskevaidis S, Mochlas S, Styliadis I, Parcharidis G, Insulander P, Bastani H, Braunschweig F, Kenneback G, Schwieler J, Tabrizi F, Jensen-Urstad M, Hanazawa K, Kaitani K, Yoshitani K, Miyake M, Motooka M, Izumi T, Izumi C, Nakagawa Y, Romanov A, Pokushalov E, Shugaev P, Artemenko S, Turov A, Albenque JP, Bortone A, El Bayomy M, Combes N, Hausman P, Combes S, Donzeau JP, Boveda S. Moderated Posters: Outcome of catheter ablation. Europace 2009. [DOI: 10.1093/europace/euq196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Radinovic A, Ciconte G, Mazzone P, Gulletta S, Paglino G, Pappone C, Santinelli V, Kaitani K, Hanazawa K, Yoshitani K, Miyake M, Motooka M, Izumi T, Izumi C, Nakagawa Y, Scherr D, Sharma K, Dalal D, Spragg D, Chilukuri K, Berger RD, Calkins H, Marine JE, Chen J, Hoff PI, Solheim E, Off MK, Schuster P, Ohm OJ, Bertaglia E, Tondo C, De Simone A, Zoppo F, Mantica M, Turco P, Zerbo F, Stabile G, Sonne K, Patel D, Riedlbauchova L, Armaganijan L, Ali M, Wu CT, Di-Biase L, Natale A. Abstracts: Long term results of catheter ablation for atrial fibrillation. Europace 2009. [DOI: 10.1093/europace/euq224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marti Almor J, Bazan V, Matiello M, Cian D, Oliva X, Altaba C, Guijo MA, Bruguera J, Fiala M, Sknouril M, Dorda M, Chovancik J, Nevralova R, Jiravsky O, Jiravska-Godula B, Branny M, Elvan A, Beukema WP, Smit JJJ, Delnoy PPHM, Ramdat Misier AR, Tuan J, Chung I, Jeilan M, Kundu S, Osman F, Stafford P, Ng GA, Vergara P, Mazzone P, Paglino G, Saviano M, Crisa S, Maida G, Vicedomini G, Pappone C, Miyazaki S, Wright M, Hocini M, Jais P, Haissaguerre M, Yoshitani K, Kaitani K, Hanazawa K, Nakagawa Y, Yokokawa M, Tada H, Naito S, Oshima S, Taniguchi K, Romanov A, Pokushalov E, Shugaev P, Artemenko S, Turov A, Gindele FM, Wiedemann M, Ewertsen C, Heiderfazel S, Andresen D, Kaitani K, Hanazawa K, Yoshitani K, Miyake M, Motooka M, Izumi T, Izumi C, Nakagawa Y, Sunthorn H, Burri HB, Gentil PG, Shah DS, Sugiura S, Fujii E, Senga M, Yamazato S, Nakamura M, Ito M, Den Uijl DW, Delgado V, Tops LF, Trines SAIP, Zeppenfeld K, Van Der Wall EE, Schalij MJ, Bax JJ, Pappalardo A, Forleo GB, Avella A, Bencardino G, De Girolamo PG, Dello Russo A, Laurenzi F, Tondo C, Mueller H, Burri H, Gentil-Baron P, Lerch R, Shah D, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Pedrote Martinez AA, Arana E, Garcia-Riesco L, Urbano-Moral JA, Frutos-Lopez M, Sanchez-Brotons JA, Torres-Llergo J, Martinez-Martinez A, Matsuda H, Harada T, Nakano E, Takai M, Fujita S, Sasaki T, Mizuno K, Miyake F, Doshi A, Hummel J, Daoud E, Augostini R, Weiss R, Hart D, Houmsse M, Kalbfleisch S, Fiala M, Chovancik J, Gorzolka J, Bulkova V, Wojnarova D, Neuwirth R, Januska J, Branny M, Cerrato E, Amellone C, Tizzani E, Antolini M, Massa R, Golzio PG, Comoglio C, Rinaldi M, El-Domiaty HA, Kamal HM, Moubarak AM, Mansy MM, El-Kerdawy H, Ahmed S, Klinkenberg TJ, Ten Hagen A, Wiesfeld ACP, Tan ES, Van Gelder IC. Poster Session 1: Ablation of atrial fibrillation. Europace 2009. [DOI: 10.1093/europace/euq213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yoshitani K, Kawaguchi M, Iwata M, Sasaoka N, Inoue S, Kurumatani N, Furuya H. Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia. Br J Anaesth 2005; 94:341-6. [PMID: 15591331 DOI: 10.1093/bja/aei046] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A severe reduction in haemoglobin concentration can lead to a decrease in jugular venous bulb oxygen saturation (Sj(O(2))). However, recent evidences suggests that cerebral oxygen saturation (Sc(O(2))) measured by near infrared spectroscopy decreased during even mild haemodilution. We therefore tested the hypothesis that the changes in Sc(O(2)) may not be parallel to those in Sj(O(2)) during haemodilution. In addition, as cerebral oxygen balance during the operation can vary depending on the anaesthetics used, the changes in Sj(O(2)) and Sc(O(2)) during haemodilution were compared between patients under propofol and isoflurane/nitrous oxide anaesthesia. METHODS Forty-two patients with pre-donated autologous blood were randomly assigned to receive propofol (Group P) or sevoflurane/nitrous oxide (Group S) anaesthesia. A fibreoptic catheter was placed in the jugular bulb to measure Sj(O(2)). A cerebral oximeter, INVOS 4100S was used to monitor Sc(O(2)). Arterial and jugular bulb blood samples were drawn simultaneously at: (i) 10 min after the start of operation, (ii) after 400 ml of blood loss, (iii) after 800 ml of blood loss, (iv) just before the transfusion of pre-donated autologous blood, and (v) after 400 ml transfusion. RESULTS Mean (sd) control values of Sj(O(2)) in Group P were significantly lower than those in Group S (55 (8)% vs 71 (10)%, respectively; P<0.05), whereas there was no significant difference in control values of Sc(O(2)) between the two groups. During the operation, haemoglobin (Hb) concentrations significantly deceased in the both groups compared with control values (from 9.8 to 7.6 g dl(-1) in Group P and from 9.9 to 8.0 g dl(-1) in Group S). During a reduction in Hb concentration, Sj(O(2)) values remained unchanged in both groups, whereas Sc(O(2)) values significantly decreased in both groups (from 57 to 51% in Group P and from 59 to 52% in Group S). CONCLUSION The results indicated that, although the changes in Sj(O(2)) and Sc(O(2)) during a reduction in haemoglobin concentration were similar under propofol and sevoflurane/nitrous oxide anaesthesia, the changes in Sc(O(2)) were not parallel to those in Sj(O(2)). The discrepancy of the results in Sj(O(2)) and Sc(O(2)) may make the interpretation of their values difficult during haemodilution.
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Affiliation(s)
- K Yoshitani
- Department of Anaesthesiology, Nara Medical University, Kashihara, Nara 634-8521, Japan.
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Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H. Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. Br J Anaesth 2005; 94:243-6. [PMID: 15567812 DOI: 10.1093/bja/aei031] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ilioinguinal and iliohypogastric (IG-IH) nerve block has been widely used in children undergoing inguinal hernia repair. This technique may provide insufficient analgesia for intraoperative management as the inguinal region may receive sensory innervation from genitofemoral nerve. We proposed that addition of a genitofemoral nerve block might improve the quality of analgesia. METHODS Ninety-eight children undergoing inguinal hernia repair were assigned randomly to receive either IG-IH nerve block (Group I) or IG-IH and genitofemoral nerve blocks (Group II). Systolic arterial pressure (SAP) and heart rate (HR) were recorded before surgery (control), after skin incision, at sac traction and at the end of surgery. Postoperative analgesic requirements and incidence of complications were recorded until discharge. RESULTS At sac traction, SAP and HR were significantly higher in Group I (P<0.05), and the incidence of episodes of increased HR was also significantly higher in Group II (29 vs 12%, respectively, P<0.05). There were no significant differences in SAP and HR at other time points, postoperative analgesic requirements or incidence of complications between the groups. CONCLUSIONS The benefit of the additional genitofemoral nerve block to IG-IH nerve block was limited only to the time of sac traction without any postoperative effect. This suggests there is little clinical benefit in the addition of a genitofemoral nerve block.
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Affiliation(s)
- N Sasaoka
- Department of Anesthesiology, Nara Medical University, Nara, Japan.
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Fujimoto S, Matsushima A, Yoshitani K, Oya M, Shimono D, Takeda T, Kurose T, Yamada Y, Seino Y. Type-1 diabetes mellitus with insufficient serum immunoreactive insulin elevation after subcutaneous NPH-insulin injection. Diabetes Res Clin Pract 2003; 60:69-73. [PMID: 12639768 DOI: 10.1016/s0168-8227(02)00250-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of Type-1 diabetes with insufficient serum immunoreactive insulin (IRI) elevation after subcutaneous NPH-insulin injection. Favorable glycemic control was achieved by a continuous subcutaneous insulin infusion (CSII) using regular insulin. A 34-year-old woman with Type-1 diabetes (height 158 cm, weight 43.4 kg) was admitted to our hospital to improve glycemic control. On admission, her glycosylated hemoglobin (HbA(1c)) level was 10.9% and her fasting plasma glucose (FPG) level was 332 mg/dl. After admission, her insulin regimen was altered from two injections a day using premixed insulin to four injections a day using regular insulin before each meal and NPH insulin at bedtime. Although the dosage of NPH insulin at bedtime was increased to 32 U/day, there was no improvement in the FPG level. The peak IRI value after NPH insulin injection was not observed but that after the regular insulin injection was observed. Therefore, her insulin administration regimen was changed to CSII, using regular insulin alone. Her fasting plasma glucose level decreased, glycosylated hemoglobin (HbA(1c)) level improved to 7.0%, her body weight increased to 46.6 kg 4 months after starting CSII.
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Affiliation(s)
- Shimpei Fujimoto
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Japan.
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Yoshitani K, Kawaguchi M, Takahashi M, Kitaguchi K, Furuya H. Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass. Br J Anaesth 2003; 90:122-6. [PMID: 12538365 DOI: 10.1093/bja/aeg010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND During cardiopulmonary bypass (CPB), several factors affect drug disposition and action. This topic has not been studied extensively during normothermic CPB. In this study, we related propofol dose to plasma propofol concentration and burst suppression of the EEG during normothermic bypass. METHODS After institutional approval and informed consent, 45 patients having cardiac surgery were assigned randomly to receive propofol infusions at 4 (Group A), 5 (Group B) and 6 (Group C) mg kg(-1) h(-1) during normothermic CPB. In all patients, small to moderate doses of fentanyl were also administered. Plasma propofol concentration and burst suppression ratio (BSR) were measured at the following times: (1) 10 min before CPB, (2) 10 min after the start of CPB, (3) 30 min after the start of the CPB, (4) just after aortic declamping, and (5) 60 min after CPB. RESULTS At baseline, plasma propofol concentrations were similar among the three groups. After the start of CPB, the concentrations of propofol decreased significantly by 41, 35, and 30% of control values in Groups A, B, and C, respectively. In Group A, the concentration of propofol during CPB remained unchanged at less than the concentration before bypass. In Groups B and C, plasma propofol concentrations gradually increased during CPB to the pre-bypass concentrations. In Group A, BSR values did not change significantly during CPB. In Groups B and C, BSR values gradually increased and became significantly greater than baseline values. No patient reported intraoperative awareness. CONCLUSION The pharmacokinetics and pharmacodynamics of propofol change during normothermic CPB. During normothermic CPB, the efficacy of propofol may be enhanced compared with before CPB.
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Affiliation(s)
- K Yoshitani
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Kitamura Y, Nariyuki S, Yoshitani K. Volume profile for the trans .dblharw. cis isomerization of the chloroaquabis(ethylenediamine)cobalt(III) ion. Inorg Chem 2002. [DOI: 10.1021/ic00213a030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yoshitani K, Kawaguchi M, Sugiyama N, Sugiyama M, Inoue S, Sakamoto T, Kitaguchi K, Furuya H. The Association of High Jugular Bulb Venous Oxygen Saturation with Cognitive Decline After Hypothermic Cardiopulmonary Bypass. Anesth Analg 2001; 92:1370-6. [PMID: 11375807 DOI: 10.1097/00000539-200106000-00003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED This study was conducted to investigate whether jugular bulb venous oxygen saturation (SjVO(2)) predicted cognitive decline after cardiac surgery with hypothermic cardiopulmonary bypass (CPB). We studied 35 patients undergoing cardiac surgery. After the induction of anesthesia, a 5.5F fiberoptic oximetry catheter was retrogradely inserted into the jugular bulb, and SjVO(2) and other cerebral oxygenation variables were analyzed before, during, and after CPB. At each point, an oxyhemoglobin dissociation curve was drawn, and the P(50) value of jugular bulb venous blood was calculated by computer analysis. Cognitive function was assessed with the revised version of Hasegawa's Dementia Scale and the Benton Revised Visual Retention Test before and early after the operation. In 15 patients (the Decline group), cognitive function was declined after surgery, whereas it remained unchanged in 20 patients (the Normal group). SjVO(2) was significantly higher and cerebral oxygen extraction was significantly lower before and during CPB in the Decline group than in the Normal group (P < 0.05). The oxygen pressure at an oxygen saturation of 50% was significantly lower before and after CPB in the Decline group than in the Normal group (P < 0.05). Logistic regression analysis showed that high SjVO(2) was a predictor of cognitive decline after cardiac surgery. We conclude that high SjVO(2) was associated with cognitive decline after cardiac surgery with hypothermic CPB. IMPLICATIONS Jugular bulb venous oxygen desaturation has been suggested as a predictor of cognitive decline after cardiac surgery. However, the clinical value of jugular bulb venous oxygen saturation (SjVO(2)) may be limited during hypothermic cardiopulmonary bypass (CPB) when oxygen affinity to hemoglobin is increased. This study shows that high SjVO(2) before and during hypothermic CPB is a predictor of subsequent cognitive decline.
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Affiliation(s)
- K Yoshitani
- Department of Anesthesiology, Nara Medical University, Nara, Japan.
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Yoshitani K, Kitamura Y, Shibata A. Reaction volume for the covalent hydration of cobalt(III) complexes with a hexafluoro-2,4-pentanedionato ligand in water and in methanol. Polyhedron 1994. [DOI: 10.1016/s0277-5387(00)83087-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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