Language：Japanese   Publisher：(公財)日本心臓財団  

症例は62歳男性。Marfan症候群の家族歴があり、小学生の頃より大動脈弁輪拡大でフォローされていた。37歳の時にStanford A型急性大動脈解離を発症し、Cabrol法による大動脈基部置換術を施行された。術後16年目のCTで人工血管と左右冠動脈の吻合部狭窄を指摘されていたが無症状のため経過観察となっていた。その後徐々に心不全症状が出現し、術後23年目(60歳)の時に入院となり、両側吻合部ともに99%狭窄を認めPCIを施行された。いったんは心不全は改善したが翌年には心不全再増悪を認め、精査の結果、右冠動脈完全閉塞および左冠動脈吻合部ステント内90%狭窄を認めた。これ以上の内科的治療は困難と判断され、今回on pump beating CABG(LITA-#7、RITA-#14、RGEA-#4PD)を施行した。術後合併症なく経過し、術後29日目に退院となった。Cabrol法は大動脈基部置換術のうち小口径人工血管を用いて冠動脈再建を行う手法であり、止血視野の確保や確実な心筋保護といった点で非常に有効であり普及していったが、遠隔期の人工血管吻合部の狭窄や人工血管の閉塞が問題となった。治療方法として新たに小口径人工血管を付け替える方法やCarrel patch法として再建する方法、CABGなどがあげられる。本症例のように若年であり、低心機能で大動脈基部に高度な癒着が想定される場合は動脈グラフトを使用したCABGが有用と考えられるが、今後大動脈解離の進展の可能性もあるため注意深く経過観察していく必要があると考えられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00679&link_issn=&doc_id=20220818230025&doc_link_id=%2Fah2sinzd%2F2022%2F005408%2F029%2F0966-0971%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2022%2F005408%2F029%2F0966-0971%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We report the case of a 2-year-old girl with Loeys-Dietz syndrome complicated by aortic root dilatation and aortic regurgitation. We performed valve-sparing aortic root replacement with reimplantation technique and aortic valve repair using central plication and free-margin reinforcement simultaneously. The postoperative course was uneventful and the latest echocardiography, 5 years after procedure, revealed trivial aortic insufficiency.

DOI： 10.1093/icvts/ivab367

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The risk of thrombus development is considered to be increased by malignant tumors and chemotherapy. In addition, thrombosis of the ascending aorta is rare. We report a case of ascending aortic thrombectomy in a patient with esophageal cancer who developed ascending aortic thrombus after starting neoadjuvant chemotherapy, including operative findings and surgical treatment. CASE PRESENTATION: A 63-year-old man with esophageal cancer was administered chemotherapy comprising cisplatin plus 5-fluorouracil. A week after completing 1 cycle of chemotherapy, computed tomography angiography showed acute aortic thrombosis at the ascending aorta. The risk of embolization appeared high because the thrombosis was floating, so we performed emergency ascending aortic thrombectomy. The postoperative course was good and uncomplicated. A month after this surgery, the patient underwent surgery for esophageal cancer. As of 1 year after the cancer surgery, neither cancer nor thrombosis has recurred. CONCLUSION: We describe a case of acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy, that was treated by aortic thrombectomy. The treatment strategy should depend on thrombus location and the condition of the patient, but surgical treatment should be considered where possible to achieve better prognosis.

DOI： 10.1186/s40792-022-01431-8

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.xjon.2021.09.048

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

肺静脈閉塞を合併したFontan術後患者に対する有効な治療法はなく予後は不良である。今回我々はFontan術後に右肺静脈閉塞を来し、多量の胸水、浮腫、心房性不整脈が出現した急性心不全の3歳女児例に対して体肺側副血管と右肺動脈の塞栓後に開窓作成術を行った。体肺側副血管の塞栓は3回のセッションに分けて51本のコイルを使用した。右肺動脈塞栓は計5個のAmplatzer Vascular Plug(AVP)と計2本のコイルを用いて、手技時間は3時間程度で合併症なく完全閉塞できた。その後に開窓作成術を行い、中心静脈圧は閉塞術前の20mmHgから7mmHgへ低下した。手技に伴う合併症はなく、手技時間も短く施行し得た。しかし術後9日目に心タンポナーデを発症し死亡した。過去に肺静脈閉塞を合併したFontan術後症例に対して体肺側副血管と患側の肺動脈を完全に塞栓した報告はない。本治療は一時的に肺静脈閉塞を伴うFontan患者の循環動態を安定させた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Georg Thieme Verlag KG  

<title>Abstract</title>Near-infrared spectroscopy (NIRS) does not provide information about changes in oxygenation in whole-brain areas. Although the branching vessels of the aortic arch are not always easy to identify using transesophageal echocardiography (TEE), the blood flow status of cervical arteries can always be assessed by applying an ultrasound probe via the “ultrasound window” on the patient's neck, which can be ensured by devising alternative insertion approaches of the central venous catheter. This method is very simple but compensates for the limitations of the combination of NIRS and TEE, especially during cardiac surgery with cardiopulmonary bypass management using selective cerebral perfusion.

DOI： 10.1055/s-0041-1725181

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Systemic intravenous administration of opioids is the main treatment strategy for intraoperative and postoperative pain management in patients undergoing cardiac surgery with sternotomy. However, using lower doses of opioids may achieve the well-established benefits of the fast-track approach, with minimal opioid-related side effects. Postoperative pain is coupled with a long stay in the intensive care unit. Although neuraxial anesthesia has some benefits, its use remains controversial due to the potential development of epidural hematoma after anticoagulation for cardiopulmonary bypass and coagulopathy after cardiac surgery. Therefore, there is a need for other effective postoperative analgesic strategies, such as peripheral nerve blocks other than neuraxial anesthesia, for cardiac surgery with sternotomy. The effects of real-time ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain after sternotomy have been reported; however, the pain and discomfort in the epigastric area caused by chest drainage tubes placed through the rectus abdominis muscle also are major postoperative problems after cardiac surgery. Herein, the authors report on a preoperative combination of TTP block and rectus sheath block (RSB) for postoperative pain management after cardiac surgery with sternotomy that addresses pain in both the chest and epigastric areas. Considering previous studies, it is presumed that preemptive analgesic effects can be expected via a combination of the TTP block and RSB, and indeed, the preemptive effect was observed in the present study's patients. In this article, the procedure and tips for combining the TTP block and RSB are introduced.

DOI： 10.1053/j.jvca.2020.07.041

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Language：English   Publishing type：Research paper (scientific journal)  

his letter discusses precautions regarding the waterproof structure of the oximetry central venous catheter (CVC) shaft and the risk of blood reflux and leakage that can occur when the catheter shaft is cut. To assess oxygen supply-demand balance [1] and haemodynamics [2], the Swan-Ganz pulmonary artery catheter has been used for perioperative and postoperative management and treatment of critically ill patients for a half a century. In current clinical practice, haemodynamic parameters such as stroke volume (SV) and cardiac output (CO), as well as central venous oxygen saturation (ScvO2), can be measured continuously using a combination of FloTrac Sensor (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [3], Edwards PreSep Oximetry Catheter (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [4], and EV1000 Clinical Platform (Edwards Lifesciences Japan Ltd., Tokyo, Japan) or Vigileo Monitor (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [5, 6]. These methods are less invasive than the Swan-Ganz pulmonary artery catheter, and the changes in the parameter values can be used as an index for perioperative management in both cardiovascular and non-cardiovascular surgeries. In addition, they can be used for the treatment of critically ill patients in the intensive care unit, enabling proactive determination of an appropriate therapy [7]. Compared to intermittent sampling and traditional vital signs alone, continuous ScvO2 monitoring is a more sensitive indicator of tissue perfusion because it reveals the true adequacy of tissue oxygenation, enabling early detection and assessment of clinical response to intervention [7, 8].

DOI： 10.5114/ait.2020.100300

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

外科医がカンファレンスにおいて内科医(小児科医)に求めるものは各外科医の技量や経験と施設により異なると思われるが、特に若く経験の少ない外科医はカンファレンスから得られた患者情報をもとに手術を組み立てる。診断および治療方針はもちろんであるが、体外循環確立のための血管走行などの解剖学的情報や心内形態・解剖など必要な術前情報は疾患および術式ごとに異なる。内科医(小児科医)には基本的な体外循環確立と手術術式の知識も踏まえて、術式を導くようなカンファレンスでの術前情報の提示をしていただけると我々若い外科医にとって非常に有用である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02003&link_issn=&doc_id=20201202260005&doc_link_id=%2Fee7shoni%2F2020%2F003603%2F007%2F0209-0214%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fee7shoni%2F2020%2F003603%2F007%2F0209-0214%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We previously presented a cardiopulmonary bypass (CPB) method with blood delivery via femoral artery cannulation for pediatric aortic arch repair operations using the Radifocus Introducer sheath. However, the flow rate with the Radifocus Introducer sheath is limited by accessory parts with the same structure having a smaller inner diameter among different sizes, rather than the sheath body. Therefore, we further devised a combination of the JELCO IV catheter, an extension tube, and a three-way stopcock with a larger opening to obtain more flow rate keeping the CPB circuit pressure significantly lower than when using the Radifocus Introducer sheath successfully.

DOI： 10.1055/s-0040-1715604

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

症例は37歳男性。三尖弁閉鎖の診断で左Blalock Taussigシャント手術原法、Glenn手術原法、左肺動脈形成術の既往あり。10歳時にBjoerk手術を施行したが、術後に循環不全となり心肺補助装置を装着された。上下大静脈間の著明な圧較差を認めたため、人工血管による右房・無名静脈バイパス術を追加し心肺補助装置を離脱し得た。術後他院にて経過観察されていたが、30歳頃より心房頻拍が出現、36歳時より蛋白漏出性胃腸症を発症した。内科的治療でも改善を認めないため当院再診した。心臓カテーテル検査にて右房・無名静脈間の人工血管の開存が確認され、左肺動脈が低形成のため下大静脈血流は一部が人工血管経由に無名静脈から右肺動脈へ還流しており、上下大静脈間の圧較差を認めた。手術は人工心肺・心停止下に右房アブレーション、心外導管を用いたTCPC転換術、大動脈前方での左肺動脈再建、右房-心外導管間のfenestration作成および心外膜ペースメーカーリード装着術を行った。術後34日に退院した。蛋白漏出性胃腸症は軽快し3年経過した現在も再発は認めていない。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

The choice of graft material for reconstruction of the vena cava in pediatric patients remains controversial. We successfully treated an eight-month-old female patient with single ventricle physiology and long segment obstruction of the left superior vena cava using the right superior vena cava autograft at the time of bilateral bidirectional superior cavopulmonary anastomosis. Postoperative computed tomography confirmed the patency of the reconstruction.

DOI： 10.1177/2150135117706951

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

Marfan症候群(MFS)に心室中隔欠損(VSD)を合併し、急速に心不全が進行し、手術前後で心機能が低下した乳児例を経験した。症例は2ヵ月の女児で、VSDによる高肺血流性心不全と診断され、当院を紹介となった。家族歴、身体所見からMFSが疑われた。高肺血流に心機能低下も伴うため、段階的に修復術を施行された。肺動脈絞扼術直後と心内修復術直後にそれぞれ心機能は低下したが、徐々に回復した。3歳時に水晶体脱臼を認め、父がMFSであることから改訂Ghent基準を満たした。MFSは潜在的な心機能障害を有する可能性があり、治療介入が必要な先天性心疾患を合併する例では、術前の心不全の進行や術後管理に注意し、慎重な経過観察や治療戦略を考慮すべきである。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In a Fontan candidate, univentricular pacing may cause delay in interventricular conduction, which induces asynchronous contraction. Cardiac resynchronization therapy is expected to be an effective mode of therapy in such a case. CASE PRESENTATION: A 7-month-old girl, diagnosed with dextrocardia, congenitally corrected transposition of the great artery [situs solitus, L-loop, and L-transposition], ventricular septal defect, infundibular and pulmonary valvular stenosis, and straddling of the tricuspid valve, was considered as a candidate for the Fontan procedure. She had undergone Blalock-Taussig shunt, and epicardial univentricular pacemaker implantation for persistent complete atrioventricular block. She underwent a bidirectional cavopulmonary shunt concomitant with ventricular lead translocation from the morphological left ventricle to the morphological right ventricle. After discharge, ventricular dyssynchrony was noted and cardiac failure persisted. She was converted to cardiac resynchronization therapy (CRT) at 13 months of age. Two-dimensional speckle tracking imaging was used by cardiologists to determine the most suitable pacing site. CRT rapidly corrected the heart failure; thus, she underwent the Fontan procedure after 1.5 years. Five years have passed since the cardiac resynchronization therapy; her interventricular synchrony is maintained well and the level of brain natriuretic peptide remains within normal range. CONCLUSION: We describe the successful conversion from single ventricular pacing to CRT, in a case of congenitally corrected transposition of the great artery indicated for the Fontan procedure. The long-term prognosis of cardiac resynchronization therapy is undetermined in the pediatric population; therefore, further follow-up is required.

DOI： 10.1186/s40792-020-00863-4

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：新潟医学会  

1950年代に開始された先天性心疾患に対する外科治療は様々な手術手技や人工心肺装置、周術期管理の改良などに伴い、半世紀でその治療成績は急激な向上が得られている。単純心奇形の治療成績は安定し、救命が困難であった完全大血管転位症などの新生児や左心低形成症候群・無脾症候群などの単心室疾患の重症例の長期生存も得られる様になった。心房中隔欠損や動脈管開存に対しカテーテル治療が行われるようになり、単純心奇形に対する外科治療の比率は減少傾向にあるが、その一方で低体重児や単心室疾患群の治療成績の向上に伴いノーウッド手術・グレン手術・フォンタン手術などの段階的手術の比率が増加している。この他にも、成人期に到達した成人先天性心疾患患者に対する右室流出路再建やTCPC conversion等の再手術も近年増加し、さらなる患者数の増加が予想される。今後は小児集中治療体制の拡充と成人先天性心疾患診療体制の確立が課題であり早急な対応が望まれる。また、小児心臓手術の施設集約化の必要性が全国的に叫ばれており、新潟県全体でどの様に小児循環器治療を行うかの議論が必要である。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

A right-sided descending aorta with a left aortic arch is a rare congenital anomaly in which the aortic arch crosses the midline from the left side of the trachea coursing to the descending aorta in the right thoracic cavity. The surgical repair of an interrupted aortic arch with a right-sided descending aorta carries great risks of bronchial and oesophageal obstruction. Herein, we describe a case of successful surgical repair of an interrupted aortic arch with a right-sided descending aorta using the swing-back and trap-door techniques.

DOI： 10.1093/icvts/ivz175

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Language：English   Publishing type：Research paper (scientific journal)  

The optimal timing of stage-2-palliation (S2P) in single left ventricle is not clear. The aim of this study was to identify S2P related factors associated with outcomes after total cavopulmonary connection (TCPC), particularly relative to the dominant systemic ventricle. A total of 405 patients who underwent both S2P and TCPC at our institute between 1997 and 2017 was included. Patients were divided into two groups, dominant right ventricle (RV type, n = 235) and dominant left ventricle (LV type, n = 170). S2P related factors associated with mortality, postoperative ventricular function, and late exercise capacity following TCPC, were analyzed. The median age at S2P was 4 [3-7] and 6 [3-11] months in RV and LV type patients, respectively (p = 0.092). Survival after TCPC was similar in RV and LV type patients (p = 0.280). In those with RV type, risk factors for mortality following TCPC were older age (p < 0.001), heavier weight (p = 0.001), higher PAP (p < 0.001), higher TPG (p = 0.010), and lower SO2 (p = 0.008) at S2P. In those with LV type, no risk factor was identified. Risk factors for postoperative impaired ventricular function were older age and higher weight at S2P in both RV and LV type patients. Older age at S2P was also identified as a risk for inferior peak oxygen uptake (VO2) years after TCPC both in RV and LV type patients. Older age at S2P was associated with higher mortality after Fontan completion only in RV type patients. However, it was associated with postoperative ventricular dysfunction and lower exercise capacity after TCPC in both RV and LV type patients.

DOI： 10.1007/s00246-019-02172-6

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A 7-year-old female suffering from syncope attacks and deafness was genetically diagnosed with Jervell and Lange-Nielsen syndrome (JLNS). A transvenous-designed shock lead and implantable cardioverter-defibrillator (ICD) were atypically implanted subcutaneously, because the patient's body was small. Six years after implantation, we confirmed the patient's eligibility for a subcutaneous ICD (S-ICD) based on electrocardiogram screening. The implanted ICD system was replaced with a new standard S-ICD system. Implantation of the S-ICD may be considered a reliable and safe option in young patients with JLNS, even if their electrocardiograms show remarkable prolongation of the QT interval and T-wave alternans.

DOI： 10.1536/ihj.19-076

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A 46-year-old man who had undergone atrial septal defect closure during childhood was referred for surgery for residual partial anomalous pulmonary venous connection. The anomalous pulmonary veins were connected to the higher (cephalad) segment of the superior vena cava. As the usual caval division technique was not applicable, we chose to utilize the anterior wall of the superior vena cava as a flap for anomalous pulmonary vein rerouting. Bovine pericardium was used to reconstruct the systemic venous pathway. Systemic or pulmonary venous stenosis was not detected. The patient was discharged with a sinus rhythm.

DOI： 10.1177/2150135119862596

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The main goal of palliative procedures for congenital heart defects is adequate pulmonary blood flow (PBF), but precise intraoperative PBF evaluation is sometimes difficult. The purpose of this preliminary study was to investigate the usefulness of velocity time integral of the pulmonary vein (PV-VTI) measured by transoesophageal echocardiography (TOE) at the time of palliative procedure as a parameter for PBF. METHODS: Case histories of 63 patients who underwent palliative procedures (bilateral pulmonary artery banding in 18 patients, main pulmonary artery banding in 22 patients and systemic-to-pulmonary artery shunt in 23 patients) and whose intraoperative PV-VTI was measured by TOE from 2011 to 2017 at our centre were retrospectively reviewed. Low-body-weight infants, cases in which cardiopulmonary bypass was used and cases that were anatomically difficult to measure were excluded. RESULTS: PV-VTIs measured at 4 orifices of the pulmonary veins were all significantly decreased in both the bilateral pulmonary artery banding and main pulmonary artery banding groups and increased in the systemic-to-pulmonary artery shunt group immediately after the procedure. There were significant correlations between the velocity time integrals of both right and left pulmonary veins and arterial oxygen saturation (r = 0.564 and 0.703). Nine patients (6 bilateral pulmonary artery banding and 3 systemic-to-pulmonary artery shunt) required unplanned early reoperation due to inadequate PBF; their PV-VTIs were significantly different from those of patients not requiring reoperation. No major complications related to TOE occurred postoperatively. CONCLUSIONS: The PV-VTI measured by TOE during palliative procedures reflected the change of PBF and could help identify patients at higher risk of early reoperation due to inadequate PBF. This parameter may be a useful additional tool for evaluating intraoperative PBF.

DOI： 10.1093/ejcts/ezy465

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Language：English   Publisher：日本成人先天性心疾患学会  

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BackgroundsThe aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection. METHODS: We conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, 6 months (n=67). RESULTS: The proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044). CONCLUSIONS: Early bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

DOI： 10.1017/S1047951118001543

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Background: To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). Methods: Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. Results: The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. Conclusions: The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.

DOI： 10.21037/jtd.2017.11.53

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Language：Japanese   Publisher：新潟医学会  

小児心臓手術をどの様な施設で行うべきかは現在も議論のあるところであり、本邦においても大学病院・小児専門施設・循環器専門施設・一般総合病院など様々な種類の施設で手術が行われているのが現状である。新潟県及びその周辺医療圏には当院以外に多数例の小児心臓手術を行う施設は少なく、先天性心疾患の緊急性・希少性と地理的な環境から考えると当院が集約化した小児心臓手術施設として求められる役割は大きい。当院の小児心臓手術は1962年から始まっており本邦でも有数の長い歴史を有する。近年の手術治療成績の急激な向上と診断・管理技術の改善により、これまで治療困難であった新生児例・複雑心奇形例・ハイリスク例の救命が次々に得られるようになっているが、それに伴い当院の新たな問題点も明らかとなってきている。マンパワー・診療体制等のソフト面と、亜急性期病棟・集中治療病床等のハード面など今後クリアすべき課題は多い。現状の新潟県の小児心臓外科医療の観点から考えれば、大学病院併設型の小児専門医療施設(こども病院)の設置が望ましいと考えられる。(著者抄録)

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BACKGROUND: Non-bacterial thrombotic endocarditis (NBTE) is an uncommon pathological situation, which involves the presence of bland, fibrin-platelet thrombi. It usually occurs at the endocardium of cardiac valves, in association with endothelial injury and a hypercoagulative state. However, NBTE on the endocardium at the right atrial free wall in a patient without any apparent hypercoagulative background is rarely reported. CASE PRESENTATION: A girl aged 4 years with severe pectus excavatum was referred to our hospital for treatment of a recurrent right atrial tumor. The tumor was removed concomitant with pectus excavatum repair. The tumor was revealed as recurrent thrombus. Pathological findings showed that NBTE caused by an operative scar on the endocardium of the right atrium and sustained rheological stress in the right atrium due to compression from pectus excavatum lead to recurrent thrombus formation. Three years after the discontinuation of anticoagulation therapy, no sign of thrombus formation was found. CONCLUSIONS: To our knowledge, this is the first report of NBTE related to an interaction between sustained rheological stress from cardiac compression and endocardial injury. In such patients, we recommend concomitant chest wall repair when the operative scar is present at the site of the rheological force.

DOI： 10.1186/s40792-016-0236-4

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Atresia of the left coronary artery ostium is extremely rare. We report the case of a 13-year-old boy who played volleyball in school and collapsed with severe chest pain during practice. He was referred to our hospital, and imaging modalities showed atresia of the left main coronary artery ostium. Urgent coronary ostioplasty was performed using a patch of 0.6% glutaraldehyde-treated autologous pericardium. His postoperative course was uneventful, and he has had a normal everyday life without chest pain 8 months postoperatively. Physicians should be aware of the patient's history, as in this case, because prompt imaging diagnosis is essential when there is a high likelihood that the event is related to myocardial ischemia. Since long-term outcome is uncertain even after successful surgical revascularization, close follow-up is required.

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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A 15-day-old boy after intracardiac repair was discharged from the intensive care unit with a low-flow nasal cannula for oxygen administration. The cannula was a 4-Fr multi-purpose tube with a side hole that was inserted into his left nostril. Next day, he suddenly developed pneumocephalus emerging from the right periorbital swelling and extending to his face and subcutaneous scalp over the next 6 h. A computed tomography (CT) scan revealed massive air pockets in the orbit, subdural space, subcutaneous scalp, and face. The nasal cannula was found to have been inserted deeper than we thought and was thus presumed to be the source of the air pockets. We immediately removed the cannula. Follow-up CTs revealed rapid resolution of the intracranial and subcutaneous air. The subcutaneous emphysema completely disappeared over the next 4 days, and he was discharged without any incident.

DOI： 10.1007/s11748-014-0454-2

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

症例は男児。在胎38週3日、体重2,880gで仮死なく出生し、生直後より高度のチアノーゼを認め心エコー検査にて両大血管右室起始(DORV)と診断され同日当院NICUへ緊急搬送された。大血管関係は大動脈がやや右後方、肺動脈がやや左前方であり、心室中隔欠損は肺動脈弁下に存在するposterior TGA型DORVであった。漏斗部中隔は三尖弁側の心室漏斗部皺襞(VIF)側に挿入し、心室中隔にほぼ整列していた。手術は日齢25に胸骨正中切開・体外循環下に行った。心停止下に三尖弁経由に心室中隔欠損(secondary IVF)を閉鎖(心室内血流路作成)し、次に動脈スイッチ手術を行った。冠動脈パターンは1R2LCXのShaher 9型であり、trap-door法を用いた冠動脈移植を行った。肺動脈再建は前方転位を行わないJatene原法を行った。術後血行動態は早期から安定し、術後2日に人工呼吸器離脱、術後19日に退院した。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

症例は男児。在胎40週0日、体重3,465gで仮死なく出生した。生直後より高度のチアノーゼを認め心エコー検査にて両大血管右室起始・大動脈弓離断症と診断された。同日よりプロスタグランディン製剤の持続静注が開始され、当院NICUへ緊急搬送された。高肺血流に伴う急性心不全状態であったため、4生日に両側肺動脈絞扼術を施行した。術後に利尿が得られ全身状態は改善したが心不全状態が継続したため、9生日時に根治手術を行った。胸骨再正中切開下に上下半身分離体外循環を確立し、三尖弁経由にVSDから心室内血流路を作成し、次にtrap door法を用いて冠動脈移植を行った。Lecompte maneuverの後に大動脈弓再建(直接吻合)を行った。さらに右室流出路をパッチで拡大し、大動脈遮断解除後に肺動脈再建を行った。人工心肺離脱はとくに問題なく、開胸状態で手術を終了し4病日に閉胸し14病日に人工呼吸器を離脱した。術後に肺炎・乳び胸などを合併したが内科的治療にて改善し、78病日に退院した。(著者抄録)

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Takotsubo cardiomyopathy is very rare in the paediatric population and has not been described in a single-ventricle patient yet. We report the case of a 4-year old boy with a history of Takotsubo cardiomyopathy in whom we performed a Fontan operation. After coil embolization of the minor aortopulmonary collateral arteries, the patient developed Takotsubo cardiomyopathy. His cardiac function largely recovered over 3 months. He subsequently progressed to a Fontan operation and was weaned uneventfully off cardiopulmonary bypass, on minimal doses of dopamine and milrinone; he was sedated using a dexmedetomidine infusion and a midazolam bolus. There were no signs of recurrent Takotsubo cardiomyopathy over the subsequent 2 years.

DOI： 10.1093/icvts/ivu108

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Language：Japanese   Publisher：新潟医学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

症例は女児。在胎41週1日、体重3,032gで仮死なく出生し、生直後より心雑音とチアノーゼを認め心エコー検査にて総動脈幹症・大動脈弓離断症と診断された。同日よりプロスタグランディン製剤の持続静注が開始され、当院NICU緊急搬送された。肺血流増多に伴う多呼吸・尿量減少がみられたため、11生日に両側肺動脈絞扼術を施行した。術後に心不全症状は改善し体重増加が得られ、生後2ヵ月時に根治手術を行った。胸骨再正中切開下に心・大血管周囲を剥離した後に、腕頭動脈および下行大動脈送血を併用した上下半身分離体外循環下に大動脈弓再建(拡大直接吻合)し、心停止下に右室切開を置きVSDを閉鎖した。大動脈遮断解除後にあらかじめ作製しておいた二弁付12mmGoreTex人工血管を用いて右室流出路再建を行った。人工心肺離脱は特に問題なく、開胸状態で手術を終了し3病日に閉胸し4病日に人工呼吸器を離脱した。術後に右横隔膜の軽度挙上に伴う頻呼吸があったが徐々に改善し、49病日に退院した。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

症例は4歳7ヵ月の男児。出生後よりチアノーゼを認めFallot四徴症(TOF)・肺動脈閉鎖(PA)と診断されていた。肺動脈は膜様閉鎖であり、中心肺動脈と上行大動脈は大動脈肺動脈窓(APW)を介して交通していた。4歳時に手術目的に当院を紹介され、心臓カテーテル検査と造影CTにてはじめて主要大動脈肺動脈側副動脈(MAPCA)が指摘された。手術は胸骨正中切開アプローチで行った。MAPCAを剥離同定した後に体外循環を確立し、左肺下葉に灌流するMAPCAを中心肺動脈へ統合した。APWの開口部は直接閉鎖し、VSDをpatch閉鎖した後に右室流出路を再建した。体外循環離脱は問題なく右室/体血圧比は0.8であった。術後経過は良好であり26病日に退院した。術後7ヵ月時に行われた心臓カテーテル検査では右室/左室圧比(RVp/LVp)は0.56まで低下していた。今回われわれは非常に稀なAPWを合併したTOF/PA/MAPCAに対し一期的修復術を経験したので報告する。(著者抄録)

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Tracheobronchial obstruction and unilateral hypoplasia of the pulmonary artery are serious barriers to successful Fontan completion. We describe a 5-year old girl with left bronchial obstruction, hypoplasia of the left pulmonary artery and a single ventricle (double inlet left ventricle). She had undergone external stenting to treat left bronchial stenosis at 3 years of age, bidirectional cavopulmonary anastomosis and Damus-Kaye-Stansel anastomosis at 4 years of age, intrapulmonary artery septation 1 year later and, finally, completion of the Fontan operation with excellent postoperative haemodynamics.

DOI： 10.1093/icvts/ivt038

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Two girls aged 1 and 15 years with heart murmurs were diagnosed with aortico-left ventricular tunnel. In the 1-year-old, the tunnel had an intracardiac aneurysm within the right ventricular outflow tract; both openings were closed The 15-year-old had no aneurysmal dilatation, but she had mild aortic regurgitation; the aortic opening of the tunnel was closed with a patch. Both girls had uneventful postoperative courses with excellent early results.

DOI： 10.1177/0218492312443529

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PURPOSE: The aim of this study was to investigate the surgical outcomes and change in cardiac performance after total cavopulmonary connection (TCPC) in patients with reduced ventricular ejection preoperatively. METHODS: Among the 195 patients undergoing TCPC between 1990 and 2001 were 52 who had a preoperative ejection fraction of ≤50% (30%-50%, mean 44%). A dominant ventricle was of the morphologically right type in 81% of patients. RESULTS: A total of 9 of the 52 patients died early. Two patients died in the intermediate term. Postoperative exercise testing showed maximum oxygen uptake of 26.4 ± 5.8 ml/kg/min (anaerobic threshold 18.3 ± 3.2 ml/kg/ min). The cardiac index was 3.1 ± 0.9 l/min/m(2) at 1 year after TCPC, with no fundamental change at 5 years (3.1 ± 0.8 l/min/m(2)). The end-diastolic volume of the dominant ventricle was 130% ± 74% of the anticipated normal value at 1 year and 93% ± 27% at 5 years after TCPC, with ejection fractions of 48% ± 13% and 49% ± 9%, respectively. When these parameters were plotted for the individual patients, the ejection fraction increased during the first postoperative year, with the percent end-diastolic volume decreasing in 31 survivors; the trend appeared atypical in the remaining 12 survivors. Even in these patients, however, the parameters eventually changed toward favorable circumstances 5 years after TCPC. CONCLUSION: Change in ventricular function was not necessarily pessimistic after TCPC in patients with reduced ventricular contraction preoperatively.

DOI： 10.1007/s11748-011-0812-2

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Language：Japanese   Publisher：(株)南江堂  

6生日女児。徐脈を主訴とした。胎児エコーで徐脈と先天性心疾患を指摘されており、出生直後の心エコーにて両大血管右室起始症、12誘導心電図にて完全房室ブロックと診断された。徐脈による心不全のため、剣状突起下切開でペースメーカ埋込み術を行ったが、術後3日目にペースメーカ感染をきたしたため、システムを完全に抜去して一時ペーシングリードを右室壁に縫着し、感染コントロールを図った。約1ヵ月で創がほとんど治癒したため、左側開胸で左Blalock-Taussig短絡手術を行うと同時に新しいペースメーカを感染巣と隔離して植込んだ。術後経過は良好で、術後15ヵ月経過後もペーシング不全やペースメーカ感染は認めていない。

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A 6-day-old girl underwent pacemaker implantation for complete atrioventricular block through a subxiphoid incision. Epicardial leads were sutured on the right ventricle, and the pulse generator was buried in a subcutaneous pocket on the abdomen. After 3 days, the pacemaker site became infected. The whole pacing system was extracted immediately and replaced by temporary pacing leads. After the infection was controlled, a new pacemaker was implanted through a left thoracotomy during which an original Blalock-Taussig shunt was established. The new pulse generator was buried in a subcutaneous pocket in the left precordial area. The patient's postoperative course was uneventful, and there have been no signs of lead problems or re-infection. Using temporary pacing leads as a bridge to implant a new system and choosing a precordial subcutaneous pocket for the implantation site following suturing of the leads on the left ventricle through a left thoracotomy were useful in this case.

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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BACKGROUND: Although the Fontan procedure is now being applied to younger patients, the influence of patients' age at the time of surgery on long-term results remains unclear. We investigated whether age at Fontan completion affects subsequent hemodynamics and exercise capacity in patients with a dominant left ventricle followed up for more than 5 years. METHODS: Between January 1990 and December 2001, 68 patients with a dominant left ventricle underwent total cavopulmonary connection (TCPC) at our institute. The survivors routinely underwent postoperative exercise tests and catheterization at 1 year and then every 5 years after TCPC, and were divided into group A (< 3 years; n = 32) and group B (> or = 3 years; n = 33), according to age at time of the Fontan procedure and retrospectively reviewed. We also examined the correlation between age at Fontan and data from postoperative catheterization or exercise tests. RESULTS: None of the patients died during a follow-up period of 91.2 +/- 46.7 months. The postoperative exercise capacity (peak oxygen consumption; % of normal [61.3 +/- 11.5 versus 51.9 +/- 9.1, p = 0.0001]), cardiac index at 5 years (3.31 +/- 0.62 versus 2.86 +/- 0.69, p = 0.0133) and at 10 years after TCPC (3.24 +/- 0.46 versus 2.61 +/- 0.65, p = 0.0194), and ventricular ejection fraction (%) at 10 years after TCPC (62.1 +/- 7.6 versus 53.0 +/- 8.0, p = 0.0131) were significantly higher in group A. Age at Fontan completion inversely correlated with postoperative peak oxygen consumption (R = -0.374, p = 0.0006) and cardiac index at 5 years (R = -0.452, p = 0.0003) and 10 years after TCPC (R = -0.491, p = 0.0072). CONCLUSIONS: Earlier TCPC is beneficial in the long term from the viewpoint of exercise capacity and hemodynamics among patients with a dominant left ventricle.

DOI： 10.1016/j.athoracsur.2008.11.015

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.31.1_43_1

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OBJECTIVE: We initiated an off-pump Fontan procedure by using temporary bypass from the inferior vena cava to the atrium and advanced the procedure in selected patients by simply cross-clamping the inferior vena cava. We aimed to investigate whether the off-pump Fontan procedure could ameliorate the volume and duration of pleural and peritoneal effusion. METHODS: We retrospectively reviewed 74 patients (aged <4 years) who underwent Fontan completion between January 2001 and December 2006. The patients were classified into the following two groups: a cardiopulmonary bypass group in which cardiopulmonary bypass was required (n=27) and an off-pump group in which the procedure was completed without the use of cardiopulmonary bypass (n=47). A propensity score was used to control the treatment selection bias for the use of cardiopulmonary bypass. Fourteen patients from each group were successfully matched. Both bilateral pleural and peritoneal drainage tubes were placed in all the patients. The total volume of the effusion was measured at 6, 12, 24, 48, and 72h postoperatively and was corrected for body weight (kg) and intervals (h). RESULTS: Significantly reduced effusion (ml/kg/h) was noted in the off-pump group compared to the cardiopulmonary bypass group at 12h (cardiopulmonary bypass group, 8.6 [4.8-11.5]; off-pump group, 2.5 [1.2-5.4]; p=0.006) and at 48h (cardiopulmonary bypass group, 6.1 [2.6-9.9]; off-pump group, 1.4 [0.9-3.1]; p=0.008). CONCLUSIONS: The off-pump Fontan procedure may reduce the volume of postoperative pleural and peritoneal effusion.

DOI： 10.1016/j.ejcts.2008.04.053

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The purpose of this study is to analyze the operative maneuver and long term outcome of the arterial switch operation (ASO) for congenitally corrected transposition of the great arteries (c-TGA) or double inlet left ventricle (DILV). Since October 1977, 221 patients had undergone ASO in National Cardiovascular Center, Japan. Of these, 8 patients underwent ASO as a part of double switch operation (DSO) for c-TGA, and 1 patient underwent ASO and ventricular septation for the DILV with a rudimentary right ventricle simultaneously. We retrospectively reviewed these 9 patients. Six patients had a past history of the pulmonary artery banding. Age at the time of ASO ranged from 6 months to 5 years (median 3 year). As a reconstruction of the pulmonary artery at the time of ASO, Lecompte maneuver was performed in 7 patients, and original Jatene procedure was performed in 2. Coronary transfer was done as usual in all patients. There was no early death, and 1 patient died 1 year after the operation due to chronic heart failure. Late complication related to the ASO was pulmonary artery stenosis (1 patient after DSO) and aortic regurgitation (1 patient after ventricular septation).

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00349&link_issn=&doc_id=20080325110012&doc_link_id=40015922463&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40015922463&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

The purpose of this study is to analyze the operative maneuver and long term outcome of the arterial switch operation (ASO) for congenitally corrected transposition of the great arteries (c-TGA) or double inlet left ventricle (DILV). Since October 1977, 221 patients had undergone ASO in National Cardiovascular Center, Japan. Of these, 8 patients underwent ASO as a part of double switch operation (DSO) for c-TGA, and 1 patient underwent ASO and ventricular septation for the DILV with a rudimentary right ventricle simultaneously. We retrospectively reviewed these 9 patients. Six patients had a past history of the pulmonary artery banding. Age at the time of ASO ranged from 6 months to 5 years (median 3 year). As a reconstruction of the pulmonary artery at the time of ASO, Lecompte maneuver was performed in 7 patients, and original Jatene procedure was performed in 2. Coronary transfer was done as usual in all patients. There was no early death, and 1 patient died 1 year after the operation due to chronic heart failure. Late complication related to the ASO was pulmonary artery stenosis (1 patient after DSO) and aortic regurgitation (1 patient after ventricular septation).

PubMed

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(株)学研メディカル秀潤社  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

von Recklinghausen病に伴う血管病変は稀であるが多くは狭窄病変であり,瘤状病変はさらに稀とされ末梢血管病変は文献的にも報告は少ない.今回われわれはvon Recklinghausen病に伴う稀な前脛骨動脈瘤の破裂例を経験したので報告する.症例は41歳,女性.以前よりvon Recklinghausen病の診断を受けていた.5日前より右下腿に強い疼痛を伴う腫脹を自覚し当院受診,CTにより周囲に多量の血腫を伴う前脛骨動脈瘤の破裂と診断し緊急入院した.CT上は同肢の後脛骨動脈は開存していた.症状の軽快なく下腿以下の神経障害の進行も認めたため緊急手術を行った.手術はtourniquet techniqueにより一時的に右下肢血流を遮断しつつ脛骨外側アプローチで動脈瘤切除,前脛骨動脈の中枢側および末梢側を結紮した.術後軽度の右下肢神経障害は認めたがリハビリテーションにより軽快,第21病日に独歩退院した.病理所見にてHE染色で動脈壁の中膜および外膜は肥厚し中膜への紡錘状細胞の浸潤を認め,紡錘状細胞はS100蛋白陽性でありSchwann細胞などの神経原性であることが示唆された(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J01122&link_issn=&doc_id=20060727310004&doc_link_id=10.4326%2Fjjcvs.35.210&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.35.210&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：(株)南江堂  

59歳男.呼吸苦,悪寒の後に胸痛が出現し,心電図でST上昇を,経胸壁心エコーで心嚢液貯留と側壁の壁運動低下を認めた.心カテーテル検査でSeg 14に完全閉塞を認め,回旋枝の急性心筋梗塞に伴う心タンポナーデと診断し,緊急開胸術を行った.心臓を脱転すると心尖部から側壁にかけて梗塞巣と小さな断裂を認め,左室自由壁断裂(LVFWR)と診断した.フィブリンによるsutureless repairを行ったが,循環動態は改善しなかった.経食道心エコーで乳頭筋断裂による僧帽弁閉鎖不全を認め,僧帽弁置換術を行う方針とした.僧帽弁は前外側乳頭筋が断裂しており,前尖に穿孔部と疣贅を認めた.疣贅の細菌培養では緑色連鎖球菌が検出された.術後循環動態は安定したが,第20病日に突然ショックとなり,心エコーで再破裂を疑い,緊急手術を行った.梗塞巣は脆弱化しており,20mm程度の断裂を認め,blow-out型LVFWRと診断し,Teflon stripを用いた左室縫合術を行った.その後は経過良好で,第40病日に退院した

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We previously used the Fontan procedure, when applicable, by placing a temporary bypass from the inferior vena cava to the atrium. Alternatively, we have striven to achieve the procedure even without use of a temporary bypass in patients having collaterals between the inferior vena cava and the superior vena cava, so as to simplify the procedure. The azygous vein was intentionally left patent at the bidirectional Glenn procedure in the most recent 9 patients, expecting reasonable venovenous communication at Fontan completion. Surgical results will be described for the preliminary experience. METHODS: Since 2001, this alternative technique has been attempted in 34 patients undergoing the staged Fontan procedure, and eventually used in 22. Duration between the staged procedures was 4 to 108 months (median, 10 months). We considered that the technique was feasible unless femoral venous pressure exceeded 20 mm Hg immediately after cross-clamping the inferior vena cava. Although catheterization before the Fontan completion illustrated development of venovenous collaterals in 14 patients, oxygen saturation remained greater than 80% throughout the period of the bidirectional Glenn physiology. RESULTS: In all 22 patients, the extracardiac channel was readily reconstructed with an excellent surgical field of view, without operative mortality. On cross-clamping the inferior vena cava, the systemic circulation could be well maintained by administration of dopamine. Oxygen saturation immediately became approximately 97% to 100%. Maximal pressure gradient was 11 +/- 5 mm Hg between the superior vena cava and the femoral vein. Postoperatively, serum concentration of enzymes did not critically increase (maximal aspartate transaminase, 96 +/- 89 U/L; alanine transaminase, 65 +/- 59 U/L; total bilirubin, 1.8 +/- 1.1 mg/dL; creatine kinase, 437 +/- 230 U/L). CONCLUSIONS: This alternative technique, when feasible under the current criteria, was simple and did not provide any clinically significant impediments.

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Language：Japanese   Publisher：(株)南江堂  

CAD,AAA合併左室機能症例に対し体外循環下一期的手術は有効な治療の一つであると考えられた

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Language：Japanese   Publisher：新潟医学会  

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Other Link： http://search.jamas.or.jp/link/ui/2015038134

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Other Link： http://search.jamas.or.jp/link/ui/2015038161

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Other Link： http://search.jamas.or.jp/link/ui/2013320275

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Other Link： http://search.jamas.or.jp/link/ui/2013186308

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：新潟医学会  

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Language：English   Publisher：Japanese Circulation Society  

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Language：Japanese   Publisher：Japanese Circulation Society  

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Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2008088791

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2007115831

Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2006130345

Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2006091888

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Other Link： http://search.jamas.or.jp/link/ui/2005152188

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：社団法人日本循環器学会  

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Language：Japanese   Publisher：社団法人日本循環器学会  

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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