General Thoracic and Cardiovascular Surgery最新文献

{"title":"Predictive factors for size change of aorta in patients with acute blunt traumatic aortic injury.","authors":"Soojin Lee, Seunghwan Song, Seon Hee Kim, Chang Won Kim, Hoon Kwon, Dongman Ryu, Na Hyeon Lee, Eunji Kim","doi":"10.1007/s11748-024-02054-6","DOIUrl":"10.1007/s11748-024-02054-6","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the changes in aorta size, the factors affecting size changes in patients with acute blunt traumatic aortic injury and to evaluate the adequacy of the current 120% thoracic endovascular aortic repair graft oversizing policy.</p><p><strong>Design and methods: </strong>This retrospective review study was conducted using the prospectively collected medical records of 45 patients (mean age: 53.5 years, male: 39 patients) with blunt traumatic aortic injury treated at a level 1 trauma center between 2012 and 2021. Aortic diameter was measured by computed tomography angiographic images at four different levels [ascending aorta (A), isthmus (B), descending thoracic aorta (C), and infrarenal aorta (D)] on arrival and follow-up (median time interval, 13 days). Associated factors including patient characteristics and hemodynamic parameters on arrival and follow-up were collected to determine their influence on changes in the aorta.</p><p><strong>Results: </strong>The mean diameter of all four aortic levels increased on follow-up computed tomography compared to initial computed tomography (A: + 11.77%, B: + 10.19%, C: + 7.71%, D: + 12.04%). Patient age and injury severity score influenced changes in the diameter of the ascending aorta (P < 0.05). Patient age and blunt traumatic aortic injury grade were significantly associated with changes in the infrarenal aortic diameter (P < 0.05). Three cases of type 1 endoleak were observed at follow-up but all were spontaneously resolved without further intervention at next computed tomography follow-up.</p><p><strong>Conclusions: </strong>In patients with acute blunt traumatic aortic injury, aortic diameter is significantly smaller by about 10% under shock and is not considered a basis for oversizing the currently implemented 120% thoracic endovascular aortic repair graft sizing. However, in young patients under the age of 40, the change is significantly large and subsequent computed tomography follow-up is required.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"209-217"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-pump versus on-pump coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.","authors":"Anelise Poluboiarinov Cappellaro, Luiz F Costa de Almeida, Manoela Lenzi Pinto, Marcelo Albuquerque Barbosa Martins, Augusto Graziani E Sousa, Júlia Gonçalves Gadelha, Ana Carolina Putini Vieira, Luís Fernando Rosati Rocha, Myat Soe Thet","doi":"10.1007/s11748-025-02116-3","DOIUrl":"10.1007/s11748-025-02116-3","url":null,"abstract":"<p><strong>Introduction: </strong>Off-pump coronary artery bypass graft surgery (OPCAB) has been suggested as superior to on-pump coronary artery bypass graft surgery (ONCAB) in certain high-risk subgroups, but its benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. This meta-analysis aimed to evaluate OPCAB versus ONCAB outcomes in COPD patients.</p><p><strong>Methods: </strong>We followed PRISMA guidelines and searched PubMed, Embase, and the Cochrane Library in August 2024 for studies comparing OPCAB and ONCAB in COPD patients. Statistical analysis was conducted using Review Manager 5.4.1 and Rstudio with a fixed or random effects model.</p><p><strong>Results: </strong>Six studies with a total of 1,687 patients were included, of which 1,062 (62.95%) underwent OPCAB. The mean patient age was 63.6 years. OPCAB did not significantly affect all-cause mortality compared to ONCAB (OR 1.14; 95% CI 0.65-1.99). There were no significant differences in reintubation (OR 0.81; 95% CI 0.53-1.23), prolonged ventilation (OR 0.54; 95% CI 0.24-1.22), post-operative atrial fibrillation (OR 0.90; 95% CI 0.70-1.15), or ARDS (OR 0.43; 95% CI 0.14-1.33). However, ventilation time was significantly shorter in the OPCAB group (MD - 5.30 h; 95% CI - 7.22 to - 3.38).</p><p><strong>Conclusion: </strong>OPCAB is associated with reduced ventilation time in COPD patients though it shows no significant difference in all-cause mortality or other post-operative complications compared to ONCAB.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"201-208"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic and cardiovascular surgeries in Japan during 2022 : Annual report by the Japanese Association for Thoracic Surgery.","authors":"Naoki Yoshimura, Yukio Sato, Hiroya Takeuchi, Tomonobu Abe, Toyofumi Fengshi Yoshikawa, Yasutaka Hirata, Michiko Ishida, Hisashi Iwata, Takashi Kamei, Nobuyoshi Kawaharada, Shunsuke Kawamoto, Kohji Kohno, Hiraku Kumamaru, Kenji Minatoya, Noboru Motomura, Rie Nakahara, Morihito Okada, Hisashi Saji, Aya Saito, Masanori Tsuchida, Kenji Suzuki, Hirofumi Takemura, Tsuyoshi Taketani, Yasushi Toh, Wataru Tatsuishi, Hiroyuki Yamamoto, Takushi Yasuda, Masayuki Watanabe, Goro Matsumiya, Yoshiki Sawa, Hideyuki Shimizu, Masayuki Chida","doi":"10.1007/s11748-024-02106-x","DOIUrl":"10.1007/s11748-024-02106-x","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"254-294"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-lung transplant outcomes of connective tissue disease-related interstitial lung diseases compared with idiopathic interstitial pneumonia: a single-center experience in Japan.","authors":"Miho Yamaguchi, Takafumi Yamaya, Mitsuaki Kawashima, Chihiro Konoeda, Hidenori Kage, Masaaki Sato","doi":"10.1007/s11748-024-02073-3","DOIUrl":"10.1007/s11748-024-02073-3","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to investigate the outcomes of lung transplantation for connective tissue disease-related interstitial lung disease (CTD-ILD) conducted at our institution, compared with those for idiopathic interstitial pneumonias (IIPs).</p><p><strong>Methods: </strong>We retrospectively reviewed patients with CTD-ILD and IIPs who underwent lung transplantation at our hospital from July 2015 to October 2023. We compared patients' backgrounds, early complications within 28 days post-transplant (CTCAE grade 3 or higher), postoperative courses, and prognoses between the two groups.</p><p><strong>Results: </strong>The CTD-ILD group (n = 19) and the IIPs group (n = 56) were compared. The CTD-ILD group had significantly higher preoperative use of corticosteroids and antifibrotic agents, mean pulmonary arterial pressure, anti-human leukocyte antigen antibody positivity, and donor age (p < 0.05). In addition, the CTD-ILD group had significantly longer operation times (579.0 vs 442.5 min), longer stays in the intensive care unit (17.0 vs 9.0 days) and hospital (58.0 vs 44.0 days); required more tracheostomies (57.9 vs 25.0%); and experienced more respiratory (52.6 vs 25.0%) and gastrointestinal (42.1 vs 8.9%) complications (p < 0.05). However, there were no significant differences in overall survival, nor chronic lung allograft dysfunction (CLAD)-free survival between the two groups.</p><p><strong>Conclusion: </strong>Perioperative complications, notably respiratory and gastrointestinal complications, were prevalent after lung transplantation among CTD-ILD patients. Despite this, long-term survival rates were comparable to those observed in IIP cases.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"227-234"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing identification of early-stage lung adenocarcinomas through solid component analysis of three-dimensional computed tomography images.","authors":"Sanae Kuroda, Megumi Nishikubo, Nanase Haga, Yuki Nishioka, Nahoko Shimizu, Wataru Nishio","doi":"10.1007/s11748-024-02076-0","DOIUrl":"10.1007/s11748-024-02076-0","url":null,"abstract":"<p><strong>Objectives: </strong>As the role of segmentectomy expands in managing early-stage lung adenocarcinoma, precise preoperative assessments of tumor invasiveness via computed tomography become crucial. This study aimed to evaluate the effectiveness of solid component analysis of three-dimensional (3D) computed tomography images and establish segmentectomy criteria for early-stage lung adenocarcinomas.</p><p><strong>Methods: </strong>This retrospective study included 101 cases with adenocarcinoma diagnoses, with patients undergoing segmentectomy for clinical stage 0 or IA between 2012 and 2017. The solid component volume (3D-volume) and solid component ratio (3D-ratio) of tumors were calculated using 3D computed tomography. Additionally, based on two-dimensional (2D) computed tomography, the solid component diameter (2D-diameter) and solid component ratio (2D-ratio) were calculated. The area under the receiver-operating characteristic curve (AUC) was calculated for each method, facilitating predictions of mortality and recurrence within 5 years. The AUC of each measurement was compared with those of invasive component diameter (path-diameter) and invasive component ratio (path-ratio) obtained through pathology analysis.</p><p><strong>Results: </strong>The predictive performance of 3D-volume did not differ significantly from that of path-diameter, whereas 2D-diameter exhibited less predictive accuracy (AUC: 3D-volume, 2D-diameter, and path-diameter: 0.772, 0.624, and 0.747, respectively; 3D-volume vs. path-diameter: p = 0.697; 2D-diameter vs. path-diameter: p = 0.048). Results were similar for the solid component ratio (AUC: 3D-ratio, 2D-ratio, path-ratio: 0.707, 0.534, and 0.698, respectively; 3D-ratio vs. path-ratio: p = 0.882; 2D-ratio vs. path-ratio: p = 0.038).</p><p><strong>Conclusion: </strong>Solid component analysis using 3D computed tomography offers advantages in prognostic prediction for early-stage lung adenocarcinomas.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"235-244"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal size of Frozenix for true thoracic aneurysms: is downsizing an option?","authors":"Jun Hayashi, Shingo Nakai, Kimihiro Kobayashi, Yoshinori Kuroda, Eiichi Ohba, Masahiro Mizumoto, Atsushi Yamashita, Tomonori Ochiai, Tetsuro Uchida","doi":"10.1007/s11748-024-02074-2","DOIUrl":"10.1007/s11748-024-02074-2","url":null,"abstract":"<p><strong>Objective: </strong>During total arch replacement (TAR) using frozen elephant trunk (FET) technique with Frozenix for true thoracic aortic aneurysm (tTAA), oversized FET tends to be chosen similar to the endovascular devise selection. However, the oversized FET is considered a risk factor for intimal injury. The appropriate size selection of FET remains insufficiently understood.</p><p><strong>Methods: </strong>Between October 2014 and March 2022, a total of 49 patients underwent TAR using Frozenix for tTAA. Out of 49 patients, four patients planned to staged surgery were excluded, 19 patients were operated on with an undersized Frozenix compared with the descending aorta (undersized FET group) and in 26 patients an equal or oversized Frozenix was used (oversized FET group). Clinical outcomes and postoperative diameter changes were investigated.</p><p><strong>Results: </strong>In-hospital mortality was 0%. The mean diameter of Frozenix and the descending aorta was 30.7 mm and 28.8 mm, respectively, in the oversized FET group, and 26.7 mm and 30.1 mm in the undersized FET group. Postoperative computed tomography (CT) demonstrated no endoleaks not only in the oversized FET group but also in the undersized FET group. CT also revealed that undersized FET had expanded more than the original diameter in all cases except for two, with an average of 2.47 ± 1.53 mm. Additionally, the descending aorta covered with Frozenix shrank in 10 patients (53%). Postoperative adverse aortic events were not observed.</p><p><strong>Conclusions: </strong>Undersized Frozenix tightly fit the descending aorta and resulted in complete sealing without endoleaks. Oversized FET is not strictly necessary considering the size-related adverse complications.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"218-226"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between walking distance within the first 24 h following lung cancer surgery and clinical outcomes.","authors":"Makoto Asaeda, Yukio Mikami, Akihiro Matsumoto, Yuki Nakashima, Kouki Fukuhara, Tomoya Hirai, Atsushi Kamigaichi, Norifumi Tsubokawa, Takahiro Mimae, Yoshihiro Miyata, Morihito Okada","doi":"10.1007/s11748-025-02139-w","DOIUrl":"https://doi.org/10.1007/s11748-025-02139-w","url":null,"abstract":"<p><strong>Objectives: </strong>Lung cancer remains a major health concern in Japan, with over 126,000 cases diagnosed in 2019. Surgery is the primary treatment for stage I-III non-small-cell lung cancer. The 6-min walk test is widely used to assess physical endurance before and after surgery, with preoperative distances below 500 m associated with prolong hospital stays. Postoperatively, endurance typically decreases by 50-100 m. Early mobilization is critical to prevent this decline; however, no clear consensus exists on optimal rehabilitation protocols after lung cancer surgery.</p><p><strong>Methods: </strong>This retrospective cohort study examined the relationship between early postoperative walking distance and clinical outcomes in 104 patients who underwent lung cancer surgery between 2020 and 2023. Physical function was assessed using the 6-min Walk Test before admission and before discharge.</p><p><strong>Results: </strong>A significant correlation was found between the distance walked within the first 24 h after surgery and the pre- and postoperative 6-min walk test performance. However, no significant association was observed between early walking distance and length of hospital stay or postoperative complications.</p><p><strong>Conclusions: </strong>Early mobilization after lung cancer surgery aligns closely with preoperative endurance levels, suggesting that improving preoperative physical function can enhance postoperative recovery and reduce complications. Further research is needed to standardize the rehabilitation protocols.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel pulmonary abdominal normothermic regional perfusion circuit for simultaneous in-donor evaluation and preservation of lungs and abdominal organs in donation after circulatory death.","authors":"Shin Tanaka, Masashi Umeda, Hiroyuki Ujike, Tsuyoshi Ryuko, Yasuaki Tomioka, Kentaroh Miyoshi, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka","doi":"10.1007/s11748-025-02137-y","DOIUrl":"https://doi.org/10.1007/s11748-025-02137-y","url":null,"abstract":"<p><strong>Objective: </strong>To overcome limitations of traditional ex vivo lung perfusion (EVLP) for controlled donation after circulatory death (cDCD) lungs, this study aimed to evaluate a novel pulmonary abdominal normothermic regional perfusion (PANRP) technique, which we uniquely designed, for in situ assessment of lungs from cDCD donors.</p><p><strong>Methods: </strong>We modified the abdominal normothermic regional perfusion circuit for simultaneous lung and abdominal organ assessment using independent extracorporeal membrane oxygenation components. Blood was oxygenated via a membrane oxygenator and returned to the body, with pulmonary flow adjusted to maintain pressure < 25 mmHg. Femoral cannulation was performed, and the lungs were ventilated with standard settings. Organ function was assessed over 2 h using PaO2/FiO2, AST, ALT, BUN, and Cr measurements to monitor perfusion and oxygen delivery.</p><p><strong>Results: </strong>PANRP maintained stable lung function, with P/F ratios above 300, and preserved abdominal organ parameters, including stable AST, ALT, BUN, and Cr levels. Adequate urine output was observed, indicating normal renal function. Pulmonary artery pressure remained < 20 mmHg, and pulmonary vascular resistance was kept at 400 dyn・s/cm⁵, showing no signs of lung dysfunction or injury throughout the circuit.</p><p><strong>Conclusions: </strong>PANRP offers a promising alternative to traditional EVLP for cDCD lung evaluation, allowing in situ assessment of multiple organs simultaneously. This approach may overcome logistical and economic challenges associated with ex vivo techniques, enabling a more efficient evaluation process. Further studies are warranted to confirm its clinical applicability and impact on long-term outcomes.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey on perioperative antibiotic use for minimally invasive coronary artery bypass grafting.","authors":"Xiuxiu Zhang, Chaohua Wang, Huanjun Yu, Yichang Song, Yingxue He, Tiantong Zhao, Tingting Liu, Xinyan Liu, Dapeng Yu","doi":"10.1007/s11748-025-02136-z","DOIUrl":"https://doi.org/10.1007/s11748-025-02136-z","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the use of antimicrobials during the perioperative period of minimally invasive coronary artery bypass grafting (MICS CABG) and traditional open-heart bypass grafting. We aimed to determine whether the duration of perioperative antibiotic use and infection rate is significantly different between different surgical methods.</p><p><strong>Methods: </strong>A total of 471 cases of coronary artery bypass grafting (CABG) were collected from January 2019 to December 2022. Patients were divided into minimally invasive group (229 cases) and a conventional group (242 cases) according to the type of surgery. We compared differences in the duration of antimicrobial use and infection rates between the two groups.</p><p><strong>Results: </strong>Compared with the conventional group, the minimally invasive group had a significantly shorter average duration of antimicrobial therapy [(1.95 ± 2.40) d vs. (4.67 ± 5.89) d, P < 0.001], a higher rate of short antibiotic treatment duration (T ≤ 24 h) [51.97% vs. 7.02%, P < 0.001], lower postoperative pneumonia rate [38.86% vs. 56.20%, P < 0.001], lower positive rate of blood and surgical site sample culture (1 case and 0 case) vs. (7 cases and 3 cases), P < 0.001. Subgroup analysis of different durations of antimicrobial treatment (T ≤ 24 h, 24 h < T ≤ 48 h, and 48 h < T ≤ 96 h) in the minimally invasive group showed that there was no statistically significant difference in the incidence of infection among the various medication durations (P > 0.05).</p><p><strong>Conclusion: </strong>Compared with traditional surgery, MICS CABG requires a significantly shorter duration of perioperative antibiotic treatment duration and a reduced incidence of infection. Extending the duration of antibiotic treatment did not reduce the incidence of infection.</p><p><strong>Trial registration: </strong>chictr.org.cn ChiCTR2400091571.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial ischemia risk in Fontan candidates with pulmonary atresia with intact ventricular septum.","authors":"Naoki Masaki, Hideki Tatewaki, Satoshi Matsuo, Masaru Kumae, Kohei Yagi, Takehiko Onoki, Eiichiro Kawai, Megumi Nitta, Akira Ozawa, Sadahiro Sai","doi":"10.1007/s11748-025-02131-4","DOIUrl":"https://doi.org/10.1007/s11748-025-02131-4","url":null,"abstract":"<p><strong>Objectives: </strong>Sinusoidal communication (SC) is prevalent among Fontan candidates with pulmonary atresia with intact ventricular septum (PA/IVS), making it crucial in understanding its dynamics and potential impact on myocardial perfusion. This study aimed to assess the risk of myocardial ischemia in these patients.</p><p><strong>Methods: </strong>Sixteen Fontan candidates with PA/IVS were included in this study. All patients initially underwent Blalock-Taussig shunt (BTS), followed by bidirectional Glenn shunt in 15 cases, culminating in a total cavopulmonary connection (TCPC) at a median age of 24 months. SC severity and risk of myocardial ischemia were assessed via angiography and scintigraphy, respectively. Changes in SCs across the procedural stages and their correlation with ischemic responses in scintigraphy were retrospectively analyzed.</p><p><strong>Results: </strong>No deaths occurred during the study period. Ischemic events were observed in only one patient. SCs were observed in all 16 patients (100%). Significant regression of SCs occurred after BTS, particularly in coronary arteries with major SCs. However, no significant changes were found thereafter, particularly among coronary arteries without major SCs. No improvement or exacerbation of ischemic lesions was observed from pre- to post-TCPC. A positive correlation was revealed between angiographic SC grade and positive ischemic response on scintigraphy.</p><p><strong>Conclusions: </strong>In Fontan candidates with PA/IVS, an SC grade of 2 or higher was associated with a high risk of myocardial ischemia, emphasizing the need for careful monitoring and clinical management.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}