156 results on '"Koichi Maeda"'
Search Results
2. One-year outcomes of the pivotal clinical trial of a balloon-expandable transcatheter aortic valve implantation in Japanese dialysis patients
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Keiichi Fukuda, Hideyuki Shimizu, Yasushi Sakata, Kentaro Hayashida, Hikaru Tsuruta, Tatsuo Takahashi, Isamu Mizote, Koichi Maeda, Toru Kuratani, and Yoshiki Sawa
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Prosthesis Design ,Dialysis patients ,law.invention ,Transcatheter Aortic Valve Replacement ,Japan ,Valve replacement ,Renal Dialysis ,Risk Factors ,law ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Stroke ,Dialysis ,Aged ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Intensive care unit ,Clinical trial ,Stenosis ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Aortic valve stenosis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Dialysis patients with aortic stenosis are generally considered as being at extreme or high surgical risk. Herein, the first clinical trial was conducted to investigate clinical safety and effectiveness of transcatheter aortic valve replacement (TAVR) using the balloon-expandable transcatheter aortic valve (SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) in Japanese dialysis patients. Methods The clinical trial is a single arm, prospective, open, non-randomized, Japanese multicenter study. The primary purpose of this trial is to evaluate the efficacy and safety of TAVR using SAPIEN 3 in 28 Japanese dialysis patients. Results Mean age was 79.2 years and 67.9% were male (Mean STS score was 14.3%). Transfemoral and transapical approaches were performed in 25 (89.3%) and 3 patients (10.7%), respectively. All bioprostheses were successfully implanted. Median intensive care unit stay and hospital stay after TAVR were 1.4 days and 6.3 days, respectively. In-hospital mortality was 3.6% and freedom from all-cause mortality at 1 year was 89.3%. Disabling stroke and life-threatening bleeding at 1 year was 7.7% and 8.5%, respectively. There was no structural valve deterioration during follow-up. New York Heart Association functional status, six-minute walk test, and EuroQOL visual analogue scale score significantly improved through 1 year compared with baseline. Conclusions TAVR using SAPIEN 3 is safe and effective for the treatment of Japanese dialysis patients with symptomatic severe aortic valve stenosis.
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- 2021
3. Factors associated with viral clearance periods from patients with COVID-19: A retrospective observational cohort study
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Ryuichi Nakano, Hisakazu Yano, Koichi Maeda, Tomoaki Imamura, Hiroyuki Fujikura, Taku Ogawa, Nao Okuda, Naokuni Hishiya, Yuki Suzuki, Natsuko Imakita, Tatsuya Fukumori, Nobuyasu Hirai, Yuji Nishihara, Masatoshi Sato, Takahiro Sekine, Tomoko Nishimura, Kei Kasahara, and Yuichi Nishioka
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Isolation (health care) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030106 microbiology ,Angiotensin-Converting Enzyme Inhibitors ,Real-Time Polymerase Chain Reaction ,Isolation period ,Patient Isolation ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,Age ,0302 clinical medicine ,Older patients ,Humans ,Medicine ,Pharmacology (medical) ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Viral clearance periods ,Reverse Transcriptase Polymerase Chain Reaction ,SARS-CoV-2 ,business.industry ,Medical record ,COVID-19 ,Middle Aged ,Viral Load ,Comorbid conditions ,Infectious Diseases ,COVID-19 Nucleic Acid Testing ,Hypertension ,Original Article ,Female ,business ,Cohort study - Abstract
Introduction Knowledge is limited on the virologic course of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, particularly the time taken for viral clearance and the optimal time to discontinue isolation. This study aims to identify the clinical and demographic factors influencing the time taken for viral clearance in patients with COVID-19 to determine the optimal isolation period. Methods This two-center retrospective observational cohort study was conducted between March 1 and June 31, 2020. Patients with COVID-19, which was confirmed by real-time reverse transcription polymerase chain reaction, were included. Data were extracted from medical records. The positive duration, which was defined as the period from the day of symptom onset to the negative conversion day, was assessed using a generalized linear model. Results We included 63 patients. The mean positive duration was 20 days. The positive duration was significantly shorter for patients younger than 30 years of age and those between 30 and 60 years of age than for patients older than 60 years of age. We observed a more scattered distribution of the positive duration in older patients than in younger patients. Conclusions Younger patients who recovered from COVID-19 took less time to clear SARS-CoV-2 than older patients; thus, a classification of the isolation periods based on age could be considered. A uniform viral clearance period for older patients may be difficult to determine because of biases such as underlying medical conditions. Further surveillance measures are recommended to determine the viral clearance time and the optimal isolation period.
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- 2021
4. Transcatheter aortic valve replacement as a bridge to surgical aortic valve replacement in a younger patient with extremely high surgical risk
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Yu Yamada, Koichi Toda, Kazuo Shimamura, Koichi Maeda, Toru Kuratani, and Yoshiki Sawa
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ejection fraction ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,Aortic aneurysm ,Stenosis ,0302 clinical medicine ,Bicuspid aortic valve ,Bridge (graph theory) ,030228 respiratory system ,Aortic valve replacement ,Valve replacement ,medicine.artery ,Ascending aorta ,cardiovascular system ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 50-year-old man with decompensated aortic stenosis displayed significantly reduced ejection fraction, an ascending aortic aneurysm (55 mm in diameter), and bilateral giant bullae, and was evaluated as having extremely high surgical risk. Therefore, as a bridge to definitive treatment, he simultaneously underwent transcatheter aortic valve replacement (TAVR) and upper left lung lobectomy. His heart function recovered 6 months later and he underwent surgical aortic valve replacement (SAVR) and graft replacement of the ascending aorta. TAVR may serve as a bridge procedure before SAVR for aortic stenosis in younger patients with high surgical risk.
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- 2020
5. Simultaneous Aortic Valve-in-Valve and Ascending Stent Grafting for Prosthetic Valve Stenosis and Ascending Flap
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Toru Kuratani, Yoshiyuki Yamashita, Yoshiki Sawa, Toru Ide, Kazuo Shimamura, Yu Yamada, and Koichi Maeda
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Prosthetic valve ,Aortic valve ,medicine.medical_specialty ,valve-in-valve ,Transcatheter aortic ,ascending stent grafting ,business.industry ,Prosthetic aortic valve stenosis ,Case Report ,General Medicine ,Stent grafting ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,medicine.artery ,Heart failure ,Ascending aorta ,medicine ,cardiovascular system ,business - Abstract
Report on total endovascular repair for a diseased aortic valve and the ascending aorta is few. Therefore, we report a case of prosthetic aortic valve stenosis and internal bovine pericardial flap after ascending aortic replacement complicated by congestive heart failure and hemolysis. Because the patient had high surgical risk and was anatomically suitable to undergo ascending endovascular repair, simultaneous transcatheter aortic valve-in-valve implantation and ascending endografting were performed. Her symptoms of heart failure and hemolysis resolved postoperatively. Thus, a simultaneous transcatheter procedure for a diseased aortic valve and the ascending aorta is a feasible option for appropriately selected patients.
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- 2020
6. Long-Term Outcomes of High-Risk or Inoperable Patients Who Underwent Transcatheter Aortic Valve Implantation
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Koichi Maeda, Yasushi Sakata, Isamu Mizote, Toru Kuratani, Masaki Tsuda, Takashi Mukai, Yoshiki Sawa, Yasuhiro Ichibori, and Toshinari Onishi
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Male ,medicine.medical_specialty ,Transcatheter aortic ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Interquartile range ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Long term outcomes ,Humans ,030212 general & internal medicine ,Heart valve ,Survival rate ,Aged, 80 and over ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Survival Rate ,Stenosis ,medicine.anatomical_structure ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Few studies have evaluated transcatheter aortic valve implantation (TAVI) beyond 5 years. We investigated long-term outcomes (≥5 years) and transcatheter heart valve (THV) performance in patients who had undergone TAVI at least 5 years previously, based on annual follow-up. We reviewed 114 consecutive patients who were of high surgical risk or inoperable and underwent TAVI for severe aortic stenosis from October 2009 to November 2013. There was no lost to follow-up, and median time to death or latest follow-up was 5.0 years (range: 0.1 to 8.5). Structural valve degeneration (SVD) was defined on transthoracic echocardiography (TTE) as follows: (1) mean pressure gradient ≥20 mm Hg with a >10 mm Hg increase from the post-TAVI baseline, and/or (2) moderate or severe transvalvular regurgitation. The mean patient age was 82.7 ± 6.4 years, and 37.7% of patients were men. Median Society of Thoracic Surgeons score was 7.6% (interquartile range 5.8 to 10.9). TTE ≥5 years was 76.1% complete (51 of 67 patients who survived ≥5 years postoperatively). The estimated cumulative survival rates at 1, 3, 5, and 7 years were 88.6%, 72.8%, 58.8%, and 45.3%, respectively. Albumin
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- 2019
7. Midterm Outcomes of Transcatheter Aortic Valve Replacement in Dialysis Patients With Aortic Valve Stenosis
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Takayoshi Ueno, Kazuo Shimamura, Isamu Mizote, Yasuhiro Ichibori, Yasushi Sakata, Koichi Maeda, Satoshi Nakatani, Toru Kuratani, Toshinari Onishi, Koichi Toda, and Yoshiki Sawa
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Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Dialysis patients ,Disease-Free Survival ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Dialysis ,Aged ,Cardiovascular mortality ,Aged, 80 and over ,business.industry ,Mean age ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Surgery ,Survival Rate ,Aortic valve stenosis ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Little is known about late outcomes after transcatheter aortic valve replacement (TAVR) in dialysis patients.Methods and Results:We enrolled 25 dialysis patients (mean age 76.5 years; mean STS score 14.7%; men 60.0%) with aortic valve stenosis undergoing TAVR at our institute. Cardiovascular mortality and stroke were defined according to the VARC-2 criteria, and major adverse cardiac and cerebrovascular events (MACCE) were investigated. Twenty-three patients (92.0%) were discharged, and the median hospital stay after TAVR was 9 days (IQR, 7.5-11 days). Mortality at 30 days was not observed. The overall survival rate at 1 and 3 years were 80.0% and 55.7%, respectively (follow-up period, 879±493 days; range, 40-1,826 days). At 1 and 3 years, rates of freedom from cardiovascular mortality, disabling stroke, and MACCE were 100% and 83.0%, 91.2% and 84.7%, and 69.8% and 39.9%, respectively. Three patients required redo-TAVR for valve dysfunction at 23, 36, and 38 months after the first TAVR, respectively (The rate of freedom from severe structural valve deterioration at 1 and 3 years was 100% and 85.9%, respectively). Conclusions Satisfactory in-hospital outcomes were achieved in dialysis patients after TAVR. Various problems, however, such as complications particular to dialysis patients and valve durability, remained at midterm follow-up. Further studies are recommended to solve these problems, and prudent preoperative assessments should be mandatory.
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- 2019
8. Impact of Liver Cirrhosis on Early and Midterm Results After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study
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Isamu Mizote, Kazuo Shimamura, Koichi Maeda, Ryoto Sakaniwa, Kei Torikai, Yuki Nakamura, Yasuhiro Ichibori, Yasushi Sakata, Toru Kuratani, and Yoshiki Sawa
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medicine.medical_specialty ,Cirrhosis ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,medicine.disease ,law.invention ,Cardiac surgery ,Valve replacement ,law ,Internal medicine ,Aortic valve stenosis ,cardiovascular system ,medicine ,Cardiopulmonary bypass ,Cardiology ,Hypoalbuminemia ,Risk factor ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Liver cirrhosis (LC) is a risk factor for open cardiac surgery; however, its impact on transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to validate the ou...
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- 2019
9. Safety and Efficacy of Transcatheter Aortic Valve Implantation in Nonagenarians in Japan: Procedural Outcome and Long-term Results in a Single Center
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Yasuhiro Ichibori, Toru Kuratani, Toshinari Onishi, Yoshiki Sawa, Ryohei Matsuura, Isamu Mizote, Koichi Maeda, Satoshi Nakatani, Yasushi Sakata, Koichi Toda, and Kei Torikai
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine ,Long term results ,Single Center ,business ,Outcome (game theory) ,Surgery - Published
- 2019
10. III. Respiratory Infection
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Koichi Maeda and Masatoshi Sato
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business.industry ,Immunology ,Respiratory infection ,Medicine ,General Medicine ,business - Published
- 2018
11. A hybrid approach for a case with a high risk of not only surgical but transcatheter aortic valve replacement
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Daisuke Nakamura, Koichi Toda, Koichi Maeda, Tsubasa Mikami, Isamu Mizote, Satoshi Kainuma, Yasushi Sakata, Toru Kuratani, Yoshiki Sawa, and Kazuo Shimamura
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Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Bypass, Off-Pump ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Aortic valve replacement ,Risk Factors ,medicine.artery ,Internal medicine ,medicine ,Brachiocephalic artery ,Humans ,Aged, 80 and over ,business.industry ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Cardiac surgery ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Cardiothoracic surgery ,Aortic Valve ,cardiovascular system ,Cardiology ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
An 86-year-old woman with severe aortic stenosis was thought to be at a high risk for surgical aortic valve replacement and inoperability due to old age and porcelain aorta. Furthermore, transcatheter aortic valve replacement (TAVR) was considered difficult due to high risk of coronary obstruction secondary to the aortic root anatomy and poor vascular access associated with marked atherosclerotic lesions on the distal aortic arch with peripheral artery disease. We successfully treated her with TAVR via the brachiocephalic artery in combination with prophylactic off-pump coronary artery bypass grafting.
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- 2021
12. Nosocomial infections caused by vancomycin-resistant Enterococcus in a Japanese general hospital and molecular genetic analysis
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Kazue Masuo, Masatoshi Sato, Daisuke Kitagawa, Koichi Maeda, Miyako Oka, Soma Suzuki, Masaru Komatsu, Fumihiko Nakamura, Akihiro Nakamura, and Etsuko Hamanaka
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Microbiology (medical) ,Enterococcus faecium ,medicine.disease_cause ,Hospitals, General ,Microbiology ,Japan ,Vancomycin ,Pulsed-field gel electrophoresis ,medicine ,Humans ,Pharmacology (medical) ,Vancomycin-resistant Enterococcus ,Gram-Positive Bacterial Infections ,Cross Infection ,Molecular Epidemiology ,Molecular epidemiology ,biology ,Outbreak ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Molecular analysis ,Anti-Bacterial Agents ,Infectious Diseases ,Enterococcus ,Multilocus sequence typing ,Multilocus Sequence Typing - Abstract
Introduction Vancomycin-resistant Enterococcus (VRE) is a rare bacterium in Japan, but an outbreak due to nosocomial transmission in medical facilities has been reported in recent years. Here, we report the outbreak of vanA vancomycin-resistant Enterococcus faecium (VREfm) in multiple wards of Nara Prefectural General Medical Center in 2019 and results of the molecular epidemiology analysis. Methods An aggressive screening program was conducted after the first VREfm was detected in a patient in the A ward. During the outbreak, 6000 rectal swab samples were screened for VRE by culture. Isolates from 60 patients with VREfm detected were clustered using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Results PFGE revealed a cluster consisting of three major clusters and four multi-strains. The first major cluster consisted of 26 isolates, the second consisted of 10 isolates, the third consisted of 6 isolates, and the remaining 4 clusters consisted of 2 isolates. MLST identified an allele profile (ST80) in most clusters of clone types P01–P06 but an allele profile (ST992) in cluster P07. Conclusion Based on the PFGE pattern, this case was considered to be a nosocomial infection due to multiple clones. Later, in addition to screening, sharing of hospital information, cohorting of patients and staff, and strengthening of environmental cleanup were carried out, and horizontal infection was suppressed.
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- 2021
13. Outcomes of Redo Transcatheter Aortic Valve Implantation for Structural Valve Degeneration of Transcatheter Aortic Valve
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Koichi Maeda, Yoshiki Sawa, Toshinari Onishi, Toru Kuratani, Yasushi Sakata, Takashi Mukai, Yasuhiro Ichibori, Isamu Mizote, and Masaki Tsuda
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medicine.medical_specialty ,Bypass grafting ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Aortic stenosis ,Mean pressure ,Original article ,Aortic regurgitation ,General Medicine ,Regurgitation (circulation) ,Redo transcatheter aortic valve implantation ,Surgery ,Structural valve degeneration ,medicine.anatomical_structure ,Valve replacement ,Valvular Heart Disease ,Multidetector computed tomography ,medicine ,In patient ,business ,Artery - Abstract
Background: The outcome of redo transcatheter aortic valve (TAV) implantation (TAVI) is unknown for TAV structural valve degeneration (SVD). This paper reports the initial results of redo TAVI for TAV-SVD in Japanese patients. Methods and Results: Of 630 consecutive patients, 6 (1.0%) underwent redo TAVI for TAV-SVD (689-1,932 days after the first TAVI). The first TAV were 23-mm balloon-expandable valves (BEV, n=5) and a 26-mm self-expandable valve (SEV, n=1). All patients underwent multidetector computed tomography (MDCT) before redo TAVI, which showed first-TAV under-expansion (range, 19.1-21.0 mm) compared with the label size. Two BEV and 4 SEV were successfully implanted as second TAV, without moderate/severe regurgitation or 30-day mortality. One of 2 patients with a BEV-inside-BEV implantation had a high transvalvular mean pressure gradient post-procedurally (34 mmHg) and required surgical valve replacement 248 days after the redo TAVI. This, however, was unnoted in patients with SEV implantation during redo TAVI. Planned coronary artery bypass grafting was concomitantly performed in 1 patient with a small sino-tubular junction and SEV-inside-SEV implantation because of the risk of coronary malperfusion caused by the first TAV leaflets. Five of the 6 patients survived during the follow-up period (range, 285-1,503 days). Conclusions: Redo TAVI for TAV-SVD appears safe and feasible, while specific strategies based on MDCT and device selection seem important for better outcomes.
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- 2021
14. P1276EXPLORING POSSIBLE PREDICTORS OF STRUCTURAL DETERIORATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION IN HEMODIALYSIS PATIENTS
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Satoshi Masuyama, Koichi Maeda, Masayuki Mizui, Yoshiki Sawa, Yasushi Sakata, Yusuke Sakaguchi, Toru Kuratani, and Yoshitaka Isaka
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Aortic valve ,Transplantation ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Magnesium level ,medicine.disease ,Hypomagnesemia ,medicine.anatomical_structure ,Restenosis ,Aortic valve replacement ,Nephrology ,Internal medicine ,Aortic valve stenosis ,medicine ,Cardiology ,Hemodialysis ,business - Abstract
Background and Aims Transcatheter aortic valve implantation (TAVI) is an effective treatment for aortic stenosis (AS) in high-risk patients, such as those who are suffering ESRD on hemodialysis. We previously showed that long-term survival of hemodialysis patients underwent TAVI was lower than that of non-hemodialysis patients but was comparable with that of hemodialysis patients treated with surgical aortic valve replacement. It is known that hemodialysis is a high risk of the bioprosthetic structural valve deterioration (SVD) after valve replacement surgery. Consistently, higher incidence of re-TAVI operation due to restenosis was observed in hemodialysis patients than in non-hemodialysis patients (Odds ratio [OR]:29.4, p In this study, we aimed to identify predictors of SVD in post-TAVI hemodialysis patients. Method From April 2012 to December 2015, 24 patients on hemodialysis were selected to receive TAVI for the treatment of AS in Osaka University Hospital. Demographic and laboratory data at pre- and post-operation were compared between patients who underwent re-TAVI (valve-in-valve) (SVD group) and those who did not (no-SVD group). Results During the follow-up period (maximal 7 years), 4 out of 24 patients required re-TAVI (valve-in-valve) operation because of SVD. Although serum calcium, phosphate, and PTH levels before operation were comparable between SVD group and no-SVD group, serum magnesium levels were significantly lower in SVD group. Lower serum magnesium quartiles were associated with a higher risk of SVD (OR 5.83, p=0.036). While effective orifice area index (EOAi) of aortic valve at 1 week after TAVI was similar between the 2 groups, EOAi improvement at 1 month was significantly poorer in SVD group than in no-SVD group (1.70 ± 0.15 vs 2.50 ± 0.56, p = 0.049). Conclusion The higher incidence of re-TAVI due to SVD in hemodialysis patients could be related with pre-operative low magnesium levels and with one-month post-operative low EOAi improvement. This was a single center observational study, and the number of patients was very small so that our data would not be necessarily applicable for every patient. Further investigation is necessary for identifying a prognostic predictor of SVD, which will lead to the prevention of unfavorable re-operation in hemodialysis patients.
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- 2020
15. Development of a new risk model for a prognostic prediction after transcatheter aortic valve replacement
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Yasushi Sakata, Koichi Maeda, Isamu Mizote, Koichi Toda, Shigeru Miyagawa, Kyongsun Pak, Kazuo Shimamura, Toru Kuratani, and Yoshiki Sawa
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Creatine ,Severity of Illness Index ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Ejection fraction ,biology ,business.industry ,Stroke Volume ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Prognosis ,Cardiac surgery ,Stenosis ,Treatment Outcome ,chemistry ,Cardiothoracic surgery ,Aortic Valve ,Cardiology ,biology.protein ,Surgery ,Creatine kinase ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Current guidelines for transcatheter aortic valve replacement (TAVR) recommend that TAVR should be performed in patients with a life expectancy > 1 year. However, it is challenging to estimate the patients’ life expectancy because it is related to various factors, including frailty and nutritional status. A new risk model can estimate the prognosis of patients after TAVR. We randomly divided 388 patients with aortic stenosis (AS) undergoing TAVR from October 2009 to August 2016 into two groups (2:1 ratio; training cohort, 259; validation cohort, 129). Using 94 baseline factors in the training cohort, we developed possible scoring models by the Cox proportional hazard regression model with the overall survival as the endpoint. Then, cross-validated 5-year C-statistics were calculated to assess the accuracy of the model. Of 94 baseline factors, 12 factors were finally identified (5-year C-statistics in the training cohort: 0.709)—age, gender, body mass index, left ventricular ejection fraction, % vital capacity, forced expiratory volume 1.0 (s) %, albumin, hemoglobin, creatine, platelet, creatine kinase, and prothrombin time-international normalized ratio. The cross-validated 1-, 3-, and 5-year C-statistics in the validation cohort were 0.792, 0.758, and 0.778, respectively. Furthermore, calibration plots in the validation cohort revealed that 5-year survival is well predicted (r = 0.962). The new survival prediction model after TAVR could provide appropriate guidance during decision making regarding the TAVR implementation.
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- 2020
16. The role of cardiopulmonary support system for transcatheter valve therapy
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Shigetaka Kusumoto, Yasushi Sakata, Kiyoshi Yoshida, Takamitsu Kato, Masaki Takashina, Koichi Maeda, Toru Kuratani, Yoshiki Sawa, Isamu Mizote, and Kei Torikai
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medicine.medical_specialty ,business.industry ,medicine ,General Earth and Planetary Sciences ,Support system ,Intensive care medicine ,business ,General Environmental Science - Published
- 2018
17. A novel method for prevention of stent graft-induced distal re-dissection after thoracic endovascular aortic repair for Type B aortic dissection†
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Kazuo Shimamura, Toru Kuratani, Tomohiko Sakamoto, Kenta Masada, Yoshiki Sawa, Tomoaki Kudo, Takayuki Shijo, Koichi Maeda, and Kei Torikai
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Dissection (medical) ,030204 cardiovascular system & hematology ,Aortography ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Risk Factors ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aortic dissection ,Aorta ,Aortic Aneurysm, Thoracic ,Type B aortic dissection ,business.industry ,Incidence ,Endovascular Procedures ,Stent ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Aortic Dissection ,Treatment Outcome ,Descending aorta ,Cuff ,Female ,Stents ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Objectives Stent graft-induced distal re-dissection (SIDR) is a burdensome complication after thoracic endovascular aortic repair (TEVAR) for Type B aortic dissection. We developed a novel method to prevent SIDR by placing a small-diameter short stent graft [Excluder Aortic Extender (Cuff)] at the distal landing zone (DLZ) and reviewed its effectiveness in this study. Methods Ninety patients who underwent TEVAR for Type B aortic dissection using commercially available devices between January 2008 and September 2016 were retrospectively reviewed. Among them, TEVAR with the Cuff technique was performed in 36 (40%) cases, in which a Cuff was placed at the DLZ in the descending aorta prior to the main stent graft deployment to avoid excessive stent graft oversizing at the distal end. The effectiveness of the Cuff technique was assessed by evaluating mid-term clinical results, including the incidence of SIDR. Results Technical success was achieved in all 90 cases. During a median follow-up time of 40.4 months (range 0.2-90.6 months), 8 SIDRs were documented using multidetector computed tomography images. Freedom from SIDR was significantly lower in the Cuff group (Cuff: 100%/5 years vs non-Cuff: 84.6%/5 years; P = 0.04), whereas no difference was observed between both groups in the oversizing rate at the DLZ (19.9 ± 8.5% vs 17.8 ± 9.9%; P = 0.29). Conclusions Placement of a small-diameter short stent graft at the DLZ (Cuff technique) in TEVAR for aortic dissection is an easy procedure that may reduce the incidence of SIDR.
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- 2017
18. Five-Year Outcomes of the First Pivotal Clinical Trial of Balloon-Expandable Transcatheter Aortic Valve Replacement in Japan (PREVAIL JAPAN)
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Morimasa Takayama, Koichi Maeda, Tatsuhiko Komiya, Tetsuya Tobaru, Shuichiro Takanashi, Yoshiki Sawa, Toru Kuratani, Yasushi Sakata, and Tsuyoshi Goto
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Male ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Japan ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Clinical trial ,Balloon expandable stent ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Transcatheter aortic valve replacement (TAVR) has been an alternative less invasive therapy for high-surgical risk/inoperable patients with aortic valve stenosis (AS) in Japan. We report 5-year outcomes of the first pivotal clinical trial of TAVR in Japan (PREVAIL JAPAN).Methods and Results:A total of 64 patients with AS who were considered unsuitable candidates for surgery were enrolled at 3 centers in Japan (mean age: 84.3±6.1 years, female: 65.6%, STS score: 9.0±4.5%). Transfemoral approach (TF) and transapical approach (TA) was performed in 37 patients and 27 patients, respectively. At 5 years, freedom from all-cause death was 52.7% (TF: 51.3%, TA: 56.3%). Risk of all stroke at 5-year was 15.8% (TF: 8.9%, TA: 25.5%) and risk of major adverse cardiac and cerebrovascular events at 5 years was 58.0% (TF: 51.3%, TA: 69.2%). Mild or greater aortic regurgitation (AR) at 1 week was not associated with increased all-cause death at 5 years (69.1%) compared with none or trace AR (48.3%) (P=0.184). Patients with high STS score (>8) had higher mortality rate than those with low STS scores (≤8). Conclusions The 5-year data from PREVAIL JAPAN show the clinical benefit of TAVR and suggest that balloon-expandable TAVR is an effective treatment option for Japanese patients with severe AS who are not suitable for surgery. (Funded by Edwards Lifesciences Limited; ClinicalTrials.gov number, NCT01113983.).
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- 2017
19. Antibody Response to Live Attenuated Vaccines in Adults in Japan
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Keiichi Mikasa, Taku Ogawa, Mitsuru Konishi, Fukumi Uchiyama-Nakamura, Kei Kasahara, Kenji Uno, Aiko Sugata-Tsubaki, Yutaka Yamada, and Koichi Maeda
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medicine.medical_specialty ,Varicella vaccine ,viruses ,030231 tropical medicine ,Population ,Varicella ,Gastroenterology ,Measles ,Rubella ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,education ,Mumps ,education.field_of_study ,Attenuated vaccine ,Antibody titer ,biology ,Occupational health ,business.industry ,Vaccination ,virus diseases ,General Medicine ,medicine.disease ,biology.protein ,Antibody ,business ,Research Article - Abstract
The purpose of this study was to examine the efficacy rendered with a single dose of live attenuated measles, rubella, mumps, and varicella containing vaccine. We inoculated healthcare workers (HCWs) with a single dose of vaccine to a disease lacking in antibody titer for those not meeting the criteria of our hospital (measles: We included 48 HCWs. A total of 32, 15, 31, and 10 individuals were inoculated with a single dose of measles-containing, rubella-containing, mumps, or varicella vaccine, respectively, and showed significant antibody elevation (9.2 ± 12.3 to 27.6 ± 215.6, p In a limited population, a single dose of live attenuated vaccine showed elevation of antibody titer without any severe adverse reactions. However, whether the post-vaccination response rate criteria of our university was fulfilled could not be determined owing to limited sample size.
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- 2016
20. Two cases of lobectomy for lung cancer after transcatheter aortic valve implantation
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Takashi Kanou, Naoko Ose, Masato Minami, Koichi Maeda, Yasushi Shintani, Isamu Mizote, Meinoshin Okumura, Ryu Kanzaki, Yasushi Sakata, Yoshiki Sawa, Hideki Nagata, Toru Kuratani, and Soichiro Funaki
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,lcsh:Surgery ,Case Report ,lcsh:RD1-811 ,Spinal canal stenosis ,medicine.disease ,Thoracic aortic aneurysm ,Surgery ,Coronary artery disease ,TAVI ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Aortic valve replacement ,030220 oncology & carcinogenesis ,medicine ,Lobectomy ,030211 gastroenterology & hepatology ,Lung cancer ,business ,Kidney transplantation - Abstract
Background The age of patients with lung cancer is advancing, and the number of patients with lung cancer who have cardiac diseases is expected to increase. Recently, the rate of transcatheter aortic valve implantation (TAVI) has increased as treatment for aortic stenosis (AS). TAVI is minimally invasive compared with conventional aortic valve replacement. We herein report two patients with lung cancer who underwent lobectomy after TAVI for severe AS. Case presentation Two patients with AS and lung cancer were treated with two-stage surgery of TAVI followed by lobectomy. In patient 1 (77 years of age), conventional aortic valve replacement was considered to be risky because of his history of coronary artery disease and thoracic aortic aneurysm and his relatively high logistic euroSCORE. He underwent TAVI followed by right middle and lower lobectomy. In patient 2 (75 years of age), TAVI was chosen because the patient had poor ADL due to spinal canal stenosis and had taken immunosuppressant agents after a kidney transplantation. He underwent TAVI followed by right lower lobectomy. The postoperative course of the two patients was uneventful. Conclusions Two-stage surgery of TAVI and lung resection could be a viable option for patients with both lung cancer and severe AS, for whom conventional AVR by an open-heart operation is not indicated.
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- 2018
21. JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases: The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy – The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG
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Jun-ichi Kadota, Futoshi Higa, Yosuke Aoki, Nobuki Aoki, Koichi Maeda, Satoshi Iwata, Masahumi Seki, Hiroshi Sakata, Katsunori Yanagihara, Hiroki Tsukada, Osamu Kobayashi, Yutaka Tokue, Naoki Kishida, Fukumi Nakamura-Uchiyama, Keiichi Mikasa, Shuichi Abe, Koichiro Yoshida, Kazunobu Ouchi, and Kei Kasahara
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Antimicrobial chemotherapy ,Medicine ,Outpatient clinic ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Intensive care medicine ,book ,Respiratory Tract Infections ,Respiratory tract infections ,business.industry ,Guideline ,Antimicrobial ,Clinical research ,Infectious Diseases ,Infectious disease (medical specialty) ,Immunology ,Pediatric Infectious Disease ,book.journal ,business - Abstract
The Japanese Association for Infectious Diseases (JAID) and Japanese Society of Chemotherapy (JSC) announced the “Guide for the Use of Antimicrobial Drugs” in 2001 and the “Guidelines for the Use of Antimicrobial Drugs” in 2005. Subsequently, the “The JAID/JSC guide to clinical management of infectious diseases 2011” was published. With its revision, guidelines were newly prepared. Concerning respiratory infectious diseases, in Japan, the Japanese Respiratory Society published guidelines for the management of community-acquired pneumonia, hospital-acquired pneumonia, respiratory tract infection, and -/nursing and healthcare-associated pneumonia. Furthermore, the Japanese Society of Pediatric Pulmonology and Japanese Society for Pediatric Infectious Diseases announced the “Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan”. Internationally, many guidelines, including those established by the American Thoracic Society and Infectious Diseases Society of America, have been published from various countries. Thereafter, clinical research on respiratory infectious diseases has advanced, leading to the accumulation of many outcomes regarding epidemiology, clinical diagnosis, and treatment. However, the types of microorganisms that cause respiratory infectious diseases have increased with the number of resistant bacteria. In addition, conditions have also varied with causative microorganisms through the recent compromised host's severe status. The place of treatment varies: from the outpatient clinic to the ICU. Physicians responsible for treatment also vary: practitioners, hospital doctors, pulmonologists, emergency physicians, board certified member of JAID, Japanese antimicrobial chemotherapy physician. There are a large number of options of antimicrobial drugs that are available, including new drugs; therapeutic strategies are confused. On the other hand, recently, the entity of PK-PD has been commonly recognized, and the importance of scientifically using antimicrobial drugs has been emphasized. In addition, the Japanese Society of Chemotherapy established a system for antimicrobial chemotherapy-certified physicians, and promoted the widespread, adequate use of antimicrobial drugs. Based on these, the two societies prepared the JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases. If specific treatment guidelines can be presented, this may contribute to an improvement in the treatment responses of respiratory infectious diseases, a reduction in health expenditure, and the prevention of resistant bacteria. The guidelines were prepared based on the EBM so that they reflected the management of respiratory infectious diseases in Japan and covered all such diseases in adults and children. To prepare the guidelines, a committee was established in 2012, and a draft was published on homepage based on an approval from the boards of directors at the two societies through a review-based consensus. Opinions were collected from the two societies' members. In Japan, there have been no such guidelines covering respiratory infectious diseases. In the future, with further advances in research, the contents of the guidelines must be revised. However, we successfully provided treatment guidelines that are the most advanced at present. The guidelines were prepared for all clinicians to understand the Treatment of Respiratory Infectious Diseases and manage them with antimicrobial drugs adequately. They do not limit treatment by individual physicians or affect their rights to select it. The guidelines may be commonly applied for respiratory infectious disease management/research/education in Japan, improving the quality of respiratory infectious disease management, preventing an increase in the number of resistant bacteria, and contributing to national health. We hope that the guidelines will be utilized by a large number of clinicians in respiratory infectious disease management. Lastly, we thank the committee members and secretariat staff for their cooperation. 1. Descriptions on the recommendation grade and evidence level Recommendation grade Evidence level A Strongly recommended, I Randomized comparative study B General recommendation II Non-randomized comparative study C Comprehensive evaluation by the attending physician III Case report IV Specialist's opinion Open in a separate window 2. Definition of first- and second-choice drugs First-choice drugs Drugs to be recommended for initial treatment Second-choice drugs Alternative drugs when first-choice drugs cannot be used due to allergy, organ disorder, or local factors Open in a separate window 3. Precautions - In this article, with respect to the administration method (especially doses) of antimicrobial drugs, they are recommended based on sufficient doses. Considering the products adopted at each medical institution, antibiograms, severity, underlying disease, age, and presence or absence of organ disorder, the dose should be increased or decreased if necessary. - The spectra of third-generation cephems for intravenous injection, CTX and CTRX, are similar, but CTX, which is excreted in the kidney, should be primarily used when liver dysfunction is present, and CTRX, which is excreted in bile, should be primarily used when renal dysfunction is present. - As quinolones exhibit antitubercular actions, patients with pulmonary tuberculosis should be excluded for use. 4. A list of antimicrobial drug abbreviations and doses for neonates are presented at the end of this volume.
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- 2016
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22. Impella 5.0 as a Bridge to Implantable Left Ventricular Assist Device - First Clinical Case in Japan
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Kazuo Shimamura, Shunsuke Saito, Isamu Mizote, Yasushi Yoshikawa, Keitaro Domae, Shigeru Miyagawa, Keiwa Kin, Taito Masawa, Yoshiki Sawa, Kenta Masada, Kei Nakamoto, Yoshiki Watanabe, Koichi Toda, Kei Torikai, Hiroki Hata, Toru Kuratani, Shohei Yoshida, Koichi Maeda, Shungo Hikoso, Yasushi Sakata, Fusako Sera, and Ryohei Matsuura
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Male ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Shock, Cardiogenic ,General Medicine ,030204 cardiovascular system & hematology ,Middle Aged ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Ventricular assist device ,Cardiology ,Medicine ,Humans ,Clinical case ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Bridge (dentistry) ,Impella - Published
- 2018
23. The role of echocardiography in transcatheter aortic valve implantation
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Yasushi Sakata, Isamu Mizote, Yasuhiro Ichibori, Koichi Maeda, Kaoruko Sengoku, Toshinari Onishi, Yoshiki Sawa, and Toru Kuratani
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Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Population ,Review Article ,030204 cardiovascular system & hematology ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,Heart valve ,education ,Mitral regurgitation ,education.field_of_study ,business.industry ,medicine.disease ,Aortic valvuloplasty ,Stenosis ,medicine.anatomical_structure ,Cardiology ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment. In this review, the role of echocardiography in the pre-, intra-, and post-TAVI procedure periods is described in detail.
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- 2018
24. Predictors of Prolonged Hemodynamic Compromise After Valve Deployment During Transcatheter Aortic Valve Implantation
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Takahiko Kamibayashi, Koichi Maeda, Takeshi Iritakenishi, Yoshiki Sawa, Yuji Fujino, Toru Kuratani, and Kei Torikai
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Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,Hemodynamics ,Transcatheter Aortic Valve Replacement ,Hemodynamic compromise ,Postoperative Complications ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Aortic Valve Stenosis ,Odds ratio ,medicine.disease ,Confidence interval ,Stenosis ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Quartile ,Aortic Valve ,Heart Valve Prosthesis ,Anesthesia ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective To identify the risk factors of prolonged hemodynamic compromise caused by rapid pacing for valve deployment during transcatheter aortic valve implantation. Design A retrospective study. Setting Academic hospital. Participants Forty-seven patients with severe aortic stenosis who underwent transcatheter aortic valve implantation. Interventions The time after the end of rapid pacing until systolic arterial pressure and SvO2 recovery (systolic arterial pressure>90 mmHg and SvO2>65%) was defined as “the hemodynamic recovery time” and was measured from online anesthetic charts. The total study population was divided into 2 groups according to the recovery time (third quartile in all patients; 33 and 14 patients in the early and delayed recovery groups, respectively). Subsequently, the factors associated with prolonged hemodynamic compromise after rapid pacing for valve deployment were identified by univariate and multivariate analyses. Measurements and Main Results Multivariate analysis identified left ventricular end-diastolic diameter (odds ratio, 0.774; 95% confidence interval, 0.608-0.915) and SvO2 (odds ratio, 0.748; 95% confidence interval, 0.590-0.868) as independent factors associated with prolonged hemodynamic compromise after rapid pacing for valve deployment. Conclusions SvO2 and left ventricular end-diastolic diameter were found to be significant independent predictors of prolonged hemodynamic compromise immediately after rapid pacing for valve deployment during transcatheter aortic valve implantation.
- Published
- 2015
25. New Self-Expanding Transcatheter Aortic Valve Device for Transfemoral Implantation – Early Results of the First-in-Asia Implantation of the ACURATE Neo/TFTM System –
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Satoshi Nakatani, Toshinari Onishi, Isamu Mizote, Koichi Maeda, Yoshiki Sawa, Toru Kuratani, Yasuhiro Ichibori, Yasushi Sakata, Kei Torikai, and Koichi Toda
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Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Stent ,EuroSCORE ,General Medicine ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Early results ,Internal medicine ,Clinical endpoint ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
BACKGROUND Feasibility and early results of transfemoral aortic valve implantation using the ACURATE neo/TF(TM)self-expanding stent are reported. METHODS AND RESULTS The study group of 15 patients (mean age 83.3±6.0) was enrolled with a mean EuroSCORE and STS score of 21.9±11.6% and 7.5±3.1%, respectively. Clinical and echocardiographic evaluations were performed at baseline, discharge, 30 days and 6 months. The primary endpoint was all-cause mortality at 30 days. Transcatheter aortic valve implantation (TAVI) using the ACURATE neo/TF device was successful in 14 patients; 1 patient underwent valve-in-valve implantation because the prosthetic valve embolized during withdrawal of the delivery system. Conversion to surgery, coronary obstruction, peri-operative stroke, and pacemaker implantation did not occur at 30 days. Mean transvalvular gradients at discharge significantly decreased from 44.2±10.5 mmHg (preprocedural) to 7.7±3.1 mmHg (P
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- 2015
26. A Case of Disseminated Cutaneous Mycobacterium chelonae Infection Successfully Improved with Thermal Therapy
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Masatoshi Sato, Keiichi Mikasa, Kei Kasahara, Taku Ogawa, Tatsuya Fukumori, Naotaka Shiraishi, Mitsuru Konishi, Yutaka Yamada, Akira Yoshimoto, Naokuni Hishiya, Masahide Yoshikawa, Fukumi Nakamura-Uchiyama, Kenji Uno, and Koichi Maeda
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medicine.medical_specialty ,Cilastatin ,biology ,business.industry ,Mycobacterium chelonae ,General Medicine ,Dermatomyositis ,Azithromycin ,medicine.disease ,biology.organism_classification ,Surgery ,Methylprednisolone ,Subcutaneous nodule ,Moxifloxacin ,Clarithromycin ,medicine ,business ,medicine.drug - Abstract
A 54-year-old female with dermatomyositis treated with cyclosporine and methylprednisolone presented with multiple subcutaneous nodules on her upper and lower extremities on December 2011. The number of lesions gradually increased. She had a history of surgical intervention such as debridement, skin graft of right lower leg due to trauma and subsequent bacterial infection on August 2011. Culture from a skin lesion on June 2012 confirmed Mycobacterium chelonae, which was susceptible to clarithromycin (CAM). We started treatment with CAM, imipenem/cilastatin (IPM/CS) and tobramycin (TOB) for 2 weeks. Then CAM monotherapy was continued, however CAM was discontinued because of liver dysfunction. In September 2012 new nodular lesions were observed on the left arm and right leg. We administrated azithromycin, IPM/CS and TOB. Subcutaneous nodules were partially improved, but new lesions appeared on her right leg. A culture of skin lesion yielded M. chelonae, which was highly resistant to CAM and IPM/CS. Based on the sensitivity test, moxifloxacin was used. However, there was no significant improvement in her skin lesions, so we started thermal therapy on day 57 after admission. She showed an excellent response to thermal therapy, and there has been no recurrence.
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- 2015
27. Midterm Outcomes With a Self-Expandable Transcatheter Heart Valve in Japanese Patients With Symptomatic Severe Aortic Stenosis
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Kei Torikai, Shigeru Saito, Yutaka Tanaka, Junjiro Kobayashi, Nobuyuki Komiyama, Hideaki Kanzaki, Toru Kuratani, Angie Zhang, Hiroshi Niinami, Yoshiki Sawa, and Koichi Maeda
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Asian People ,Japan ,Internal medicine ,Multicenter trial ,medicine ,Humans ,030212 general & internal medicine ,Heart valve ,Prospective Studies ,Prospective cohort study ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Aortic valve stenosis ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Transcatheter aortic valve implantation (TAVI) is a viable alternative to surgical aortic valve replacement in high-risk or inoperable patients with aortic stenosis (AS). Here we report the midterm outcomes of high-risk Japanese patients with severe AS who underwent TAVI with a self-expandable TAV.Methods and Results:The CoreValve Japan Trial was a prospective, multicenter trial of the CoreValve System. A group of 55 patients (mean age 82.5±5.5 years, 30.9% male, 100% NYHA class III/IV, STS 8.0±4.2%) were enrolled in the 26-mm/29-mm CoreValve study, and 20 patients (mean age 81.0±6.6 years, 5.0% male, 100% NYHA class III/IV, STS 7.0±3.3%) were enrolled in the 23-mm CoreValve study, which started 1 year later. For the 26-mm/29-mm cohort, the 3-year all-cause mortality rate was 32.6%; major stroke was 15.4%. Mean pressure gradient (MPG), effective orifice area (EOA), and NYHA class showed sustained improvement. Paravalvular regurgitation (PVR) at 3 years was 28.6% (none), 25.7% (trace), 40.0% (mild), 5.7% (moderate), and 0.0% (severe). For the 23-mm cohort, the 2-year all-cause mortality rate was 5.0%; major stroke was 5.0%. MPG, EOA, and NYHA class showed sustained improvement. PVR at 2 years was 16.7% (none), 33.3% (trace), 44.4% (mild), 5.6% (moderate), and 0.0% (severe). Conclusions TAVI with the CoreValve System was associated with sustained clinical and functional cardiac improvement in high surgical risk Japanese patients with severe AS. (Clinicaltrials.gov Identifiers: NCT01437098 and NCT01634269.).
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- 2017
28. Transient Constrictive Pericarditis Following Cardiac Surgery
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Takayoshi Ueno, Koichi Maeda, Yoshiki Sawa, Toru Toda, Toru Kuratani, and Shunsuke Saito
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Male ,Pulmonary and Respiratory Medicine ,Constrictive pericarditis ,Aortic valve ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Heart Rupture ,Pericarditis ,Hemodynamically stable ,Internal medicine ,medicine ,Humans ,Implantation procedure ,Pericardiectomy ,Aged ,Heart Rupture, Post-Infarction ,Ultrasonography ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Pericarditis, Constrictive ,Gastroenterology ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,cardiovascular system ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transient constrictive pericarditis (CP) is quite rare, with only a few reports presented. Herein, we report 2 cases of transient CP following cardiac surgery. Case 1 was an 80-year-old man who underwent repair of a left ventricular free wall rupture, while Case 2 was a 69-year-old woman who underwent a conventional aortic valve implantation procedure. In both cases, constrictive features developed about 2 weeks after surgery, which were treated successfully by administrations of non-steroidal anti-inflammatory drugs (NSAIDs). Prior to performing a pericardiectomy, NSAID administration should be considered for affected patients who are hemodynamically stable.
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- 2014
29. Coronary Artery Bypass Grafting in a Patient Initially Presenting with Systemic Lupus Erythematosus
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Hiroyuki Nishi, Toru Kuratani, Shigeru Miyagawa, Takayoshi Ueno, Yoshiki Sawa, Koichi Maeda, and Taichi Sakaguchi
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Bypass grafting ,Coronary Artery Bypass, Off-Pump ,Renal function ,Coronary Artery Disease ,Coronary Angiography ,Drug Administration Schedule ,Coronary artery disease ,Postoperative Complications ,immune system diseases ,Internal medicine ,medicine ,Humans ,Lupus Erythematosus, Systemic ,skin and connective tissue diseases ,Postoperative Care ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,Steroid therapy ,medicine.anatomical_structure ,Concomitant ,Cardiology ,Steroids ,Surgery ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Artery - Abstract
We report a 51-year-old man who was diagnosed with concomitant coronary artery disease and systemic lupus erythematosus (SLE). He required urgent coronary artery bypass grafting (CABG) before the initiation of steroid therapy. Steroid therapy was initiated on postoperative day 2 due to the aggravation of SLE. However, he displayed persistent infection and fever, and the steroid dose was gradually decreased, resulting in the worsening of SLE by postoperative day 21. We closely monitored his infection status and renal function and regulated the steroid dose accordingly. The patient stabilized and was discharged on postoperative day 60 without further complication. Meticulous post-operative management is required in acute SLE patients who need open heart surgery.
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- 2014
30. Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration
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Koichi Maeda, Kazuo Shimamura, Tomoaki Kudo, Keiwa Kin, Kenta Masada, Yoshiki Sawa, Takayuki Shijo, Toru Kuratani, Tomohiko Sakamoto, and Kei Torikai
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Pulmonary and Respiratory Medicine ,Male ,Reoperation ,medicine.medical_specialty ,Endoleak ,medicine.medical_treatment ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Logistic regression ,Aortic repair ,Prosthesis Design ,Thoracic aortic aneurysm ,Aortography ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Multidetector Computed Tomography ,medicine ,Humans ,Aortic rupture ,Aged ,Aortic Aneurysm, Thoracic ,business.industry ,Hazard ratio ,Endovascular Procedures ,Stent ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Aortic Dissection ,Treatment Outcome ,030228 respiratory system ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objectives Type 1a endoleak is one of the most severe complications after thoracic endovascular aortic repair (TEVAR), because it carries the risk of aortic rupture. The association between bird-beak configuration and Type 1a endoleak remains unclear. The purpose of this study was to analyse the predictors of Type 1a endoleak following Zone 1 and Zone 2 TEVAR, with a particular focus on the effect of bird-beak configuration. Methods From April 2008 to July 2015, 105 patients (mean age 68.6 years) who underwent Zone 1 and 2 landing TEVAR were enrolled, with a mean follow-up period of 4.3 years. The patients were categorized into 2 groups, according to the presence (Group B, n = 32) or the absence (Group N, n = 73) of bird-beak configuration on the first postoperative multidetector computed tomography. Results The Kaplan-Meier event-free rate curve showed that Type 1a endoleak and bird-beak progression occurred less frequently in Group N than in Group B. Five-year freedom from Type 1a endoleak rates were 79.7% and 100% for Groups B and N, respectively (P = 0.007). Multivariable logistic regression analysis showed that dissecting aortic aneurysm (odds ratio 3.72, 95% confidence interval 1.30-11.0; P = 0.014) and shorter radius of inner curvature (odds ratio 1.09, 95% confidence interval 0.85-0.99; P = 0.025) were significant risk factors for bird-beak configuration. Multivariable Cox proportional hazard regression showed that Z-type stent graft (hazard ratio 2.69, 95% confidence interval 1.11-6.51; P = 0.030) was a significant risk factor for bird-beak progression. Conclusions Appropriate stent grafts need to be chosen carefully to prevent Type 1a endoleak and bird-beak configuration after landing Zone 1 and 2 TEVAR. Patients with bird-beak configuration on early postoperative multidetector computed tomography require closer follow-up to screen for Type 1a endoleak.
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- 2016
31. 3D-Navigation System Use Experience in Transcatheter Aortic Valve Replacement
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Yasuhiro Yanagawa, Tomohiro Asada, Tukasa Doi, Koichi Maeda, Kazuo Shimamura, Kei Torikai, Toru Kuratani, and Yoshiki Sawa
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business.industry ,Medicine ,business - Published
- 2013
32. Infective Endocarditis Caused by Enterococcus faecalis treated with Continuous Infusion of Ampicillin without Adjunctive Aminoglycosides
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Kei Kasahara, Mitsuru Konishi, Shinsuke Yonekawa, Chiyo Nakagawa, Keiichi Mikasa, Koichi Maeda, Masatoshi Sato, Kenji Uno, and Taku Ogawa
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biology ,business.industry ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,Pharmacology ,medicine.disease ,biology.organism_classification ,Antimicrobial ,Enterococcus faecalis ,Microbiology ,Penicillin ,Minimum inhibitory concentration ,Streptomycin ,Infective endocarditis ,Ampicillin ,Internal Medicine ,medicine ,Endocarditis ,business ,medicine.drug - Abstract
Aminoglycosides are useful antimicrobial agents for treating infective endocarditis; however, they occasionally cause troublesome side effects, such as nephrotoxicity and ototoxicity. We herein report a case of infective endocarditis caused by Enterococcus faecalis that was treated successfully with continuous infusion of ampicillin without adjunctive aminoglycosides. The serum ampicillin concentrations were higher than the minimal inhibitory concentration for the target strain. Although the use of ampicillin monotherapy is currently avoided because double β-lactam therapy is reportedly more effective, continuous penicillin administration remains an effective therapeutic choice for treating infective endocarditis.
- Published
- 2013
33. Manual microdissection technique in a case of subcutaneous panniculitis-like T-cell lymphoma: a case report and review
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Shane Meehan, Marsha Chaffins, Milena Cankovic, Koichi Maeda, and Daniel M. Hoffman
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Pathology ,medicine.medical_specialty ,Panniculitis ,Skin Neoplasms ,Histology ,Population ,Dermatology ,Biology ,Pathology and Forensic Medicine ,Subcutaneous Tissue ,Subcutaneous Panniculitis-Like T-Cell Lymphoma ,medicine ,Humans ,Gene Rearrangement, beta-Chain T-Cell Antigen Receptor ,Pathology, Molecular ,education ,Microdissection ,education.field_of_study ,Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor ,Molecular pathology ,Cutaneous T-cell lymphoma ,Clinical course ,DNA, Neoplasm ,Middle Aged ,medicine.disease ,Clone Cells ,Lymphoma, T-Cell, Cutaneous ,Lymphoma ,Reactive lymphocyte ,Female - Abstract
Demonstration of T-cell receptor gene monoclonality often plays an important role in the diagnosis of T-cell lymphoma. When a test to detect monoclonality is performed on whole tissue sections, the presence of a reactive lymphocyte population may reduce sensitivity. This may be especially true for early or borderline cases of lymphoma. Microdissection techniques may be utilized to more readily identify a clonal population of lymphocytes. Subcutaneous panniculitis-like T-cell lymphoma represents a cutaneous lymphoid neoplasm whose clinical course may vary from an indolent, waxing and waning course to an aggressive course resulting in death. We report the first case of a microdissection technique used to facilitate diagnosing a case of subcutaneous panniculitis-like T-cell lympoma. Hoffman D, Chaffins M, Cankovic M, Maeda K, Meehan S. Manual microdissection technique in a case of subcutaneous panniculitis-like T-cell lymphoma: a case report and review.
- Published
- 2012
34. Transcatheter aortic valve replacement in a patient with Werner syndrome
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Koichi Maeda, Kenta Masada, Yoshiki Sawa, Kei Torikai, and Toru Kuratani
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,Achilles Tendon ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Multidetector Computed Tomography ,Skin Ulcer ,Elbow ,medicine ,Humans ,Werner syndrome ,business.industry ,Calcinosis ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Treatment Outcome ,030228 respiratory system ,Echocardiography ,Aortic Valve ,Cardiology ,Surgery ,Werner Syndrome ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
35. Clinical features and treatment outcomes of isolated secondary central nervous system lymphomas in Miyazaki Prefecture
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Kiyoshi Yamashita, Junzo Ishizaki, Hitoshi Matsuoka, Shuro Yoshida, Koichi Maeda, Seiichi Satou, Hidenobu Ochiai, Koichi Oshima, Kazuya Shimoda, Takanori Toyama, Kotaro Shide, Akira Ueda, Katsuto Takenaka, Tomonori Hidaka, Hiroshi Kawano, Haruko Shimoda, Keiko Katayose, Kenichiro Yamaguchi, Yoshiya Shimao, Tatsuhiko Yano, Yoko Kubuki, and Noriaki Kawano
- Subjects
Male ,Nervous system ,Pathology ,medicine.medical_specialty ,Central nervous system ,Lymphoma, T-Cell ,Central Nervous System Neoplasms ,Antibodies, Monoclonal, Murine-Derived ,Recurrence ,Surgical oncology ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Aged ,Aged, 80 and over ,business.industry ,Standard treatment ,Hematology ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Lymphoma ,Methotrexate ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,Monoclonal ,Female ,Surgery ,Rituximab ,Lymphoma, Large B-Cell, Diffuse ,business ,medicine.drug ,Rare disease - Abstract
Secondary central nervous system lymphoma (SCNSL) without extra-central nervous system (CNS) involvement is characterized by isolated secondary CNS relapse in malignant lymphoma patients. SCNSL is a rare disease, and no standard treatment has yet been established.To elucidate the clinical characteristics and outcomes of SCNSL, we retrospectively analyzed 12 patients (median age 67 years) in Miyazaki prefecture for the last 5 years.The initial histological diagnoses of the patients were diffuse large B-cell lymphoma (DLBCL), mantle-cell lymphoma, and adult T-cell lymphoma in 9, 2, and 1 patient, respectively. We focused on analysis of the 9 SCNSL cases originating from DLBCL. The locations of CNS relapse were the cerebral hemisphere, basal ganglia, and cerebellum in 7, 1, and 1 patient, respectively. Three patients were treated with high-dose methotrexate (HD-MTX) therapy; 4 with whole-brain radiation therapy (WBRTX); and 1 with both HD-MTX and WBRTX. The remaining patients were treated with rituximab. Partial remission was achieved in 6 out of 9 patients (67%); the other 3 patients (33%) did not respond to therapy. Median survival of the 9 patients with CNS relapse was 253 days; 6 of the 9 patients survived for more than 6 months. As of March 2011, 2 HD-MTX group patients but none of the WBRTX group patients were alive.In this retrospective study, 6 of 9 patients with SCNSL originating from DLBCL survived for more than 6 months. Both HD-MTX and WBRTX had clinical benefits in the treatment of SCNSL.
- Published
- 2011
36. Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline
- Author
-
Ken Kikuchi, Shinsuke Yonekawa, Taku Ogawa, Keiichi Mikasa, Kei Kasahara, Mitsuru Konishi, Koichi Maeda, and Chiyo Nakagawa
- Subjects
Male ,Microbiology (medical) ,Imipenem ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Administration, Oral ,Nocardia Infections ,Minocycline ,Nocardia ,Microbiology ,Medical microbiology ,medicine ,Humans ,Pharmacology (medical) ,Kidney transplantation ,Cilastatin ,business.industry ,Ceftriaxone ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Anti-Bacterial Agents ,Transplantation ,Infectious Diseases ,Injections, Intravenous ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
We report a case of pulmonary infection caused by a rare Nocardia species, Nocardia beijingensis, in a 48-year-old man who received multiple immunosuppressive therapy after renal transplantation. This pathogen was isolated from a bronchoscopic protected specimen brush and was identified as N. beijingensis by 16S rRNA gene sequence analysis. The patient was initially treated with imipenem/cilastatin followed by ceftriaxone and oral minocycline. Traditionally, trimethoprim-sulfamethoxazole (SXT) has been one of the first-line antibiotics chosen as an initial therapy for pulmonary nocardiosis, but this case was successfully treated without SXT. Considering recent reports about failures of both prophylaxis and treatment for nocardial infections with SXT and its various side effects, treatment with beta-lactam antibiotics and minocycline for pulmonary nocardiosis can be chosen in mild to moderate cases with confirmed susceptibility to these antibiotics in vitro.
- Published
- 2011
37. THP-COP regimen for the treatment of peripheral T-cell lymphoma and adult T-cell leukemia/lymphoma: a multicenter phase II study
- Author
-
Kazuo Tamura, Junji Suzumiya, Atae Utsunomiya, Koichi Maeda, Junichi Tsukada, Keisuke Shibata, Hitoshi Suzushima, Yasushi Takamatsu, and Hitoshi Matsuoka
- Subjects
Adult ,Male ,Vincristine ,medicine.medical_specialty ,Pathology ,Prednisolone ,Pirarubicin ,CHOP ,Neutropenia ,Lymphoma, T-Cell ,Gastroenterology ,Adult T-cell leukemia/lymphoma ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Leukemia-Lymphoma, Adult T-Cell ,Cyclophosphamide ,Aged ,business.industry ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Peripheral T-cell lymphoma ,Lymphoma ,Doxorubicin ,Female ,business ,Febrile neutropenia ,medicine.drug - Abstract
Objective The efficacy of pirarubicin (THP)-COP was previously compared with cyclophophamide + doxorubicin + vincristine + prednisolone (CHOP) in elderly patients with lymphoma. The subset analysis showed that T-cell lymphoma had a significantly better response with THP-COP, whereas no such difference was observed in B-cell lymphoma. The aim of this study is to confirm the efficacy of THP-COP in the treatment of T-cell lymphoma. Methods We underwent a multicenter phase II study of THP-COP as a first-line treatment for T-cell lymphoma. The overall response rate, survival period, and toxicity were analyzed. Results Fifty-three patients were enrolled in this study. Seventeen patients had peripheral T-cell lymphoma (PTCL), including nine of PTCL not otherwise specified (PTCL-NOS) and eight of angioimmunoblastic T-cell lymphoma (AITL). Thirty-six patients had adult T-cell leukemia/lymphoma (ATLL), including 20 of acute type and 16 of lymphoma type. A treatment response was obtained in 35 (66%) patients, including 17 (32%) complete responses. Median overall survival (OS) and progression-free survival (PFS) times were 14.3 months and 5.2 months, respectively. Patients with ATLL showed a tendency to obtain low response rate (61% vs. 77%, P = 0.27) and had a significantly inferior OS (13.3 vs. 28.6 months, P = 0.04) and PFS (4.6 vs. 8.1 months, P = 0.01) in comparison with PTCL. Grade 3 to 4 neutropenia, anemia, and thrombocytopenia occurred in 72%, 34%, and 58% of the patients, respectively. Febrile neutropenia was observed in 51% and grade 3 non-hematological toxicities in 2-9% of the patients. Conclusion The efficacy of THP-COP is equivalent to that of CHOP for the first-line therapy in T-cell lymphoma.
- Published
- 2010
38. Coronary Artery Bypass Grafting in a Man with Myocardial Ischemia and Left Ventricular Noncompaction
- Author
-
Koichi Maeda, Nobuo Sakagoshi, Ryohei Matsuura, and Yasuhisa Shimazaki
- Subjects
medicine.medical_specialty ,Myocardial ischemia ,medicine.anatomical_structure ,Bypass grafting ,business.industry ,Internal medicine ,medicine ,Cardiology ,Left ventricular noncompaction ,business ,Artery - Abstract
左室心筋緻密化障害は胎生期に左室心筋の緻密化が障害された先天性の心筋症であり,心不全が進行する予後不良の疾患である.最近では成人例の報告も散見されるようになり,成人例左室心筋緻密化障害に開心術を施行した報告もされている.今回著者らは,成人例左室心筋緻密化障害に陳旧性心筋梗塞を合併した症例に対して冠動脈バイパス術を施行したので報告する.症例は54歳男性.労作時呼吸苦を主訴に入院となり,心エコーにて左室緻密化障害を伴う左心機能障害(LVEF 25%)を認めた.また,冠動脈造影では#1,#6の完全閉塞を含む3枝病変を認めた.心筋シンチ,心臓MRIでは前壁心尖部のviabilityはないものの,前壁基部から中部にかけてはviabilityが存在した.保存的に心不全をコントロールした後,冠動脈バイパス術を施行した.術後の経過は良好で,術後7日目に退院した.術後1カ月時のLVEFは52%に改善していた.左室緻密化障害は進行性に心機能の低下をきたす可能性があり,本症例においても今後は綿密に経過観察していく必要があると考えられた.
- Published
- 2010
39. Posterior dislocation of the hip joint with fracture of both the femoral head and neck
- Author
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Sung-Gon Kim, Reiko Kubota, Masahiko Nozawa, Koichi Maeda, Keiji Matsuda, Masataka Nagayama, Haruka Kaneko, and Takashi Ikegami
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Posterior hip dislocation ,Acetabulum ,Surgery ,Femoral head ,medicine.anatomical_structure ,medicine ,Fracture (geology) ,Internal fixation ,Orthopedics and Sports Medicine ,Posterior dislocation ,business ,Joint (geology) ,Reduction (orthopedic surgery) - Abstract
Fracture of both the femoral head and neck associated with posterior hip dislocation is a rare injury. This report describes a rare case of fracture-dislocation of the hip joint with a separated femoral head with a residual fragment in the acetabulum, and a subcapital fracture. We performed open reduction with internal fixation immediately after the injury. Osteonecrosis of the femoral head was detected one year after the surgery, however this patient had no symptoms related to the hip joint.
- Published
- 2008
40. A Case of Acute Renal Failure Involving High Amounts of Tenofovir After HAART Start
- Author
-
Mitsuru Konishi, Koichi Maeda, Kei Kasahara, Keiichi Mikasa, Shinsuke Yonekawa, Kenji Uno, Chiyo Nakagawa, and Eiichiro Yoshimoto
- Subjects
Male ,medicine.medical_specialty ,Anti-HIV Agents ,medicine.medical_treatment ,Organophosphonates ,Renal function ,HIV Infections ,urologic and male genital diseases ,chemistry.chemical_compound ,Antiretroviral Therapy, Highly Active ,Internal medicine ,medicine ,Humans ,Tenofovir ,Dialysis ,Acute tubular necrosis ,Creatinine ,medicine.diagnostic_test ,business.industry ,Adenine ,General Medicine ,Middle Aged ,medicine.disease ,chemistry ,Vomiting ,Kidney Failure, Chronic ,Anuria ,Renal biopsy ,medicine.symptom ,business ,Viral load - Abstract
A 58-year-old man admitted for fever, nausea, vomiting, and anuria after the start of HAART, including tenofovir, had a viral load of 1.1 x 10(5) copies/mL, a CD4-positive lymphocyte count of 81/microL, and serum creatinine of 0.8 mg/dL before HAART. He underwent renal biopsy and temporary dialysis. We concluded that the patient had acute tubular necrosis because of potentially impaired renal function and the high amount of medication, and judging from the renal biopsy specimen and clinical course. When implementing HAART, physicians should be aware of and monitor potential patient misunderstanding of instructions on dosage and administration and for possible complications in medicinal combinations and potential side effects. TDF taken together with lopinavir may increase the plasma concentration of TDF or other medications that could worsen renal function. It should also be noted that renal dysfunction is a potential complication in the elderly.
- Published
- 2008
41. Adult T-cell Lymphoma/Leukemia With Angioimmunoblastic T-cell Lymphomalike Features: Report of 11 Cases
- Author
-
Mamoru Sakaguchi, Masahiro Kikuchi, Kennosuke Karube, Morishige Takeshita, Hideki Tsushima, Masataka Okamoto, Tomohisa Inada, Junji Suzumiya, Koichi Maeda, and Koichi Ohshima
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Angioimmunoblastic T-cell lymphoma ,T cell ,High endothelial venules ,Lymphoma, T-Cell ,Adult T-cell leukemia/lymphoma ,Pathology and Forensic Medicine ,Antigens, CD ,immune system diseases ,hemic and lymphatic diseases ,Biopsy ,Biomarkers, Tumor ,Humans ,Leukemia-Lymphoma, Adult T-Cell ,Medicine ,Aged ,medicine.diagnostic_test ,Follicular dendritic cells ,business.industry ,Middle Aged ,medicine.disease ,HTLV-I Infections ,Lymphoma ,Survival Rate ,Leukemia ,medicine.anatomical_structure ,Immunoblastic Lymphadenopathy ,DNA, Viral ,Female ,Surgery ,Anatomy ,business - Abstract
In adult T-cell lymphoma/leukemia (ATLL), the neoplastic lymphoid cells are usually medium-sized to large, often with pronounced nuclear pleomorphism compatible with the diagnosis of diffuse pleomorphic peripheral T-cell lymphoma. We describe here 11 patients with the rare morphologic variant of ATLL, angioimmunoblastic T-cell lymphoma (AILT)-like type. The examined lymph nodes showed proliferation of high endothelial venules and presence of various infiltrating inflammatory cells including plasma cells and eosinophils. The lymphoma cells were medium-to-large size with clear cytoplasm. These findings were suggestive of AILT. However, immunohistochemical features of AILT, namely, CD10 and CXCL13 expression in lymphoma cells and proliferation of CD21-positive follicular dendritic cells, were not detected. Two cases were CXCR3-positive, whereas 9 expressed CCR4, which are usually positive in ATLL. All patients were positive for antiadult T-cell leukemia/lymphoma-associated antigen, which is a specific antibody for human T-cell lymphotropic virus type-I. Southern blot analysis revealed proviral DNA integration in lymphoma cells in 9 patients. The latter was not evident in the first biopsy of 2 patients but in the second biopsy obtained within several months after the first biopsy revealed definite proviral integration. Almost all patients showed aggressive clinical course and poor survival (median survival: 5 mo). This is the first report of ATLL with AILT-like morphologic features.
- Published
- 2007
42. Early Outcomes in Japanese Dialysis Patients Treated With Transcatheter Aortic Valve Implantation
- Author
-
Satoshi Nakatani, Takayoshi Ueno, Kei Torikai, Toshinari Onishi, Yasushi Sakata, Koichi Maeda, Koichi Toda, Yasuhiro Ichibori, Toru Kuratani, Kazuhiro Nakatani, and Yoshiki Sawa
- Subjects
Male ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Dialysis patients ,Transcatheter Aortic Valve Replacement ,Asian People ,Japan ,Renal Dialysis ,medicine ,Humans ,Dialysis ,Aged ,Aged, 80 and over ,business.industry ,EuroSCORE ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Clinical trial ,Early results ,Paravalvular leakage ,Aortic valve stenosis ,Kidney Failure, Chronic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
BACKGROUND Although transcatheter aortic valve implantation (TAVI) is a new alternative treatment with acceptable midterm results for high surgical risk patients, at present performing the procedure in dialysis patients is not reimbursed in Japan. METHODS AND RESULTS The study group of 17 dialysis patients (mean age, 76.7±5.0 years) underwent TAVI with the SAPIEN/SAPIEN XT. EuroSCORE and STS score were 25.0±19.0% and 15.4±12.3%, respectively. Transiliofemoral and transapical approaches were performed in 7 (41.2%) and 10 patients (58.8%), respectively. ICU and hospital stays after TAVI were 1.8±1.6 and 12.9±12.7 days, respectively. Mean transvalvular gradients at discharge significantly decreased from 45.9±13.3 mmHg to 10.7±4.3 mmHg (P
- Published
- 2015
43. Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis
- Author
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Kazunori Yoshikata, Kazuo Kaneko, Koichi Maeda, and Takahito Yuasa
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,Mandible ,Case Report ,General Medicine ,Femoral fracture ,medicine.disease ,Short stature ,Surgery ,Femoral head ,lcsh:RD701-811 ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Radiological weapon ,Pycnodysostosis ,medicine ,medicine.symptom ,business ,After treatment ,Total hip arthroplasty - Abstract
The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition.
- Published
- 2015
44. Hematologic Malignancies With Primary Retroperitoneal Presentation: Clinicopathologic Study of 32 Cases
- Author
-
Robert C. Hawley, Lei Lei Chen, Koichi Maeda, Nalini Janakiraman, and Philip Kuriakose
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Lymphoma ,Disease ,World health ,Immunophenotyping ,Pathology and Forensic Medicine ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Biomarkers, Tumor ,medicine ,Humans ,Retroperitoneal Neoplasms ,Retroperitoneal Space ,Aged ,Retrospective Studies ,Aged, 80 and over ,Retroperitoneal mass ,business.industry ,Medical record ,Biopsy, Needle ,General Medicine ,Middle Aged ,Flow Cytometry ,medicine.disease ,Combined Modality Therapy ,Immunohistochemistry ,Surgery ,Medical Laboratory Technology ,Female ,Histopathology ,Lymph Nodes ,Radiology ,Presentation (obstetrics) ,medicine.symptom ,business - Abstract
Context.—The retroperitoneum is an uncommon location for primary lymphomatous involvement. Initial presentation of disease in this site (primary retroperitoneal lymphoma) is considered to be rare. Because of the uncommon anatomic location, the diagnosis and subsequent management of these patients tend to be difficult for both pathologists and clinicians.Objective.—This report describes our experience during a period of 6 years 4 months with patients with hematologic malignancies primarily presenting in the retroperitoneum.Design.—A retrospective search of our medical records generated 32 patients who presented initially with abdominal pain or discomfort as their predominant symptom and who were found by imaging studies to have retroperitoneal mass or masses. All the histopathology slides were reviewed and classified based on the World Health Organization classification.Results.—There were 13 male and 19 female patients. Tumor types included diffuse large B-cell lymphoma (n = 12); grade 1 follicular lymphoma (n = 4); grade 3 follicular lymphoma (n = 1); B chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 2); multiple myeloma (n = 1); mixed-cellularity Hodgkin lymphoma (n = 1); nodular sclerosis Hodgkin lymphoma (n = 1); aggressive B-cell lymphoma (n = 4); low-grade B-cell lymphoma (n = 4); lymphoblastic lymphoma, null cell type (n = 1); and precursor B-lymphoblastic lymphoma/leukemia (n = 1). More than half of the cases (17/32) were diagnosed on needle biopsy with immunophenotyping.Conclusions.—Although open lymph node biopsy is a preferred method for diagnosis, needle biopsy plays a significant role in this setting, and, coupled with other information such as flow cytometry and immunohistochemistry, it is considered a practical and reliable method.
- Published
- 2005
45. Clonal Dissemination of Macrolide-Resistant and Penicillin-Susceptible Serotype 3 and Penicillin-Resistant Taiwan 19F-14 and 23F-15 Streptococcus pneumoniae Isolates in Japan: a Pilot Surveillance Study
- Author
-
Eiji Kita, Kei Kasahara, Koichi Maeda, Keiichi Mikasa, Mitsuru Konishi, Ken Takahashi, Hiroshi Kimura, Koichi Murakawa, Eiichiro Yoshimoto, and Kenji Uno
- Subjects
Microbiology (medical) ,Serotype ,medicine.drug_class ,Penicillin Resistance ,Antibiotics ,Taiwan ,Erythromycin ,Pilot Projects ,Microbial Sensitivity Tests ,Penicillins ,Biology ,medicine.disease_cause ,Polymerase Chain Reaction ,Pneumococcal Infections ,Microbiology ,Bacterial Proteins ,Japan ,Drug Resistance, Bacterial ,Streptococcus pneumoniae ,Prevalence ,medicine ,Pulsed-field gel electrophoresis ,Humans ,Serotyping ,Antibacterial agent ,Bacteriology ,medicine.disease ,Virology ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Penicillin ,Pneumococcal infections ,Population Surveillance ,Macrolides ,medicine.drug - Abstract
Large-scale surveillance studies using molecular techniques such as pulsed-field gel electrophoresis (PFGE) have revealed that the spread of antibiotic-resistant pneumococci is due to clonal spread. However, in Japan, surveillance studies using such molecular techniques have never been done. Therefore, we conducted a pilot surveillance study to elucidate the present situation in Japan. Among the 145 isolates examined, the most prevalent serotype was type 19F (20%), for which most isolates were not susceptible to penicillin (86.2%) but were positive for the mef (A)/ mef (E) gene (89.7%). The secondmost prevalent was serotype 3 (16.6%), for which most isolates were susceptible to penicillin (87.5%) and positive for the erm (B) gene (91.7%). PFGE analysis showed that both serotypes consisted mainly of clonally identical or related isolates and, in particular, 38% of the type 19F isolates were indistinguishable from or closely related to the Taiwan 19F-14 clone. In addition, some of the Japanese type 23F isolates with the erm (B) gene were indistinguishable from or related to the Taiwan 23F-15 clone as analyzed by PFGE. Based on the results of our pilot study performed in a single institution, it is likely that international antibiotic-resistant clones have already spread in Japan; therefore, a nationwide surveillance study should be urgently conducted.
- Published
- 2005
46. Amphotericin B-induced Nephrogenic Diabetes Insipidus in a Case of Cryptococcemia
- Author
-
Yukio Fujita, Itsuto Amano, Keiichi Mikasa, Koichi Maeda, Takeshi Morii, Kei Kasahara, Hiroshi Kimura, Kenji Uno, Eiichiro Yoshimoto, Koichi Murakawa, and Mitsuru Konishi
- Subjects
Antimetabolites, Antineoplastic ,medicine.medical_specialty ,Antifungal Agents ,Antigens, Fungal ,Lymphoma ,endocrine system diseases ,Renal function ,Bacteremia ,Diabetes Insipidus, Nephrogenic ,urologic and male genital diseases ,Gastroenterology ,Renal tubular acidosis ,Polyuria ,Amphotericin B ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Aged ,Mercaptopurine ,business.industry ,nutritional and metabolic diseases ,Cryptococcosis ,General Medicine ,Nephrogenic diabetes insipidus ,medicine.disease ,Hypokalemia ,Surgery ,Diabetes insipidus ,Cryptococcus neoformans ,Drug Therapy, Combination ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Follow-Up Studies ,medicine.drug ,Kidney disease - Abstract
A 66-year-old woman with malignant lymphoma became neutropenic during chemotherapy and developed cryptococcemia. After amphotericin B had been commenced, she developed significant hypokalemia and polyuria, though her renal function remained stable. The laboratory findings showed no evidence of renal tubular acidosis. With vigorous water and potassium replacement, amphotericin B had been continued until the cumulative dose reached 2.5 g. After the cessation of amphotericin B, the hypokalemia and polyuria resolved promptly. Based on theses findings, she was diagnosed as nephrogenic diabetes insipidus with hypokalemia and without renal tubular acidosis due to amphotericin B. This complication is usually reversible, and vigorous water and potassium replacement may allow completion of treatment by amphotericin B, though careful monitoring of body water balance and renal function is of importance.
- Published
- 2005
47. Influence of the Patient/Doctor Relationship on the Non-attendance Rate of General Practice, and Investigation of Reasons for Hospital Non-attendance
- Author
-
Masahiko Matsumura, Shinobu Nakamura, Daisuke Danno, Koichi Maeda, Shinichi Fujimoto, Takashi Fujimoto, Reiko Mizuno, Yuka Yamamoto, and Masatoshi Kanno
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,General practice ,medicine ,business ,Non attendance ,Independent medical examination - Published
- 2005
48. Surgical Treatment of Coronary Arteriovenous Fistulas and Aortic Valve Insufficiency
- Author
-
Shigeru Miyagawa, Takayoshi Ueno, Koichi Maeda, Yasushi Yoshikawa, Toru Kuratani, Satsuki Fukushima, Yoshiki Sawa, Koichi Toda, and Hiroyuki Nishi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Takayasu arteritis ,Aortic Valve Insufficiency ,medicine.disease ,law.invention ,Aortic valve replacement ,Coronary steal ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,Surgical treatment ,Ligation ,business - Abstract
We report a 76-year-old female with Takayasu arteritis who was found to have multiple coronary arteriovenous fistulas (CAVFs), a pulmonary-to-systemic ratio of 2:1, and aortic valve insufficiency. Aortic valve replacement and ligation of multiple CAVFs with cardiopulmonary bypass were performed under cardioplegic arrest, thus minimizing coronary steal. doi: 10.1111/jocs.12102 (J Card Surg 2013;28:380–382)
- Published
- 2013
49. On-pump Transcatheter Aortic Valve Replacement in Patients with Poor Left Ventricular Function
- Author
-
Koichi Maeda, Yoshiki Sawa, Kei Torikai, Toru Kuratani, and Kazuo Shimamura
- Subjects
Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Severity of Illness Index ,Ventricular Function, Left ,Valve replacement ,Internal medicine ,Humans ,Medicine ,In patient ,Aged ,Heart Valve Prosthesis Implantation ,Lv function ,Cardiopulmonary Bypass ,Ventricular function ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,Treatment Outcome ,cardiovascular system ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve replacement (TAVR) has recently been shown to be feasible in patients with severe aortic stenosis who are considered inoperable. We perform TAVR with cardiopulmonary support (CPS) for patients with low left ventricular (LV) function. We report two successful cases of TAVR on CPS in patients with low LV function and describe this technique. (J Card Surg 2012;27:686-688)
- Published
- 2012
50. Transcatheter Aortic Valve Replacement using DynaCT
- Author
-
Kazuo Shimamura, Yoshiki Sawa, Toru Kuratani, Koichi Maeda, and Kei Torikai
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Prosthesis Implantation ,Valve replacement ,Humans ,Medicine ,Intraoperative imaging ,Radiological imaging ,Aged, 80 and over ,business.industry ,Ultrasonography, Doppler ,Aortic Valve Stenosis ,medicine.disease ,Radiographic Image Enhancement ,Treatment Outcome ,Fluoroscopy ,Heart Valve Prosthesis ,Aortic valve stenosis ,Surgery ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
We report a successful transcatheter aortic valve replacement (TAVR) using syngo DynaCT (Siemens AG, Forchheim, Germany) in an 86-year-old man who had severe aortic valve stenosis. Syngo DynaCT is a cross-sectional radiological imaging system that facilitates intraoperative imaging via interventional angiographic systems; this navigation system is useful during TAVR, especially in cases of poor calcification at the annulus. (J Card Surg 2012;27:551-553)
- Published
- 2012
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