Details of a Researcher - NAKAJIMA Tomohiro

Papers - NAKAJIMA Tomohiro

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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 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.

腹部大動脈瘤拡大因子としての瘤壁三次リンパ組織形成および濾胞関連新規リンパ球サブセットの解明

保坂到, 池上一平, 三上拓真, 佐藤達也, 小川俊文, 武川慶, 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. ) S149 - S150 2024.10

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

SFA領域のEVTにおけるDevice選択再狭窄形態からDESをどう選ぶべきか REALDES study preliminary dateより

柴田豪, 伊庭裕, 新垣正美, 中西敬太郎, 山下修, 椿本恵則, 木村文昭, 畑田充俊, 笠島史成, 植野恭平, 中島智博, 仲澤順二, 三浦修平, 在原綾香, 川原田修義

日本血管外科学会雑誌 ( (NPO)日本血管外科学会 ) 33 ( Suppl. ) PD2 - 3 2024

Diaphragmatic paralysis following open-heart surgery in an adult.

Masayuki Akatsuka, Tomohiro Nakajima, Saori Miyagishima, Yutaka Iba, Yoshiki Masuda

Oxford medical case reports 2023 ( 12 ) omad140 2023.12 [Refereed] [International journal]

Ten-year follow-up study of a young woman with loeys-dietz syndrome: a case report.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Itaru Hosaka, Jyunji Nakazawa, Nobuyoshi Kawaharada

Journal of cardiothoracic surgery 18 ( 1 ) 209 - 209 2023.07 [International journal]

One Year Outcomes of Zilver PTX Versus Eluvia for Femoropopliteal Disease in Real-World Practice: REALDES Study.

Tsuyoshi Shibata, Yutaka Iba, Masami Shingaki, Osamu Yamashita, Yoshinori Tsubakimoto, Fumiaki Kimura, Atsutoshi Hatada, Fuminori Kasashima, Kyohei Ueno, Keitaro Nakanishi, Kiyofumi Morishita, Tomohiro Nakajima, Junji Nakazawa, Akihito Ohkawa, Itaru Hosaka, Ayaka Arihara, Shingo Tsushima, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028231179861 - 15266028231179861 2023.06 [International journal]

PURPOSE: This multicenter, prospective, observational study aimed to compare Zilver PTX and Eluvia stents in real-world settings for treating femoropopliteal lesions as the differences in the 1-year outcomes of these stents have not been elucidated. MATERIALS AND METHODS: Overall, 200 limbs with native femoropopliteal artery disease were treated with Zilver PTX (96 limbs) or Eluvia (104 limbs) at 8 Japanese hospitals between February 2019 and September 2020. The primary outcome measure of this study was primary patency at 12 months, defined as a peak systolic velocity ratio of ≤2.4, without clinically-driven target lesion revascularization (TLR) or stenosis ≤50% based on angiographic findings. RESULTS: The baseline clinical and lesion characteristics of Zilver PTX and Eluvia groups were roughly comparable (of all limbs analyzed, approximately 30% presented with critical limb-threatening ischemia, approximately 60% presented with Trans-Atlantic Inter-Society Consensus II C-D, and approximately half had total occlusion), except for the longer lesion lengths in the Zilver PTX group (185.7±92.0 mm vs 160.0±98.5 mm, p=0.030). The Kaplan-Meier estimates of primary patency at 12 months were 84.9% and 88.1% for Zilver PTX and Eluvia, respectively (log-rank p=0.417). Freedom from clinically-driven TLR rates were 88.8% and 90.9% for Zilver PTX and Eluvia, respectively (log-rank p=0.812). CONCLUSIONS: The results of the Zilver PTX and Eluvia stents were not different regarding primary patency and freedom from clinically-driven TLR at 12 months after treating patients with femoropopliteal peripheral artery disease in real-world settings. CLINICAL IMPACT: This is the first study to reveal that the Zilver PTX and Eluvia have similar results in real-world practice when the proper vessel preparation is performed. However, the type of restenosis in the Eluvia stent may differ from that in the Zilver PTX stent. Therefore, the results of this study may influence the selection of DES for femoropopliteal lesions in routine clinical practice.

Initial Outcomes of Physician-Modified Inner Branched Endovascular Repair in High-Surgical-Risk Patients.

Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Akihito Ohkawa, Itaru Hosaka, Ayaka Arihara, Shingo Tsushima, Keishi Ogura, Kenta Yoshikawa, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028231169183 - 15266028231169183 2023.04 [International journal]

PURPOSE: To report the initial outcomes of physician-modified inner branched endovascular repair (PMiBEVAR) for pararenal aneurysms (PRAs), thoracoabdominal aortic aneurysms (TAAAs), and aortic arch aneurysms in high-surgical-risk patients. MATERIALS AND METHODS: A total of 10 patients (6 men; median age, 83.0 years) treated using PMiBEVAR were enrolled in this retrospective, single-center study. All patients were at high surgical risk because of severe comorbidities (American Society of Anesthesiologists physical status score≥3 or emergency repair). End points were defined as technical success per patient and per vessel (successful deployment), clinical success (no endoleaks postoperatively), in-hospital death, and major adverse events. RESULTS: There were 3 PRAs, 4 TAAAs, and 3 aortic arch aneurysms with 12 renal-mesenteric arteries and 3 left subclavian arteries incorporated by inner branches. The technical success rate was 90.0% (9/10) per patient and 93.3% (14/15) per vessel. The clinical success rate was 90% (9/10). There were 2 in-hospital deaths, unrelated to aneurysms. Paraplegia and shower emboli occurred separately in 2 patients. Three patients experienced prolonged ventilation for 3 days after surgery. Aneurysm sac shrinkage occurred in 4 patients, and aneurysm size stabilized in 1 patient during follow-up, more than 6 months later. None of the patients required intervention. CONCLUSION: PMiBEVAR is a feasible approach for treating complex aneurysms in high-surgical-risk patients. This technology may complement the existing technology in terms of improved anatomical adaptability, no time delay and practicability in many countries. However, long-term durability remains undetermined. Further large-scale and long-term studies are needed. CLINICAL IMPACT: This is the first clinical study to investigate outcomes of physician-modified inner branched endovascular repair (PMiBEVAR). PMiBEVAR for treating pararenal aneurysm, thoracoabdominal aortic aneurysm, or aortic arch aneurysm is a feasible procedure. This technology is likely to complement existing technology in terms of improved anatomical adaptability (compared to off-the-shelf devices), no time delay (compared to custom-made devices), and the potential to be performed in many countries. On the other hand, surgery time varied greatly depending on the case, suggesting a learning curve and the need for technological innovation to perform more consistent surgeries.

Temperature analysis of aortic repair with hypothermic circulatory arrest to quantify the injury by cooling.

Hiroshi Sato, Yutaka Iba, Nobuyoshi Kawaharada, Joji Fukada, Yuu Iwashiro, Shingo Tsushima, Itaru Hosaka, Akihito Okawa, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Takeo Hasegawa, Yukihiko Tamiya

Interdisciplinary cardiovascular and thoracic surgery 36 ( 1 ) 2023.01 [International journal]

OBJECTIVES: We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. METHODS: A total of 340 patients who underwent elective ascending aortic replacement or total arch replacement with moderate HCA from December 2006 to January 2021 were studied. The change in body temperature trends recorded during surgery was shown graphically. Several parameters, such as the nadir temperature, cooling speed and the degree of cooling (cooling area), which was the area under curve of inverted temperature trends from cooling to rewarming as calculated by the integral method, were analyzed. The relationships between these variables and a major adverse outcome (MAO) postoperatively defined as prolonged ventilation (>72 h), acute renal failure, stroke, reoperation for bleeding, deep sternal wound infection or in-hospital death were evaluated. RESULTS: An MAO was observed in 68 patients (20%). The cooling area was larger in the MAO group than in the non-MAO group (1668.7 vs 1383.2°C min; P < 0.0001). A multivariate logistic model showed that old myocardial infarction, peripheral vascular disease, chronic renal dysfunction, cardiopulmonary bypass time and the cooling area were independent risk factors for an MAO (odds ratio = 1.1 per 100°C min; P < 0.001). CONCLUSIONS: The cooling area, which indicates the degree of cooling, shows a significant relationship with an MAO after aortic repair. This finding indicates that the cooling status with HCA can affect clinical outcomes.

REALDES studyZilver PTXとEluviaの実臨床における多施設前向き研究の一年次結果

柴田豪, 伊庭裕, 新垣正美, 中西敬太郎, 山下修, 椿本恵則, 木村文昭, 畑田充俊, 笠島史成, 植野恭平, 中島智博, 仲澤順二, 大川陽史, 保坂到, 川原田修義

日本血管外科学会雑誌 ( (NPO)日本血管外科学会 ) 32 ( Suppl. ) EA - 4 2023

Pararenal aortic aneurysm repair using a physician-modified stent-graft with inner branches.

Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Itaru Hosaka, Nobuyoshi Kawaharada

Journal of vascular surgery cases and innovative techniques 8 ( 3 ) 356 - 357 2022.09 [International journal]

Improvement of predicted hematocrit values after the initiation of cardiopulmonary bypass in cardiovascular surgery.

Takeo Hasegawa, Yutaka Iba, Shuichi Naraoka, Tomohiro Nakajima, Syuichi Hashimoto, Takao Murohashi, Riko Umeta, Itaru Hosaka, Akihito Ohkawa, Naomi Yasuda, Tsuyoshi Shibata, Nobuyoshi Kawaharada

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 25 ( 2 ) 117 - 124 2022.06 [Domestic journal]

Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient's background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44-67) mL/kg. In Study 2, bias ± LOA was - 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.

Scattered Media Elastic Fibers from the Aortic Root to the Ascending Aorta in a 30-Year-Old Marfan Syndrome Patient.

Tomohiro Nakajima, Yutaka Iba, Syuichi Naraoka, Tsuyoshi Shibata, Shintaro Sugita, Nobuyoshi Kawaharada

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 2022.05 [Domestic journal]

腹部大動脈瘤治療をマスターする:Short neckに対する治療戦略 Short neckに対するphysician modified inner branchの有用性

柴田豪, 梅田璃子, 保坂到, 大川陽史, 安田尚美, 中島智博, 伊庭裕, 川原田修義

日本心臓血管外科学会学術総会抄録集 ( (NPO)日本心臓血管外科学会 ) 52回 PD9 - 5 2022.03

A case of a giant pulmonary artery aneurysm due to an atrial septal defect with left main coronary artery occlusion.

Takuma Mikami, Syuichi Naraoka, Akiyoshi Hashimoto, Hirosato Doi, Keitaro Nakanishi, Tsuyoshi Shibata, Tomohiro Nakajima, Ryo Harada, Takeshi Kamada, Nobuyoshi Kawaharada

General thoracic and cardiovascular surgery 69 ( 9 ) 1338 - 1343 2021.09 [Domestic journal]

Cases of coronary artery occlusion due to the exclusion of pulmonary artery aneurysm are extremely rare, and there are few reports of surgical treatment. A 60-year-old woman with pulmonary hypertension due to an atrial septal defect and obstruction of the left main coronary trunk due to the exclusion of a giant pulmonary artery aneurysm underwent surgery. The surgery included atrial septal defect closure, tricuspid annulus plasty, pulmonary artery aneurysmorrhaphy, and coronary artery bypass grafting. One and a half years after the surgery, no re-expansion of the pulmonary artery was observed, and the symptoms of heart failure had improved. There are no reports of improvement in pulmonary valve regurgitation by aneurysmorrhaphy in pulmonary artery aneurysm. Surgery for pulmonary artery aneurysm with the exclusion of other organs was effective, and aneurysmorrhaphy for pulmonary artery aneurysm was acceptable.

Descending thoracic aorta-abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report.

Takuma Mikami, Takeshi Kamada, Toshiyuki Yano, Tomohiro Nakajima, Naomi Yasuda, Tsuyoshi Shibata, Keitaro Nakanishi, Ryo Harada, Syuichi Naraoka, Kojiro Toda, Nobutaka Nagano, Atsuko Muranaka, Nobuyoshi Kawaharada

Journal of cardiothoracic surgery 16 ( 1 ) 219 - 219 2021.08 [International journal]

BACKGROUND: There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. CASE PRESENTATION: A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu's arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. CONCLUSION: In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.

Acute kidney injury post-heart transplant: An analysis of peri-operative risk factors.

Brandon M Jocher, Joel D Schilling, Irene Fischer, Tomohiro Nakajima, Fei Wan, Yuki Tanaka, Gregory A Ewald, Kunal Kutkar, Muhammad Masood, Akinobu Itoh

Clinical transplantation 35 ( 6 ) e14296 2021.06 [International journal]

Acute kidney injury is a common complication following heart transplantation, and the factors contributing to acute kidney injury are not well understood. We conducted a retrospective cohort study evaluating patients who underwent heart transplantation between 2009 and 2016 at a single institution. The primary endpoint was incidence of acute kidney injury as defined by Kidney Disease Improving Global Outcomes criteria. Secondary endpoints included 30-day hospital readmission, 30-day mortality, and 1-year mortality. A total of 228 heart transplant patients were included in the study for analysis. In total, 145 (64%) developed acute kidney injury, where 43 (30%) were classified as stage I, 28 (19%) as stage II, and 74 (51%) as stage III. Risk factors found to be associated with the presence of acute kidney injury included increased use of vasopressors and inotropes post-transplant. Protective factors included cardiopulmonary bypass time <170 min. Acute kidney injury was found to be associated with increased 30-day and 1-year mortality.

Extracorporeal Life Support for Cardiogenic Shock With Either a Percutaneous Ventricular Assist Device or an Intra-Aortic Balloon Pump.

Tomohiro Nakajima, Yuki Tanaka, Irene Fischer, Kunal Kotkar, Ralph J Damiano Jr, Marc R Moon, Muhammad F Masood, Akinobu Itoh

ASAIO journal (American Society for Artificial Internal Organs : 1992) 67 ( 1 ) 25 - 31 2021.01 [International journal]

Extracorporeal life support (ECLS) can result in complications due to increased left ventricular (LV) afterload. The percutaneous ventricular assist device (PVAD) and intra-aortic balloon pump (IABP) are both considered to be effective means of LV unloading. This study describes the efficacy of LV unloading and related outcomes with PVAD or IABP during ECLS. From January 2010 to April 2018, all cardiogenic shock patients who underwent ECLS plus simultaneous PVAD or IABP were analyzed. Forty-nine patients received ECLS + PVAD, while 91 received ECLS + IABP. At 48 hours, mean pulmonary artery pressure was significantly reduced in both groups [34 mm Hg to 22, p < 0.01; 32 mm Hg to 21, p < 0.01; ECLS + PVAD and ECLS + IABP group, respectively]. The two groups had similar 30 day survival rates [19 patients (39%) vs. 35 (39%), p = 0.56]. The ECLS + PVAD group had higher incidences of bleeding at the insertion site [11 (22%) vs. 0, p < 0.01] and major hemolysis [9 (18%) vs. 0, p < 0.01]. Both groups had improvement in LV end-diastolic dimension (61 ± 12 mm to 54 ± 12, p = 0.03; 60 ± 12 mm to 47 ± 10, p < 0.01), and LV ejection fraction (16 ± 7% to 22 ± 10, p < 0.01; 22 ± 12% to 29 ± 15, p = 0.01). Both ECLS + PVAD and ECLS + IABP effectively reduced pulmonary artery pressure and improved LV function. Bleeding at the PVAD or IABP insertion site occurred more frequently in the ECLS + PVAD group than the ECLS + IABP group (p < 0.01). Nine patients (18%) in the ECLS + PVAD group experienced major hemolysis, while there was no hemolysis in the ECLS + IABP group (p < 0.01). Careful considerations are required before selecting an additional support to ECLS.

The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation.

Yuki Tanaka, Tomohiro Nakajima, Irene Fischer, Fei Wan, Kunal Kotkar, Marc R Moon, Ralph J Damiano Jr, Muhammad F Masood, Akinobu Itoh

The Journal of thoracic and cardiovascular surgery 160 ( 6 ) 1490 - 1500 2020.12 [International journal]

OBJECTIVE: The study objective was to investigate the progression of uncorrected mild aortic insufficiency and its impact on survival and functional status after left ventricular assist device implantation. METHODS: We retrospectively reviewed 694 consecutive patients who underwent implantation of a continuous-flow left ventricular assist device between January 2006 and March 2018. Pre-left ventricular assist device transthoracic echocardiography identified 111 patients with mild aortic insufficiency and 493 patients with trace or no aortic insufficiency. To adjust for differences in preoperative factors, propensity score matching was used, resulting in 101 matched patients in each of the mild aortic insufficiency and no aortic insufficiency groups. RESULTS: Although both groups showed similar survival (P = .58), the mild aortic insufficiency group experienced higher incidence of readmission caused by heart failure (hazard ratio, 2.62; 95% confidence interval, 1.42-4.69; P < .01). By using the mixed effect model, pre-left ventricular assist device mild aortic insufficiency was a significant risk factor for both moderate or greater aortic insufficiency and worsening New York Heart Association functional status (P < .01). CONCLUSIONS: Patients with uncorrected mild aortic insufficiency had a higher risk of progression to moderate or greater aortic insufficiency after left ventricular assist device implantation with worse functional status and higher incidence of readmission caused by heart failure compared with patients without aortic insufficiency. Further investigations into the safety and efficacy of concomitant aortic valve procedures for mild aortic insufficiency at the time of left ventricular assist device implant are warranted to improve patients' quality of life, considering the longer left ventricular assist device use as destination therapy and bridge to transplant with the new US heart allocation system.

Surgery of giant right coronary artery aneurysm complicated with coronary artery fistula to left ventricle.

Takeshi Uzuka, Masanori Nakamura, Tomohiro Nakajima, Noriyasu Watanabe, Yuichiro Fukazawa

Journal of cardiac surgery 33 ( 2 ) 95 - 96 2018.02 [International journal]

Absent left circumflex artery detected by computed tomography-angiography.

Ryo Harada, Tomohiro Nakajima, Nobuyoshi Kawaharda

Asian cardiovascular & thoracic annals 25 ( 5 ) 401 - 401 2017.06 [International journal]

Histomorphologic superiority of internal thoracic arteries over right gastroepiploic arteries for coronary bypass.

Tomohiro Nakajima, Kazutoshi Tachibana, Nobuyuki Takagi, Toshiro Ito, Nobuyoshi Kawaharada

The Journal of thoracic and cardiovascular surgery 151 ( 6 ) 1704 - 8 2016.06 [International journal]

OBJECTIVE: In this study, we compared the histologic and morphometric properties of both internal thoracic arteries and the right gastroepiploic artery (GEA) in patients undergoing coronary artery bypass grafting (CABG). METHODS: We microscopically examined transverse sections of segments of both internal thoracic arteries and the right GEA obtained from 83 consecutive patients who underwent CABG. RESULTS: There were no significant differences between the internal thoracic arteries. Significant differences were found between the left and right internal thoracic arteries and GEA in the intimal width (21.8, 21.5, and 71.7 μm, respectively; P < .01), intima-to-media ratio (0.286, 0.256, and 0.749, respectively; P < .01), and media width (148.5, 157.5, and 164.8 μm, respectively; P = .43). No atherosclerotic lesions, medial calcification, or intimal thickening were seen in the internal thoracic arteries; however, atherosclerotic lesions were seen in the GEA. The intima of the GEA was thicker than that of the internal thoracic arteries. Intimal thickening of the GEA, but not the internal thoracic arteries, was positively correlated with risk of arteriosclerosis. In patients with diabetes mellitus, dietary/drug therapy and insulin therapy were associated with GEA intimal thickness (P = .02 and .01, respectively). CONCLUSIONS: The internal thoracic arteries have equivalent histologic and morphometric properties that differ from those of the GEA only in intimal width. The former had no intimal thickening, and is thus preferable to the GEA for CABG.

Idiopathic bronchial hemorrhage: a rare but catastrophic complication in cardiac surgery.

Takeshi Uzuka, Masanori Nakamura, Tomohiro Nakajima, Shinichi Kusudoh, Hiroaki Usubuchi, Akihiko Tanaka, Noriyasu Watanabe

Journal of cardiothoracic surgery 11 ( 1 ) 78 - 78 2016.05 [International journal]

BACKGROUND: Hemoptysis is a common complication in all kinds of surgery. However, it is rarely critical because it resolves with or without intervention. CASE PRESENTATION: Here the authors present what is believed to be an unprecedented report of a case involving a fatal idiopathic bronchial hemorrhage complication during cardiac surgery. Eighty-five-year-old female with severe aorticvalve stenosis had elective aortic valve replacement. Subsequently, she developed diffuse bilateral severe idiopathic bronchial hemorrhage which required maximum intervention such as external bronchial ligation, V-A ECMO, coil embolization of bronchial artery and internal airway blockage by spigot. CONCLUSIONS: Airway bleeding is not a rare complication in cardiac surgery, but this case should increase awareness of this potentially life threatening perioperative complication.

Acute dilatation of the ascending aorta and aortic valve regurgitation in Loeys-Dietz syndrome.

Tomohiro Nakajima, Kazutoshi Tachibana, Yasuko Miyaki, Nobuyuki Takagi, Takayuki Morisaki, Tetsuya Higami

The Annals of thoracic surgery 97 ( 6 ) 2188 - 90 2014.06 [International journal]

Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder caused by mutations of the transforming growth factor (TGF)-β receptors. It is an autosomal dominant syndrome characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate. We treated an 18-year-old woman with a 100-mm-diameter aortic root aneurysm and severe aortic valve regurgitation. She underwent urgent aortic root replacement and bioprosthetic valve implantation. LDS was diagnosed by postoperative genetic screening results. Histopathologic examination of the aortic wall showed diffuse degeneration and elastin fragmentation in the media.

[Henoch-Schönlein Purpura with lung abscess].

Junji Nakazawa, Atsushi Watanabe, Tomohiro Nakajima, Taijiro Mishina, Masahiro Miyajima, Tetsuya Higami

Kyobu geka. The Japanese journal of thoracic surgery 66 ( 10 ) 886 - 9 2013.09 [Domestic journal]

A 72-year-old man had underwent left lower lobectomy for squamous cell carcinoma in our hospital in 2008. Postoperative stage was I A (T1N0M0). In 2010, follow-up chest computed tomography (CT) images showed similar cavitary nodules in segments 2 and 8 of the right lung with positive uptake on fluorodeoxyglucose-positron emission tomography (FDG-PET) images. Physical examination, blood tests, and levels of serum tumor markers showed no abnormality. Transbronchial lung biopsy revealed the absence of malignant cells. Segment 8 of the right lower lobe with the nodule was partially resected, and pathological examination demonstrated lung abscess. He was discharged but was hospitalized in another hospital for purpuric rash, fever, and arthralgia. Microscopic albuminuria was noted, and renal biopsy revealed nephritis with immunoglobulin A( IgA)deposition. He was made a diagnosis of Henoch-Schönlein purpura. Oral steroid therapy( prednisolone 60 mg/d) was initiated, resulting in the improvement of symptoms and disapearance of the cavitary nodule in the right lung segment 2.

[Aortic valve surgery in a patient with cold agglutinin disease; effectiveness of continuous retrograde cardioplegia].

Yasuko Miyaki, Nobuyuki Takagi, Takeo Hasegawa, Naomi Yasuda, Tomohiro Nakajima, Kazutoshi Tachibana, Tetsuya Higami

Kyobu geka. The Japanese journal of thoracic surgery 66 ( 3 ) 187 - 9 2013.03 [Domestic journal]

A 76-year-old female was hospitalized because of congestive heart failure and anemia. A thorough examination led to a diagnosis of severe aortic stenosis and cold agglutinin disease. The critical temperature for hemagglutination was 27 °C, which caused particular problems with regard to the myocardial protection temperature during surgery. Aortic valve replacement was performed safely by increasing the normal myocardial protection temperature from 15 °C to 32 °C and using 3 times the normal volume of cardioplagic fluid. As a result of strict perioperative thermal management, the operation was completed without any complications.

Transmanubrial approach with video-assisted thoracoscopic surgery for left superior sulcus tumour with dense adhesion after replacement of descending thoracic aorta.

Tomohiro Nakajima, Atsushi Watanabe, Jyunji Nakazawa, Tetsuya Higami

Interactive cardiovascular and thoracic surgery 14 ( 6 ) 906 - 8 2012.06 [International journal]

There are various surgical approaches to superior sulcus tumours according to the location of the tumour. The chief difficulties in the operation are broadening of the operative field and adhesiolysis. This study presents the case of surgical treatment of superior sulcus tumour following chemoradiation therapy with dense pleural adhesion due to a history of graft replacement of the descending thoracic aorta. The patient underwent left upper lobectomy via a transmanubrial osteomuscular-sparing approach combined with video-assisted thoracoscopic surgery (VATS). Transmanubrial approach combined with VATS offered a good overview during local tumour dissection.

[Aneurysm of the aortic cusp; report of a case].

Shuichi Naraoka, Satomi Inoue, Tomohiro Nakajima, Yukihiro Niida

Kyobu geka. The Japanese journal of thoracic surgery 63 ( 13 ) 1164 - 7 2010.12 [Domestic journal]

We performed surgical therapy to the rare case of the perforation of an aneurysm of the aortic cusp which had caused the congestive heart failure. 71-year-old man having developed coughing was diagnosed as a severe aortic regurgitation and came to our hospital for surgery. The non coronary cusp was dilated and perforated. The aortic valves were removed and replaced with a bioprosthetic valve. The pathological examination of the valves showed healed infective endocarditis. The patient discharged home uneventfully.

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