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医学部 附属病院 心臓血管外科 |
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Mori K, Ishii H, Sakaguchi S, Sakurahara D, Iwasaki A, Furukawa K
Annals of vascular diseases 15 ( 1 ) 58 - 61 2022年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Annals of Vascular Diseases 編集委員会
Surgery for vascular complications of a patient with vascular Ehlers–Danlos syndrome (vEDS) is challenging due to the fragility of the associated tissues. In this study, we present a type A acute aortic dissection case in a patient with vEDS successfully treated via total arch replacement. A 42-year-old woman was transferred to our hospital 10 days after the onset of symptoms and underwent emergency surgery. Intraoperative findings revealed severe inflammatory changes without tissue fragility that is distinctive of vEDS. The postoperative course was uneventful except for left recurrent laryngeal nerve palsy, and 24 months after the operation, the patient has remained free from any arterial event.
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弓部置換術後の大動脈食道瘻に対し，分割的に食道切除術と再建，大網充填術を施行し救命した1例
内勢 由佳子, 田代 耕盛, 宗像 駿, 北村 英嗣, 濱田 朗子, 河野 文彰, 武野 慎祐, 森 晃佑, 阪口 修平, 石井 廣人, 古川 貢之, 七島 篤志
Japanese Journal of Acute Care Surgery advpub ( 0 ) 95 - 99 2022年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：一般社団法人 日本Acute Care Surgery 学会
〔要旨〕患者は73歳，男性。急性A型大動脈解離に対する弓部大動脈人工血管置換術後2年目のCT検査で人工血管より末梢側の胸部大動脈瘤破裂を認め，緊急ステントグラフト内挿術が施行された。術後5日目のCT検査と上部消化管内視鏡検査で大動脈食道瘻（aorto-esophageal fistula；AEF）が確認され，同日に右開胸下に食道切除，食道切除後12日目に人工血管周囲のデブリドマン，大網被覆・充填術および食道再建術を施行した。AEFの救命には，迅速な出血と感染のコントロールが必要である。食道切除と感染人工血管置換が望ましいが，耐術能を考慮した術式の選択が現実的である。大網被覆・充填は感染コントロールに有効であり，ICG蛍光法を用いた大網の血流評価はその利点を向上させる。
DOI： 10.50840/jjacs.12-5
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Furukawa K, Yano M, Ishii H, Sakaguchi S, Mori K, Nishimura M, Nakamura K
Heart and vessels 36 ( 7 ) 1064 - 1071 2021年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Heart and Vessels
Objectives: The objective of this study was to analyze our surgical experiences with mitral valve plasty (MVP) combined with subvalvular procedures (SVPs) for functional mitral regurgitation (FMR) and to determine which preoperative factors affected clinical outcomes. Methods: This study retrospectively analyzed 33 patients who underwent MVP combined with SVPs for FMR with a left ventricular ejection fraction lower than 40% and advanced remodeled left ventricles. The mean follow-up period was 49 ± 33 months. Results: The preoperative mean right ventricular fractional area change (RVFAC) used to quantify right ventricular (RV) systolic function was 26 ± 11%. Sixteen patients (48%) had an RVFAC < 26%. One patient died during hospital stay, and nine more patients died of cardiac causes during follow-up. The 3- and 5-year rates of freedom from cardiac-related mortality were 78% and 68%, respectively. RVFAC was the significant predictor of cardiac-related mortality in a univariate analysis (risk ratio [RR] = 0.92, 95% confidence interval [CI] 0.85–0.99, p = 0.03) and demonstrated a non-significant tendency to predict cardiac-related mortality in the Cox multivariate analysis (RR = 0.94, 95% CI 0.86–1.003, p = 0.08). Continued reverse left ventricular remodeling was associated with an RVFAC ≥ 26%. At 3 years, there was also a significant difference in survival rates of cardiac-related mortality between patients with an RVFAC ≥ 26% and < 26% (94% vs. 61%; p = 0.03). Conclusions: Preoperative RV function affected left ventricular remodeling and cardiac-related mortality after MV surgery. MVP combined with SVPs for FMR provided promising results for patients without severe RV dysfunction.
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Furukawa K, Yano M, Ishii H, Sakaguchi S, Mori K, Nishimura M, Nakamura K
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 27 ( 1 ) 32 - 40 2020年6月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Annals of Thoracic and Cardiovascular Surgery 編集委員会
Purpose: To evaluate clinical outcomes of customized mitral valve plasty (MVP) for the treatment of functional mitral regurgitation (FMR) with a low ejection fraction (EF) and to determine which preoperative factors affected the clinical outcome.Methods and Results: MVP was adjusted according to the degree of left ventricle (LV) remodeling. We performed mitral annuloplasty (MAP) alone in 14 patients and added subvalvular procedures (SVPs) in 22 patients at a high risk of recurrent MR. During follow-up, reverse LV remodeling was obtained and the 3-year and 5-year non-recurrence rates of MR grade ≥2 were 94% and 89%, respectively. Two patients died during their hospital stay, and four more patients died of cardiac causes during follow-up. The 3-year and 5-year rates of freedom from cardiac-related mortality were 86% and 81%, respectively; no significant difference was observed between the two treatment groups. Right ventricular fractional area change (RVFAC) was a significant predictor of cardiac mortality. Patients with an RVFAC of <26% had significantly poorer cardiac-related mortality (71% at 3 years) than those with an RVFAC of ≥26% (95% at 3 years).Conclusion: Customized MVP provided durable mitral competence and reverse LV remodeling. Preoperative RV function was associated with cardiac-related mortality.
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Mori K., Furukawa K., Ishii H., Sakaguchi S., Iwasaki A., Taniguchi T., Nakamura K.
General Thoracic and Cardiovascular Surgery 2020年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：General Thoracic and Cardiovascular Surgery
© 2020, The Japanese Association for Thoracic Surgery. Removal of the infected prosthesis is considered an essential procedure in the treatment of prosthetic graft infection following cardiovascular surgery. Here, we present a case of left ventricular patch infection following repair of left ventricular rupture that was successfully treated by coverage with a latissimus dorsi muscle flap without patch removal. A 61-year-old man underwent double-patch repair for left ventricular-free wall rupture following posterior myocardial infarction. He underwent drainage and omental transposition with re-sternotomy for postoperative mediastinitis by Candida albicans, followed by pericardial fenestration via left thoracotomy for infectious pericarditis; however, left ventricular patch infection was detected. Considering the high invasiveness of a reoperation for patch removal, we preserved and covered the patch using a left pedicled latissimus dorsi muscle flap via left thoracotomy. The postoperative course was uneventful, and the patient was asymptomatic with no signs of recurrence at 30 months.
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脳卒中から見る若年者AVRの人工弁選択の検討
阪口 修平
第52回日本心臓血管外科学会学術集会 2022年3月
開催年月日： 2022年3月3日 - 2022年3月5日
記述言語：英語 会議種別：口頭発表（一般）
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60歳未満に対するSurgical AVRの術後遠隔期成績：25年間の単施設研究
阪口 修平
第74回日本胸部外科学会学術集会 2021年11月
開催年月日： 2021年10月31日 - 2021年11月3日
記述言語：英語 会議種別：口頭発表（一般）
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非細菌性血栓性心内膜炎(NBTE)を伴う腱索断裂により急性僧帽弁閉鎖不全をきたした１例
阪口 修平
第11回日本心臓弁膜症学会 2021年11月
開催年月日： 2021年11月20日 - 2021年11月21日
記述言語：日本語 会議種別：口頭発表（一般）
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「両大血管右室起始＋doubly committed subarterial VSDに対する２期的根治術」
阪口 修平
日本超音波医学会第31回九州地方学術集会 2021年10月3日
開催年月日： 2021年10月3日
記述言語：日本語 会議種別：口頭発表（一般）
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腋窩ポケット経胸腔アプローチPMIを行った乳児早期例
阪口 修平
日本胸部外科学会 九州地方会 2021年7月
開催年月日： 2021年7月29日 - 2021年7月30日
記述言語：日本語 会議種別：口頭発表（一般）