Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiology  

The autonomic cardiac nerves reach the heart after passing through the vicinity of the aortic root and the pulmonary trunk. The arterial switch operation (ASO) completely transects the ascending aorta and the putmonary trunk. Therefore, this surgical procedure virtually denerves the heart. Cardiac sympathetic denervation and reinnervation were evaluated in patients after ASO using iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and parasympathetic denervation and reinnervation using ambulatory electrocardiography [Holter electrocardiogram (ECG)]. MIBG scintigraphy was performed in 14 patients who underwent ASO (ASO group) and 3 patients who underwent other open heart surgery (control group). All patients in the ASO group underwent the operation in the neonatal or infantile period. Planar and single photon emission computed tomography (SPECT) images of the myocardium were obtained. Defect score was determined by the SPECT images as a semi-quantitative index. The mean interval between ASO and MIBG scintigraphy was 25.6 ± 14.6 months. Holter ECG was also performed in 14 patients in the ASO group and 19 age-matched normal children. The Holter ECGs were plotted on a Lorenz plot. The H index, which is related to vagal tone for the cardiovascular system, was calculated from the R-R intervals. The mean interval between the ASO and Holter ECG was 8.3 ± 9.7 months. MIBG scintigraphy in the control group demonstrated an almost normal homogeneous tracer uptake, but showed extremely reduced tracer uptake and significantly higher defect score in the ASO group. The extent and degree of the reduction of MIBG uptake improved with time after the ASO. The heart-to-mediastinum MIBG count ratio tended to increase with time. The H index of the ASO group was lower than that of normal children (< 12 months: Control group 0.0280 ± 0.0068 vs ASO group 0.0219 ± 0.0083), and gradually increased with time (1-3 years: 0.0470 ± 0.0157 vs 0.0314 ± 0.0124). These results indicate that MIBG scintigraphy reflects the presence of sympathetic denervation and the possibility of reinnervation after ASO, and that H index reflects the presence of parasympathetic denervation and the possibility of reinnervation after ASO. These are simple and useful methods for assessing the extent and degree of autonomic denervation and reinnervation.

Scopus

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：General Thoracic and Cardiovascular Surgery  

We report the long-term clinical outcome of an 8-month-old infant who underwent tricuspid reconstruction using fresh autologous pericardium for severe tricuspid regurgitation due to defects in the leaflets of the tricuspid valve after ventricular septal defect closure and ablation. Ten years after surgery, the tricuspid function is good with mild regurgitation and mild stenosis. From the age of 8 months to 11 years, the patient’s body weight and height increased fourfold and twofold, respectively. Thus, a fresh autologous pericardial patch could be the material of choice for tricuspid leaflet repair in pediatric patients.

DOI： 10.1007/s11748-020-01486-0

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Language：English   Publisher：Journal of Artificial Organs  

A 31-year-old man with a HeartMate 3 was admitted with a “Driveline Communication Fault” alarm due to liquid infiltration. Eleven months earlier, the connector between the modular and pump cables had gotten wet when he was taking a shower. The cable connector was dried immediately, and no alarm had been observed during follow-up. Subsequently, the modular cable and system controller were replaced, with corrosion found on the modular cable connector. The “Communication Fault” alarm recurred, and complete damage to the communication cables was discovered. The pump was replaced, and the removed pump cable connector showed corrosion as well. If the driveline connector gets wet, the multidisciplinary team should discuss if it should be immediately disconnected and dried, averting the need for future pump replacements due to corrosion.

DOI： 10.1007/s10047-024-01464-w

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Language：Japanese   Publisher：Japanese Society for Adult Congenital Heart Disease  

We report a very rare surgical case of congenital heart disease complicated with intracardiac stone. A 20-year-old woman with ventricular septal defect (VSD) was referred to our hospital. After detailed examination, she was recommended for surgery and underwent repair of the VSD using the trans-atrial approach. The septal leaflet of the tricuspid valve formed a membranous septal aneurysm (MSA). When we incised the MSA to visualize the whole aspect of the VSD, a pearl-like intracardiac stone (white, solid and 4.0 mm in size) emerged from the aneurysm. To prevent the stone from entering the systemic circulation, we carefully removed it from the MSA. Pathological examination of that intracardiac stone revealed findings of chronic inflammation. We speculated that the cause of the intracardiac calculus may have been the long-term persistence of chronic inflammation due to the sequestration of infective endocarditis within the MSA. If the intracardiac stone was left untreated, the patient could be potentially at risk for serious embolic complications, recurrent infective endocarditis, tricuspid valve dysfunction, and right heart failure. Therefore, in adult patients with VSD associated with MSA, we believe that it is important to keep in mind the presence of such intracardiac stone, to accurately diagnose it preoperatively by imaging studies, and to ensure surgical removal of the cardiac stone.

DOI： 10.34376/jsachd.c-2024-0001

CiNii Research

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiology Cases  

Congenital left atrial wall aneurysm is a rare disorder that occurs in a wide range of age groups from infancy to adulthood. Here, we present a case of a congenital left atrial wall aneurysm that was detected in a 19-year-old man who was surgically treated. Although the patient was asymptomatic without any pre-existing conditions, chest radiography performed as part of a routine health examination detected abnormalities in the heart. Contrast-enhanced computed tomography revealed a giant aneurysm measuring 72 mm × 56 mm that extended from the posteroinferior wall of the left atrium to the posterior surface of the left ventricle. Transthoracic echocardiography revealed mild mitral regurgitation. The patient was diagnosed as having a congenital left atrial wall aneurysm associated with mild mitral regurgitation. The aneurysm was resected through median sternotomy under cardiopulmonary bypass with cardioplegic arrest. During surgery, no structural abnormalities were noted in the mitral valve. After surgery, the patient was discharged without complications. Neither recurrence of the aneurysm nor exacerbation of mitral regurgitation was observed at 1 year postoperatively. Learning objective: A congenital left atrial wall aneurysm is a rare disorder. Rupture of the aneurysm is rare. However, when they are left untreated, there are concerns regarding arrhythmias, heart failure, and systemic embolism. Thus, surgical treatment is recommended. Aneurysms are resected under cardiopulmonary bypass. In cases of aneurysms complicated by moderate or severer mitral regurgitation, mitral valve repair is necessary. The prognosis following surgical treatment is favorable.

DOI： 10.1016/j.jccase.2023.06.010

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.24509/jpccs.23-001

Other Link： https://www.jstage.jst.go.jp/article/jpccs/7/2/7_23-001/_article

Language：Japanese   Publisher：Japanese Society of Pediatric Cardiology and Cardiac Surgery  

<p>A 16-year-old girl, who noted palpitations, and tightness in her chest, was referred to our hospital with a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). She underwent surgery using the Takeuchi method without difficulty, but she had respiratory distress and decreased cardiac function following surgery. Her symptoms improved rapidly after treatment with bisoprolol. Cardiac catheterization, performed to identify the cause of her symptoms, confirmed congestion of blood flow within the coronary vessels and regurgitation of right and left coronary blood flow into the ascending aorta. Although there are few reports discussing the cause of cardiac dysfunction in adults with ALCAPA, congestion of blood flow within the coronary vessels may cause postoperative cardiac dysfunction. Preoperative coronary sinus evaluation may identify a possible cause of postoperative cardiac dysfunction.</p>

DOI： 10.9794/jspccs.38.249

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiology  

Background:: The indication of Fontan conversion (FC) from atriopulmonary connection (APC) to total cavopulmonary connection (TCPC) is unclear. We sought to analyze the mid-term outcome of prophylactic and therapeutic Fontan conversion compared with that of primary TCPC. Methods:: Patients with a univentricular heart who underwent cardiac catheterization at >18 years of age between July 2005 and July 2019 were included and divided into three groups: symptomatic APC patients who underwent therapeutic FC (t-FC, n = 13), asymptomatic APC patients after prophylactic FC (p-FC, n = 15), and patients who had primary TCPC procedure (pTCPC, n = 24). Results:: The mean last follow up was at the age of 32.0 ± 7.8, 26.8 ± 3.8, and 27.3 ± 7 years (p = 0.07) in t-FC, p-FC, and pTCPC, respectively. There was no late death. All of t-FC and 12 (80%) of p-FC cases underwent concomitant arrhythmic surgery. Consequently, five and four patients in t-FC and p-FC groups required pacemaker implantations mostly due to sinus node dysfunction. Thromboembolism was seen in 2 cases in both t-FC (15%) and p-FC (13%), and 1 case in pTCPC (4%) (p = 0.50). The last cardiac catheterization was performed at the age of 29.5 ± 8.5, 24.6 ± 3.8, and 26.3 ± 7.1 years (p = 0.11) in t-FC, p-FC, and pTCPC patients, respectively. There was no significant difference in central venous pressure, aortic pressure, and cardiac index among the three groups. There was no late supraventricular tachyarrhythmic event seen in t-FC and p-FC, whereas two patients in pTCPC had newly developed atrial flutter. Conclusions:: FC is a safe and feasible procedure to bring APC patients back onto the same track of primary TCPC patients in terms of hemodynamics as well as arrhythmia. The antiarrhythmic procedure should be carefully chosen because sinus node dysfunction can frequently occur and FC itself would reduce the risk of arrhythmia.

DOI： 10.1016/j.jjcc.2021.02.005

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PubMed

Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Interactive Cardiovascular and Thoracic Surgery  

OBJECTIVES: To reveal the mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries in a multicentre study. METHODS: Between April 2013 and December 2019, 178 Contegra conduits were implanted at 5 Japanese institutes. The median age and body weight at operation were 16 months (25th-75th percentile: 8-32) and 8.3 kg (6.4-10.6). Sixteen patients were neonates (9.0%). Selected conduit sizes were 12 mm in 28 patients (15.7%), 14 mm in 67 patients (37.6%), 16 mm in 66 patients (37.1%), 18 mm in 5 patients (2.8%) and <12 mm in 12 patients (6.7%). Fifty-six grafts (31.4%) were ring supported. Proximal branch pulmonary arteries were concomitantly augmented in 85 patients (47.5%). Follow-up was completed in all patients and the median follow-up period was 3.1 years (1.3-5.1). RESULTS: The overall, conduit explantation-free and conduit infection-free survival rates at 5 years were 91.3%, 71.0% and 83.7%, respectively. Infection (P = 0.009) and common arterial trunk (P = 0.024) were risk factors for explantation. Conduit durability was shorter in smaller one (P < 0.001). Catheter interventions (for conduit to proximal branch pulmonary artery)-free survival rates at 5 years was 52.9%; however, need for catheter interventions was not a risk factor for conduit explantation. CONCLUSIONS: Mid-term outcomes of reconstruction of the right ventricular outflow tract to the proximal branch pulmonary arteries with Contegra were acceptable. The need for explantation over time was higher in smaller conduits. Conduit infection was a strong risk factor for conduit explantation. Frequently and repeated catheter interventions effectively extended the conduit durability.

DOI： 10.1093/icvts/ivab075

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Cardiovascular and Thoracic Annals  

A 7-year-old boy with a history of neonatal pulmonary artery banding underwent almost complete closure of a sieve-like “Swiss-cheese” ventricular septal defect, using a combination sandwich patch technique through a right ventriculotomy. Although defects existed in the high-, mid-, and low-trabecular septa, a right ventriculotomy and division of the muscle trabeculations continuing the septal and moderator bands helped delineate the edges of the defects. Although patients with “Swiss-cheese” ventricular septal defects may be candidates for a Fontan operation conventionally, a combination patch technique could be considered the procedure of choice.

DOI： 10.1177/0218492320976245

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Cardiology in the Young  

This is a case of a female infant with bilateral coronary ostial atresia associated with pulmonary atresia and ventricular septal defect. She developed coronary ischemia at 1-month of age, when she underwent an aortopulmonary shunt and an aorta-right ventricle shunt. The double-orifice tricuspid valve was separating the right ventricle from the left ventricle. She required extracorporeal cardiopulmonary support because of ventricular dysfunction and mitral regurgitation. Although she was temporarily weaned off the support after mitral valvuloplasty, she died from multiple organ failure. To the best of our knowledge, bilateral coronary ostial atresia associated with pulmonary atresia with ventricular septal defect has not been reported previously.

DOI： 10.1017/S1047951121000779

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Cardiovascular and Thoracic Annals  

DOI： 10.1177/0218492320966131

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Authorship：Last author   Language：Japanese  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Heart Journal Association  

<p>Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about left atrial (LA) function thereafter. The present study aimed to determine LA function in 43 children with ASD and 13 controls based on LA strain measured by two-dimensional echocardiographic speckle tracking (2DE-ST). Among these children, 12 underwent surgery (ASD-S), 31 had device closure (ASD-D), and 13 were included as controls. LA strain was significantly decreased after ASD-D but was not significantly altered after ASD-S, indicating that percutaneous occlusion of an ASD might decrease LA function. Furthermore, the size of the ASD device negatively correlated with LA strain. These results imply that ASD occlusion devices negatively influence LA function and might be important when decided therapeutic strategies for ASD. LA strain measured by 2DE-ST should become a good indicator of LA function after ASD treatment in children.</p>

DOI： 10.1536/ihj.19-173

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CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Total cavopulmonary connection (TCPC) conversion prevents late complications after the atrio-pulmonary-Fontan procedure. However, the outcomes and effects of TCPC conversion are not fully known. We performed TCPC conversion in 31 patients (2004~2017). Concomitantly, we performed anti-arrhythmia surgery in 28 patients( 90%), atrioventricular valve surgery in 4, and pacemaker implantation in 2. There were no perioperative deaths, but one late death occurred due to protein-losing gastroenteropathy. Five-year survival was 96.8%. Eleven patients were readmitted for various reasons, including arrhythmia in 7 and heart failure in 1. The 5-year cardiac event-free rate was 67.7%. The cardiac index was significantly improved:1.58 l/min/m2 before to 3.57 l/min/m2 after surgery ( p=0.0075). Surgical and midterm outcomes of TCPC conversion were favorable. In the perioperative and late periods, therapeutic intervention was usually for atrial arrhythmia. This study demonstrated that TCPC conversion is an effective therapeutic procedure.

Scopus

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Mid-aortic syndrome (MAS) is a very rare disease characterized by stenosis from the distal of the thoracic aorta to the abdominal aorta, in many case it is found as a result of hypertension and the like, and it needs surgical intervention in early childhood to adolescence. Here, we report a case of MAS which recognized prominent left ventricular myocardial hypertrophy from the early stage and needed surgical intervention in the infancy. We selected patch angioplasty using expanded polytetrafluoro ethylene( ePTFE) graft, and after surgery pressure gradient was disappeared.

Scopus

Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.49.1142

CiNii Research

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/ejcts/ezw376

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：European Journal of Cardio-thoracic Surgery  

OBJECTIVES: Bilateral pulmonary artery banding (bil-PAB) has been developed as a part of a hybrid procedure for hypoplastic left heart syndrome (HLHS). We use this procedure for palliation of complex congenital heart disease, particularly in patients with arch anomaly. We reviewed our experience with bil-PAB. METHODS: Sixty-six consecutive cases between 2003 and 2014 were reviewed retrospectively. RESULTS: Fifty-one patients (77%) had single ventricle physiology (HLHS: 37, HLHS variant: 13, others: 1). Twelve patients had biventricular physiology [5 interrupted aortic arch with ventricular septal defect (VSD); 4 coarctation of the aorta with VSD; 2 truncus arteriosus; 1 other]. In 3 patients, it was difficult to determine if the physiology was single ventricle or biventricle due to borderline left ventricle size. Age and body weight at the time of operation were 4.3 ± 3.4 days and 2.7 ± 0.5 kg, respectively. Overall hospital mortality was 11% (7/66). Of the 42 patients from 2010, only 1 with multiple anomalies died between bil-PAB and the second-stage operation. Thirteen patients (20%) required reoperation of bil-PAB. The mean waiting time for the next operation was 44.3 ± 42.8 days. The body weight at the second-stage operation was 3.2 ± 0.8 kg. Seven (11%) patients developed patent ductus arteriosus obstruction during the waiting period. Twenty-four patients were 2.5 kg or less; 20 patients in this group progressed to the second-stage operation and of these 19 gained body weight. Forty-two patients were above 2.5 kg, but of these only 23 patients gained body weight. Ten patients underwent bil-PAB because of shock and 8 of these recovered from shock. In 2 borderline cases, the patients underwent the Norwood procedure and 1 patient had arch repair and VSD closure. CONCLUSIONS: Bil-PAB could be applied to a wide variety of complex diseases. Our mortality rates with bil-PAB improved significantly post-2010. Good indications for bil-PAB were shock and situations where it was unclear whether the physiology was single ventricle or biventricular. Body weight gain was difficult to predict, but patients weighing less than 2.5 kg could be expected to gain body weight after the procedure.

DOI： 10.1093/ejcts/ezw056

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Cardiovascular and Thoracic Annals  

We herein report a case of a hypoplastic left heart syndrome variant complicated with partial anomalous pulmonary venous connection to the left innominate vein. We left the vertical vein at the time of the bidirectional Glenn procedure, and ligated the vertical vein at the time of the total cavopulmonary connection procedure, without reconnecting the vertical vein to the left atrium. Because of the development of an interlobar vein draining from the left upper lung into the lower lung after the bidirectional Glenn procedure, the circulation of the left upper lung was preserved after the total cavopulmonary connection procedure.

DOI： 10.1177/0218492315587993

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PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：General Thoracic and Cardiovascular Surgery  

Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium. We were able to clearly expose the left main trunk behind the pulmonary artery because the obstruction was divided for the patch material. The postoperative course was uneventful, and coronary angiography at 4 months after surgery showed excellent patency of the left main trunk. The auto-pulmonary arterial wall was easy to handle during angioplasty, and its favorable durability has been established both in the Ross procedures and in an arterial switch procedure. Therefore, we conclude that patch angioplasty using a piece of the pulmonary arterial wall represents a good alternative to conventional coronary artery bypass grafting.

DOI： 10.1007/s11748-013-0330-5

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PubMed

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：World Journal for Pediatric and Congenital Heart Surgery  

Aortico-left ventricular tunnel (ALVT) is a rare congenital anomaly presenting abnormal connection between the ascending aorta and the left ventricle. In most reported cases, the aortic end of the tunnel is above the right coronary sinus. Cases of ALVT related to the left aortic sinus are extremely rare. We herein report a case diagnosed preoperatively as ALVT arising from the left aortic sinus. The actual diagnosis observed at surgery was aortic valve insufficiency with a left ventricular outflow tract aneurysm. We successfully performed aortic valve repair and plication of the left ventricular aneurysm. © 2014, SAGE Publications. All rights reserved.

DOI： 10.1177/2150135114542164

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PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Cardiovascular and Thoracic Annals  

Background: Atrial tachyarrhythmias are frequent complications in the late period after the Fontan procedure, and important risk factors for a poor prognosis. The impact of Fontan conversion and arrhythmia surgery in failed Fontan patients has been described in many reports. Objective: We evaluated our experience with Fontan conversion procedures, concomitant arrhythmia surgery, and pacemaker implantation. Methods: We reviewed the hospital records of 25 consecutive patients who underwent a Fontan conversion procedure from January 2004 to March 2012. Twenty-four patients had arrhythmia surgery using cryoablation and radiofrequency ablation at the time of conversion. A bilateral atrial maze procedure was performed in 6 patients, right-side maze in 15, and isthmus block in 3. Three patients with a diagnosis of corrected transposition of the great arteries underwent simultaneous pacemaker implantation electively. Results: There was no early death and one late death during a mean follow-up period of 21.2 months. Three tachyarrhythmia recurrences developed, and there were 4 occurrences of sinus bradycardia. Five of these patients required postoperative pacemaker implantation. Conclusion: The mid-term results of Fontan conversion and arrhythmia surgery in our institute were satisfactory. The occurrence of unexpected postoperative pacemaker requirement was high in the patients who underwent a right atrial or bilateral atrial maze procedure. Pacemaker or lead implantation is recommended for patients planned to undergo a right-side or full maze procedure. © 2013 The Author(s).

DOI： 10.1177/0218492313504939

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PubMed

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Circulation  

DOI： 10.1161/CIRCULATIONAHA.113.001546

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PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

PubMed

Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Annals of Thoracic Surgery  

A saphenous vein graft pseudoaneurysm is a rare complication of coronary artery bypass grafting. Its natural course is largely unknown because there have been few observational studies of medically observed patients. We herein report a case of spontaneous regression of a saphenous vein graft pseudoaneurysm in the early postoperative period, which has never been described, to our knowledge, in the previous literature. © 2013 The Society of Thoracic Surgeons.

DOI： 10.1016/j.athoracsur.2012.05.088

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Thoracic and Cardiovascular Surgery  

DOI： 10.1016/j.jtcvs.2011.10.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Circulation  

DOI： 10.1161/CIRCULATIONAHA.111.058701

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Thoracic and Cardiovascular Surgery  

DOI： 10.1016/j.jtcvs.2011.02.029

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：General Thoracic and Cardiovascular Surgery  

A 79-year-old woman was referred to undergo surgery for a type A dissection. The patient had a history of previous coronary artery bypass. She was in shock and had a hematoma surrounding the ascending aorta and the heart. In this case, a coronary sinus cardioplegia cannula was placed under a short period of circulatory arrest via a small atriotomy, and the atriotomy was closed immediately to establish selective cerebral perfusion. © 2011 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-010-0653-4

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery  

A 60-year-old woman was referred to the Department of Cardiovascular Surgery of Social Insurance Chukyo Hospital for the rupture of a postinfarction papillary muscle. The rupture was in the posterior part of the anterolateral papillary muscle, in which more than two-thirds of its posterior leaflet was prolapsed. Mortality from the surgical repair of a papillary muscle rupture is quite high. For this case, we resuspended the uninfarcted papillary muscle heads case to preserve mitral ventricular continuity because the mitral annulus was quite small and more than two-thirds of the posterior leaflet were detached from the papillary muscle. The post-operative course of the patient was uneventful. Resuspension of uninfarcted papillary muscle is a useful technique to repair a rupture in the papillary muscle.

DOI： 10.5761/atcs.cr.09.01500

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CiNii Research

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiac Surgery  

We present a case of severe hemolysis following a mitral valve repair, which was successfully treated by removing the annuloplasty ring. The etiology of the hemolysis appeared to be a small regurgitant jet at the level of the annuloplasty ring. © 2010 Wiley Periodicals, Inc.

DOI： 10.1111/j.1540-8191.2010.01134.x

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Authorship：Lead author   Language：Japanese  

Authorship：Lead author  

DOI： 10.4326/jjcvs.38.7

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Thoracic and Cardiovascular Surgery  

Objectives: Despite pacemaker therapy in children and adolescents favoring an initial epicardial approach, predictors of lead failure have not been well clarified. The aim of this study was to assess the long-term outcomes and to determine predictors affecting lead durability in pediatric pacing therapy. Methods: We reviewed the outcomes of 109 consecutive pacing leads implanted in 55 patients (median age, 5.2 years; range, 31 days-15.8 years), including 38 atrial and 71 ventricular leads. They consisted of 58 (53%) fishhooks, 37 (34%) screw-in leads, and 14 (13%) steroid-eluting suture-on leads. Seventy (64%) were implanted in patients with structural heart disease. Results: The leads were followed for a median of 6.4 years (range, 3 days-22.9 years). Lead failure occurred in 29 leads (27%; median of 8.4 years after implantation). Exit block or elevation of pacing threshold was the most common cause (n = 18), but failures did not directly cause patient death. The overall 1-, 5-, 10-, and 15-year lead survivals were 100%, 89.0%, 72.5%, and 55.5%, respectively. Multivariate Cox analysis revealed concurrent structural heart disease (relative risk, 2.85; 95% confidence interval, 1.27-6.42; P = .011) to be the only significant predictor of lead failure. Conclusions: Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease. © 2008 The American Association for Thoracic Surgery.

DOI： 10.1016/j.jtcvs.2007.09.002

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Pediatric Cardiology  

We report an unusual anomaly of the upper body venous drainage in a patient with visceroatrial situs inversus. The patient had a persistent right superior vena cava draining into the left-sided right atrium by way of the coronary sinus, with the absence of the left superior vena cava associated with atrioventricular discordant levocardia, pulmonary atresia, and ventricular septal defect. © Springer Science+Business Media, Inc. 2006.

DOI： 10.1007/s00246-005-1111-4

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Patients with tetralogy of Fallot showing unilateral obstruction of a pulmonary artery, especially the right pulmonary artery, are a high-risk group for pulmonary hypertension after repair. This case of tetralogy of Fallot with the obstruction of the right pulmonary artery received a Blalock-Taussig shunt at 7 months old, and the occluded right pulmonary artery caused empyema after surgery. At 2 years old, a cardiac catheter study showed a pulmonary artery index of 193.6 mm2/m2, so we undertook intracardiac repair. After the repair, she showed a relativery favorable clinical course. Systolic pulmonary artery pressure and right ventricular pressure were about 30 and 50 mmHg, respectively. We considered that tetralogy of Fallot with obstruction of right pulmonary artery could be repaired, as long as the pulmonary artery index was within the limits of indication and the left ventricle was well-developed.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Journal of Angiology  

A case of marked dilatation of cerebral arteries and capillary beds associated with cyanotic congenital heart disease is reported. Computed tomography revealed many cyanosis-induced tortuous vessels in the basal cistern at 12 years old, and cerebral angiography verified the diffuse marked dilatation of main trunks, perforating arteries, and capillary beds at 15 years old. After the ventriculoperitoneal shunt was performed for the venous congestion-induced hydrocephalus, cerebral hemorrhaging occured three times, in which cyanosis-derived vasodilatation and venous hypertension were suggested to be involved.

DOI： 10.1007/s00547-005-2003-4

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Despite an extensive experience with Fontan operation, there is a paucity of information to guide the indication of the procedure in patients with Down syndrome. Of 79 patients who had undergone a Fontan operation in our hospital between 1995 and 2003, 3 had Down syndrome. All 3 patients had complete atrioventricular septal defect with single ventricular physiology. Two patients survived, and 1 died of chylothorax and respiratory infection. The 2 survivors have done well in the short-term without complications. We consider that in appropriately selected patients with Down syndrome in whom biventricular repair is precluded, the Fontan operation is the choice of the procedures.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Thoracic and Cardiovascular Surgery  

Objective: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. Methods: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. Results: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5 ± 3.4 mL/kg. Intraoperative donation was 21.7 ± 6.1 mL/kg in Group 1 and 12.8 ± 4.0 mL/kg in Group 2 (p < 0.001). On admission, serum hemoglobin was lower in Group 1 (12.2 ± 1.0 g/dL versus 13.6 ± 1.6 g/dL, p < 0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2 ± 1.4 versus 10.2 ± 1.1 g/dL, p < 0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p < 0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. Conclusion: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.

DOI： 10.1007/s11748-003-0079-3

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

We report the repair of tetralogy of Fallot in a 51-year-old man. He underwent a left classical Blalock-Taussig (B-T) shunt when he was ten years old. Preoperative angiography showed a patent B-T shunt. Total corrective surgery was performed. Postoperatively, he suffered from left ventricular failure. Re-intubation was required three times. Postoperative catheterization showed excellent correction of the right ventricular system, however, descending aortography revealed a great many aorto-pulmonary collateral arteries, which caused the left ventricular failure. Coil embolization of these 13 collateral arteries was performed and he recovered from the left ventricular failure. We conclude that even in an elderly patient with tetralogy of Fallot, total correction should be performed, since the surgical risk is acceptable and the procedure improves the capacity for physical activity and quality of life. Preoperative examination of collateral arteries is important, especially in elderly patients, and coil embolization should be considered.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

We measured levels of bisphenol-A (BPA) in a priming solution and blood of a cardiopulmonary bypass (CPB) circuit. Eight circuits were used in the study of a priming solution. Blood samples were obtained from 6 patients who underwent open heart surgery after the commencement of CPB and at the termination of CPB. Another 3 samples were collected directly from the saline in a polyethylene container as a control. Then the concentrations of BPA in them were determined by means of gas chromatography. No detectable BPA was found in controls. However, a small amount was detected in the saline from the circuits (0.9 +/- 1.1 micrograms/l). A very small amount was also detected in the blood after the commencement and at the termination of CPB (0.3 +/- 0.2 microgram/l, and 0.4 +/- 0.3 microgram/l, respectively). BPA was considered to be leached from the circuit to the priming solution and the blood because the parts of the reservoir and the oxygenator were made of polycarbonate containing BPA. We suppose the BPA concentration is probably at a safe level. However, the data on the endocrinologically toxic level of blood BPA are insufficient. Therefore, the use of plastic in a circuit may require closer scrutiny to determine whether BPA contributes to exposure to xenoestrogens.

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Between February 1993 and July 2000, 18 patients with a mean age of 7.9 years underwent re-operation for critical stenosis of the right ventricular outflow tract. Their diagnoses of these patients included tetralogy of Fallot (n = 7), transposition of the great arteries (n = 6), truncus arteriosus communis (n = 3), and double outlet right ventricle with pulmonary stenosis (n = 2). The first operations were extracardiac conduit operations (n = 9), arterial switch operations (n = 6) and patch reconstruction of the right ventricular outflow tract (n = 3). At re-operation, the right ventricular outflow tract obstruction was released completely and reconstructed using a monocusp ventricular outflow patch (n = 14), valved pericardial roll (n = 2), or bovine pericardial patch sparing the native pulmonary valve annulus (n = 2). There were no early deaths, although one patient died of arrhythmia 2.6 years after re-operation. The pressure gradient across the right ventricular outflow tract, right ventricular systolic pressure, and right ventricle to systemic systolic pressure ratio were satisfactorily relieved (84.3 +/- 19.0 vs. 16.7 +/- 19.7 mmHg, 109.2 +/- 20.5 vs. 48.7 +/- 16.7 mmHg, 0.92 +/- 0.25 vs. 0.43 +/- 0.16; p < 0.001, p < 0.001, p < 0.001, respectively). The right ventricular end-diastolic volume index and right ventricular ejection fraction were also improved (166.3 +/- 85.2 vs. 105.6 +/- 28.8% of normal, 38.3 +/- 12.6 vs. 50.9 +/- 8.8%; p < 0.05, p < 0.005, respectively). Re-operation should be done before the development of marked right ventricular dysfunction, while it can still be performed at a low risk with satisfactory results.

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)  

Web of Science

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

We measured levels of di-2-ethylhexyl phthalate (DEHP) in a priming solution of a cardiopulmonary bypass circuit. The circuit consisted of a venous reservoir, an oxygenator, and polyvinyl chloride (PVC) tubes. Eight circuits were used in this study. In 4 circuits a heparin-coating PVC tube was used and, in the others, a non-coating PVC tube. After they were primed with 1,500 ml of saline, the saline was circulated for 30 minutes at a rate of 6 l/min at 42 degrees C. Another four samples were collected directly from the saline in a polyethylene container as a control. Then the concentrations of DEHP in them were determined by means of gas chromatography. No detectable DEHP was found in controls. But, a small amount was detected in the saline from the circuits (2.75 +/- 4.27 ppb, and 3.75 +/- 4.99 ppb, respectively). DEHP was considered to be leached from the circuit to the priming solution because the tubes were made of PVC containing DEHP as a plasticizer. We suppose the DEHP concentration is probably at a safe level. However, the data on the endocrinologically toxic level of blood DEHP are insufficient. Therefore, the use of plastic in a circuit may require closer scrutiny to determine whether DEHP leached from PVC contributes to exposure to xenoestrogens.

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Brain and Nerve  

A case of central nervous system anomalies(agenesis of corpus callosum, colpocephaly, hydrocephalus, congenital dermal sinus) associated with congenital heart disease (double-outlet right ventricle, complete endocardial cushion defect, atrial septal defect, pulmonary arterial stenosis, patent ductus arteriosus) is reported. Female patient had been already diagnosed as hydrocephalus during pregnancy and ventricular drainage was performed soon after the delivery. Prostaglandin E 1 was also applied for heart disease, but saturation of O2 decreased to 80% on arterial blood gas analysis. Blalock-Taussig operation and ligation of ductus arteriosus was done 41 days after the delivery and ventricle-peritoneal shunt was also made for the progressive hydrocephalus on the same day. Chromosome analysis showed no abnormality. The genesis of this complicated brain and heart anomaly is discussed from the viewpoint of neural crest cell abnormality.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

A one-year-old infant underwent repair of atrioventricular septal defect with common orifice. About 2 years later, echocardiography revealed a left ventricular outflow tract obstruction for the first time. Because of progression of the obstructive lesion, a modified Konno procedure through a transaortic transpulmonary approach was later performed at 8 years old, and the postoperative course was uneventful. This is a useful procedure for left ventricular outflow tract obstruction with normal aortic valve and aortic annulus, because it can both preserve a native aortic valve and dose not necessitate right ventriculotomy in resection of hypertrophied muscle and patch enlargement of interventricular septum.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

To evaluate the differences in patch-materials used to reconstruct the pulmonary artery in arterial switch operation for transposition of the great arteries, we compared mid-term results in 50 consecutive survivors who underwent arterial switch operation. In 35 patients (XP-group), the pulmonary artery was reconstructed using a glutaraldehyde-treated heterologous pericardial patch, while in 15 patients (AP-group) it was reconstructed using a fresh autologous pericardial patch. A W-shaped patch was used in 14 patients of the XP-group. In 21 patients of the XP-group and all those of the AP-group, a square patch was used. The mean length of follow-up has been 94.1 +/- 38.1 months after surgery in XP-group, and 16.7 +/- 11.8 months in AP-group, respectively. Four patients in XP-group required balloon angioplasty for pulmonary stenosis and 5 patients in XP-group underwent reoperation, but no patients in AP-group required balloon angioplasty or reoperation for pulmonary stenosis. The risk factors influencing postoperative pulmonary stenosis (sex, age at surgery, preliminary pulmonary artery banding, patch shape and material) were analyzed by multiple regression analysis. The patch material (heterologous patch) was the only identifiable risk factor for pulmonary stenosis. These data suggest that pulmonary artery reconstruction with an autologous pericardial patch may be effective to prevent postoperative pulmonary stenosis, although the long-term prognosis remains unknown.

Scopus

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Pediatric Cardiology  

The case of an 8-month-old boy with aortic dissection caused by intraaortic balloon pumping is reported. The balloon was inserted during an operation for the anomalous origin of the left coronary artery. It is important to realize the potential risk of aortic dissection even in infants and to select an appropriately sized balloon. Modification of the balloon for use in infants is necessary.

DOI： 10.1007/s002469900489

Web of Science

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

We reviewed the records of 9 pediatric patients with muscular trabecular ventricular septal defects undergoing repair between April 1994 and June 1998 (mean age 2.6 +/- 3.1 years, mean weight 9.0 +/- 5.2 kg). The prevalence rate for muscular trabecular defects in the patients undergoing open-heart surgery for congenital heart disease was 2.0%. Although only 6 of the 9 patients were diagnosed as having muscular trabecular defects preoperatively, 60 degrees left anterior oblique and 30 cranially tilted projections of left ventricular cineangiocardiogram were useful to detect these defects. The technique of filling the left heart with blood by stopping to vent the left heart and inflating the lungs during the last one or two ligatures in closure of the defects was also useful to detect these defects intraoperatively. In closure of muscular trabecular defects, division of some trabeculations including a moderator band enabled complete repair through a right atriotomy. The nearer the inferior border of the ventricular septal defects were to the heart apex, the more postoperative residual shunts were left. We consider that apical left ventriculotomy may be needed in apical defects, although the right atrial approach is satisfactory for most muscular trabecular defects.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai zasshi  

Severe tricuspid valve regurgitation and decreased pulmonary blood flow in neonatal Ebstein's anomaly with pulmonary atresia, may result in cardiac respiratory failure and hypoxemia. The poor natural course and lack of standard surgical treatment make treatment for neonatal Ebstein's anomaly very difficult. The Blalock-Taussig operation was performed for hypoxemia in Ebstein's anomaly associated with pulmonary atresia and severe tricuspid regurgitation on 36th day after birth. On the 63rd day after birth, tricuspid valve orifice closure and right atrium plication (Starnes procedure) were accomplished under cardiopulmonary bypass. Heart failure became controllable and the patient condition was satisfactory at one year after surgery.

DOI： 10.1007/BF03217902

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PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Nippon Geka Gakkai zasshi  

A 37-year-old male was referred to our hospital with symptoms suggesting pneumonia. The preoperative diagnosis was primary lung cancer of the left upper lobe invading the distal aortic arch (DAA) (T4, stage IIIB). Complete resection was performed with associated resection of the pneumonectomy, DAA, and left subclavian artery. Dacron graft replacement was performed using ECC with selective cerebral perfusion. Histological examination revealed squamous cell carcinoma, n1 and negative surgical margins. We expect this patient to achieve long-term survival. We conclude that ECC with selective cerebral perfusion is both safe and effective for pulmonary surgery in cases with combined resection of the DAA.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

A 1-month-old male infant with respiratory distress was referred to our hospital for operation of the ventricular septal defect. A chest roentgenogram demonstrated pulmonary emphysema especially in the right upper and middle lobes. At 3 months, a perimembranous ventricular septal defect was closed. But the infant could not be weaned from the ventilator. On the 21st postoperative day, a right upper and middle bilobectomy was performed. Three days later, he was weaned from the ventilator and the postoperative course was uneventful. The pathologic diagnosis revealed no bronchial cartilagenous abnormality. Infantile lobar emphysema of the right upper lobe with congenital heart disease is rather rare. We emphasize the need for lobectomy simultaneous with, secondary to, cardiac surgery in these cases.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Artificial Organs  

In the present study we investigated the changes in contact factors in cardiopulmonary bypass (CPB) using hemofiltration (HF) for priming blood. Red cell concentrates containing MAP (RC-MAP) and albumin solution were used for the priming. Blood samples were collected from RC-MAP, priming solution before and after HF, hemofiltrate and patient before CPB, 5 and 60 minutes after CPB and at the end of CPB. In 10 cases, high molecular weight kininogen (HMWK), prekallikrein (PK), factor XII (F XII) and bradykinin (BK) levels were examined in each sample. Through hemodilution and contact with the CPB circuit, HMWK, PK and F XII were consumed and a large quantity of BK was generated, but BK was hemofiltrated well. At the beginning of CPB, HMWK, PK and F XII were significantly decreased, since then they were not significantly changed. BK was not significantly changed during CPB. Because BK increases vasodilation and capillary permeability, HF is useful to prevent a drop in blood pressure at the beginning of CPB and for the reduction of postoperative edema, especially is neonates and infants.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai  

A 78-year-old woman was operated on with a diagnosis of oozing-type cardiac rupture after an acute anteroseptal myocardial infarction. Pericardial drainage was performed and hemostasis was obtained by dressing with local hemostatics. As hemodynamics improved, elevation of pulmonary artery pressure and a step-up in oxygen concentration in the pulmonary artery from a Swan-Ganz catheter sample appeared. A left-to-right shunt was observed in the operative field with color Doppler echocardiography and a diagnosis of ventricular septal perforation (VSP) was made. Subsequently, intracavitary repair with two sheets of equine pericardial patch, sutured using interrupted mattress sutures with felt pledgets, was performed. Her early course after operation was satisfactory in spite of a small residual shunt. However, thirty-one days later she was returned to surgery because of an increasing residual shunt. Looseness of several interrupted mattress sutures and thrombus adherent to the internal surface of the pericardial patch were observed. The thrombus was removed and the patch was reattached using both interrupted mattress sutures with felt pledgets and continuous suture. She had an uneventful recovery thereafter. As double rupture is not a rare complication after myocardial infarction, a careful hemodynamic examination is necessary and important in the diagnosis and treatment of cardiac rupture. We consider that interrupted mattress sutures are a better technique for early repair of the VSP to reduce a risk of residual shunt due to the weakness and unclear border of infarcted myocardial tissue, and continuous suture is acceptable to repair the VSP 3 to 4 weeks later after infarction. Long-term anticoagulant therapy is necessary after intracavitary repair using equine pericardial patch.

Scopus

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society for Cardiovascular Surgery  

DOI： 10.4326/jjcvs.22.192

CiNii Research

Responsible for pages：133-136   Language：Japanese Book type：Scholarly book

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

Authorship：Lead author   Language：Japanese  

Authorship：Lead author   Language：Japanese  

Authorship：Lead author   Language：Japanese  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)