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Yoshihisa Tanoue - One of the best experts on this subject based on the ideXlab platform.
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consequences of a hypertensive right ventricle on left ventricular performance of patients with pulmonary atresia and intact ventricular septum after right heart bypass surgery
Progress in Pediatric Cardiology, 2010Co-Authors: Yoshihisa Tanoue, Hideaki Kado, Tomoki Ushijima, Ryuji TominagaAbstract:Abstract A hypertensive right ventricle adversely affects left ventricular function in patients who are Fontan candidates with pulmonary atresia with intact ventricular septum (PAIVS). Decompression of a hypertensive right ventricle should improve left ventricular performance. Recently, a right ventricular outflow tract reconstruction, the closed Brock Procedure, and/or percutaneous balloon pulmonary valvuloplasty were performed to decompress the hypertensive right ventricle before and during the Bidirectional Glenn Procedure in Fontan-candidate patients with PAIVS in our hospital. This strategy significantly improved left ventricular performance (contractility and ventricular efficiency) after the Bidirectional Glenn Procedure and a staged total cavopulmonary connection.
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Three hundred and thirty-three experiences with the Bidirectional Glenn Procedure in a single institute
Interactive cardiovascular and thoracic surgery, 2006Co-Authors: Yoshihisa Tanoue, Hideaki Kado, Noriko Boku, Hideki Tatewaki, Toshihide Nakano, Kouji Fukae, Munetaka Masuda, Ryuji TominagaAbstract:OBJECTIVES Introduction of the Bidirectional Glenn Procedure (BDG) in low-risk Fontan candidates would improve clinical outcomes. Over the last decade, not only high-risk Fontan candidates, but all candidates underwent BDG and staged Fontan operation (TCPC) in our hospital. METHODS Three hundred and thirty-three consecutive patients (age range, 42 days to 16 years old) underwent BDG at Fukuoka Children's Hospital Medical Center from 1992 to 2004. Diagnoses included hypoplastic left heart syndrome in 47, pulmonary atresia with intact ventricular septum in 32, tricuspid valve atresia in 35, and other complex univentricular heart defects in 219 patients (right dominant in 166, left dominant in 53). RESULTS There were three hospital deaths and 27 late deaths (five after TCPC). Six patients underwent takedown operation. Two hundred and thirty patients underwent TCPC, while 66 patients were waiting for TCPC. In five patients, completion of TCPC was contraindicated. A univariate analysis revealed that for patients less than six months old, diagnoses besides tricuspid atresia, right ventricular morphology, mean pulmonary arterial pressure, pulmonary vascular resistance, ventricular end-diastolic pressure, atrioventricular valve regurgitation greater than moderate, atrioventricular valvuloplasty/valve replacement in concomitant Procedure, and total anomalous pulmonary venous connection repair in concomitant Procedure were significant predictors of death, takedown, or out of indication for completion of TCPC. A stepwise logistic regression analysis showed that mean pulmonary arterial pressure and heterotaxy were independent predictors. CONCLUSIONS The staged strategy used for all Fontan candidates provides excellent clinical results. The main risk factor for death, takedown, or out of indication for completion of TCPC was elevated pulmonary arterial pressure. Appropriate surgical interventions such as atrioventricular valvuloplasty and total anomalous pulmonary venous connection repair, before and/or on BDG for the control of pulmonary circulation are of great importance to prevent elevation of pulmonary arterial pressure.
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Midterm ventricular performance after Norwood Procedure with right ventricular-pulmonary artery conduit.
The Annals of thoracic surgery, 2004Co-Authors: Yoshihisa Tanoue, Hideaki Kado, Yuichi Shiokawa, Naoki Fusazaki, Shiro IshikawaAbstract:Background Midterm and long-term results of patients who underwent a Norwood Procedure with a right ventricular–pulmonary artery conduit remain unclear. This study aimed to compare the midterm ventricular performance of the Norwood Procedure with right ventricular–pulmonary artery conduit and the Norwood Procedure with systemic–pulmonary shunt. Methods Twenty-one patients who underwent both a Bidirectional Glenn Procedure and a total cavopulmonary connection after Norwood palliation at Fukuoka Children's Hospital Medical Center were divided into two groups: the systemic–pulmonary shunt group (n = 11) and the right ventricular–pulmonary artery conduit group (n = 10). End-systolic elastance (contractility), effective arterial elastance (afterload), and ventriculoarterial coupling and the ratio of stroke work and pressure-volume area (ventricular efficiency) were measured on the basis of cardiac catheterization data before the Bidirectional Glenn Procedure, before and after the total cavopulmonary connection, and at approximately 1 year after total cavopulmonary connection. Results After Bidirectional Glenn Procedure and total cavopulmonary connection, end-systolic elastance of the right ventricular–pulmonary artery conduit group was lower than that of the systemic–pulmonary shunt group, whereas effective arterial elastance of the right ventricular–pulmonary artery conduit group was lower than that of the systemic–pulmonary shunt group. Consequently, there was no difference in ventricular efficiency in both groups 1 year after total cavopulmonary connection. Conclusions The midterm ventricular performance of the right ventricular–pulmonary artery conduit group was comparable with the systemic–pulmonary shunt group in terms of ventricular efficiency. However, after Bidirectional Glenn Procedure and total cavopulmonary connection, contractility in patients who underwent a Norwood Procedure with a right ventricular–pulmonary artery conduit was inferior to that of patients who underwent a Norwood Procedure with a systemic–pulmonary shunt.
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ventricular mechanics in the Bidirectional Glenn Procedure and total cavopulmonary connection
The Annals of Thoracic Surgery, 2003Co-Authors: Yoshihisa Tanoue, Akira Sese, Yutaka ImotoAbstract:Abstract Background The time course of ventricular efficiency in Fontan candidates who underwent both the Bidirectional Glenn Procedure (BDG) and total cavopulmonary connection (TCPC) were analyzed in this study. We previously reported that volume-load reduction of BDG preceding TCPC allowed for any afterload mismatch to be corrected, thereby improving ventricular efficiency after staged TCPC. Methods We measured percent normal systemic ventricular end-diastolic volume (%N-EDV), contractility (end-systolic elastance [Ees]), afterload (effective arterial elastance [Ea]), and ventricular efficiency (ventriculoarterial coupling [Ea/Ees]) based on cardiac catheterization data before and after both BDG and staged TCPC in 30 patients. Ees and Ea were approximated as follows: Ees=mean arterial pressure/minimal ventricular volume, and Ea=maximal ventricular pressure/(maximal ventricular volume − minimal ventricular volume), and Ea/Ees was then calculated. Ventricular volume was divided by body surface area. Results The %N-EDV decreased both after BDG and after staged TCPC, thus resulting in an improvement of Ees. Although Ea increased both after BDG and after staged TCPC, Ea decreased during the interval between BDG and staged TCPC. These changes resulted in an improvement in Ea/Ees during the interval period and after staged TCPC, although Ea/Ees worsened after BDG. Conclusions Correction of afterload mismatch during the interval period between BDG and staged TCPC is considered to be one of the most important factors for obtaining excellent clinical results when selecting a staged strategy to treat high-risk Fontan candidates.
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ventricular mechanics in the Bidirectional Glenn Procedure and total cavopulmonary connection
The Annals of Thoracic Surgery, 2003Co-Authors: Yoshihisa Tanoue, Akira Sese, Yutaka Imoto, Kunitaka JohAbstract:Abstract Background The time course of ventricular efficiency in Fontan candidates who underwent both the Bidirectional Glenn Procedure (BDG) and total cavopulmonary connection (TCPC) were analyzed in this study. We previously reported that volume-load reduction of BDG preceding TCPC allowed for any afterload mismatch to be corrected, thereby improving ventricular efficiency after staged TCPC. Methods We measured percent normal systemic ventricular end-diastolic volume (%N-EDV), contractility (end-systolic elastance [Ees]), afterload (effective arterial elastance [Ea]), and ventricular efficiency (ventriculoarterial coupling [Ea/Ees]) based on cardiac catheterization data before and after both BDG and staged TCPC in 30 patients. Ees and Ea were approximated as follows: Ees=mean arterial pressure/minimal ventricular volume, and Ea=maximal ventricular pressure/(maximal ventricular volume − minimal ventricular volume), and Ea/Ees was then calculated. Ventricular volume was divided by body surface area. Results The %N-EDV decreased both after BDG and after staged TCPC, thus resulting in an improvement of Ees. Although Ea increased both after BDG and after staged TCPC, Ea decreased during the interval between BDG and staged TCPC. These changes resulted in an improvement in Ea/Ees during the interval period and after staged TCPC, although Ea/Ees worsened after BDG. Conclusions Correction of afterload mismatch during the interval period between BDG and staged TCPC is considered to be one of the most important factors for obtaining excellent clinical results when selecting a staged strategy to treat high-risk Fontan candidates.
Hajime Ichikawa - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of prophylactic damus kaye stansel anastomosis concomitant with Bidirectional Glenn Procedure
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Masatoshi Shimada, Toshikatsu Yagihara, Takaya Hoashi, Koji Kagisaki, Isao Shiraishi, Hajime IchikawaAbstract:Objective We evaluated prophylactic Damus-Kaye-Stansel (DKS) anastomosis in association with the timing of a Bidirectional Glenn (BDG) Procedure as second-stage palliation aiming at Fontan completion to prevent late systemic ventricular outflow tract obstruction. Methods Between 1996 and 2005, 25 patients (14 boys; median age, 12 months) underwent a BDG Procedure concomitant with DKS anastomosis. All had a systemic ventricular outflow tract through an intraventricular communication or morphologically developed subaortic conus and had previously undergone pulmonary artery banding. Enlargement of intraventricular communication and/or resection of a subaortic conus were not performed before or during the operation. Results Twenty-one (84%) patients subsequently underwent a Fontan operation, with a follow-up period of 6.8 ± 1.9 years (range, 4-11 years), with no mortalities after the Fontan operation. Cardiac catheterization showed that systemic ventricular end-diastolic volume was significantly decreased from 187% ± 74% of normal before BDG to 139% ± 35% after ( P = .038) and to 73% ± 14% at 4.3 years after the Fontan operation ( P Conclusions Regardless of a significant reduction in systemic ventricular volume, DKS anastomosis concomitant with a BDG Procedure shows promise for a nonobstructive systemic ventricular outflow tract after a Fontan operation.
Frank L Hanley - One of the best experts on this subject based on the ideXlab platform.
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interstage evaluation of homograft valved right ventricle to pulmonary artery conduits for palliation of hypoplastic left heart syndrome
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Nefthi Sandeep, Olaf Reinhartz, Rajesh Punn, Sowmya Balasubramanian, Shea N Smith, Yulin Zhang, Gail E Wright, Lynn F Peng, Lisa Wisefaberowski, Frank L HanleyAbstract:Abstract Objective Palliation of hypoplastic left heart syndrome with a standard nonvalved right ventricle to pulmonary artery conduit results in an inefficient circulation in part due to diastolic regurgitation. A composite right ventricle pulmonary artery conduit with a homograft valve has a hypothetical advantage of reducing regurgitation, but may differ in the propensity for stenosis because of valve remodeling. Methods This retrospective cohort study included 130 patients with hypoplastic left heart syndrome who underwent a modified stage 1 Procedure with a right ventricle to pulmonary artery conduit from 2002 to 2015. A composite valved conduit (cryopreserved homograft valve anastomosed to a polytetrafluoroethylene tube) was placed in 100 patients (47 aortic, 32 pulmonary, 13 femoral/saphenous vein, 8 unknown), and a nonvalved conduit was used in 30 patients. Echocardiographic functional parameters were evaluated before and after stage 1 palliation and before the Bidirectional Glenn Procedure, and interstage interventions were assessed. Results On competing risk analysis, survival over time was better in the valved conduit group ( P = .040), but this difference was no longer significant after adjustment for surgical era. There was no significant difference between groups in the cumulative incidence of Bidirectional Glenn completion ( P = .15). Patients with a valved conduit underwent more interventions for conduit obstruction in the interstage period, but this difference did not reach significance ( P = .16). There were no differences between groups in echocardiographic parameters of right ventricle function at baseline or pre-Glenn. Conclusions In this cohort of patients with hypoplastic left heart syndrome, inclusion of a valved right ventricle to pulmonary artery conduit was not associated with any difference in survival on adjusted analysis and did not confer an identifiable benefit on right ventricle function.
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major aortopulmonary collateral arteries with anatomy other than pulmonary atresia ventricular septal defect
The Annals of Thoracic Surgery, 2017Co-Authors: William L Patrick, Richard D Mainwaring, Olaf Reinhartz, Rajesh Punn, Theresa A Tacy, Frank L HanleyAbstract:Background Major aortopulmonary collateral arteries (MAPCAs) are frequently found in association with pulmonary atresia with ventricular septal defect (PA/VSD). However, some patients with MAPCAs do not have PA/VSD but have a variety of other "atypical" anatomic diagnoses. Methods This was a retrospective review of patients with MAPCAs and atypical anatomy. The 50 patients with MAPCAs could be divided into two subgroups: (1) single ventricle anatomy (n = 33) and (2) two ventricle anatomy (n = 17). Results The 33 patients with MAPCAs and single ventricle included 15 with unbalanced complete atrioventricular canal (CAVC), 6 with pulmonary atresia-intact ventricular septum, and 12 with other forms of single ventricle. The initial cardiac operation included unifocalization/shunt in 24 patients and creation of aortopulmonary window or central shunt in 9 patients. There were seven operative and eight late deaths. Sixteen patients have had a Bidirectional Glenn Procedure and 6 had a Fontan Procedure. The 17 patients with MAPCAs and two ventricles included 5 with CAVC, 4 with corrected transposition, 3 with double outlet right ventricle, 3 with scimitar syndrome, and 2 with complex D-transposition. The initial cardiac operation included single-stage complete repair in 5 patients, unifocalization/shunt in 10 patients, and aortopulmonary window in 2 patients. There were two operative and two late deaths. Thirteen patients have achieved complete repair status. Conclusions The data demonstrate the wide diversity of anatomy seen in patients with MAPCAs when evaluating diagnoses other than PA/VSD. Two-thirds of the patients had single ventricle and was associated with a relatively high mortality.
Yutaka Okita - One of the best experts on this subject based on the ideXlab platform.
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appropriate additional pulmonary blood flow at the Bidirectional Glenn Procedure is useful for completion of total cavopulmonary connection
The Annals of Thoracic Surgery, 2005Co-Authors: Masahiro Yoshida, Masahiro Yamaguchi, Naoki Yoshimura, Hirohisa Murakami, Hironori Matsuhisa, Yutaka OkitaAbstract:Background The role and effect of additional pulmonary blood flow at the time of Bidirectional Glenn Procedure (BDG) is controversial. We assessed our experiences to clarify the effects of controlled additional pulmonary blood flow on outcomes after BDG. Methods Thirty-eight patients who underwent BDG (2.1 ± 2.1 years of age) were enrolled in this study. In group A (n = 29) additional pulmonary blood flow was controlled by the banding of the pulmonary trunk, or the previously created Blalock-Taussig shunt, to keep the central venous pressure equal to or less than 16 mm Hg at BDG. In group B (n = 9), BDG was the only source of pulmonary blood flow. Results One operative death occurred in group B. In group A, 24 patients underwent total cavopulmonary connection (TCPC) 14 ± 6 months after BDG, and the remaining 5 patients are waiting for TCPC in good condition. In group B, 6 patients underwent TCPC 8 ± 7 months after BDG. One patient is awaiting TCPC and the remaining patient is considered unsuitable for TCPC. Cardiac catheterization performed in 32 patients showed significant decrease of pulmonary artery (Nakata) index from 307 ± 73 to 215 ± 45 mm 2 /m 2 after BDG in group B ( p 2 /m 2 in group A, and there was a significant correlation between the Nakata index and the percentage of its difference (Y = 40.823 − 0.144 X; n=26, R=0.740, p Conclusions Appropriate additional pulmonary blood flow is useful for the completion of TCPC by means of suppressing the decrease in the size of the pulmonary artery, especially in patients with underdeveloped pulmonary arteries.
Toshikatsu Yagihara - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of prophylactic damus kaye stansel anastomosis concomitant with Bidirectional Glenn Procedure
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Masatoshi Shimada, Toshikatsu Yagihara, Takaya Hoashi, Koji Kagisaki, Isao Shiraishi, Hajime IchikawaAbstract:Objective We evaluated prophylactic Damus-Kaye-Stansel (DKS) anastomosis in association with the timing of a Bidirectional Glenn (BDG) Procedure as second-stage palliation aiming at Fontan completion to prevent late systemic ventricular outflow tract obstruction. Methods Between 1996 and 2005, 25 patients (14 boys; median age, 12 months) underwent a BDG Procedure concomitant with DKS anastomosis. All had a systemic ventricular outflow tract through an intraventricular communication or morphologically developed subaortic conus and had previously undergone pulmonary artery banding. Enlargement of intraventricular communication and/or resection of a subaortic conus were not performed before or during the operation. Results Twenty-one (84%) patients subsequently underwent a Fontan operation, with a follow-up period of 6.8 ± 1.9 years (range, 4-11 years), with no mortalities after the Fontan operation. Cardiac catheterization showed that systemic ventricular end-diastolic volume was significantly decreased from 187% ± 74% of normal before BDG to 139% ± 35% after ( P = .038) and to 73% ± 14% at 4.3 years after the Fontan operation ( P Conclusions Regardless of a significant reduction in systemic ventricular volume, DKS anastomosis concomitant with a BDG Procedure shows promise for a nonobstructive systemic ventricular outflow tract after a Fontan operation.
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use of the Bidirectional Glenn Procedure in the presence of forward flow from the ventricles to the pulmonary arteries
Circulation, 1995Co-Authors: Hideki Uemura, Toshikatsu Yagihara, Yasunaru Kawashima, Kenji Okada, Tetsuro Kamiya, Robert H AndersonAbstract:Background Relative regression of the pulmonary arterial size has been reported after a conventional Bidirectional Glenn Procedure. Maintaining a supplemental pulmonary flow could be of surgical value unless the option also militates against the efficacy of the partial right heart bypass. Methods and Results Twenty-seven patients considered unsuitable for a Fontan-type Procedure underwent a Bidirectional Glenn Procedure in the presence of forward flow from the ventricles to the pulmonary arteries, the flow being maintained through the pulmonary trunk in 22 or a systemic-to-pulmonary shunt in 5. There was one surgical death due to atrioventricular valvular regurgitation. Subsequently, 9 patients have successfully undergone a total cavopulmonary connection 2.6±1.9 years after the initial Procedure. Preoperative and postoperative catheterizations revealed changes in arterial oxygen saturation (75±11% compared with 83±7%, P<.001) and end-diastolic volumes of the systemic ventricles (from 238±92% to 188±97% of...