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Tamagawa Y, Kawamura M, Shibata K, Asada S, Ryugo M, Tsutsumi YI, Monta O. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 2024; 72:305-310. [PMID: 37656401 DOI: 10.1007/s11748-023-01970-3] [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] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Aortic dilatation concurrent with aortic valve disease is a common condition. However, the incidence of aortic dissection after aortic valve replacement for tricuspid aortic valve has not been fully investigated. Therefore, we performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. METHODS We retrospectively reviewed 599 patients who underwent aortic valve replacement at our hospital between January 2000 and December 2020. We performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. RESULTS Seven patients developed late aortic dissections during the follow-up period. All patients with aortic dissection underwent aortic valve replacement for aortic regurgitation. Multivariable analysis revealed that aortic regurgitation was an independent predictor of aortic dissection (p < 0.0001). The mean ascending aortic diameter at aortic valve replacement for aortic regurgitation was significantly greater in patients with aortic dissection than in those without aortic dissection (46 [43.5-46] mm vs. 39 [36-42] mm, p < 0.001). The predictive cutoff value of ascending aortic diameter was indicated using receiver operating characteristic curve analysis; 46.0 mm (area under the curve: 0.8987). Freedom rates from aortic dissection in patients with aortic regurgitation and an ascending aortic diameter ≥ 46 mm were significantly lower than those in patients with an ascending aortic diameter < 46 mm (66.7% vs. 100% at 5 years, p < 0.0001). CONCLUSION Aortic regurgitation combined with ascending aortic dilatation at aortic valve replacement could be a significant risk factor for late aortic dissection.
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Affiliation(s)
- Yuki Tamagawa
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan.
| | - Kana Shibata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Satoshi Asada
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Yasush I Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
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Asada S, Oda S, Maeda Y, Fujita S, Hongu H, Yamashita E, Nakatsuji H, Nagase T, Nakai R, Hayashi T, Ikarashi J, Goto Y, Yamagishi M. Configuration of the neoaortic root after chimney reconstruction in the Norwood procedure. Eur J Cardiothorac Surg 2024; 65:ezae103. [PMID: 38489836 DOI: 10.1093/ejcts/ezae103] [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: 09/20/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES After staged reconstruction for hypoplastic left heart syndrome, the neoaortic root tends to dilate, and the incidence of significant neoaortic valve insufficiency increases with time. This study aimed to evaluate the mid-term outcomes of the neoaortic root geometries and valve function after chimney reconstruction in the Norwood procedure. METHODS Between 2013 and 2021, 20 consecutive patients who underwent chimney reconstruction during the Norwood procedure for hypoplastic left heart syndrome and its variants in our institution were enrolled. The actual diameters of the following points were measured, and Z-scores were calculated based on the normal aortic root geometries using the long axis view of echocardiography at the pre-Norwood stage and the lateral view of angiography at pre-Glenn, pre-Fontan, post-Fontan and follow-up (age 5-6 years) stages: neoaortic valve annulus; sinus of Valsalva; sinotubular junction; and ascending aorta just proximal to the anastomosis to the aortic arch. The degree of neoaortic valve regurgitation was evaluated by echocardiography at each stage. RESULTS The median follow-up period was 3.9 years. Neoaortic roots after chimney reconstruction were spared from progressive dilation over time. With growth, the conical configuration of the neoaortic roots was preserved without geometrical distortion. The Z-scores of the annulus, sinus of Valsalva, sinotubular junction and ascending aorta ranged roughly from 4 to 6, 4 to 6, 2 to 4 and 0 to 2, respectively. All neoaortic valves at each stage had mild or no regurgitation. CONCLUSIONS Chimney reconstruction prevented neoaortic root dilation and avoided significant neoaortic valve regurgitation in the mid-term. These neoaortic dimensions with smooth flow profiles in the neoaorta after chimney reconstruction may have contributed to the current results. Further studies are needed to clarify the long-term outcomes.
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Affiliation(s)
- Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rie Nakai
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takaaki Hayashi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Ikarashi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasutaka Goto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hirai K, Kawasaki T, Soejima T, Kajiyama K, Fukami Y, Asada S, Haraguchi K, Fukuoka R, Orita Y, Umeji K, Koga H, Yamabe H. Impact of Intensive Low-Density Lipoprotein Cholesterol-Lowering Therapy on Coronary Artery Plaques in Acute Coronary Syndrome. Am J Cardiol 2023; 204:84-91. [PMID: 37541152 DOI: 10.1016/j.amjcard.2023.07.049] [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: 03/13/2023] [Revised: 06/24/2023] [Accepted: 07/09/2023] [Indexed: 08/06/2023]
Abstract
Acute coronary syndrome (ACS) is associated with a high incidence of unstable plaques beyond the culprit lesion, leading to early recurrence of cardiovascular events. Coronary computed tomography angiography (CCTA) can be used to noninvasively observe plaques throughout the coronary arteries. To evaluate the impact of intensive low-density lipoprotein cholesterol (LDL-C)-lowering therapy on quantitative changes in coronary plaque, assessed using CCTA in a study population with ACS. In total, 81 consecutive patients with ACS who underwent CCTA at discharge and at 1-year follow-up from April 2018 to March 2020 were analyzed. The patients were divided into 2 groups: those who achieved LDL-C <70 mg/100 ml and those who did not. Changes in plaque morphology within and between the 2 groups were compared using CCTA. A total of 198 vessels were analyzed. The calcified plaque volume was significantly increased in the LDL-C <70 group (65.8 ± 80.1 mm3 to 73.6 ± 83.7 mm3, p = 0.007), whereas no significant change was observed in the LDL-C ≥70 group (106.9 ± 161.7 mm3 to 105.7 ± 137.5 mm3, p = 0.552). Percent change in low-attenuation plaque volume in the LDL <70 group was significantly lower than in the LDL-C ≥70 group (17.2 ± 90.9% vs 84.4 ± 162.6%, p = 0.020). Receiver operating characteristic curve analysis demonstrated that the target LDL-C level for low-attenuation plaque volume regression was 64 mg/100 ml. In conclusion, noninvasive CCTA demonstrated that intensive LDL-C lowering in high-risk patients with ACS could potentially lead to plaque stabilization.
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Affiliation(s)
- Keisuke Hirai
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan.
| | - Tomohiro Kawasaki
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Toshiya Soejima
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Kimihiro Kajiyama
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Yurie Fukami
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Kazuki Haraguchi
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Ryota Fukuoka
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Yoshiya Orita
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Kyoko Umeji
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Hisashi Koga
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Hiroshige Yamabe
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
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Asada S, Yamagishi M, Oda S, Maeda Y, Fujita S, Hongu H, Yamashita E, Nakatsuji H, Nagase T, Nakai R, Hayashi T. Modified half-turned truncal switch operation for posterior transposition of the great arteries with left ventricular outflow tract obstruction. JTCVS Tech 2023; 20:138-142. [PMID: 37555022 PMCID: PMC10405312 DOI: 10.1016/j.xjtc.2023.05.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yosinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rie Nakai
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takaaki Hayashi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hongu H, Oda S, Maeda Y, Asada S, Fujita S, Yamashita E, Nagase T, Yamagishi M. A new predictor of the optimal pulmonary artery reconstruction method during the arterial switch operation. Eur J Cardiothorac Surg 2023; 64:ezad173. [PMID: 37140552 DOI: 10.1093/ejcts/ezad173] [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: 10/03/2022] [Revised: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to more accurately predict the optimal pulmonary artery (PA) reconstruction procedure (Lecompte manoeuvre or original Jatene procedure) during the arterial switch operation, we focused on the horizontal sectioning (HS) angle between the left hilum PA and the great arteries using preoperative computed tomography imaging. METHODS We defined the HS angle α (β) as the angle between the tangential line from the posterior (anterior) wall of the left PA at the hilum to the left anterior (right posterior) surface of the main PA and the tangential line from the left surface of the ascending aorta to the left anterior (right posterior) surface of the main PA. We identified 14 consecutive patients diagnosed with transposition of the great arteries or transposition of the great artery-type double-outlet right ventricle who underwent preoperative computed tomography imaging. The original Jatene or Lecompte procedure was used for 9 (OJ group) and 5 (L group) patients. Relationships of the great arteries of the OJ and L groups were side by side in 8 and 2 patients, oblique in 1 and 1 patient and anteroposterior in 0 and 2 patients, respectively. RESULTS In the OJ group, β was greater than α in all patients. The median α/β value was 0.618. In group L, α was greater than β in all patients. The median α/β was 1.307. Left PA stenosis caused by stretching was not observed in the L group. Coronary obstruction was not identified in the OJ group. Left PA stenosis behind the neo-ascending aorta was observed in 1 patient in the OJ group and required reoperation. CONCLUSIONS The HS angle may be a useful predictor of optimal intraoperative PA reconstruction during arterial switch operation, especially for side-by-side or oblique relationships.
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Affiliation(s)
- Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Angiographic Coronary Calcification: A Simple Predictor of Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. J Atheroscler Thromb 2023; 30:990-1001. [PMID: 36273917 PMCID: PMC10406646 DOI: 10.5551/jat.63856] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
AIMS Coronary calcification detected by coronary angiography is a simple risk marker for long-term clinical outcomes in stable coronary artery disease. However, the significance of angiographic coronary calcification in the culprit lesion of acute myocardial infarction (AMI) has not been fully discussed. The purpose of this retrospective study was to assess the usefulness of angiographic coronary calcification as a risk marker for long-term clinical outcomes following percutaneous coronary intervention to the culprit lesions of AMI. METHODS We included 1209 patients with AMI and divided them into the none-mild calcification group (n=923) and the moderate-severe calcification group (n=286) according to angiographic coronary calcification in the culprit lesion of AMI. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, nonfatal MI, readmission for heart failure, and ischemia-driven target vessel revascularization. RESULTS The median follow-up duration was 542 (Q1: 182, Q3: 990) days. A total of 345 MACE were observed during the study period. The occurrence of MACE was significantly greater in the moderate-severe calcification group than in the none-mild calcification group (43.4% vs. 23.9%, p<0.001). In the multivariate Cox hazard model, moderate-severe calcification was significantly associated with MACE (hazard ratio 1.302, 95% confidence interval 1.011-1.677, p=0.041) after controlling multiple confounding factors. CONCLUSIONS Angiographically moderate to severe calcification in AMI culprit lesion was associated with long-term worse clinical outcomes. Angiographic coronary calcification can be a simple risk marker in patients after AMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Akiyama K, Wu IY, Hori K, Sakamoto H, Kosumi R, Koto H, Asada S, Nakajima Y. ST Segment Elevation Immediately After Cardiopulmonary Bypass During Modified Blalock-Taussig Shunt and Pulmonary Artery Banding. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00342-7. [PMID: 37296023 DOI: 10.1053/j.jvca.2023.05.034] [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] [Received: 05/11/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Koichi Akiyama
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan.
| | - Isaac Y Wu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Kei Hori
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan
| | - Hiroatsu Sakamoto
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan
| | - Reiko Kosumi
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan
| | - Hirokazu Koto
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan
| | - Satoshi Asada
- Department of Cardiovascular Surgery, Kindai University Hospital, Osakasayama City, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kindai University Hospital, Osakasayama City, Japan
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Honde K, Asada S. Giant coronary pseudoaneurysm associated with stent fracture treated successfully with coil embolization and a vascular plug. J Cardiol Cases 2023; 27:116-119. [PMID: 36910033 PMCID: PMC9995659 DOI: 10.1016/j.jccase.2022.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
A 59-year-old man with acute cholangitis was referred to us because of a coronary artery aneurysm that was incidentally detected on contrast-enhanced computed tomography. Intravascular ultrasonography showed a loss of vascular layers and complete stent fracture, which was suggestive of a pseudoaneurysm. After some management protocols, such as observation, covered stent implantation, and surgical treatment, had failed, we treated the pseudoaneurysm successfully using coil embolization and a vascular plug. There were no complications during the perioperative period. We suggest that, if conventional management fails, treatment with coil embolization and a vascular plug should be considered. Learning objective A rare complication of percutaneous coronary intervention resulting from stent fracture is a coronary artery aneurysm. Here, we discuss the chronic complications of stent implantation and discuss the optimal management strategy for coronary pseudoaneurysms. Further, we discuss the strengths and weaknesses of each strategy.
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Affiliation(s)
- Kei Honde
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Satoshi Asada
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
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Nagase T, Yamagishi M, Maeda Y, Asada S, Hongu H, Yamashita E, Nakai R, Yaku H. Multiple Pulmonary Artery Plasty With Tissue-Engineered Vascular Grafts. Ann Thorac Surg 2023; 115:e11-e13. [PMID: 35259392 DOI: 10.1016/j.athoracsur.2022.02.039] [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: 12/31/2021] [Revised: 02/12/2022] [Accepted: 02/20/2022] [Indexed: 12/31/2022]
Abstract
In pediatric cardiovascular surgery, the autologous pericardium is useful for pulmonary artery augmentation. However, in some cases, the autologous pericardium may not be available for various reasons. Since 2014, we have developed tissue-engineered vascular grafts (TEVGs) and obtained good results. We report a successful case of multiple pulmonary artery plasty with TEVGs for pulmonary atresia/ventricular septal defect with major aortopulmonary collateral arteries. TEVGs are useful alternatives to autologous pericardium in pediatric cardiovascular operations that often require multistage procedures.
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Affiliation(s)
- Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rie Nakai
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of collateral flow with clinical outcomes in patients with acute myocardial infarction. Heart Vessels 2022; 37:1496-1505. [PMID: 35290505 DOI: 10.1007/s00380-022-02054-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 10/15/2021] [Accepted: 03/04/2022] [Indexed: 01/27/2023]
Abstract
Coronary collateral flow is an important prognostic marker in percutaneous coronary intervention (PCI) for chronic total occlusion. However, the role of collateral flow to the culprit lesion of acute myocardial infarction (AMI) has not been fully established yet. The purpose of this retrospective study was to examine the association between collateral flow and long-term clinical outcomes in patients with AMI. We included 937 patients with AMI, and divided those into the no-collateral group (n = 704) and the collateral group (n = 233) according to the presence or absence of collateral flow to the culprit lesion of AMI. The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, non-fatal MI, re-admission for heart failure, and ischemia driven target vessel revascularization. The median follow-up duration was 473 days (Q1: 184 days- Q3: 1027 days), and a total of 263 MACE was observed during the study period. The incidence of MACE was significantly greater in the no-collateral group than in the collateral group (29.8% vs. 22.3%, p = 0.027). In the multivariate COX hazard model, the presence of collateral flow was inversely associated with MACE (HR 0.636, 95% CI 0.461-0.878, p = 0.006) after controlling multiple confounding factors. In conclusion, the presence of collateral flow to the culprit lesion of AMI was inversely associated with long-term adverse outcomes. Careful observation of collateral flow may be important in emergent coronary angiography to stratify a high-risk group among various patients with AMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
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11
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Nagase T, Yamagishi M, Maeda Y, Asada S, Hongu H, Yamashita E, Nakai R, Yaku H. Surgical repair of a posterior left ventricular aneurysm in a 4-year-old boy. Asian Cardiovasc Thorac Ann 2022; 30:931-934. [PMID: 35821584 DOI: 10.1177/02184923221114458] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left ventricular aneurysms are rarely encountered in pediatric patients. A 4-year-old boy was diagnosed with severe mitral regurgitation and a posterior left ventricular aneurysm associated with a viral infection. The aneurysm was surgically resected and plicated longitudinally with a combination of an interrupted mattress and continuous over-and-over sutures with an outer felt reinforcement. The mitral regurgitation was reduced to a trivial degree postoperatively. The patient's postoperative recovery was good. He was discharged 31 days after surgery without cardiac dysfunction or lethal arrhythmia. Considering the location and spread of the aneurysm, an appropriate surgical procedure should be adopted for pediatric patients.
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Affiliation(s)
- Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rie Nakai
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, and Division of Cardiovascular Surgery, Department of Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
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Asada S, Yamagishi M, Itatani K. Gradual caliber transition of the neoaortic arch after the Norwood procedure can prevent neoaortic dilation and right ventricular deterioration. JTCVS Open 2022; 10:350-351. [PMID: 36004230 PMCID: PMC9390451 DOI: 10.1016/j.xjon.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Hohri Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Numata S, Yaku H. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6580210. [PMID: 35512199 PMCID: PMC9387505 DOI: 10.1093/icvts/ivac119] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Corresponding author. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. Tel: +81-75-2515752; fax: +81-75-2575910; e-mail: (Y. Hohri)
| | - Masaaki Yamagishi
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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14
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction. Sci Rep 2021; 11:21403. [PMID: 34725407 PMCID: PMC8560938 DOI: 10.1038/s41598-021-00832-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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15
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Asada S, Yamagishi M, Maeda Y, Itatani K, Fujita S, Hongu H, Nakatsuji H, Yaku H. Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation. Eur J Cardiothorac Surg 2021; 60:1408-1416. [PMID: 33890109 DOI: 10.1093/ejcts/ezab184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 10/01/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary artery (PA) compression by the neoaorta is a serious complication after the Norwood-type palliation (NP) for hypoplastic left heart syndrome. Either excess patch tailoring or limited use of autologous tissue may cause narrowing of the subaortic space. The chimney technique could theoretically provide a wide subaortic space. METHODS Twenty-nine patients with both pre- and post-NP computed tomography data available of the 37 consecutive patients who underwent NP in our institution were reviewed. Arch height, arch width, sinus of Valsalva diameter, area under the neoaortic arch and arch angle were measured. These patients were divided according to the neo-arch reconstruction technique, chimney reconstruction technique (CR) or conventional direct reconstruction technique (DR). RESULTS Median age and weight at NP were 2.1 months and 3.5 kg, respectively. Twenty-two patients underwent previous bilateral PA banding. During NP, 17 CR and 12 DR were performed. Four patients in the DR group developed PA compression. No neoaortic arch dilatation was found in either group. Post-NP arch width, area under the neo-arch and the arch angle were significantly larger in the CR group. Pre-NP arch height was significantly smaller in DR patients with PA compression than in those without. CONCLUSIONS The chimney technique decreased the risk of PA compression and provided a wider subaortic space and a less acute arch angle. This technique had no short-term effect on the neoaortic root. Small preoperative arch height is a potential risk factor for PA compression in DR, and the chimney technique could be an effective solution.
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Affiliation(s)
- Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Clinical Factors Associated with Long Fluoroscopy Time in Percutaneous Coronary Interventions to the Culprit Lesion of Non-ST-Segment Elevation Myocardial Infarction. Int Heart J 2021; 62:282-289. [PMID: 33731534 DOI: 10.1536/ihj.20-634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/18/2022]
Abstract
The clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) were comparable or even worse than those with ST-segment elevation myocardial infarction (STEMI). Although successful percutaneous coronary intervention (PCI) to the culprit lesions of NSTEMI would improve the clinical outcomes, some PCI require long fluoroscopy time, reflecting the difficulty of PCI. This study aims to find clinical factors associated with long fluoroscopy time in PCI to the culprit lesion of NSTEMI. We included 374 patients and divided those into the conventional fluoroscopy time (n = 302) and long fluoroscopy time (n = 72) groups according to the quintiles of fluoroscopy time. Clinical and angiographic parameters were compared between the two groups. Calcification and tortuosity were significantly more severe in the long fluoroscopy time group than in the conventional fluoroscopy time group. The prevalence of previous coronary artery bypass grafting (CABG) and bifurcation lesions was significantly greater in the long fluoroscopy time group than in the conventional fluoroscopy time group. In the multivariate stepwise logistic regression analysis, previous CABG (odds ratio [OR], 3.368; 95% confidence interval [CI], 1.407-8.064; P = 0.006), bifurcation lesion (OR, 2.407; 95% CI, 1.285-4.506; P = 0.006), excessive tortuosity (versus mild to moderate tortuosity; OR, 4.095; 95% CI, 1.159-14.476; P = 0.029), and moderate to severe calcification (versus none to mild; OR, 5.792; 95% CI, 3.254-10.310; P < 0.001) were significantly associated with long fluoroscopy time. In conclusion, previous CABG, bifurcation, excessive tortuosity, and moderate to severe calcification were associated with long fluoroscopy time. Our study provided a reference for PCI operators to identify the difficulties in PCI to the culprit lesion of NSTEMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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17
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Hongu H, Yamagishi M, Maeda Y, Itatani K, Asada S, Fujita S, Nakatsuji H, Yaku H. Comparison of half-turned truncal switch and conventional operations. Interact Cardiovasc Thorac Surg 2021; 33:101-109. [PMID: 33667315 DOI: 10.1093/icvts/ivab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare conventional procedures with the half-turned truncal switch operation (HTTSO) for the management of complete transposition of the great arteries with left ventricular outflow tract (LVOT) obstruction using time-resolved 3-dimensional magnetic resonance phase-contrast imaging. METHODS We identified 2 cases that underwent the Rastelli procedure and one case that underwent the Réparation a l'étage ventriculaire before 2002 [conventional procedures group (group C)], and 16 cases of HTTSO that were performed between 2002 and 2020 [HTTSO group (group H)]. Postoperative haemodynamics were assessed using time-resolved 3-dimensional magnetic resonance phase-contrast imaging in cases in both groups. RESULTS The median follow-up period was 20.4 years in group C, and 6.1 years in group H. In group C, all 3 patients underwent reoperation because of postoperative right ventricular outflow tract obstruction and/or insufficiency. In addition, permanent pacemaker implantation was needed in 1 patient because of complete atrioventricular block complicated by ventricular septal defect enlargement. In group H, reoperation for LVOT/right ventricular outflow tract obstruction was not needed. A time-resolved 3-dimensional magnetic resonance phase-contrast imaging examination revealed high energy loss and wall shear stress in the winding LVOT in the group C. In contrast, low energy loss and wall shear stress, with straight and smooth LVOT, were identified in group H. CONCLUSIONS HTTSO was shown to be superior to conventional procedures because a straight and wide LVOT could be obtained. Therefore, HTTSO should be the first choice for complete transposition of the great arteries with LVOT obstruction.
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Affiliation(s)
- Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yamaguchi M, Omori K, Asada S, Yoshida H. Epigenetic Regulation of ALS and CMT: A Lesson from Drosophila Models. Int J Mol Sci 2021; 22:ijms22020491. [PMID: 33419039 PMCID: PMC7825332 DOI: 10.3390/ijms22020491] [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] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the third most common neurodegenerative disorder and is sometimes associated with frontotemporal dementia. Charcot–Marie–Tooth disease (CMT) is one of the most commonly inherited peripheral neuropathies causing the slow progression of sensory and distal muscle defects. Of note, the severity and progression of CMT symptoms markedly vary. The phenotypic heterogeneity of ALS and CMT suggests the existence of modifiers that determine disease characteristics. Epigenetic regulation of biological functions via gene expression without alterations in the DNA sequence may be an important factor. The methylation of DNA, noncoding RNA, and post-translational modification of histones are the major epigenetic mechanisms. Currently, Drosophila is emerging as a useful ALS and CMT model. In this review, we summarize recent studies linking ALS and CMT to epigenetic regulation with a strong emphasis on approaches using Drosophila models.
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Affiliation(s)
- Masamitsu Yamaguchi
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan; (K.O.); (S.A.)
- Kansai Gakken Laboratory, Kankyo Eisei Yakuhin Co. Ltd., Seika-cho, Kyoto 619-0237, Japan
- Correspondence: (M.Y.); (H.Y.)
| | - Kentaro Omori
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan; (K.O.); (S.A.)
| | - Satoshi Asada
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan; (K.O.); (S.A.)
| | - Hideki Yoshida
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan; (K.O.); (S.A.)
- Correspondence: (M.Y.); (H.Y.)
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19
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Fujita S, Yamagishi M, Miyazaki T, Maeda Y, Itatani K, Yamamoto Y, Asada S, Hongu H, Nakatsuji H, Yaku H. Long-term results of large-calibre expanded polytetrafluoroethylene-valved conduits with bulging sinuses. Eur J Cardiothorac Surg 2020; 58:1274-1280. [PMID: 32984875 DOI: 10.1093/ejcts/ezaa240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 03/16/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In Japan, homograft and bovine jugular vein are available in very limited institutions for the reconstruction of the right ventricular outflow tract, and handmade expanded polytetrafluoroethylene (ePTFE)-valved conduits have been widely used instead. This study aimed to clarify the long-term outcomes and the durability of the ePTFE-valved conduits purely by narrowing down to those with large sizes to eliminate the influence of the body growth. METHODS Between January 2002 and December 2015, patients who underwent right ventricular outflow tract reconstruction in 34 Japanese institutions using ePTFE-valved conduits with a diameter of ≥18 mm were included. All the valved conduits were made in the authors' institution and delivered to each participating institution. RESULTS Overall, 502 patients were included. Early mortality was 1.4% and not related to conduit failure. The overall survival rate was 98.2% at 5 years and 96.6% at 10 years. Freedom from conduit explantation was 99.5% at 5 years and 89.0% at 10 years. Three patients (0.13 per 100 patient-years) developed infective endocarditis of the conduit, and only 1 patient required conduit removal. Pulmonary insufficiency was mild or less in 480 (96%) patients, and conduit stenosis was mild or less in 436 (88%) patients at the latest follow-up. CONCLUSIONS By narrowing the analyses down to only ePTFE conduits with a large size, satisfactory long-term outcomes of these conduits with a fan-shaped valve and bulging sinuses were shown. These conduits would be among the optimal choices for right ventricular outflow tract reconstruction.
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Affiliation(s)
- Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takako Miyazaki
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ryugo M, Monta O, Saitou S, Asada S, Tamagawa Y, Takehara T, Tsutsumi Y. [Risk Analysis of Acute Kidney Injury after Cardiac Surgery and Protective Effect by Less Invasive Surgery]. Kyobu Geka 2020; 73:895-900. [PMID: 33130709] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We aimed to determine the incidence and risk of acute kidney injury (AKI) in patients after cardiac surgery, and to assess the effects of less invasive cardiac surgery on the prevention of postoperative AKI. METHODS We retrospectively analyzed perioperative parameters in patients who underwent cardiac surgery. Risk factors for AKI were determined using univariate and multiple logistic regression models. The incidence of postoperative AKI was also compared between conventional and minimally invasive cardiac surgeries. RESULTS Among 126 patients, 36 (28.6%) who developed postoperative AKI stayed significantly longer in the intensive care unit(ICU), required prolonged postoperative ventilation and had a higher frequency of renal replacement therapy. Multivariate analysis revealed cardio-pulmonary bypass (CPB) duration and red blood cell transfusion as independent risk factors for postoperative AKI. The incidence of postoperative AKI was significantly lower after off-pump coronary artery bypass grafting than conventional coronary artery bypass grafting (CABG)(0% versus 11%, p=0.025), and after minimally invasive cardiac surgery compared with conventional valve surgery( 4% versus 44%, p=0.01) Conclusion:The duration of CPB and red blood cell transfusion were considered independent factors for the development of postoperative AKI. Less invasive cardiac surgeries might protect against postoperative AKI.
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Affiliation(s)
- Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
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Asada S, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Association of the long fluoroscopy time with factors in contemporary primary percutaneous coronary interventions. PLoS One 2020; 15:e0237362. [PMID: 32776989 PMCID: PMC7416924 DOI: 10.1371/journal.pone.0237362] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Since the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI). METHODS A total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time. RESULTS In univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397-2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498-10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107-3.140, P = 0.019) were significantly associated with the long fluoroscopy-time. CONCLUSIONS In primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.
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Affiliation(s)
- Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
- * E-mail:
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Shin-ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
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22
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Fujita S, Yamagishi M, Maeda Y, Itatani K, Asada S, Hongu H, Yamashita E, Takayanagi Y, Nakatsuji H, Yaku H. The effect of a valved small conduit on systemic ventricle–pulmonary artery shunt in the Norwood-type palliation. Eur J Cardiothorac Surg 2020; 57:1105-1112. [DOI: 10.1093/ejcts/ezz377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/29/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to clarify the impact of valved systemic ventricle–pulmonary artery (SV–PA) shunt on outcomes after stage-1 Norwood-type palliation (NP) compared with the modified Blalock–Taussig shunt.
METHODS
Consecutive patients who underwent NP between 2003 and 2019 were enrolled. SV–PA shunts using the expanded polytetrafluoroethylene valved conduit were implanted in 18 patients (valved SV–PA group), and another 18 patients underwent modified Blalock–Taussig shunt during NP (modified Blalock–Taussig shunt group). All valved conduits were made in our institution in advance.
RESULTS
No differences in baseline characteristics were found between the groups, except for shunt size. During a median 2.9 (interquartile range 0.4–6.4, maximum 14.2) years of follow-up, 8 (22.2%) patients died across both groups. There were no statistically significant differences in early mortality (5.5% vs 11.1%, P = 0.55) and overall survival rates at 5 years (80.8% vs 71.4%, P = 0.48) in the valved SV–PA and modified Blalock–Taussig shunt groups. No statistically significant difference was observed in the frequency of interventions between the groups (31% vs 33%, P = 1.0). At the time of the bidirectional Glenn procedure, the systemic ventricular end-diastolic volume index was significantly lower (84 ± 24 vs 106 ± 31 ml/m2, P = 0.05) and the ejection fraction was significantly greater (62 ± 8% vs 55 ± 9%, P = 0.03) in the valved SV–PA group. There was no statistically significant difference in the pulmonary artery index (228 ± 85 vs 226 ± 60 mm2/m2, P = 0.92).
CONCLUSIONS
A valved SV–PA shunt using an expanded polytetrafluoroethylene valved conduit was associated with preserved ventricular function after NP and did not impair pulmonary artery growth by controlling pulmonary regurgitation.
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Affiliation(s)
- Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Takayanagi
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Affiliation(s)
- Naohiro Toda
- Department of Nephrology, Kansai Electric Power Hospital, Japan
| | - Satoshi Asada
- Department of Cardiology, Kansai Electric Power Hospital, Japan
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24
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Yamamoto Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Fujita S, Yaku H. Histopathologic Analysis of Explanted Polytetrafluoroethylene-Valved Pulmonary Conduits. Semin Thorac Cardiovasc Surg 2019; 32:990-999. [PMID: 31606427 DOI: 10.1053/j.semtcvs.2019.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
The expanded polytetrafluoroethylene (ePTFE)-valved conduits as alternative material for right ventricular outflow reconstruction provides satisfactory long-term outcomes. The purpose of this study was to investigate degenerative changes in failed conduits through histopathologic analysis of the explanted specimens. All leaflets of explanted conduits were observed macroscopically, and their longitudinal sections were examined microscopically. Three typical findings, that is, calcification of the leaflet, neointimal proliferation, and proteinaceous infiltration into the leaflet, were evaluated quantitatively by measuring their degree and appearance probability. A total of 15 leaflets from 5 failed conduits (group F) and 12 leaflets from 5 nonfailed conduits (group non-F) were included. The median duration of implantation was 7.6 years (5.3-10.9 years) in group F and 1.3 years (0.7-3.9 years) in group non-F (P = 0.003). In group F, calcification tended to occur in the middle and upper third of the leaflet, causing stiffening, distortion, and exophytic concretion of the leaflet, and mean neointimal thickness on inflow and outflow surfaces were 0.33 ± 0.02 mm and 0.22 ± 0.01 mm, respectively. There was a moderately strong correlation between appearance probability of calcification in group F and that of proteinaceous infiltration in group non-F (correlation coefficient 0.67, P < 0.001). Proteinaceous infiltration into the leaflet was presumed be responsible for future calcification of the leaflet and subsequent stenotic conduit failure. Modification of the ePTFE material to prevent proteinaceous infiltration may contribute to improving the durability of ePTFE-valved conduit.
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Affiliation(s)
- Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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25
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Asada S, Yamagishi M, Itatani K, Maeda Y, Taniguchi S, Fujita S, Hongu H, Yaku H. Early outcomes and computational fluid dynamic analyses of chimney reconstruction in the Norwood procedure†. Interact Cardiovasc Thorac Surg 2019; 29:252–259. [PMID: 30879071 DOI: 10.1093/icvts/ivz040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The ideal configuration of a reconstructed aortic arch in the Norwood procedure for hypoplastic left heart syndrome is still a matter of debate. Chimney reconstruction was developed to avoid postoperative complications and turbulent flow in the aortic arch. This study sought to clarify early outcomes of the procedure and verify its haemodynamic advantages using computational fluid dynamics (CFD). METHODS Fourteen consecutive patients with hypoplastic left heart syndrome or a variant who underwent chimney reconstruction in the Norwood procedure between January 2013 and March 2018 were enrolled. Median age and body weight at the time of operation were 2.5 months and 4.1 kg, respectively. Thirteen patients (93.9%) had been palliated with previous bilateral pulmonary artery (PA) banding. In addition, patient-specific CFD models of neoarches based on postoperative computed tomograms from 6 patients were created and the flow profiles analysed. RESULTS Survival rates at 1, 3 and 5 years were 76.6%, 67.3% and 67.3%, respectively. No patient developed left PA compression by neoaorta, neoaortic dilation or neoaortic insufficiency. Only 2 patients (14.3%) required surgical intervention for recoarctation. Fontan completion was performed on 5 patients. On CFD analysis, all reconstructed aortic arches showed low energy loss (9.16-14.4 mW/m2) and low wall shear stresses. CONCLUSIONS Chimney reconstruction was a feasible technique when homografts were not readily available. CFD analyses underscored the fact that this technique produced excellent flow profiles. Larger studies should be conducted to clarify long-term outcomes.
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Affiliation(s)
- Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Taniguchi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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26
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Miyazaki T, Yamagishi M, Yamamoto Y, Itatani K, Asada S, Fujita S, Hongu H, Maeda Y, Yaku H. Use of an expanded polytetrafluoroethylene valved patch with a sinus in right ventricular outflow tract reconstruction†. Eur J Cardiothorac Surg 2019; 56:671-678. [DOI: 10.1093/ejcts/ezz089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/14/2018] [Revised: 02/17/2019] [Accepted: 02/24/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES:
The objective of this study was to evaluate our late outcomes using expanded polytetrafluoroethylene (ePTFE) valved patches with bulging sinuses and a fan-shaped valve for right ventricular outflow tract (RVOT) reconstruction.
METHODS:
Six hundred and ninety patients underwent RVOT reconstruction using fan-shaped ePTFE valves and ePTFE valved patches with a bulging sinus. The patients’ median age and weight were 1.3 years [range 4 days–64.2 years, interquartile range (IQR) 0.9–2.3 years] and 8.7 (range 2.8–83.1, IQR 7.4–10.5) kg, respectively. The patches were monocuspid in 634 patients, bicuspid in 49 patients and tricuspid in 7 patients. Preoperative and postoperative data were collected retrospectively from the patients’ medical records. The longest follow-up period was 17.5 (7.6 ± 3.9) years.
RESULTS:
There were no deaths related to the ePTFE patch. Pulmonary insufficiency was less than mild in 77.3%, and the peak RVOT gradient was <36 mmHg in 92.3% at the latest follow-up. Redo of RVOT reconstruction was performed in 40 patients, in no cases because of patch infection. Overall freedom from reoperation at 5, 10 and 15 years was 96.5%, 93.1% and 87.9%, respectively; by patient age, the rates at 5, 10 and 15 years for those younger than 1 year were 93.2%, 91.0% and 88.9%, respectively, while for those 1 year or older, they were 97.9%, 94.0% and 88.3%, respectively.
CONCLUSIONS:
Satisfactory long-term outcomes were achieved with ePTFE patches with a bulging sinus and a fan-shaped valve. This ePTFE valved patch could be the optimal choice for RVOT reconstruction.
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Affiliation(s)
- Takako Miyazaki
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Keiichi Itatani
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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27
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Taguchi T, Saito S, Monta O, Ryugo M, Asada S, Yamada S, Tsutsumi Y. Spontaneous Recanalization of Totally Occluded Descending Aorta Due to Acute Aortic Dissection. Ann Thorac Surg 2019; 108:e123. [PMID: 30951695 DOI: 10.1016/j.athoracsur.2019.02.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Takura Taguchi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Satoshi Asada
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Shohei Yamada
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
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28
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Asada S, Yamagishi M, Nishida K, Okazaki S, Nakayama Y, Monta O, Tsutsumi Y, Ohashi H. Anomalous Origin of Left Coronary Artery From Aortic Arch Associated With Hypoplastic Left Heart Syndrome. Ann Thorac Surg 2019; 107:e51-e53. [DOI: 10.1016/j.athoracsur.2018.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/07/2018] [Accepted: 05/12/2018] [Indexed: 10/14/2022]
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29
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Kato N, Yamagishi M, Itatani K, Miyazaki T, Maeda Y, Asada S, Matsui Y, Yaku H. Effects of blood flow dynamics on autologous pericardial degeneration in reconstructed pulmonary arteries. Interact Cardiovasc Thorac Surg 2018; 26:293-300. [PMID: 29049701 DOI: 10.1093/icvts/ivx293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/06/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To clarify the risk factors for abnormal degeneration of autologous pericardium, the mechanical stress on the endothelial tissue caused by turbulent blood flow in the pulmonary artery (PA) reconstructed with autologous pericardium and major aortopulmonary collateral arteries was assumed in pulmonary atresia and ventricular septal defect. METHODS Patient-specific PA models were created for 6 patients based on their past computed tomography images taken after unifocalization of major aortopulmonary collateral arteries. Computational fluid dynamics models were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow streamline, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated from the simulated result. PA degeneration was evaluated with the computed tomography images before the intracardiac repair. RESULTS Regions with physiological high WSS had fewer abnormal changes. Excessively high WSS was often detected at the anastomosis site of the reconstructed PA, and intimal thickening was found in these regions during intracardiac repair. Regions with high OSI and low WSS had dilated change within several months. In 1 patient, in particular, detached vortex flow occurred at the rectangular angle anastomosis site of the right PA in flow streamline, resulting in high OSI and low WSS with abnormal enlargement in the pericardium. CONCLUSIONS Endothelial stress caused by blood flow would affect the degeneration of autologous pericardium and major aortopulmonary collateral arteries in the reconstructed PA. High OSI and low WSS might induce enlargement or dilatation, and excessively high WSS in the anastomosis site might induce intimal thickening.
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Affiliation(s)
- Nobuyasu Kato
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takako Miyazaki
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiro Matsui
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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30
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Hongu H, Yamagishi M, Miyazaki T, Maeda Y, Taniguchi S, Asada S, Fujita S, Yaku H. Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries. Ann Thorac Surg 2018; 106:1421-1428. [DOI: 10.1016/j.athoracsur.2018.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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31
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Kawabata KC, Hayashi Y, Inoue D, Meguro H, Sakurai H, Fukuyama T, Tanaka Y, Asada S, Fukushima T, Nagase R, Takeda R, Harada Y, Kitaura J, Goyama S, Harada H, Aburatani H, Kitamura T. High expression of ABCG2 induced by EZH2 disruption has pivotal roles in MDS pathogenesis. Leukemia 2017; 32:419-428. [PMID: 28720764 DOI: 10.1038/leu.2017.227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/28/2017] [Accepted: 07/04/2017] [Indexed: 01/10/2023]
Abstract
Both proto-oncogenic and tumor-suppressive functions have been reported for enhancer of zeste homolog 2 (EZH2). To investigate the effects of its inactivation, a mutant EZH2 lacking its catalytic domain was prepared (EZH2-dSET). In a mouse bone marrow transplant model, EZH2-dSET expression in bone marrow cells induced a myelodysplastic syndrome (MDS)-like disease in transplanted mice. Analysis of these mice identified Abcg2 as a direct target of EZH2. Intriguingly, Abcg2 expression alone induced the same disease in the transplanted mice, where stemness genes were enriched. Interestingly, ABCG2 expression is specifically high in MDS patients. The present results indicate that ABCG2 de-repression induced by EZH2 mutations have crucial roles in MDS pathogenesis.
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Affiliation(s)
- K C Kawabata
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan.,Division of Hematology/Medical Oncology, Department of Medicine, Weill-Cornell Medical College, Cornell University, New York, NY, USA
| | - Y Hayashi
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - D Inoue
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan.,Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Meguro
- Laboratory of Oncology, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - H Sakurai
- Division of Hematology, Department of Medicine, Juntendo University, Bunkyo, Japan.,Division of Hemalogy, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - T Fukuyama
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - Y Tanaka
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - S Asada
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - T Fukushima
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - R Nagase
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - R Takeda
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - Y Harada
- Division of Hematology, Department of Medicine, Juntendo University, Bunkyo, Japan.,Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Bunkyo, Japan
| | - J Kitaura
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan.,Atopy Research Center, Juntendo University. School of Medicine, Bunkyo-ku, Japan
| | - S Goyama
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
| | - H Harada
- Laboratory of Oncology, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan.,Division of Hematology, Department of Medicine, Juntendo University, Bunkyo, Japan
| | - H Aburatani
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Meguro, Japan
| | - T Kitamura
- Division of Cellular Therapy, Institute of Medical Science, The University of Tokyo, Minato, Tokyo, Japan
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32
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Kato N, Yamagishi M, Miyazaki T, Maeda Y, Asada S, Hongu H, Yamashita E, Yaku H. A Novel Surgical Technique for Right-Sided Interrupted Aortic Arch by Interposition of a Pulmonary Autograft Tube. Ann Thorac Surg 2016; 102:e125-7. [DOI: 10.1016/j.athoracsur.2015.11.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 10/21/2022]
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33
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Nishi M, Zen K, Yamaguchi S, Asada S, Kambayashi D. Popliteal artery aneurysm treated with implantation of a covered stent graft (fluency(®)) reinforced with a nitinol stent (S.M.A.R.T. (®)). Cardiovasc Interv Ther 2015; 31:316-20. [PMID: 26581492 DOI: 10.1007/s12928-015-0360-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
A 60-year-old man was admitted for right knee pain provoked by an enlarging popliteal artery aneurysm (PAA) after endovascular therapy for thromboembolism in the right popliteal artery. The PAA was treated with implantation of a covered stent graft (Fluency(®)); however, acute thromboembolism occurred 6 months after the intervention. Therefore, we implanted a nitinol stent (S.M.A.R.T.(®)) in the proximal part of the covered stent where the major hinge point existed in addition to a stent fracture. No vascular event occurred during 4.5 years of follow-up.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Satoshi Asada
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Daisuke Kambayashi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
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Nishi M, Zen K, Kambayashi D, Asada S, Yamaguchi S, Tatsukawa H. Stent dislodgement induced by a vasodilator used for severe coronary artery spasm caused by Kounis syndrome. Cardiovasc Interv Ther 2015; 31:61-4. [PMID: 25652245 DOI: 10.1007/s12928-015-0320-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
Abstract
Coronary stent dislodgement is a rare but critical complication of percutaneous coronary intervention. It can potentially result in serious consequences, such as stent embolization and emergent coronary artery bypass graft surgery. Here, we describe the successful retrieval of an extracoronary dislodged stent, where dislodgement was induced by a vasodilator used for severe coronary artery spasm caused by Kounis syndrome.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan.
| | - Kan Zen
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan
| | - Daisuke Kambayashi
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan
| | - Satoshi Asada
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan
| | - Hirotaka Tatsukawa
- Department of Cardiology, Omihachiman Community Medical Center, Tsuchidacho 1379, Omihachiman, Shiga, Japan
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Tsukamoto I, Akagi M, Inoue S, Yamagishi K, Mori S, Asada S. Expressions of local renin-angiotensin system components in chondrocytes. Eur J Histochem 2014; 58:2387. [PMID: 24998927 PMCID: PMC4083327 DOI: 10.4081/ejh.2014.2387] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022] Open
Abstract
In 2013, we reported that local reninangiotensin system (local RAS) components express during the hypertrophic differentiation of chondrocytes and can modulate it, using ATDC5 cell line that involves differentiation from mesenchymal stem cells to calcified hypertrophic chondrocytes. However, the expressions of local RAS components in normal chondrocytes have not been revealed yet. The purpose of this study is to examine the expression of the local RAS components in chondrocytes in vivo and the conditions allowing the expression. We stained five major regions of 8-week-old C57BL/6 adult mice in which chondrocytes exist, including epiphyseal plates and hyaline cartilages, with antibodies to local RAS components. We also examined the expression of local RAS components in the cultured bovine’s articular cartilage chondrocytes using quantitative reverse transcription polymerase chain reaction and western blot analysis. In result, hypertrophic chondrocytes of epiphyseal plates included in the tibia and the lamina terminals expressed local RAS components. However, hyaline chondrocytes, including the knee articular cartilages, the parenchyma of nasal septums and of the tracheal walls, did not express local RAS components. Cultured bovine’s articular cartilage chondrocytes also did not express local RAS components. However, inducing hypertrophy by administering interleukin-1β or tumor necrosis factor-α, the cultured articular chondrocytes also expressed angiotensin II type 1 receptor and angiotensin II type 2 receptor. In conclusion, local RAS components express particularly in chondrocytes which occur hypertrophy and do not in hyaline chondrocytes. The results are in accord with our previous in vitro study. We think this novel knowledge is important to investigate cartilage hypertrophy and diseases induced by hypertrophic changes like osteoarthritis.
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Maeda Y, Yamagishi M, Miyazaki T, Yamamoto Y, Taniguchi S, Kanzaki T, Asada S, Hongu H. [The treatment strategy for hypoplastic left heart syndrome]. Kyobu Geka 2014; 67:305-309. [PMID: 24917161] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the recent years, the outcomes of treatment for hypoplastic left heart syndrome (HLHS) is improved because of perioperative management and procedure. We adopt a strategy of the primary Norwood procedure basically for neonates with HLHS, however bilateral pulmonary artery banding precede in patients with risk factors. In the Norwood procedure, aortic arch is reconstructed without artificial prostheses and pulmonary blood flow is supplied from the Blalock-Taussig shunt or the right ventricle-pulmonary artery shunt by case. We administer high dose vasodilators and nitric oxide gas with low resistance strategy after the Norwood procedure. The survival rate of patients with HLHS after 2005 is 84.2% in this strategy.
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Affiliation(s)
- Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Asada S, Takahashi T, Isodono K, Adachi A, Imoto H, Ogata T, Ueyama T, Matsubara H, Oh H. Downregulation of Dicer expression by serum withdrawal sensitizes human endothelial cells to apoptosis. Am J Physiol Heart Circ Physiol 2008; 295:H2512-21. [PMID: 18978195 DOI: 10.1152/ajpheart.00233.2008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [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: 11/22/2022]
Abstract
Although the modulated expression of Dicer is documented upon neoplastic transformation, little is known of the regulation of Dicer expression by environmental stimuli and its roles in the regulation of cellular functions in primary cells. In this study, we found that Dicer expression was downregulated upon serum withdrawal in human umbilical vein endothelial cells (HUVECs). Serum withdrawal induced a time-dependent repression of Dicer expression, which was specifically rescued by vascular endothelial cell growth factor or sphingosine-1-phosphate. When Dicer expression was silenced by short-hairpin RNA against Dicer, the cells were more prone to apoptosis under serum withdrawal, whereas the rate of apoptosis was comparable with control cells in the serum-containing condition. Real-time PCR-based gene expression profiling identified several genes, the expression of which was modulated by Dicer silencing, including adhesion and matrix-related molecules, caspase-3, and nitric oxide synthase 3 (NOS3). Dicer silencing markedly impaired migratory functions without affecting cell adhesion and repressed phosphorylation of focal adhesion kinase and proline-rich tyrosine kinase 2 in adherent HUVECs. Dicer knockdown upregulated caspase-3 and downregulated NOS3 expression, and serum withdrawal indeed increased caspase-3 and decreased NOS3 expression. Furthermore, the overexpression of Dicer in HUVECs resulted in a marked reduction in apoptosis upon serum withdrawal and a decreased caspase-3 and increased NOS3 expression. The inhibition of NOS activity by Nomega-nitro-L-arginine methyl ester abrogated the effect of Dicer overexpression to rescue the cells from serum withdrawal-induced apoptosis. These results indicated that serum withdrawal decreases Dicer expression, leading to an increased susceptibility to apoptosis through the regulation of caspase-3 and NOS3 expression.
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Affiliation(s)
- Satoshi Asada
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, and Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Tagawa M, Ueyama T, Ogata T, Takehara N, Nakajima N, Isodono K, Asada S, Takahashi T, Matsubara H, Oh H. MURC, a muscle-restricted coiled-coil protein, is involved in the regulation of skeletal myogenesis. Am J Physiol Cell Physiol 2008; 295:C490-8. [DOI: 10.1152/ajpcell.00188.2008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Skeletal myogenesis is a multistep process by which multinucleated mature muscle fibers are formed from undifferentiated, mononucleated myoblasts. However, the molecular mechanisms of skeletal myogenesis have not been fully elucidated. Here, we identified muscle-restricted coiled-coil (MURC) protein as a positive regulator of myogenesis. In skeletal muscle, MURC was localized to the cytoplasm with accumulation in the Z-disc of the sarcomere. In C2C12 myoblasts, MURC expression occurred coincidentally with myogenin expression and preceded sarcomeric myosin expression during differentiation into myotubes. RNA interference (RNAi)-mediated knockdown of MURC impaired differentiation in C2C12 myoblasts, which was accompanied by impaired myogenin expression and ERK activation. Overexpression of MURC in C2C12 myoblasts resulted in the promotion of differentiation with enhanced myogenin expression and ERK activation during differentiation. During injury-induced muscle regeneration, MURC expression increased, and a higher abundance of MURC was observed in immature myofibers compared with mature myofibers. In addition, ERK was activated in regenerating tissue, and ERK activation was detected in MURC-expressing immature myofibers. These findings suggest that MURC is involved in the skeletal myogenesis that results from modulation of myogenin expression and ERK activation. MURC may play pivotal roles in the molecular mechanisms of skeletal myogenic differentiation.
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Kitamura R, Takahashi T, Nakajima N, Isodono K, Asada S, Ueyama T, Matsubara H, Oh H. Activation of endogenous Smad2 modulates cardiomyogenesis in embryonic stem cells. J Mol Cell Cardiol 2008. [DOI: 10.1016/j.yjmcc.2007.07.038] [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: 11/29/2022]
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Ogata T, Ueyama T, Nomura T, Asada S, Tagawa M, Makamura T, Takahashi T, Matsubara H, Oh H. Secreted phosphoprotein 1 enhances proliferative self-renewal through PI3K/Akt signaling in skeletal myosphere-derived progenitor cells. J Mol Cell Cardiol 2008. [DOI: 10.1016/j.yjmcc.2007.07.042] [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: 10/23/2022]
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Nomura T, Ueyama T, Ashihara E, Tateishi K, Asada S, Nakajima N, Isodono K, Takahashi T, Matsubara H, Oh H. Skeletal muscle-derived progenitors capable of differentiating into cardiomyocytes proliferate through myostatin-independent TGF-beta family signaling. Biochem Biophys Res Commun 2007; 365:863-9. [PMID: 18047832 DOI: 10.1016/j.bbrc.2007.11.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
Abstract
The existence of skeletal muscle-derived stem cells (MDSCs) has been suggested in mammals; however, the signaling pathways controlling MDSC proliferation remain largely unknown. Here we report the isolation of myosphere-derived progenitor cells (MDPCs) that can give rise to beating cardiomyocytes from adult skeletal muscle. We identified that follistatin, an antagonist of TGF-beta family members, was predominantly expressed in MDPCs, whereas myostatin was mainly expressed in myogenic cells and mature skeletal muscle. Although follistatin enhanced the replicative growth of MDPCs through Smad2/3 inactivation and cell cycle progression, disruption of myostatin did not increase the MDPC proliferation. By contrast, inhibition of activin A (ActA) or growth differentiation factor 11 (GDF11) signaling dramatically increased MDPC proliferation via down-regulation of p21 and increases in the levels of cdk2/4 and cyclin D1. Thus, follistatin may be an effective progenitor-enhancing agent neutralizing ActA and GDF11 signaling to regulate the growth of MDPCs in skeletal muscle.
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Affiliation(s)
- Tetsuya Nomura
- Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507, Japan
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Ogata T, Ueyama T, Nomura T, Asada S, Tagawa M, Nakamura T, Takahashi T, Matsubara H, Oh H. Osteopontin is a myosphere-derived secretory molecule that promotes angiogenic progenitor cell proliferation through the phosphoinositide 3-kinase/Akt pathway. Biochem Biophys Res Commun 2007; 359:341-7. [PMID: 17537408 DOI: 10.1016/j.bbrc.2007.05.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
Abstract
We have reported that skeletal myosphere-derived progenitor cells (MDPCs) can differentiate into vascular cells, and that MDPC transplantation into cardiomyopathic hearts improves cardiac function. However, the autocrine/paracrine molecules and underlying mechanisms responsible for MDPC growth have not yet been determined. To explore the molecules enhancing the proliferation of MDPCs, we performed serial analysis of gene expression and signal sequence trap methods using RNA isolated from MDPCs. We identified osteopontin (OPN), a secretory molecule, as one of most abundant molecules expressed in MDPCs. OPN provided a proliferative effect for MDPCs. MDPCs treated with OPN showed Akt activation, and inhibition of the phosphoinositide 3-kinase (PI3K)/Akt pathway repressed the proliferative effect of OPN. Furthermore, OPN-pretreated MDPCs maintained their differentiation potential into endothelial and vascular smooth muscle cells. These findings indicate an important role of OPN as an autocrine/paracrine molecule in regulating the proliferative growth of muscle-derived angiogenic progenitor cells via the PI3K/Akt pathway.
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Affiliation(s)
- Takehiro Ogata
- Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto, Japan
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Kitamura R, Takahashi T, Nakajima N, Isodono K, Asada S, Ueno H, Ueyama T, Yoshikawa T, Matsubara H, Oh H. Stage-specific role of endogenous Smad2 activation in cardiomyogenesis of embryonic stem cells. Circ Res 2007; 101:78-87. [PMID: 17540976 DOI: 10.1161/circresaha.106.147264] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 12/28/2022]
Abstract
The role of Smads and their specific ligands during cardiomyogenesis in ES cells was examined. Smad2 was activated bimodally in the early and late phases of cardiac differentiation, whereas Smad1 was activated after the middle phase. Nodal and Cripto were expressed in the early stage and then downregulated, whereas transforming growth factor-beta and activin were expressed only in the late phase. Suppression of early Smad2 activation by SB-431542 produced complete inhibition of endodermal and mesodermal induction but augmented neuroectodermal differentiation, followed by poor cardiomyogenesis, whereas inhibition during the late phase alone promoted cardiomyogenesis. Inhibitory effect of Smad2 on cardiomyogenesis in the late phase was mainly mediated by transforming growth factor-beta, and inhibition of transforming growth factor-beta-mediated Smad2 activation resulted in a greater replicative potential in differentiated cardiac myocytes and enhanced differentiation of nonmyocytes into cardiac myocytes. Thus, endogenous Smad2 activation is indispensable for endodermal and mesodermal induction in the early phase. In the late phase, endogenous transforming growth factor-beta negatively regulates cardiomyogenesis through Smad2 activation by modulating proliferation and differentiation of cardiac myocytes.
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Affiliation(s)
- Ryoji Kitamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Nomura T, Ashihara E, Tateishi K, Asada S, Ueyama T, Takahashi T, Matsubara H, Oh H. Skeletal myosphere-derived progenitor cell transplantation promotes neovascularization in delta-sarcoglycan knockdown cardiomyopathy. Biochem Biophys Res Commun 2006; 352:668-74. [PMID: 17150187 DOI: 10.1016/j.bbrc.2006.11.097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 11/14/2006] [Indexed: 12/15/2022]
Abstract
Bone marrow cells have been shown to contribute to neovascularization in ischemic hearts, whereas their impaired maturation to restore the delta-sarcoglycan (delta-SG) expression responsible for focal myocardial degeneration limits their utility to treat the pathogenesis of cardiomyopathy. Here, we report the isolation of multipotent progenitor cells from adult skeletal muscle, based on their ability to generate floating-myospheres. Myosphere-derived progenitor cells (MDPCs) are distinguishable from myogenic C2C12 cells and differentiate into vascular smooth muscle cells and mesenchymal progeny. The mutation in the delta-SG has been shown to develop vascular spasm to affect sarcolemma structure causing cardiomyopathy. We originally generated delta-SD knockdown (KD) mice and transplanted MDPCs into the hearts. MDPCs enhanced neoangiogenesis and restored delta-SG expression in impaired vasculatures through trans-differentiation, leading to improvement of cardiac function associated with paracrine effectors secretion. We propose that MDPCs may be the promising progenitor cells in skeletal muscle to treat delta-sarcoglycan complex mutant cardiomyopathy.
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Affiliation(s)
- Tetsuya Nomura
- Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507, Japan
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Nakajima N, Takahashi T, Kitamura R, Isodono K, Asada S, Ueyama T, Matsubara H, Oh H. MicroRNA-1 facilitates skeletal myogenic differentiation without affecting osteoblastic and adipogenic differentiation. Biochem Biophys Res Commun 2006; 350:1006-12. [PMID: 17045567 DOI: 10.1016/j.bbrc.2006.09.153] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 09/27/2006] [Indexed: 11/22/2022]
Abstract
MicroRNAs (miRNAs) are small non-coding RNAs emerging as important post-transcriptional gene regulators. In this study, we examined the role of miR-1, an miRNA specifically expressed in cardiac and skeletal muscle tissue, on the myogenic, osteoblastic, and adipogenic differentiation of C2C12 cells. Upon induction of myogenic differentiation, miR-1 was robustly expressed. Retrovirus-mediated overexpression of miR-1 markedly enhanced expression of muscle creatine kinase, sarcomeric myosin, and alpha-actinin, while the effects on myogenin and MyoD expression were modest. Formation of myotubes was significantly augmented in miR-1-overexpressing cells, indicating miR-1 expression enhanced not only myogenic differentiation but also maturation into myotubes. In contrast, osteoblastic and adipogenic differentiation was not affected by forced expression of miR-1. Thus, the muscle-specific miRNA, miR-1, plays important roles in controlling myogenic differentiation and maturation in lineage-committed cells, rather than functioning in fate determination.
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Affiliation(s)
- Norio Nakajima
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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Kawasaki T, Azuma A, Taniguchi T, Asada S, Kamitani T, Kawasaki S, Matsubara H, Sugihara H. Short-term fluctuations in sinus cycle length after premature ventricular beats in patients with hypertrophic cardiomyopathy and myocardial infarction. Int J Cardiol 2005; 101:315-7. [PMID: 15882685 DOI: 10.1016/j.ijcard.2004.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2003] [Accepted: 01/08/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sinus cycle length has been reported to fluctuate after a ventricular premature beat (VPB). The purpose of this study was to assess the short-term fluctuations of sinus cycle length in patients with hypertrophic cardiomyopathy (HCM) and prior myocardial infarction (MI). METHODS The relative deviation of RR intervals from the mean of the last two RR intervals preceding a VPB were calculated during the 20 subsequent beats following the VPB from Holter recordings in 92 patients with non-obstructive HCM, 57 patients with prior MI and 54 healthy controls. RESULTS In controls, the deviations of the RR intervals were negative for several beats after a VPB and subsequently changed to positive before returning to the baseline. Similar changes in RR intervals following a VPB were exhibited in HCM patients; however, the late positive deviations of RR intervals were more marked than in controls. By contrast, in patients with prior MI, the early negative deviations of RR intervals were smaller compared with controls, and the deviations returned to the baseline without incidence of the positive changes. CONCLUSIONS Short-term fluctuations in sinus cycle length after a VPB differed exclusively among HCM patients, prior MI patients, and healthy controls.
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Asada S, Kawasaki T, Taniguchi T, Kamitani T, Kawasaki S, Sugihara H. A case of ST-segment elevation provoked by distended stomach conduit. Int J Cardiol 2005; 109:411-3. [PMID: 15979741 DOI: 10.1016/j.ijcard.2005.05.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 05/14/2005] [Indexed: 11/30/2022]
Abstract
A case of ST-segment elevation provoked by distended stomach conduit is presented. An 83-year-old woman was admitted to our hospital with worsening chest discomfort. She had a previous history of subtotal esophagectomy, which was reconstructed using a stomach conduit in the posterior mediastinum. Electrocardiogram showed ST-segment elevation in the inferior leads and a prominent negative P wave in lead V1. Echocardiography demonstrated normal left ventricular function without regional wall motion abnormality; however, the left atrium and ventricle compressed by a substantially distended stomach conduit was noted. Subsequent angiocardiography revealed no coronary atherosclerotic stenosis and normal contractility of the left ventricle. Chest symptoms resolved soon after nasogastric suction, leading to resolution of electrocardiographic changes. The stomach conduit diminished on following repeated echocardiography. The patient was discharged without any evidence of myocardial infarction. Esophagus disease of the reconstructed stomach conduit should be recognized as a rare but considerable cause for electrocardiographic changes.
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Kawasaki T, Azuma A, Kuribayashi T, Taniguchi T, Asada S, Kamitani T, Kawasaki S, Matsubara H, Sugihara H. Enhanced vagal modulation and exercise induced ischaemia of the inferoposterior myocardium. Heart 2005; 92:325-30. [PMID: 15939725 PMCID: PMC1860800 DOI: 10.1136/hrt.2005.063230] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 12/21/2022] Open
Abstract
OBJECTIVE To determine whether the Bezold-Jarisch reflex or enhancement of vagal nerves, which are preferentially distributed in the inferoposterior myocardium, results from exercise induced ischaemia in this region. METHODS On the basis of exercise myocardial scintigraphy and coronary angiography, 145 patients were classified as follows: group I, 34 patients with inferoposterior ischaemia; group A, 32 with anterior ischaemia; and control, 79 without ischaemia. The relation between ischaemic areas and ECG leads with ST segment changes and vagal modulation assessed by heart rate variability (HRV) (high frequency (HF) component (0.15-0.40 Hz) and coefficient of HF component variance (CCVHF), which is the square root of HF divided by mean RR interval) were assessed. RESULTS The rate of ST segment depression in any lead did not differ between group I and group A. HF and CCV(HF) were similar before exercise but higher in group I than in group A and the control group after exercise (mean (SEM) HF: 94 (17) ms2, 41 (7) ms2, and 45 (6) ms2, respectively, p = 0.021; CCV(HF): 1.18 (0.09)%, 0.81 (0.07)%, and 0.89 (0.05)%, p = 0.0053). Furthermore, the percentage change in CCV(HF) before and after exercise was higher in group I than in group A or controls (mean (SEM) 22 (10)%, -24 (4)%, and -21 (3)%, p < 0.0001). The optimal cut off for diagnosis of inferoposterior ischaemia was -5% with a sensitivity of 74%, specificity 75%, and accuracy 75%. CONCLUSIONS Vagal modulation as assessed by HRV analysis was enhanced in association with exercise induced inferoposterior ischaemia. Exercise ECG testing combined with HRV analysis would increase accuracy in the diagnosis of ischaemic areas in selected patients with angina pectoris.
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Affiliation(s)
- T Kawasaki
- Department of Cardiology, Matsushita Memorial Hospital, Osaka 570-8540, Japan.
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Kawasaki T, Azuma A, Taniguchi T, Asada S, Kamitani T, Kawasaki S, Matsubara H, Sugihara H. Heart rate variability in adult patients with isolated left ventricular noncompaction. Int J Cardiol 2005; 99:147-50. [PMID: 15721518 DOI: 10.1016/j.ijcard.2003.11.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 11/04/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Isolated left venticular noncompaction (IVNC) is a rare congenital heart disease charactrized by a pattern of an excessively prominent trabecular meshwork with deep intertrabecular recesses. Heart rate variability (HRV) has been reported to be impaired in various heart diseases, though little is known regarding HRV in adult patients with IVNC. METHODS We measured spectral components of HRV using fast Fourier transformation of 24-h Holter recordings in 10 adult patients with IVNC, 40 patients with myocardial infarction (MI), 40 patients with hypertrophic cardiomyopathy (HCM) and 40 healthy controls. RESULTS The low frequency component and the high frequency component of HRV were lower in IVNC patients tahn those in controls (265 +/- 213 ms(2) vs. 469 +/- 195 ms(2), p < 0.01; 80 +/- 51 ms(2) vs. 185 +/- 126 ms(2), p < 0.01). Furthermore, 3 IVNC patients with a previous history of heart failure exhibited more decreased HRV (low frequency, 75 +/- 56 ms(2); high frequency, 39 +/- 18 ms(2)). Contrary, the ratio of low frequency to high frequency component was higher in patients with IVNC than controls (3.5+/-0.5 vs. 3.2 +/- 0.3, p < 0.05). The degree of impaired HRV was severest in MI patients, intermediate in IVNC patients and mildest in HCM patients compared with controls. CONCLUSIONS HRV is impaired in adult patients with IVCN, especially in patients with a previous history of heart failure, suggesting vagal withdrawal or sympathetic enhancement. HRV in IVNC adults is less impaired than in MI patients, and more impaired than in HCM patients of our cohort.
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Hadase M, Azuma A, Zen K, Asada S, Kawasaki T, Kamitani T, Kawasaki S, Sugihara H, Matsubara H. Very low frequency power of heart rate variability is a powerful predictor of clinical prognosis in patients with congestive heart failure. Circ J 2004; 68:343-7. [PMID: 15056832 DOI: 10.1253/circj.68.343] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [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: 11/09/2022]
Abstract
BACKGROUND The present study examined whether the very low frequency (VLF) power of heart rate variability (HRV) is predictive of clinical prognosis in patients with congestive heart failure (CHF). METHOD AND RESULTS The study recruited 54 consecutive CHF patients with emergency admission because of exacerbation of pulmonary congestion. Holter monitoring was performed after improvement of pulmonary congestion. The frequency components of HRV were calculated in the frequency domain (VLF, low frequency (LF), high frequency (HF), total power (TP) and the ratio of LF to HF power). The left ventricular ejection fraction was calculated, and plasma brain natriuretic peptide (BNP) and norepinephrine were also measured at discharge. Within a mean follow-up period of 19.8 +/- 11.7 months, 18 patients experienced cardiovascular events; 7 patients died and 11 patients required rehospitalization because of worsening of CHF. In univariate analysis, diabetes mellitus (DM), BNP and New York Heart Association (NYHA) functional class were significant as risk factors for cardiac events. VLF power, LF power and TP were the strong predictors for cardiac events in HRV. In multivariate analysis, VLF power predicted cardiac events independently of LF power, TP, DM, BNP and NYHA functional class (chi-square=6.24, p=0.01). CONCLUSIONS VLF power is an independent risk predictor in patients with CHF.
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Affiliation(s)
- Mitsuyoshi Hadase
- Department of Cardiology, Kyoto Prefectural University of Medicine, Japan.
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