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1.
Eur J Cardiothorac Surg ; 65(4)2024 Mar 29.
Article in English | MEDLINE | ID: mdl-38597892

ABSTRACT

OBJECTIVES: Intestinal ischaemia-reperfusion injury induced by cardiopulmonary bypass causes intestinal epithelial barrier dysfunction, leading to dysbiosis and bacterial translocation. We conducted a randomized prospective study with 2 objectives: (i) to investigate epithelial barrier dysfunction and bacterial translocation induced by cardiopulmonary bypass and changes in the gut microbiota and (ii) to verify whether probiotics can improve these conditions. METHODS: Between 2019 and 2020, patients 0-15 years old scheduled to undergo cardiac surgery using cardiopulmonary bypass were enrolled and randomly allocated to 2 groups: the intervention group received probiotics and the control group did not receive probiotics. We analysed the microbiota in faeces and blood, organic acid concentrations in faeces, plasma intestinal fatty acid-binding protein and immunological responses. RESULTS: Eighty-two patients were enrolled in this study. The characteristics of the patients were similar in both groups. The total number of obligate anaerobes was higher in the intervention group than in the control group after postoperative day 7. We identified 4 clusters within the perioperative gut microbiota, and cluster changes showed a corrective effect of probiotics on dysbiosis after postoperative day 7. Organic acid concentrations in faeces, incidence of bacterial translocation, intestinal fatty acid-binding protein levels and immunological responses, except for interleukin -17A, were not markedly different between the 2 groups. CONCLUSIONS: Administration of probiotics was able to correct dysbiosis but did not sufficiently alleviate the intestinal damage induced by cardiopulmonary bypass. More effective methods should be examined to prevent disturbances induced by cardiac surgery using cardiopulmonary bypass. CLINICAL TRIAL REGISTRATION NUMBER: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037174 UMIN000035556.


Subject(s)
Cardiopulmonary Bypass , Gastrointestinal Microbiome , Probiotics , Humans , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/methods , Probiotics/therapeutic use , Probiotics/administration & dosage , Male , Female , Gastrointestinal Microbiome/physiology , Child, Preschool , Prospective Studies , Infant , Child , Adolescent , Dysbiosis , Infant, Newborn , Bacterial Translocation , Feces/microbiology , Reperfusion Injury/prevention & control , Postoperative Complications/prevention & control , Intestines , Intestinal Mucosa/metabolism
2.
Article in English | MEDLINE | ID: mdl-38374222

ABSTRACT

OBJECTIVES: The 18- and 16-mm conduits in extracardiac total cavopulmonary connection (eTCPC) were reported to be optimal based on energy loss and flow stagnation at the relatively early phase. However, because the artificial conduit lacks growth potential, we have recently encountered some cases in which the conduit needs to be changed several years after eTCPC. These cases prompted us to reconsider the surgical strategy for eTCPC. METHODS: We reviewed our 20-year single-centre experience with eTCPC patients (n = 256) to compare the 18-mm conduit (n = 195) and 16-mm conduit (n = 61) in terms of mortality and morbidity. RESULTS: The 16-mm conduit was used significantly more frequently in patients whose main chamber was right ventricle (P < 0.001). There was also a significant difference in preoperative inferior vena cava pressure (P = 0.008). There was a significant difference in the actuarial rate of freedom from late-occurring complications, including mortality, between the 2 groups (P = 0.003). There was a significant difference in the actuarial rate of reoperation-free survival (P = 0.042); however, there was no significant difference in resurgical intervention for the conduit (P = 0.333). In multivariate analysis, preoperative inferior vena cava pressure was an independent predictor for late-occurring complications (hazard ratio 1.19; P = 0.026). Conduit size (18 or 16 mm) itself was not an independent predictive factor for late-occurring complications (P = 0.690). CONCLUSIONS: The mid-term clinical outcomes in patients who underwent eTCPC were excellent with low mortality. Preoperative inferior vena cava pressure was the only predictive risk factor for postoperative morbidity, and the 16 mm conduit was not predictive thereof.

3.
Clin Case Rep ; 9(1): 367-370, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33489184

ABSTRACT

We successfully performed concomitant septal myectomy and mitral valve repair in a child with Noonan syndrome.

4.
Surg Today ; 50(10): 1151-1158, 2020 Oct.
Article in English | MEDLINE | ID: mdl-31676999

ABSTRACT

A vascular ring is a rare congenital cardiovascular anomaly, which encircles and compresses the trachea or esophagus, or both. In this review we discuss the pathophysiology, theoretical embryopathogenesis, diagnostic modalities, and surgical treatment of the different types of vascular ring. Knowledge of the normal embryonic development of the aortic arch and related structures is important for understanding and classifying the various forms of vascular ring. The development of a vascular ring begins with the embryonic aortic arch system. The persistence, involution, or regression of the arches determines the multiple variations of vascular ring. With the development of new technologies, multi-detector computed tomography (MDCT) has become a good diagnostic modality for pre- and postoperative evaluation. MDCT provides an excellent image of aortic arch abnormalities and the related anatomy, as well as the tracheal pathology. For patients with symptoms, surgical division of the vascular ring usually achieves excellent outcomes with marked resolution of symptoms and a low risk of morbidity and mortality. Symptomatic vascular rings require early surgical intervention to prevent prolonged vascular compression of the airway and serious complications.


Subject(s)
Vascular Ring/surgery , Aorta, Thoracic/abnormalities , Aorta, Thoracic/embryology , Aorta, Thoracic/surgery , Deglutition Disorders/etiology , Dyspnea/etiology , Humans , Multidetector Computed Tomography , Vascular Ring/complications , Vascular Ring/diagnostic imaging , Vascular Ring/embryology
5.
Kyobu Geka ; 72(4): 251-255, 2019 Apr.
Article in Japanese | MEDLINE | ID: mdl-31266909

ABSTRACT

Between April 2005 and February 2019, 11 adult patients underwent redo reconstruction of the right ventricular outflow tract. The primary malformation was Fallot's tetralogy in 8, transposition of the great arteries in 2, and pulmonary atresia with intact ventricular septum in 1. Mean age at redo operation was 27.4 years. Right ventricular outflow tract was reconstructed with expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in 9, transannular patch in 1, and right ventricular outflow patch in 1. There were no early and late deaths. One patient had residual branch pulmonary stenosis, while other 10 patients had no significant pulmonary stenosis and no significant pulmonary regurgitation. Signs and symptoms were improved in these 10 patients. Re-operation should be done before the development of right ventricular dysfunction, while it can be performed with satisfactory results in adult patients.


Subject(s)
Heart Defects, Congenital , Pulmonary Atresia , Tetralogy of Fallot , Transposition of Great Vessels , Adult , Follow-Up Studies , Humans , Reoperation , Ventricular Outflow Obstruction
6.
Kyobu Geka ; 70(7): 483-487, 2017 Jul.
Article in Japanese | MEDLINE | ID: mdl-28698412

ABSTRACT

OBJECTIVES: A purpose is to compare the in-hospital rehabilitation progress after minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) with that after off pump coronary artery bypass grafting( OPCAB). METHODS: We analyzed 60 patients who underwent coronary artery bypass grafting surgery from January 2015 to December 2016. Fourteen patients underwent MICS CABG (MICS CABG group) and 46 patients underwent OPCAB (OPCAB group). The post-operative days to start standing position and independent walking, and hospitalization duration were analyzed between the 2 groups. RESULTS: There were no significant differences between the groups:standing position(1.2 vs 1.2 days) and independent walking(4.8 vs 4.9 days). Hospitalization duration was shorter in MICS CABG group(14.3 vs 17.5 days). CONCLUSION: MICS CABG may shorten hospitalization length compared with OPCAB, however, further research will be needed.


Subject(s)
Cardiac Rehabilitation , Adult , Aged , Aged, 80 and over , Coronary Artery Bypass , Female , Humans , Intensive Care Units , Male , Middle Aged , Minimally Invasive Surgical Procedures , Treatment Outcome
7.
Kyobu Geka ; 69(12): 995-998, 2016 Nov.
Article in Japanese | MEDLINE | ID: mdl-27821823

ABSTRACT

In off-pump coronary artery bypass grafting(OPCAB), a bloodless operative field has great influence on the quality of anastomosis. In addition, maintenance of distal coronary flow during anastomosis stabilizes hemodynamics. We introduced a new intracoronary shunt cannula, Mini Shunt Pro (MSP). MSP adopts the step-tip, which allows easy insertion and reduces the risk of intimal injury. The distal and proximal sides of the tips of MSP are 0.25 mm different in diameter, which improves its fitness to the coronary artery and enhances a bloodless operative field. This new shunt cannula is considered to be safe and useful for high-quality anastomosis in OPCAB.


Subject(s)
Cannula , Coronary Artery Bypass, Off-Pump/instrumentation , Coronary Artery Bypass, Off-Pump/methods , Coronary Vessels/surgery , Humans
8.
Kyobu Geka ; 69(12): 1027-1031, 2016 Nov.
Article in Japanese | MEDLINE | ID: mdl-27821829

ABSTRACT

A 68-years-old male with diabetes mellitius (HbA1c 6.5%) was referred for coronary artery bypass grafting(CABG). Preoperative coronary angiography (CAG) signed 3-vessels coronary disease[#2 75 %,#4 posterior descending (PD) 75%,#6 90%,#14 90%]. Minimally invasive coronary artery grafting (MICS CABG) was selected because of faster postoperative recovery than off-pump CABG via a 10 cm left 5th thoracotomy approach. In situ bilateral internal thoracic artery(BITA) and saphenous vein (SVG) was harvested by special manner using long type Harmonic. Bypass graft design was in situ right internal thoracic artery-LAD, in situ left internal thoracic artery-left circumtlex#14, and aorta-SVG-#4PD-#4atrio-ventricular. BITA, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed with off-pump technique. Heartstring III Proximal Seal System was used to anastomose SVG to the ascending aorta. There were no major postoperative complications. Postoperative CAG revealed all grafts patent and postoperative hospital stay was 14 days. This case was the 1st usage of Heartstring III Proximal Seal System in our clinic. We believe that the usage of Heartstring III Proximal Seal System in MICS CABG is realistically possible, and providing good quality;however, further research will be needed.


Subject(s)
Coronary Artery Bypass/instrumentation , Coronary Artery Disease/surgery , Aged , Coronary Artery Bypass/methods , Coronary Artery Disease/diagnostic imaging , Humans , Male , Thoracotomy , Tomography, X-Ray Computed , Treatment Outcome
9.
Gan To Kagaku Ryoho ; 42(5): 585-9, 2015 May.
Article in Japanese | MEDLINE | ID: mdl-25981652

ABSTRACT

Irinotecan is an effective drug in the treatment of colorectal cancer. However, there are reports of an association between certain UGT1A1 genetic polymorphisms and the development of adverse reactions(such as neutropenia)related to irinotecan metabolism. We retrospectively investigated UGT1A1 genetic polymorphisms and the occurrences of irinotecan-induced neutropenia in 25 patients of colorectal cancer at our hospital. Analysis of UGT1A1 genetic polymorphisms in these patients yielded the following classifications: a wild-type group( *1/*1)comprising 13 patients(52%), a heterozygous group(*1/ *28, *1/*6)of 10 patients(40%), and a homozygous group(*28/*28, *6/*6)of 2 patients(8%). The frequency of neutropenia was 15.4%(2/13)in the wild-type group, 30%(3/10)in the heterozygous group, and 100%(2/2)in the homozygous group. Grade 4 neutropenia only occurred in the homozygous group. These results suggest that a dose reduction of irinotecan should be considered for patients who fall into the homozygous group upon analysis of their UGT1A1 genetic polymorphisms, as such patients might be susceptible to grade 4 neutropenia.


Subject(s)
Antineoplastic Agents, Phytogenic/adverse effects , Camptothecin/analogs & derivatives , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/genetics , Glucuronosyltransferase/genetics , Leukopenia/chemically induced , Neutropenia/chemically induced , Polymorphism, Genetic , Adult , Aged , Antineoplastic Agents, Phytogenic/therapeutic use , Camptothecin/adverse effects , Camptothecin/therapeutic use , Female , Humans , Irinotecan , Male , Middle Aged , Retrospective Studies
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