Details of a Researcher - NAKAJIMA Tomohiro

Papers - NAKAJIMA Tomohiro

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Right External Iliac Artery Resection and Reconstruction Because of Cecum Cancer Invasion: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Masayuki Ishii, Maho Toyota, Koichi Okuya

Cureus 17 ( 5 ) e84916 2025.05 [International journal]

This report describes the case of a 69-year-old female patient. At the age of 68, she was diagnosed with cecum cancer, and infiltration of the right external iliac artery was detected. Owing to arterial infiltration, surgical resection was considered inappropriate, and a future risk of intestinal obstruction in the cecum region was anticipated. Therefore, a laparoscopic ileum-transverse colon bypass was performed. Subsequently, chemotherapy with the FOLFOXIRI (folinic acid, fluorouracil, oxaliplatin and irinotecan) regimen plus bevacizumab was administered for five months. Contrast-enhanced computed tomography revealed reduced infiltration of the right external iliac artery, prompting plans for ileocecal resection with combined resection of the right external iliac artery and iliopsoas muscle. After resection of the intestine, preserving the bypass site and tissue mobilization except the right external iliac artery infiltration site, systemic heparinization was performed. An 8 mm artificial vessel was then interposed to reconstruct the right external iliac artery using an end-to-end anastomosis technique. Lower extremity blood flow was unremarkable, and the postoperative course was uneventful. The patient was discharged on postoperative day 10 without complications.

Spontaneous Forearm Hemorrhage in a Patient With Polycystic Kidney Disease: A Case Report.

Tomohiro Nakajima, Akihiro Tabata

Cureus 17 ( 4 ) e81864 2025.04 [International journal]

The patient is a 73-year-old woman. She had a brain hemorrhage at 53 years of age and underwent craniotomy and hematoma removal. At 55 years of age, she was treated for multiple renal cysts. An infection has spread to the existing renal cyst. The patient's renal function gradually deteriorated, and she underwent hemodialysis at 56 years of age. At 58 years of age, an internal shunt was created using an autologous blood vessel in the left elbow fossa. Thereafter, she was hospitalized six times because of a cyst infection and received antibiotic treatment. At 72 years of age, she experienced a brain hemorrhage and received conservative treatment at our hospital. Presently, she presented with swelling in the left forearm. Upon further examination, bleeding was found in the left forearm muscles. Hemostatic surgery was performed under general anesthesia. Here, we report a rare case of forearm hemorrhage in a patient with comorbid cystic kidney disease.

Effects of temperature on transient neurologic dysfunction after total arch replacement.

Keitaro Nakanishi, Hiroshi Sato, Yutaka Iba, Ayaka Arihara, Shuhei Miura, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Takeo Hasegawa, Nobuyoshi Kawaharada

General thoracic and cardiovascular surgery 73 ( 3 ) 155 - 163 2025.03 [Domestic journal]

OBJECTIVES: The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. METHODS: We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. RESULTS: Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8 °C min; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51 °C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100 °C min; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. CONCLUSIONS: Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

Unsuccessful Thrombin Injection for Right Femoral Artery Pseudoaneurysm: A Case Report.

Tomohiro Nakajima, Yu Iwashiro, Tsuyoshi Shibata, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 17 ( 3 ) e80640 2025.03 [International journal]

A 33-year-old man was brought to the emergency department after sustaining multiple traumas. The interventional radiology team performed vascular embolization via a 6 Fr sheath inserted into the right common femoral artery due to suspected bleeding from the duodenum. The man underwent multidisciplinary management. On day 3 after injury, contrast-enhanced computed tomography (CT) revealed a pseudoaneurysm in the right common femoral artery, the radiology team opted for thrombin injection therapy, and the patient was monitored. No swelling was initially observed. However, repeat contrast-enhanced CT demonstrated a pseudoaneurysm on postinjury day 9, indicating that thrombin treatment had failed. Vascular surgery was considered, and emergency surgical intervention was performed on the same day. A pseudoaneurysm and a 6 Fr sheath puncture site were identified through a right inguinal incision, and hemostasis was achieved. The postoperative course was uneventful, and the patient was transferred for rehabilitation on postoperative day 19 following pseudoaneurysm repair. This case involved the development of a femoral artery pseudoaneurysm following endovascular treatment for multiple traumas. Although the interventional radiology team performed a local thrombin injection, the treatment ultimately failed, necessitating vascular surgery intervention. The patient underwent open surgical repair without complications. With the increasing use of local thrombin injection for pseudoaneurysms, careful post-treatment monitoring is essential, and surgical intervention should be considered at an appropriate time if necessary.

Unraveling Novel Subsets of Lymphocytes Involved in Sac Expansion in the Tertiary Lymphoid Structure Within an Abdominal Aortic Aneurysm.

Itaru Hosaka, Ippei Ikegami, Takuma Mikami, Tatsuya Sato, Toshifumi Ogawa, Kei Mukawa, Marenao Tanaka, Keisuke Endo, Yukinori Akiyama, Akihito Ohkawa, Junji Nakazawa, Tsuyoshi Shibata, Tomohiro Nakajima, Yutaka Iba, Chikara Shiiku, Satoshi Sumino, Ryuji Koshima, Kenichi Takano, Shingo Ichimiya, Nobuyoshi Kawaharada, Masato Furuhashi

Journal of the American Heart Association 14 ( 6 ) e040279 2025.02 [International journal]

BACKGROUND: Chronic inflammation is involved in the development of abdominal aortic aneurysm (AAA). A tertiary lymphoid structure (TLS) within vascular lesions has recently been focused on for its role in modulation of inflammation in local tissues. We aimed to elucidate the relationships between TLS and pathophysiology of AAA. METHODS: Abdominal aortic samples obtained from 37 patients with AAA (men/women: 34/3, age: 72.8±9.9 years) and 15 autopsied patients who died from non-aortic events (men/women: 11/4, age: 65.5±9.8 years) were investigated. RESULTS: TLSs in AAA lesions were confirmed by focal infiltration of CD3-positive cells surrounding germinal center-like structures containing CD20-positive cells between the tunica adventitia and tunica media layers. The formation of a TLS was significantly more prevalent in AAA patients than in autopsied patients. The number of TLSs in AAA lesions was positively correlated with sac diameter (r=0.357, P=0.035) and the amount of intraluminal thrombosis (r=0.466, P=0.005). T cells and B cells were predominant cellular populations among CD45+ cells in AAA lesions. There was a significantly positive correlation between the proportions of interfollicular T follicular helper (CD3+CD4+CD45RA-CXCR5+PD-1+) cells and double negative B (CD3-CD19+IgD-CD27-) cells, and they were positively correlated with sac diameter, intraluminal thrombosis, and serum lipids. Deposited single-cell RNA-sequencing data for AAA showed that T follicular helper cells and double negative B cells were associated with lipid metabolism, T cell activation/proliferation and inflammation. CONCLUSIONS: The formation of a TLS in AAA lesions is associated with sac diameter and intraluminal thrombosis in connection with interfollicular T follicular helper cells and double negative B cells, which may contribute to the pathophysiology of AAA and might be novel therapeutic targets for the development of AAA.

The Degradation of Abdominal Aortic Prosthesis After 37 Years.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Keishi Ogura, Nobuyoshi Kawaharada

Cureus 17 ( 1 ) e77408 2025.01 [International journal]

An 85-year-old man underwent abdominal aortic aneurysm (AAA) repair with a synthetic graft at age 48. Sac enlargement, likely due to an endoleak, was observed during follow-up, and covered stents were placed in the graft limbs at age 80. Despite this, the sac continued to enlarge, leading to a referral to our institution. Imaging revealed an endoleak from an uncovered graft section. An EXCLUDER® stent graft (W. L. Gore & Associates, Inc., Flagstaff, AZ) was placed to cover the graft entirely, resolving the endoleak. The patient was discharged on postoperative day 5. This case highlights the rare failure of a synthetic graft after 37 years.

Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience.

Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Shuhei Miura, Nobuyoshi Kawaharada

EJVES vascular forum 63 32 - 40 2025 [International journal]

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated. METHODS: This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%). RESULTS: Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%). CONCLUSION: When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Kei Mukawa, Yu Iwashiro, Nobuyoshi Kawaharada

Journal of clinical medicine 14 ( 1 ) 2024.12 [International journal]

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3-25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5-79.0) years, and the aneurysm diameter was 56 (50-61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45-60) min and 92 (79-308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7-41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained "unchanged" in four patients, including the one with delayed type Ia endoleak, while two patients experienced "shrinkage". Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.

Long-Term Outcomes and Late Complications of Thoracic Endovascular Aortic Repair Using the GORE TAG or Conformable GORE TAG.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Taku Sakurada, Satoshi Muraki, Toshiyuki Maeda, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Keitaro Nakanishi, Takakimi Mizuno, Kei Mukawa, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028241305960 - 15266028241305960 2024.12 [International journal]

PURPOSE: Previous clinical studies have reported on the short- and mid-term prognoses of thoracic endovascular aortic repair (TEVAR) using the GORE thoracic aortic graft (TAG) or conformable GORE TAG. We evaluated the long-term prognoses of patients who underwent TEVAR using the GORE TAG or conformable GORE TAG in a real-world setting. MATERIALS AND METHODS: This retrospective observational study analyzed the data of all consecutive patients aged 20 years or older who underwent TEVAR using either the GORE TAG or the conformable GORE TAG at a single center. The surgical criteria did not deviate from global standards. In principle, TEVAR was performed with the TAG or conformable thoracic aortic graft (CTAG) according to the manufacturer's instructions. The primary outcomes of this study were the 10-year overall survival rate and the rate of freedom from aorta-related deaths at 10 years. RESULTS: Between January 2011 and December 2021, 331 patients underwent TEVAR, of whom 175 consecutive patients treated with TEVAR using either the GORE TAG or the conformable GORE TAG were enrolled. The mean age of the patients was 72.1 ± 9.3 years. In addition, the aneurysm and chronic dissection were 61.7% and 38.3%, respectively. Of all patients, 157 had a proximal landing zone ≥3, and 18 had a zone <3. The mean follow-up time was 46.5 ± 33.1 months. The 30-day mortality rate was 2.86%. The 3-, 5-, 7-, and 10-year overall survival rates were 76.9 ± 3.4%, 63.4 ± 4.1%, 55.9 ± 4.9%, and 42.4 ± 8.4%, respectively. The rate of freedom from aorta-related deaths at 3, 5, 7, and 9 years was 97.4 ± 1.3%, 95.0 ± 2.1%, 95.0 ± 2.1%, and 95.0 ± 2.1%, respectively. Late complications occurred in 23 (13.1%) patients. Endovascular re-intervention was performed because of endoleak, false lumen enlargement, or stent graft-induced new entry tear in 14 patients. Three patients required open conversion, and 6 were observed without re-intervention. CONCLUSIONS: Thoracic endovascular aortic repair using the GORE TAG or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. CLINICAL IMPACT: Thoracic endovascular aortic repair using the GORE thoracic aortic graft (TAG) or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. The 30-day mortality rate was 2.86%. During 10 years of follow-up, the overall survival rate was low; however, the risk of aorta-related deaths was also low. No significant differences in freedom from late complications and re-intervention are seen between the TAG and conformable thoracic aortic graft (CTAG) groups. Further investigations into the treatment of late complications are required.

Clinical Frailty Scale Predicts Outcomes After Elective Thoracic Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Keitaro Nakanishi, Takakimi Mizuno, Kei Mukawa, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028241302658 - 15266028241302658 2024.12 [International journal]

PURPOSE: The Clinical Frailty Scale (CFS), used to define frail patients, is significantly associated with clinical outcomes. The CFS can predict postoperative prognosis after cardiovascular procedures. However, no reports exist on the relationship between frailty defined by the CFS and thoracic endovascular aortic repair (TEVAR) outcomes. MATERIALS AND METHODS: We analyzed data obtained from patients who underwent TEVAR between January 2011 and December 2021. Frailty was assessed using the 9-point CFS and was defined as a score of ≥5 points. The primary outcome was the 5-year overall survival rate. The secondary outcomes included the rate of freedom from aneurysm-related death at 5 years, postoperative complications, length of stay, rate of nonhome discharge, need for mobility assistance, 30-day mortality rate, and re-intervention rate. RESULTS: Of 331 patients who underwent TEVAR, 186 were included. The mean age of frail (n=36) and nonfrail (n=150) patients was 73.2 ± 7.3 years and 70.9 ± 9.0 years, respectively (p=0.15). The length of stay (17 [9-39] vs 11 [10-16] days; p=0.09) and re-intervention rate (8.3% vs 13.3%; p=0.58) were not significantly different, although frail patients had a higher rate of nonhome discharge (33.3% vs 4.7%; p<0.001), need for mobility assistance (38.9% vs 6.0%; p<0.001), and 30-day mortality (11.1% vs 0.7%; p=0.005) than nonfrail patients. The 5-year overall survival rate after TEVAR was 6.2 ± 5.5 and 84.5 ± 3.4% in frail and nonfrail patients (p<0.001). The median survival time was 22 (6-40) and 136 (87-138&x41; months, the number of recorded deaths in 5 years was 28 (77.8%) and 18 (12.0%; p<0.001), and the rate of freedom from aneurysm-related death at 5 years was 80.7%±11.2% and 96.9%±1.5% (p=0.01) in frail and nonfrail patients, respectively. The mean follow-up time was 53.3 ± 2.7 months. Multivariate Cox regression indicated that the CFS (hazard ratio, 10.14; 95% confidence interval, 5.06-20.32) was significantly associated with overall survival. CONCLUSION: The CFS is a valuable prognosis predictor, and TEVAR for frail patients with a high surgical risk could not improve the overall survival. Thoracic endovascular aortic repair in frail patients should be approached cautiously. CLINICAL IMPACT: The Clinical Frailty Scale (CFS) could be a useful predictor of prognosis in patients undergoing thoracic endovascular aortic repair (TEVAR). A significant difference was observed between frail and nonfrail patients in the 5-year overall survival rate following TEVAR. Thoracic endovascular aortic repair for frail patients (CFS was ≥5 points) could not improve overall survival because their death was attributed to their comorbidities. Thus, TEVAR in frail patients should be approached cautiously.

A Case of Problem-Free Survival Five Years After Abdominal Aortic Sigmoid Colon Fistula Surgery.

Tomohiro Nakajima, Tsuyoshi Shibata, Shuhei Miura, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 12 ) e75026 2024.12 [International journal]

An aortoenteric fistula (AEF) is a rare but life-threatening condition where an abnormal connection forms between the aorta and the gastrointestinal tract, most commonly the duodenum. It can be primary (arising spontaneously due to an aortic aneurysm or infection) or secondary (complicating prior vascular surgery). Immediate recognition and surgical intervention are critical to manage severe gastrointestinal bleeding and prevent fatal outcomes. A 71-year-old male developed an AEF following abdominal aortic graft surgery. Four months postoperatively, he presented with persistent lower gastrointestinal bleeding and was diagnosed with a secondary AEF. A staged surgical approach was employed, involving initial bowel resection, stoma creation, and graft cleaning, followed by subsequent aortic graft replacement with omental flap coverage. Postoperatively, a graft rupture at the proximal anastomosis required emergency endovascular stenting, which stabilized the patient. Antibiotic therapy successfully managed graft infection, including meropenem, linezolid, and later levofloxacin. The patient was discharged home on day 65 and has remained free of aortic events for five years. This case illustrates the complexity of AEF management, emphasizing the importance of a multidisciplinary, staged approach to achieve infection control, hemostasis, and long-term stability. He has been followed up in an outpatient clinic since then. He is now 76 years old, five years later, and is progressing without an aortic event.

Aortic Unicuspid Valve Surgery in a Young Patient: A Case Report.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Masayuki Akatsuka, Nobuyoshi Kawaharada

Cureus 16 ( 12 ) e75305 2024.12 [International journal]

The patient was a 33-year-old male. He was noted to have a systolic murmur in the aortic valve region during childhood and underwent balloon valvuloplasty at a pediatric clinic. However, he was not followed up thereafter. Recently, he began experiencing exertional dyspnea and presented to our cardiology department. Detailed examinations, including echocardiography, revealed moderate aortic regurgitation and stenosis, and a unicuspid aortic valve was suspected morphologically. After discussing the findings with the patient, he opted for surgical treatment. The operation was performed under general anesthesia via a median sternotomy. Intraoperative inspection of the aortic valve confirmed a unicuspid morphology, consistent with the preoperative findings. The unicuspid valve was excised and replaced with a mechanical valve (St. Jude Medical (SJM) 25 mm). The surgery was completed without complications, and the postoperative course was uneventful. The patient was discharged home on postoperative day 10. Five years postoperatively, the patient remains asymptomatic and in good condition. Given the rarity of unicuspid aortic valve cases, this report is of significant clinical value.

Luminal shape and aortic remodelling after total arch replacement for type A aortic dissection: conventional and frozen elephant trunks.

Hiroshi Sato, Yutaka Iba, Takuma Mikami, Shingo Tsushima, Hiroki Uchiyama, Itaru Hosaka, Kei Mukawa, Yu Iwashiro, Ayaka Arihara, Shuhei Miura, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Shigeki Komatsu, Nobuyoshi Kawaharada, Joji Fukada

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 66 ( 5 ) 2024.11 [International journal]

OBJECTIVES: This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen was analysed based on elliptical Fourier analysis and evaluated as a predictor of AR. METHODS: This study involved patients who underwent total arch replacement with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual true lumen at all four levels was analysed based on elliptical Fourier analysis to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting was performed for adjustment between the groups. RESULTS: In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The inverse probability of treatment weighting-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. CONCLUSIONS: In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual true lumen can be an important reference for predicting postoperative AR.

Multicentre retrospective analysis of physician-modified fenestrated/inner-branched endovascular repair for complex aortic aneurysms.

Tsuyoshi Shibata, Yutaka Iba, Kiyomitsu Yasuhara, Noriaki Kuwada, Yoshiaki Katada, Hitoki Hashiguchi, Takeshi Uzuka, Itaru Hosaka, Tomohiro Nakajima, Nobuyoshi Kawaharada

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 66 ( 5 ) 2024.11 [International journal]

OBJECTIVES: In this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. METHODS: We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoracoabdominal aortic aneurysms at 6 centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events. RESULTS: Seven and 31 patients (median age, 80.5 years) had pararenal and thoracoabdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in 6 patients (15.8%), acute kidney injury in 3 patients (7.9%), respiratory failure in 3 patients (7.9%), bowel ischaemia in 1 patient (2.6%), stroke in 1 patient (2.6%) and paraplegia in 1 patient (2.6%). Among elective cases, in-hospital deaths occurred in 3 patients (9.7%), while in non-elective cases, the mortality rate was higher, with 3 patients (42.9%) succumbing. The median follow-up duration was 14 months. CONCLUSIONS: Physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.

A Case of Acute Aortic Dissection in an Older Patient of Advanced Age.

Tomohiro Nakajima, Kei Mukawa, Yutaka Iba, Tsuyoshi Shibata, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e74567 2024.11 [International journal]

The patient an 85-year-old female resided in a care facility where she maintained an independent daily activity level. She was discovered hunched over a table in her room, displaying reduced responsiveness and prompting an emergency call. Initially, her blood pressure was within 60 mmHg, and she was transported by ambulance to our hospital. Further examination revealed acute Stanford type A aortic dissection accompanied by signs of cardiac tamponade, necessitating urgent surgery. The operation was performed under general anesthesia and tracheal intubation. After exposing the femoral vessels through an incision in the right groin, cannulation was achieved for cardiopulmonary bypass. Subsequently, a median sternotomy was performed and the pericardium was opened. Blood within the pericardial cavity was carefully exposed and blood pressure was monitored. The pericardial cavity contained a large number of dark red hematomas. A left ventricular vent was inserted and cooling was initiated. The circulatory arrest was achieved at a rectal temperature of 28°C, accompanied by antegrade cerebral perfusion and selective antegrade myocardial protection to facilitate cardiac arrest. The entry tear was located on the dorsal aspect of the ascending aorta. Additionally, the ascending aorta was trimmed proximal to the brachiocephalic artery and a 26-mm Gelweave graft was anastomosed. Circulation was subsequently resumed, and rewarming commenced. The proximal dissection was extended to the non-coronary cusp, where BioGlue was applied to bond the intima and adventitia, followed by a partial adventitial inversion. The proximal anastomosis was then completed. The total operation duration was 366 min. The patient was extubated, and oral intake was initiated the following day. However, postoperative delirium persisted, and the patient developed a cerebral infarction triggered by paroxysmal atrial fibrillation. Her daily activities declined, and she experienced complications including pneumonia and urinary tract infection, which responded to antibiotic therapy. The patient was discharged on postoperative day 49.

Prevention of cardiac tamponade by left intercostal Pericardiotomy for massive recurrent pericardial effusion: a case report.

Tomohiro Nakajima, Kei Mukawa, Hidemichi Kouzu, Ayaka Kamada, Nobuyoshi Kawaharada

Oxford medical case reports 2024 ( 11 ) omae139 2024.11 [International journal]

This case involved an 89-year-old woman with a history of left nephrectomy for left renal cell carcinoma at the age of 87 years. She had been gradually accumulating pericardial effusion for the past 4 years. She presented with signs of tachycardia and hypotension suggestive of cardiac tamponade due to pericardial effusion, and pericardiocentesis was performed below the xiphoid process in the cardiology department. Serous fluid was aspirated, and malignancy was ruled out by various tests. The patient subsequently developed recurrent pericardial effusion and was admitted to the hospital. Cardiovascular surgery was performed for pericardial drainage. A left intercostal incision was made for pericardiotomy and drainage of the pericardial effusion, allowing it to accumulate in the left pleural cavity in case of future accumulation. Pathological examination of the pericardium revealed no specific findings, and no cancer cells were present in the pericardial fluid. Prednisolone therapy was initiated for idiopathic pericarditis.

Diaphragmatic Nerve Paralysis After Redo Aortic Valve Replacement That Improved Over Time and Led to Successful Ventilator Weaning: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Takeo Hasegawa, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e74783 2024.11 [International journal]

We report a 75-year-old female with a history of two heart operations: aortic valve replacement (St. Jude MedicalTM 21 mm) at the age of 44 years for severe rheumatic aortic stenosis and mitral valve replacement (CarbomedicsTM 29 mm) at the age of 51 years for rheumatic mitral regurgitation. Decades later, she presented with exertional dyspnea. Echocardiography revealed aortic stenosis with an effective orifice area of 0.79 cm². Coronary angiography showed #6 75% stenosis and a limited mechanical valve opening. After a thorough discussion, the patient agreed to undergo redo surgery. The surgery involved re-median sternotomy, left internal thoracic artery (LITA) harvesting, pannus removal, and replacement of the aortic valve with a 20 mm ATS advanced performance (AP) prosthesis (ATS Medical, Minneapolis, MN) in a supra-annular position. The LITA-left anterior descending (LAD) bypass was completed, and the patient was weaned from the cardiopulmonary bypass without complications. Postoperatively, the right phrenic nerve paralysis caused transient respiratory challenges requiring tracheotomy and prolonged ventilation. Rehabilitation improved diaphragmatic function and respiratory independence. At six months, the right phrenic nerve function had recovered, and the patient resumed walking independently with a cane. Two years postoperatively, the patient remained ambulatory and attended independent outpatient follow-ups. This report highlights the potential for gradual recovery from phrenic nerve paralysis following open heart surgery, emphasizing the importance of long-term multidisciplinary care.

A Case of Infective Endocarditis Following Bone Marrow Transplantation for Myelodysplastic Syndrome.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Yu Iwashiro, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e73564 2024.11 [International journal]

A 63-year-old man was diagnosed with myelodysplastic syndrome (MDS) at the age of 62 by the hematology department. The patient underwent four cycles of azacitidine (AZA) therapy, followed by successful bone marrow transplantation (BMT). Subsequently, he was hospitalized twice for graft-versus-host disease (GVHD). Prednisolone was initially administered at 60 mg and was gradually tapered to 10 mg/day. Additionally, the patient was prescribed 10 mg/day of a Janus kinase inhibitor. At age 63, approximately one month prior to admission, he began experiencing recurrent upper respiratory symptoms with fevers of around 37°C. He developed a persistent fever of 38°C, accompanied by dyspnea on exertion, and visited the hematology outpatient clinic. Chest radiography revealed prominent pulmonary congestion, leading to the decision to perform echocardiography, which revealed severe aortic valve regurgitation with vegetation attached to the valve. Laboratory findings included a white blood cell count of 13,200/μL and a C-reactive protein (CRP) level of 13.7 mg/dL. Blood cultures revealed the presence of gram-positive cocci. As the patient's respiratory condition progressively worsened, emergency aortic valve replacement was planned. Additionally, because of a history of percutaneous coronary intervention (PCI) at another institution, he was referred for a coronary artery bypass graft (CABG) on the right coronary artery to be performed concurrently. Surgery was performed via median sternotomy under cardioplegic arrest. The aortic valve was perforated at the right coronary cusp and was covered with vegetation. The patient underwent aortic valve replacement with a biological valve, and a saphenous vein graft was used for bypass grafting to the posterior descending branch of the right coronary artery. Postoperatively, antibiotic therapy was administered without infection recurrence. The patient was discharged 47 days postoperatively. This case demonstrated the rapid progression of infective endocarditis following BMT, highlighting the need for prompt recognition and management.

Patient-Related Progression of Steeper Sternal Wire Angles: A Case Report.

Tomohiro Nakajima, Tsuyoshi Shibata, Yu Iwashiro, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 10 ) e71324 2024.10 [International journal]

A 78-year-old female presented with a history of left atrial myxoma resection 12 years before presentation. The initial surgery involved a median sternotomy and cardiopulmonary bypass for tumor excision. Sternal closure was achieved using six titanium wires, with the lowermost wire noted to be slightly elevated from the sternum immediately post-operation. The patient, an active individual who regularly practiced yoga, including frequent prone positions, was discharged from follow-up two years postoperatively without complications. However, 12 years after the initial surgery, the patient experienced pain at the lower end of the median sternotomy site, prompting her first visit to our outpatient clinic within a decade. Physical examination revealed palpable subcutaneous protrusion of the lowermost sternal wire with visible skin discoloration. Although no evidence indicated wire penetrating the skin, wire removal was deemed necessary. Comparison with previous lateral chest radiographs demonstrated a progressive increase in wire angulation over time. The patient was admitted and the protruding wire was removed under local anesthesia. Her postoperative course was uneventful, leading to discharge on the sixth day after the procedure.

脈管分野において人工知能が果たす役割 Graph based clusteringを用いた腹部大動脈瘤拡大因子としての濾胞関連新規リンパ球サブセットの同定と機能的意義の解明

保坂到, 池上一平, 三上拓真, 佐藤達也, 小川俊文, 田中希尚, 遠藤圭佑, 秋山幸功, 大川陽史, 仲澤順二, 柴田豪, 中島智博, 伊庭裕, 高野賢一, 一宮慎吾, 川原田修義, 古橋眞人

脈管学 ( (一社)日本脈管学会 ) 64 ( Suppl. ) S114 - S114 2024.10

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