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Koji Kagisaki

Publications and source records attributed to Koji Kagisaki.

At least 19 recordsLinked to original sources
PubMed2006

Intermediate results of the double-switch operations for atrioventricular discordance.

BACKGROUND: Since 1987, anatomic biventricular repair using the double-switch operations has been our principal choice for patients with atrioventricular discordance. These alternative procedures have the theoretical advantage of using the anatomic left ventricle to support the systemic circulation. METHODS: A total of 45 patients underwent the double-switch operation. Their ages ranged from 6 months to 21 years. Associated malformations included pulmonary atresia in 27, pulmonary stenosis in 11, and Ebstein's malformation in 5. An atrial switch plus an arterial switch procedure was performed in 7, and an atrial switch plus a Rastelli-type ventriculoarterial switch procedure in 38. Follow-up ranged from 6 months to 15 years. RESULTS: Early mortality was 8.9% (n = 4). In the latter half of the series (n = 23, since 1994), there was no early death. Six patients died late. Actuarial survival at 5 and 10 years was 83.6% and 77.6%, respectively. Six patients required conduit replacement, and 2 required revision of an intraatrial baffle for pulmonary venous channel obstruction and infection, respectively. Freedom from reoperation was 95.3% at 5 years and 76.2% at 10 years. Freedom from arrhythmia was 88.8% at 5 years and 78.4% at 10 years. The systemic ventricular ejection fraction was 0.568 +/- 0.103 at 1 year (n = 39), 0.555 +/- 0.105 at 5 years (n = 17), and 0.539 +/- 0.098 at 10 years (n = 12). CONCLUSIONS: The surgical results of the double-switch operations have been improving. Intermediate follow-up suggests that these alternative procedures are a reasonable option for patients with atrioventricular discordance.

Adolescent↗
PubMed2006

Biventricular repair for right atrial isomerism.

BACKGROUND: Biventricular repair is often difficult to accomplish in patients with right atrial isomerism because of complex anomalous structures. METHODS: Ten patients with right atrial isomerism underwent biventricular repair. Their ages ranged from 15 months to 21 years. The follow-up period ranged from 1 month to 21 years. The Fontan procedure was unsuitable in 7 patients. The atrioventricular valves were separated in 5 patients and common in 5. One patient who had severe right-sided atrioventricular valvular regurgitation required concomitant prosthetic valve replacement. Another patient with a hypoplastic intraventricular septum underwent ventricular septation. Nine patients had two balanced ventricles. A ventricular septal defect was enlarged for rerouting in 3 patients. All patients had anomalous venoatrial connections and required intra-atrial baffle rerouting. One with major aortopulmonary collateral arteries underwent staged unifocalization. Three had extracardiac conduit repair. The outcomes were compared with 97 patients who underwent the Fontan procedure. RESULTS: There were 3 early deaths and 1 late death. Six survivors are in New York Heart Association functional class I or II. Two are free from medications. Two required reoperation owing to infection or prosthetic valve failure. At 1 year, cardiac index and systemic venous pressure were 3.2 +/- 0.9 L.min(-1).m(-2) and 6.6 +/- 1.6 mm Hg, respectively. There were no significant differences in survival, freedom from arrhythmia, freedom from reoperation, or exercise tolerance between biventricular repair and the Fontan procedure. CONCLUSIONS: Biventricular repair provided good long-term outcomes in patients with right atrial isomerism. In selected circumstances, biventricular repair is an acceptable alternative to the Fontan procedure.

Abnormalities, Multiple↗
PubMed2006

Partial anomalous pulmonary venous connection to the superior vena cava.

BACKGROUND: Repair of partial anomalous pulmonary venous connection (PAPVC) to the high portion of the superior vena cava (SVC) may be complicated by atrial arrhythmia and obstruction of the pulmonary veins or SVC. We reviewed our experience with the modified Warden technique, in which the SVC was transected and anastomosed to the right atrial appendage with anterior augmentation of pedicled autologous pericardial flap, and the atrial septum was directly displaced to the SVC orifice. METHODS: Twenty of 51 patients with PAPVC underwent this technique. Mean age was 11.9 years. Follow-up averaged 6.5 years. To quantify the height of insertion of anomalous pulmonary veins, the distance between the highest anomalous pulmonary venous orifice and SVC-right atrial junction was indexed by thoracic vertebral body height (height index). RESULTS: All patients are alive in sinus rhythm. No patients exhibited pulmonary venous obstruction, and mean flow was 0.61 mL. Mean flow of SVC return was 0.79 mL. The SVC occlusion occurred in 2 patients who had persistent left SVC with a good communicating vein. Three patients whose height index exceeded 2.5 successfully underwent catheter intervention at the SVC channel. CONCLUSIONS: Midterm results with the modified Warden technique were satisfactory. Patients with particularly high insertion of anomalous pulmonary veins should be treated and followed with specific caution for preserving an unobstructed caval pathway.

Adolescent↗
PubMed2005

The off-pump Fontan procedure by simply cross-clamping the inferior caval vein.

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.

Child↗
PubMed2005

Long-term outcome of right ventricular outflow tract reconstruction using a handmade tri-leaflet conduit.

OBJECTIVE: Since 1985, we have implanted handmade tri-leaflet conduits made of heterologous pericardium or expanded polytetrafluoroethylene (ePTFE), as an alternative to homograft for right ventricular outflow tract reconstruction. This report assesses the long-term outcome of these prostheses. METHODS: From 1985 to 2003, 216 handmade tri-leaflet conduits were implanted in 191 patients. Forty-two patients had previous conduit repairs. The mean age at operation was 8.1+/-7.7 years (range: 15 days-44 years). The underlying diagnoses were pulmonary atresia with ventricular septal defect in 83 patients, atrioventricular discordance in 36, transposition of the great arteries in 26, double outlet right ventricle in 14, and truncus arteriosus in 17. Whole heterologous pericardial tri-leaflet conduits were implanted in 169 patients, in the early series (porcine: 85; equine: 58; bovine: 26); bovine pericardial conduits containing ePTFE leaflets were implanted in 26 patients since 1996; whole ePTFE tri-leaflet rolls were employed in the most recent 21 patients. The conduit size was 21.1+/-3.1mm (range: 12-27 mm), 147.4+/-21.4% (range: 82.6-202.6%) of the anticipated diameter of the pulmonary valve. Follow-up was complete. RESULTS: There were 28 early deaths and 24 late deaths. The indication for conduit replacement was a peak instantaneous pressure gradient of greater than 50 mmHg. Sixty-five conduits required reoperation for conduit obstruction at 8.6+/-3.3 years after implantation. The freedom from reoperation at 5, 10, and 15 years was 93.9+/-1.9, 61.4+/-4.5, and 35.5+/-5.6%, respectively. Patients with smaller conduit size and young age at operation were predisposed to reoperation. None of the 47 ePTFE tri-leaflet conduits developed significant obstruction. The freedom from important pulmonary valve regurgitation (PR) as assessed by echocardiography was 68.3+/-3.7% at 5 years, 33.0+/-4.5% at 10 years, and 21.6+/-4.9% at 15 years. No patient required reoperation due to PR or right ventricular dysfunction. CONCLUSIONS: Handmade tri-leaflet conduits provide a reliable alternative for RVOT reconstruction in children, yielding as good a long-term outcome as do homografts. Longer follow-up is needed to determine how well ePTFE leaflets will fare.

Adolescent↗
PubMed2005

Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: serial changes in conduit geometry.

OBJECTIVE: We sought to examine midterm results of the Fontan operation with an extracardiac conduit using pedicled autologous pericardial roll, with special attention to angiographic evaluation of serial changes in conduit geometry. METHODS: Of 202 patients subjected to the Fontan operation since 1996, the conduit was used in 28 patients who had intact pericardium. We retrospectively reviewed a consecutive series of these patients, and serial changes in conduit geometry were accessed in 16 patients who underwent catheter examinations twice at 1.1 +/- 0.4 and 4.5 +/- 1.4 years postoperatively. RESULTS: There was one early and one late death. Except for a patient with apicocaval juxtaposition in whom a conduit occlusion developed caused by compression between the vertebral bodies and the ventricle, there were no important complications. Angiographically, conduit volume, estimated by using the MULTI-SLICE method, increased significantly (3490 +/- 2166 to 5426 +/- 3081 mm3, P < .001), whereas the volume per body weight remained unchanged. Conduit diameter increased significantly at both the inferior vena caval end (16.8 +/- 4.8 to 19.8 +/- 4.8 mm, P < .001) and the pulmonary artery end (11.9 +/- 3.8 to 14.2 +/- 4.2 mm, P < .001), whereas the diameter indexed to the normal right pulmonary artery remained unchanged. The cross-sectional area of the conduit increased in parallel with that of the normal right pulmonary artery. The ratio of the widest to the narrowest diameter of the conduit exhibited no significant change. CONCLUSIONS: Midterm results of the Fontan operation with pedicled autologous pericardial roll were favorable. Proportional increase of conduit size was demonstrated, with its shape preserved. This suggested a potential of the conduit to grow and that growth correlated with somatic development.

Adolescent↗
PubMed2005

[Influence of DPC on cardiovascular surgery].

After a new medical expense system "DPC (Diagnosis Procedure Combination)" had been introduced in 2003, the change in the medical treatment fee was evaluated according to each cardiovascular surgical field. Application of the DPC is limited to hospitalization fee in the general ward by a fixed daily amount The former payment system remains for operation, anesthesia, and some invasive examinations such as cardiac catheterization, therefore, the influence of the DPC introduction on cardiovascular surgery was minimum. A lot of problems are still left, however, for the classification of diagnosis, especially in a congenital heart disease, and the fee setting of intensive care. It is required also to reconsider serious cases, advanced complications and methods of life support. In the field of cardiovacular surgery, the treatment is so risky and so expensive, that more detailed analysis should be necessary by establishment of data base system.

Cardiovascular Surgical Procedures↗
PubMed2005

Is an increase in lactate concentration associated with cardiac dysfunction after the Fontan procedure?

PURPOSE: To investigate how blood lactate concentration changes in the early postoperative course after the Fontan procedure, and whether such a change is associated with postoperative hemodynamics. MATERIALS AND METHODS: Eight pediatric patients who underwent the Fontan procedure for congenital heart disease were included. Enrollment criteria were body weight >10 kg and staged Fontan procedure following the bidirectional Glenn procedure. Blood lactate concentration and central venous oxygen saturation (SvO2) were measured at five points: before skin incision, upon intensive care unit (ICU) admission, 15 minutes before, 15 minutes after, and 2 hours after extubation. Cardiac index (CI) was continuously monitored using the pulse contour technique. RESULTS: Lactate concentration increased in the ICU, peaking from 15 minutes before (2.7+/-1.3 mmol/L) to 15 minutes after (3.0+/-1.3 mmol/L) extubation. Values returned to normal parameters (1.0+/-0.1 mmol/L) within 48 hours. The CI values were also higher immediately after extubation (4.0+/-0.6 L/min/m2) than at ICU admission (3.3+/-0.6 L/min/m2) and before extubation (3.6+/-0.6 L/min/m2) (p=0.012). No significant change in central SvO2 or blood pressure (BP) was evident during the study period. CONCLUSION: In the early postoperative period after the Fontan procedure, blood lactate concentration increased temporarily around the time of extubation but the increase was not associated with hemodynamic deterioration.

Adolescent↗
PubMed2004

Midterm result of a case after Starnes operation.

We describe the midterm result after Starnes operation for a severely symptomatic neonate with Ebstein's anomaly by reviewing the reported cases. A 4-day-old baby with "wall to wall heart" underwent Starnes operation. The tricuspid valve was closed without fenestration and the coronary sinus was drained into the right ventricle. Consequently, she underwent bidirectional Glenn shunt and Fontan operation at 6 and 23 months, respectively, and is now attending kindergarten without limitation. The follow-up study at 5 years revealed normally sized left ventricle with good function and the small right ventricle in the absence of thrombus formation with systolic forward flow.

Cardiac Surgical Procedures↗
PubMed2004

Functional biventricular repair using left ventricle-pulmonary artery conduit in patients with discordant atrioventricular connections and pulmonary outflow tract obstruction-does conduit obstruction maintain tricuspid valve function?

OBJECTIVE: The aim of the study is to determine whether function of the tricuspid valve placed for the systemic circulation is related to left ventricular pressure supporting the pulmonary circulation after functional repair for atrioventricular discordance. METHODS: Right ventricular volume and tricuspid regurgitation (TR) were investigated, in relation to left ventricular pressure, in 15 patients with this malformation who underwent functional biventricular repair with left ventricle-pulmonary artery conduit. RESULTS: After the functional biventricular repair, ratio of systolic left ventricular pressure to right ventricular one (LVP/RVP) was 0.58+/-0.24 and right ventricular end-diastolic pressure (RVEDV) significantly increased from 104+/-24 to 137+/-39% of normal predicted value (P = 0.015). Five patients with LVP/RVP>0.6 were free from TR, however, six of seven with LVP/RVP<0.6 developed TR. Three patients required eventual tricupid valve replacement. Conduit replacement was required in seven patients and five were assessed similarly. After the conduit replacement, LVP/RVP decreased from 1.08+/-0.34 to 0.58+/-0.14 and RVEDV increased significantly from 87+/-24 to 129+/-19% (P = 0.011). One patient with postoperative LVP/RVP of 0.36 developed moderate TR. CONCLUSION: Mild obstruction at the pulmonary channel is not necessarily an evil after functional biventricular repair for this malformation, in terms of TR and right ventricular dilatation.

Adolescent↗
PubMed2004

Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot.

OBJECTIVE: Aortic regurgitation (AR) in the tetralogy of Fallot (TOF) is not frequent, but when present it impacts significantly on surgical management. Furthermore, the incidence of late AR development has been increasing, along with surgical interest in current practices. METHODS: Pre- and post-operative studies on 427 patients (TOF, 374; TOF/PA (TOF with pulmonary atresia), 53) who survived corrective operation were reviewed. AR (> or =mild) was detected in 28. RESULTS: Nine had AR preoperatively, while 25 (including six with preoperative AR) exhibited AR post-operatively. In the 19 who developed AR post-operatively, the aortic root diameter (AoRoD) and indexed AoRoD (%AoRoD) were 42+/-11 mm and 166+/-36%, increased from the preoperative values of 30+/-10mm and 149+/-24%. AR-free rate at 20 years was 95.1% of all cases studied, 84.3 vs 96.5% in TOF/PA vs classic TOF (P<0.0001), and 82.2 vs 97.0% in bulboventricular VSD vs infracristal VSD (P<0.0001). Older age at repair, and bulboventricular VSD were identified as risk factors for the progression of AR. Aortic valvuloplasty (AVP; n=5) or replacement (AVR; n=4) was performed nine times in eight patients before (n=1), during (n=4), or late after TOF repair (n=4); all showed improvement of NYHA class. Survival- and reoperation-free survival curves showed no significant difference between patients with or without AR. CONCLUSIONS: After repair of TOF, careful observation for a late progression of AR is needed for the optimal timing of surgical intervention, especially in patients who repaired at higher age with a dilated aortic root or in patients with bulboventricular VSD.

Adolescent↗
PubMed2004

Modified cavoatriotomy for combined PAPVC repair and maze procedure.

In patients with partial anomalous pulmonary venous connection (PAPVC) to the superior cavoatrial junction, the standard right-sided left atriotomy does not allow sufficient access to the mitral valve and the left atrium. And the injury and traction of the sinus node and sinus node artery should be avoided for prevention of the cardiac rhythm disturbance after operation. We herein report a useful approach to repair the sinus venosus atrial septal defect with PAPVC of the right pulmonary veins to the superior cavoatrial junction in patients also requiring mitral valve replacement and the maze procedure.

Atrial Fibrillation↗
PubMed2004

Sinus of valsalva aneurysm with congenital aortic stenosis and aortic coarctation.

A 52-year-old female was diagnosed with the extremely rare combination of sinus of Valsalva aneurysm, congenital unicuspid aortic valve stenosis, and coarctation of the aorta. She was successfully treated in a two-stage operation. The first operation consisted of a bypass graft to correct the coarctation. The second, performed 31 days later, included aortic valve replacement, patch closure of the aneurysm, and translocation of the right coronary artery.

Abnormalities, Multiple↗
PubMed2004

[Total anomalous pulmonary venous connection].

The severity of symptoms in total anomalous pulmonary venous connection (TAPVC) depends primarily on the degree of pulmonary venous obstruction (PVO). With severe PVO, patients can present in extremis with severe cyanosis, respiratory distress, and acidosis within the first few hours of life. The diagnosis is usually established by two-dimensional echocardiography. Surgical repair of TAPVC has involved a number of techniques using various strategies of cardiopulmonary bypass and circulatory arrest, methods of cardioplegia, sites of venous cannulation, and cavitary exposures. Recent clinical investigations have uncovered some long-term negative effects of deep hypothermia and circulatory arrest strategies. Our current strategies for surgical management of TAPVC are 1) using moderate hypothermic cardiopulmonary bypass with bicaval venous cannulation combined with antegrade cardioplegia strategy and 2) performing the side-to-side anastomosis between the confluence of pulmonary veins and the left atrium by right side approach. The critical parts of this anastomosis are 1) making incisions of the confluence of the pulmonary veins and the left atrium to avoid the distortion of the anastomotic site and 2) performing the anastomosis without "purse string" the suture line. The prognosis of the patients with recurrent PVO is still developing; therefore great care should be taken at the initial procedure to avoid obstruction.

Anastomosis, Surgical↗
PubMed2003

Combined right atrial resection for lung cancer that developed intractable atrial flutter.

We have encountered a patient with primary lung cancer with invasion into the right atrial wall with N2 disease. Complete resection of the tumor combined with the right atrial wall was achieved under cardiopulmonary bypass after induction chemoradiotherapy. Pathological results confirmed ypT0N0M0. Postoperatively, atrial flutter resistant to rate control with calcium-antagonists and beta-blockers was treated with catheter ablation of the atrioventricular node.

Aged↗
PubMed2003

Long-term functional results of the one and one half ventricular repair for the spectrum of patients with pulmonary atresia/stenosis with intact ventricular septum.

OBJECTIVE: To determine whether one and one half ventricular repair (1.5 VR) is definitely superior to the Fontan procedure in patients having hypoplastic right ventricle (RV) in the setting of pulmonary atresia with intact ventricular septum (PA/IVS) or its relatives, in terms of results in the longer term. METHOD: Since 1987, 1.5 VR has been chosen in seven patients with PA/IVS and in six having PS with hypoplastic RV. On preoperative catheterization, right ventricular end-diastolic volume (RVEDV) was 47+/-23% of the anticipated normal value, and annular diameter of the tricuspid valve (TVD) 72+/-22% of normal (Z value being -2.4+/-2.1). Follow-up term was 3-15 (10+/-4) years. RESULTS: All patients survived 1.5 VR, but one patient died of arrhythmia 9 years later. Freedom from arrhythmia was 80 and 20% at 10 and 12 years, respectively. Two patients have undergone conversion to the Fontan circulation, but none to true biventricular physiology. Consecutive catheterization (1, 5, and 10 years after 1.5 VR) demonstrated no changes in %RVEDV or %TVD. Cardiac index was 2.4+/-0.6 l/min per m(2) at either 5 or 10 years. RA pressure was 9+/-3 and 12+/-2 mmHg at 5 and 10 years, respectively. Smaller %RVEDV and %TVD were associated with episodes of atrial arrhythmia and higher RA pressure. Exercise testing showed anaerobic threshold of 16.6+/-3.4 ml/kg per min and 13.1+/-2.7 ml/kg per min at 5 and 10 years, respectively. These values were equivalent to those in patients with classical tricuspid atresia or PA/IVS undergoing the Fontan procedure, and unequivocally inferior to those in patients having PA/IVS. who could have undergone biventricular repair. CONCLUSION: Although we previously expected reasonable functional results after 1.5 VR between the Fontan circulation and biventricular physiology, this was not always the case in patients having pulmonary atresia or stenosis with intact ventricular septum.

Arrhythmias, Cardiac↗