Cardiovascular Surgery WEB

English papers

Komeda — 2008-08-11T01:10:50+09:00

Papers in English

１． Komeda M, Miki S, Kusuhara K, Ueda Y, Ohkita Y, Tahata T, Matsumoto M, Tsukamoto Y. Epicardial cyst -- Report of a Case with Successful Resection -- Japn Circ J 1985;49:1201-1205

２． Matsumoto M, Miki S, Kusuhara K, Ueda Y, Ohkita Y, Tahata T, Komeda M. Quadricuspid aortic valve associated with severe aortic regurgitation. Jpn Circ J 1985;49:190-191

３． Ohkita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Komeda M., Tamura T. Reoperation after aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect. Ann Thorac Surg 1986;41:489-491

４． Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M. Usefulness of electromagnetic flowmetry in intraoperative evaluation of aortic regurgitation associated with ventricular septal defect. Am J Cardiol 1987;59:1152-1155

５． Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M. Optimal flow of aorto-pulmonary artery shunt in patients with cyanotic heart disease. Ann Thorac Surg 1987;44:128-134

６． Ohkita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Komeda M., Yamanaka I, Ishii K, Kawamura J. A giant aneurysm of the non-coronary sinus of valsalva. Thorac Cardiovasc Surgeon 1987;35:316-317

７． Miki S, Kusuhara K, Ueda Y, Komeda M, Ohkita Y, Tahata T. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg 1988;45:28-34

８． Okita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Tsukamoto Y, Komeda M,Yamanaka K, Shiraishi S, Tamura T, Tastsuta N, Koie H. Early and late results of reconstructive operation for congenital mitral regurgitation in pediatric age group. J Thorac Cardiovasc Surg 1988;96:294-298

９． Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M, Tamura T, Ogawa H. Evaluation of corrective surgery from Tetralogy of Fallot from late result by multivariate analysis. Eur J Cardiothorac Surg 1988;2:124-132

１０． Okita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Komeda M, Tamura T. Massive Systemic venous thrombosis after Fontan operation: report of a case. Thorac Cardiovasc Surgeon? 1988;36:234-236

１１． David TE, Komeda M, Pollick C, Burns R.? Mitral Valve Annuloplasty: The effect of the type of left ventricular function. Ann Thorac Surg 1989;47:524-528

１２． David TE, Komeda M, Brofman P. Surgical treatment of aortic root abscess. Circulation 1989;80(Suppl I):I-269 -274

１３． Ueda Y, Miki S, Kusuhara K, Okita Y, Tahata T, Komeda M, Tamura T. Repair of intracardiac defects associated with congenitally corrected transposition of the great arteries. J Cardiovasc Surg 1989;30:729-734

１４． Komeda M, Fremes SE, David TE. Surgical repair of postinfarction ventricular septal defect. Circulation 1990;82(Suppl IV):IV-243 -247

１５． Komeda M, David TE, Malik A, Ivanov J, Sun Z. Operative risks and long-term results of surgery for left ventricular aneurysm. Ann Thorac Surg 1992;53:22-29

１６． Yau TM, Weisel RD, Mickle DAG, Komeda M, Ivanov J, Carson S, Mohabeer MK, Tumiati L.? Alternative techniques of cardioplegia. Circulation 1992;86(suppl II):II-377 -384

１７． Komeda M, David TE. Surgical treatment of postinfarction false aneurysm of the left ventricle.? ?J Thorac Cardiovasc Surg? 1993;106:1189-1191

１８． Komeda M, Feindel CM, David TE, Daly PA, Cardella CJ. Heart? transplantation - the Toronto Hospital experience and the system in Ontario and Canada. J Japan Assoc Bioethics 1994;4: 53-66

１９． Ikonomidis JS, Yau TM, Weisel RD, Hayashida N, Xinping Fu, Komeda M, Ivanov J, Carson S, Mohabeer MK, Mickle DA. Optimal flow rates for retrograde warm cardioplegia. J Thorac Cardiovasc Surg 1994;107:510-519

２０． Komeda M, Mickleborough LL. "Concealed" rupture of the left ventricle: Successful surgical repair. Ann Thorac Surg 1994;57:1333-1335

２１． Mullen JC, Baird RJ, Komeda M. Sinus of valsalva repair for annulo-aortic ectasia and aortic insufficiency.? Can J Cardiol 1994; 10(1):59-62

２２． Ingels NB, Daughters GT, Nikolic SD, DeAnda A, Moon MR, Bolger AF, Komeda M, Derby GC, Yellin EL, Miller DC. Left atrial pressure-clamp servomechanism demonstrates left ventricular suction in canine hearts with normal mitral valves. Am J Physiol 1994;267:H354-362

２３． Deanda A, Courte SE, Moon MR, Vial CM, Griffin LC, Law VS, Komeda M, Leung LLK, Miller DC. Pilot study of the efficacy of a thrombin inhibitor for anticoagulation during cardiopulmonary bypass.? Ann Thorac Surg? 1994;58:344-350

２４． Komeda M, David TE, Rao V, Sun Z, Weisel RD, Burns RJ. Late hemodynamic effects of the preserved papillary muscle during mitral valve replacement. Circulation 1994;90:II-190-194

２５． Keren A, DeAnda A, Komeda M, Tye TL, Handen CR, Daughters GT, Ingels NB, Miller DC, Popp RL, Nikolic SD. Pitfalls in Creation of Left Atrial Pressure-Area Relationships Using Automated Border Detection.? J Am Soc Echocardiogr? 1995;8:669-678

２６． Komeda M, DeAnda A, Glasson JR, Bolger AF, Daughters GT, Tomizawa Y, Tye TL, Ingels NB, Miller DC. Exploring Better Methods to Preserve the Chordae Tendineae during Mitral Valve Replacement.? Ann Thorac Surg? 1995;60:1652-1658

２７． DeAnda A, Komeda M, Nikolic SD, Daughters GT, Ingels NB, Miller DC. Left Ventricular Function, Twist, and Recoil After Mitral Valve Replacement. Circulation 1995;92[suppl II]:II-458-466

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２８． Glasson JR, Komeda M, Daughters GT, Bolger AG, Ingels NB, Miller DC. 3-Dimensional Regional Length Changes in the Normal Mitral Annulus. J Thorac Cardiovasc Surg? 1996;111:574-585

２９． Ingels NB, Daughters GT, Nikolic SD, DeAnda A, Moon MR, Bolger AF, Komeda M, Derby GC, Yellin EL, Miller DC. Left ventricular diastolic suction with zero left atrial pressure in the open-chest dog.? Am J Physiol 1996; 270(Heart Circ. Physiol. 39): H1217-224

３０． Komeda M. Operation for Repair of Ventricular Septal Perforation (letter). Ann Thorac Surg 1996;61:1587-1589

３１． Rao V, Komeda M, Weisel RD, Ivanov J, Ikonomidis JS, Shirai T, David TE. Results of Represervation of the Chordae Tendineae During Redo Mitral Valve Replacement. Ann Thorac Surg 1996;62:179-183

３２． Glasson JR, Komeda M, Daughters GT, Bolger AF, MacIsaac A, Oesterle SN, Ingels NB, Miller DC. Three-Dimensional Dynamics of the Canine Mitral Annulus During Ischemic Mitral Regurgitation.? Ann Thorac Surg 1996;62:1059-1068?

３３． Rao V, Todd TRJ, Weisel RD, Komeda M, Cohen G, Ikonomidis JS, Christakis GT. Results of Combined Pulmonary Resection and Cardiac Operation. Ann Thorac Surg 1996;62:342-347

３４． Glasson JR, Komeda M, Daughters GT, Bolger AG, Ingels NB, Miller DC. Loss of 3-D Canine Mitral Annular Systolic Contraction with Reduced LV Volumes. Circulation 1996;94(suppl II):II-152-158

３５． Komeda M, Glasson JR, Bolger AF, Daughters GT, Ingels NB, Miller DC. Three Dimensional Dynamic Geometry of the Normal Canine Mitral Annulus and Papillary Muscles. Circulation 1996;94(suppl II):II-159-163

３６． Komeda M, Bolger AF, DeAnda A, Tomizawa Y, Ingels NB Jr., Miller DC. Improving Methods of Chordal-Sparing MVR ? Part (I): A Novel Isovolumic Balloon Preparation for Left Ventricle with Intact Mitral Subvalvular Apparatus.? J Heart Valve Dis? 1996;5:376-382

３７． Komeda M, DeAnda A, Bolger AF, Daughters GT, Glasson JR, Tye TL, Nikolic SD, Ingels NB, Miller DC. Improving Methods of Chordal-Sparing MVR ? Part (II): Optimal Tension for Chordal Resuspension.? J Heart Valve Dis 1996;5:477-483

３８． Komeda M, DeAnda A, Glasson JR, Daughters GT, Bolger AF, Nikolic SD, Ingels NB, Miller DC. Improving Methods of Chordal-Sparing MVR ? Part (III): “Oblique” Direction for Artificial Chordae.? J Heart Valve Dis 1996;5:484-490

３９．? Komeda M, Glasson JR, Bolger AF, Daughters GT, Ingels NB, Miller DC. Papillary Muscle　－Left Ventricular Wall “Complex.”. J Thorac Cardiovasc Surg 1997;113:292-301

４０． Buxton BF, Windsor M, Komeda M, Gear J, Fuller J. How Good is the Radial Artery as a Bypass Graft. Yacoub M, Carpentier AF ed.? Annual of Card Surg, 10th ed. 1997;79-87? Current Science, London, UK?

４１． Moon MR, Bolger AF, DeAnda A Jr., Komeda M, Nikolic SD, Daughters GT, Miller DC, Ingels NB Jr. Septal function during left ventricular unloading. Circulation 1997;95:1320-1327

４２． Buxton BF, Windsor M, Komeda M, Gear J, Fuller J. How Good is the Radial Artery as a Bypass Graft. Coronary Artery Dis 1997;8:225-233

４３． Glasson JR, Komeda M, Daughters GT, Foppiano LE, Bolger AF, Tye TL, Ingels NB, Miller DC. Most Ovine Mitral Annular Three-Dimensional Size Reduction Occurs Before Ventricular Systole and Is Abolished With Ventricular Pacing. Circulation 1997;96[supple II]:II-115-123

４４． Komeda M, DeAnda A, Glasson JR, Bolger AF, Daughters GT, Ingels NB, Miller DC.? Complete Unloading May Not Adequately Protect the Left Ventricle. Ann Thorac Surg 1997;64:1250-1255

４５． Buxton B, Gaer J, Komeda M, Ruengsakulrach P. The Road to Complete Arterial Grafting for Coronary Artery Disease.? International J Cardiol 1997;62:S65-70

４６． Komeda M, Glasson JR, Bolger AF, McIsaak A, Oesterle SO, Daughters GT, Ingels NB, Miller DC. Geometric Determinants of Ischemic Mitral Regurgitation. Circulation 1997;96[suppl II]:II-128-133

４７． Komeda M, Buxton BF. Invited editorial comment in the chapter of Partial Left Ventriculectomy in Patients with Dilated Failing Ventricle (Kawaguchi AT, Batista RJV) In: Buxton B, Frazier OH, Westaby S, eds. Ischemic Heart Disease: Surgical Management.? Mosby, London, UK. 1998;366-367

４８． Komeda M, Glasson JR, Miller DC. Pathophysiological Geometry of the Mitral Apparatus during Ischemic Mitral Regurgitation? Rationale Towards More Anatomic Repair. In: Buxton B, Frazier OH, Westaby S, eds. Ischemic Heart Disease: Surgical Management. Mosby, London, UK. 1998;303-306

４９． Karlsson MO, Glasson JR, Bolger AF, Daughters GT, Komeda M, Foppiano LE, Miller DC, Ingels NB. Mitral Valve Opening in the Ovine Heart. Am J Physiol 1998;274:H552-563

５０． Buxton BF, Goldblatt J, Raman J, Komeda M. Reoperation. In: Buxton B, Frazier OH, Westaby S, eds. Ischemic Heart Disease: Surgical Management. Mosby, London, UK. 1998;241-250

５１． DeAnda A, Komeda M, Moon MR, Green GR, Bolger AF, Nikolic SD, Daughters GT, Miller DC. Estimation of Regional Left Ventricular Wall Stresses in Intact Canine Hearts. Am J Physiol 1998;275:H1879-885

５２． Komeda M. Left Ventricular Aneurysm with Ischemic Mitral Regurgitation. In: Buxton B, Frazier OH, Westaby S, eds. Ischemic Heart Disease: Surgical Management. Mosby, London, UK. 1998;313-320

５３． Glasson JR, Komeda M, Daughters GT, Foppiano LE, Bolger AF, Ingels NB, Miller DC.? Early Systolic Mitral Leaflet “Loitering” During Acute Ischemic Mitral Regurgitation.? ?J Thorac Cardiovasc Surg 1998;116:193-205

５４． Calafiore P, Komeda M, Raman J, Tatoulis J, Skillington P, Buxton B. Intraoperative Echocardiography; Transesophageal Echocardiography. In: Izzat, Sanderson, Sutton eds. Echocardiography in Adult Cardiac Surgery, ISIS Medical Media, UK 1998

５５． Buxton B, Komeda M, Fuller JJA. Bilateral Internal Thoracic Artery Grafting May Improve Outcome of Coronary Artery Surgery.? Circulation 1998;98:II 1-6.

５６． Buxton B, Dixit A, Tatoulis J, Fuller JJA,　Komeda M. Free Compared with Pedicled Right Internal Thoracic Arteries for Coronary Artery Bypass Grafting. Asian J Surg 1998;21:159-165

５７． Nishimura K, Kono S, Nishina T, Akamatsu T, Tsukiya T, Nojiri C, Ozaki T, Komeda M.? Results of chronic animal experiments with a new version of a magnetically suspended centrifugal pump.? ASAIO J? 1998;44(5):M725-727

５８． Nishizawa J, Nakai A, Matsuda K, Komeda M, Ban T, Nagata K. Reactive Oxygen Species Play an Important Role in the Activation of Heat Shock Factor 1 in Ischemic-Reperfused Heart.? Circulation? 1999;99:934-941

５９． Glasson JR, Green GR, Nistal JF, Dagum P, Komeda M, Daughters GT, Bolger AF, Foppiano LE, Ingels NB, Miller DC. Mitral Annular Size and Shape in Sheep with Annuloplasty Rings. J Thorac Cardiovasc Surg.? 1999;117:302-309

６０． Buxton BF, Royse A, Komeda M, Fuller JA. Chapter 8: Complete Arterial Revascularization. Franco KL, Verrier ED (eds) Advanced Therapy in Cardiac Surgery. 1999:72-83? B.C.Decker Inc. Hamilton, London, St Louis

　　
６１． Rao V, Komeda M, Weisel RD, Cohen G, Borger MA, David TE. Should the pericardium be closed routinely after heart operations?? Ann Thorac Surg? 1999;67:484-488

６２． Tadamura E, Kudoh T, Motooka M, Inubushi M, Okada T, Kubo S, Hattori N, Matsuda T, Koshiji T, Nishimura K, Komeda M, Konishi J.? Use of technetium-99m sestamibi ECG-gated sigle-photon emission tomography for the evaluation of left ventricular function following coronary artery bypass graft: comparison with three-dimensional magnetic resonance imaging.? Eur J Nucl Med.? 1999;26:705-712

６３． Ruengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton BF. Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis.? Circulation? 1999;100[suppl II]:II-139-144

６４． Komeda M. Bioengineering vs mechanical engineering for cardiovascular surgery in the next century.? Ann Thorac Cardiovasc Surg? 1999;5(6):359-60

６５． Kono s, Nishimura K, Nishina T, Akamatsu T, Komeda M.? Hemodynamics on abrupt stoppage of centrifugal pumps during left ventricular assist.? ASAIO J.? 2000;46(5):600-603

６６． Fujioka Y, Komeda M, Matsuoka S. Stoichiometry of Na+-Ca2+ exchange in inside-out patches excised from guinea-pig ventricular myocytes. J Physiol? 2000;523( Pt2):339-351

６７． Sawada N, Itoh H, Ueyama K, Yamashita J, Doi K, Chun TH, Inoue M, Masatsugu K, Saito T, Fukunaga Y, Sakaguchi S, Arai H, Ohno N, ,Komeda M, Nakao K. Inhibition of Rho-Associated Results in Suppression of Neointimal Formation of Balloon-Injured Arteries. Circulation? 2000;101:2030-2033

６８． Iwakura A, Fujita M, Hasegawa K, Sawamura T, Nohara R, Sasayama S, Komeda M. Pericardial fluid from patients with unstable angina induces vascular endothelial cell apoptosis. J Am Coll Cardiol.? 2000;35(7):1785-1790

６９． Iwakura A, Tabata Y, Miyao M, Ozeki M, Tamura N, Ikai A, Nishimura K, Nakamura T, Shimizu Y, Fujita M, Komeda M.? Novel method to enhance sternal healing after harvesting bilateral internal thoracic arteries with use of basic fibroblast growth factor. Circulation? 2000;102(Suppl 3):Ⅲ307-311

７０． Iwakura A, Tabata Y, Nishimura K, Nakamura T, Shimizu Y, Fujita M, Komeda M. Basic fibroblast growth factor may improve devascularized sternal healing. Ann Thorac Surg. 2000;70(9):824-828

７１． Terai H, Tamura N, Nakamura T, Nishina K, Tsutsui N, Shimizu Y, Komeda M. Treatment of acute stanford type B aortic dissection with a novel cylindrical balloon catheter in dogs.? Circulation.? 2000;102(Suppl Ⅲ):259-262

７２． Nishimura K, Kono S, Nishina T, Akamatsu T, Nojiri C, Komeda M.? Development of compact ventricular assist device for chronic use.? J Artif Organs.? 2000;3:85-90

７３． Ohta N, Koshiji T, Imamura M, Nishimura K, Komeda M.? Aortoesophageal fistula caused by foreign body.? Jpn J Thorac Cardiovasc Surg? 2000;48(3):184-185

７４． Kitamura T, Matsusima Y, Tokuyama T, Kono S, Nishimura K, Komeda M, Yanai M, Kijima T, Nojiri C. Physical Model-Based Indirect Measurements of Blood Pressure and Flow Using a Centrifugal Pump.? Artif Organs. 2000;24(8):589-593

７５． Ku K, Oku H, Komeda M. The mechanism of ischemic preconditioning shown by real-time quantitative PCR analysis of rat SUR2. 2000

７６． Iwakura A, Fujita M, Ikemoto M,Hasegawa K, Nohara R, Sasayama S, Miyamoto S, Yamazato A, Tambara K, Komeda M. Myocardial ischemia enhances the expression of acidic fibroblast growth factor in human pericardial fluid .? Heart Vessels 2000;15(3):112-116

７７． Timek T, Glason JR, Dagum P, Green GR, Nistal JF, Komeda M, Daughters GT, Bolger AF, Foppoano LE, Ingels NB, Miller DC. Ring annuloplasty prevents delayed leaflet coaptation and mitral regurgitation during acute left ventricular ischemia.? J Thorac Cardiovasc Sueg.? 2000;119(4 Pt 1):774-783

７８． Yuasa S, Nishina T, Nishimura K, Miwa S, Ikeda T, Hanyu M, Fujioka Y, Kihara Y, Sasayama-S, Komeda M.? A rat model of dilated cardiomyopathy to investigate partial left ventriculectomy.? J Cardiac Surg.　2001;16(1):40-47

７９． Nishina T, Nishimura K, Yuasa S, Miwa S, Nomoto T, Sakakibra Y, Handa N, Hamanaka I, Saito Y, Komeda M.? Initial Effects of the Left Ventricular Repair by Plication May Not Last Long in a Rat Ischemic Cardiomyopathy Model.? Circulation? 2001;104(12 Suppl 1):I241-245

８０． Iwakura A, Tabata Y, Tamura N, Doi K, Nishimura K, Nakamura T, Shimizu Y, Fujita M, Komeda M. Gelatin sheet incorporating basic fibroblast growth factor enhances healing of devascularized sternum in diabetic rats.? Circulation? 2001;104(12 Suppl 1):I325-I329

８１． Tamura N, Ku K, Shichiri Y, Sakurai Y, Nishimura M, Shioyama R, Kondoh M, Nishimura K, Komeda M. Renal autotransplantation in a patient with acute renal infarction after surgery for a dissecting aneurysm.? J Thorac and Cardiovasc Surg? 2001;121(5):985-986

８２． Fujita M, Komeda M, Hasegawa K, Kihara Y, Nohara R, Sasayama S.? Pericardial fluid as a new material for clinical heart research.? International J Cardiol? 2001;77(2-3):113-118

８３． Izumi C, Himura Y, Iga K, Gen H, Komeda M, Ueda Y, Konishi T. Relationship between papillary muscle size and benefit to cardiac function in mitral valve replacement with chordal preservation.? J Heart Valve Dis? 2001;10(1):57-64

８４． Sakaguchi G, Young PL, Komeda M, Yamanaka K, Buxton BF, Louis WJ.? Left ventricular aneurysm repair in rats: structural,functional,and molecular consequencs.? J Thorac Cardiovasc Surg? 2001;121(4): 750-761

８５． Iwakura A, Fujita M, Hasegawa K, Toyokuni S, Sawamura T, Nohara R, Sasayama S, Komeda M. Pericardial fluid from patients with ischemic heart disease induces myocardial cell apoptotis via an oxidant stress-sensitive p38 mitogen-activated protein kinase pathway.? J Mol Cell Cardiol? 2001;33(3): 419-430

８６． Kubo S, Tadamura E, Kudoh T, Inubushi M, Ikeda T, Koshiji T, Nishimura K, Komeda M, Tamaki N, Konishi J. Assessment of the effect of revascularization early after CABG using ECG-gated perfusion single-photon emission tomography.? Eur J Nucl Med? 2001;28(2):230-239

８７． Doi K, Ikeda T, Itoh U, Ueyama K, Hosoda K, Ogawa Y, Yamashita J, Chun TH, Inoue M, Masatsugu K, Sawada N, Fukunaga Y, Saito T, Sone M, Yamahara K, Kook H, Komeda M, Ueda M, Nakao k.? C-type natriuretic peptide induces redifferentiation of vascular smooth muscle cells with accelerated reendothlialization.? Arterioscler Thromb Vasc Biol? 2001;21(6):930-936

８８． Ohnishi T, Neo M, Matsushita M, Komeda M, Koyama T, Nakamura T.? Delayed Aortic rupture caused by an implanted anterior spinal device.? (Case report)? J Neurosurg. 2001;95(2 Suppl):253-256

８９． Minami M, Kme N, Shimaoka T, Kataoka H, Hayashida K, Akiyama Y, Nagata I, Ando K, Nobuyoshi M, Hanyuu M, Komeda M, Yonehara S, Kita T.　Expression of SR-PSOX, a novel cell-surface scavenger receptor for phosphatidylserine and oxidized LDL in human atherosclerotic lesions.　Arterioscler Thromb Vasc Biol.? 2001;21(11):1796-1800

９０． Nakao M, Komori M, Oyama H, Matsuda T, Sakaguchi G, Komeda M, Takahashi T. Haptic reproduction and interactive visualization of a beating heart based on cardiac morphology. Medinfo.? 2001;10:924-928

９１． Hanyu M, Kume N, Ikeda T, Minami M, Kita T, Komeda M. VCAM-1 expression precedes macrophage infiltration into subendothelium of vein grafts interposed into carotid arteries in hypercholesterolemic rabbits-a potential role in vein graft atherosclerosis. Atherosclerosis? 2001;158(2):313-319

９２． Nishimura K, Kono S, Nishina T, Ueyama K, Ikai A, Ikeda T, Nojiri C, Akamatsu T, Komeda M.? Compact and reliable ventricular assist device for bridge to recovery or for semi-permanent use.? Jpn J Thorac Cardiovasc Surg.? 2001;49(11):646-651

９３． Nishina T, Nishimura K, Yuasa S, Miwa S, Sakakibara Y, Ikeda T, Komeda M. A rat model of ischemic cardiomyopathy for investigating left ventricular volume reduction surgery. J Card Surg.? 2002;17(2):155-162

９４． Tambara K, Fujita M, Nagaya N, Miyamato S, Iwakura A, Doi K, Sakaguchi G, Nishimura K, Kangawa K, Komeda M. Increased pericardial fluid concentrations of the mature form of adrenomedullin in patients with cardiac remodelling.? Heart? 2002;87(3):242-246

９５． Nishina T, Miwa S, Yuasa S, Nishimura K, Komeda M.? A rat model of ischaemic or dilated cardiomyopathy for investigating left ventricular repair surgery.? Clinical and Experimental Pharmacology and Physiology 2002;29(8):728-730?

９６． Soga Y, Nishimura K, Ikeda T, Nishina T, Ueyama K, Nakamura T, Miwa S, Koyama T, Komeda M. Chordal-Sparing mitral valve replacement using artificial chordae tendineae for rheumatic mitral stenosis: experience of the “Oblique” method.? Artificial Organs.? 2002;26(9):802-805

９７． Sakakibara Y, Tambara K, Lu F, Nishina T, Nagaya N, Nishimura K, Komeda M. Cardiomyocyte transplantation dose not reverse cardiac remodeling in rats with chronic myocardial infarction.? Ann Thorac Surg?2002;74(1):25-30

９８． Sakakibara Y, Nishimura K, Tambara K, Yamamoto M, Lu F, Tabata Y, Komeda M. Prevascularization with gelatin microspheres containing basic fibroblast growth factor enhances the benefits of cardiomocyte transplamtation.? J Thorac Cardiovasc Surg? 2002;124(1):50-56

９９． Miwa S, Toyokuni S, Nishina T, Nomoto T, Hiroyasu M, Nishimura K, Komeda M. Spaciotemporal alteration of 8-hydroxy-2'-deoxyguanosine levels in cardiomyocytes after myocardial infarction in rats.? Free Radial Research.　 2002;36(8):853-858

１００．Sakaguchi G, Tadamura E, Tambara K, Onaka G, Nishina T, Nishimura K, Komeda M.Composite Arterial Y-graft Has Less Coronary Flow Reserve Than Independent Grafts.Ann Thoracic Surgery? 2002;74(2):493-496?

１０１．Ohno N, Itoh H, Ikeda T, Ueyama K, Yamahara K, Doi K, Yamashita J, Inoue M, Masatsugu K, Sawada N, Fukunaga Y, Sakaguchi S, Sone M, Yurugi T, Kook H, Komeda M, Nakao K. Accelerated reendothelialization with suppressed thrombogenic property and neointimal hyperplasia of rabbit jugular vein grafts by adenovirus-mediated gene transfer of C-Type natriuretic peptide.? Circulation? 2002;105(14):1623-1626

１０２．Sakakibara Y, Tambara K, Lu F, Nishina T, Sakaguchi G, Nagaya N, Nishimura K, Ki RK, Weisel RD, Komeda M. Combined procedure of Surgical Repair and cell transplantation for left ventricular aneurysm : An experimental study.? Circulation? 2002;106(12suppl Ⅰ):Ⅰ-193-197

１０３．Nomoto T, Nishina T, Miwa S, Tsuneyoshi H, Maruyama I, Nishimura K, Komeda M. Angiotensin-Converting enzyme inhibitor helps prevent late remodeling after left ventricular aneurysm repair in rats.? Circulation? 2002;106(12 Suppl Ⅰ); I115-119

１０４．Nishizawa J, Nakai A, Komeda M, Ban T, Nagata K. Increased preload directly induces the activation of heat shock transcription factor 1 in the left ventricular overloaded heart. Cardiovasc Res? 2002;55(2):341-348

１０５．Nakao M, Oyama H, Komori M, Matsuda T, Sakaguti G, Komeda M, Takahashi T. Haptic reproduction and interactive visualization of a beating heat for cardiovascular surgery simulation.? Int J Med Inf2002;68(1-3):155-163

１０６．Handa N, Magata Y, Tadamura E, Mukai T, Nishina T, Miwa S, Sakakibara Y, Nomoto T, Konishi J, Nishimura K, Komeda M. Quantitative fluorine 18 deoxyglucose uptake by myocardial positron emission tomography in rats.? J Nucl Cardiol 2002;9(6):616-621

１０７．Ohno N, Fedak PW, Weisel RD, Komeda M, Mickle DA, Li RK. Cell transplantation in non-ischemic dilated cardiomyopathy. A novel biological approach for ventricular restoration. Jpn J Thorac Cardiovasc Surg.2002 Nov;50(11):457-460

１０８．Koyama T, Nishimura K, Soga Y, Oriyanhan W, Ueyama K, Komeda M. Importance of Preserving the Apex and Plication of the Base in Left Ventricular Volume Reduction Surgery. J Thorac Cardiovasc Surg? 2003;125(3):669-677

１０９．Kono S, Nishimura K, Soga Y, Oriyanhan W, Ueyama K, Komeda M. Auto-synchronized systolic unloading during left ventricular assist with a centrifugal pump. J Thorac Cardiovasc Surg? 2003;125（2）353-360

１１０．Nishina T, Koshiji T, Nishimura K, Komeda M. Two cases using "epi-endocardial patch repair" for postinfarction left ventricular rupture.? Journal of Cardiac Surgery2003:18(2):164-166

１１１．Sakaguchi G, Sakakibara Y, Tambara K, Lu Fanglin, Goditha P, Nishimura K, Komeda M. A pig model of chronic heart failure by intracoronary embolization with gelatin sponge. Ann Thorac Surg? 2003;75(6):1942-1947

１１２．Yamamoto M, Sakakibara Y, Nishimura K, Komeda M, Tabata Y. Improved therapeutic efficacy in cardiomyocyte transplantation for myocardial infarction with release system of basic fibroblast growth factor. Artificial Organs? 2003;27(2):181-184

１１３．Tadamura E, Mamede M, Kubo S, Toyoda H, Yamamuro M, Iida H, Tamaki N, Nishimura K, Komeda M, Konishi J . The effect of nitroglycerin on myocardial blood flow in various segments characterized by rest-redistribution thallium SPECT. The Journal of Nuclear Medicine? 2003;144(5):745-751

１１４．Iwakura A, Fujita M, Kataoka K, Tambara K, Sakakibara Y, Komeda M, Tabata Y. Intramyocardial sustained delivery of basic fibroblast growth factor improves angiogenesis and ventricular function in a rat infarct model. Heart Vessels 2003;18(2):93-99

１１５．Soga Y, Nishimura K, Yamazaki K, Komeda M. Simplified chordal reconstruction:`oblique' placement of artificial chordae tendineae in mitral valve replacement. Eur J Cardiothorac Surg? 2003;24(4):653-655

１１６．Sakakibara Y, Tambara K, Sakaguchi G, Lu F, Yamamoto M, Nishimura K, Tabata Y, Komeda M. Toward surgical angiogenesis using slow-released basic fibroblast growth factor. Eur J Cardiothorac Surg 2003;24(1):105-112

１１７．Tambara K, Sakakibara Y, Sakaguchi G, Fanglin Lu, Premaratne G.U, Lin X, Nishimura K, Komeda M. Transplanted skeletal myoblasts can fully replace the infarcted myocardium when they survive in the host in large numbers. Circulation? 2003;108(Suppl II):II259-II263

１１８．Iwakura A, Tabata Y, Koyama T, Doi K, Nishimura K, Kataoka K, Fujita M, Komeda M.　Gelatin sheet incorporating basic fibroblast growth factor enhances sternal healing after harvesting bilateral internal thoracic arteries. J Thorac Cardiovasc Surg 2003;126(4):1113-1120

１１９．Nomoto T, Nishina T, Tsuneyoshi H, Miwa S, Nishimura K, Komeda M. Effects of two inhibitors of renin-angiotensin system on attenuation of postoperative remodeling after left ventricular aneurysm repair in rats. J Card Surg 2003;18(Suppl 2):S61-68? ?

１２０．Tamura N, Nakamura T, Terai H, Iwakura A, Nomura S, Shimizu Y, Komeda M. A new acellular vascular prosthesis as a scaffold for host tissue regeneration. The International Journal of Artificial Organs? 2003;26(9):783-792

１２１．Tokuyasu T, Oota S, Tokuyama T, Asami K, Kitamura T, Sakaguchi G, Koyama T, Komeda M. Mechanical modeling of a beating heart for a cardiac palpation training system. Advanced Robotics 2003;17(6)463-479

１２２．Horii T, Isomura T, Komeda M, Suma H. Left ventriculoplasty for nonischemic dilated cardiomyopathy. J Cardiac Surg 2003;18(2):121-124

１２４．Koyama T, Nishimura K, Nishina T, Miwa S, Soga Y, Oriyanhan W, Ueyama K, Horii T, Komeda M. Toward an ideal large animal model of dilated cardiomyopathy to study left ventricular volume reduction surgery. Matsumori A(Edited).Cardiomyopathies and Heart Failure Biomolecular, Infectious and Immune Mechanisms. Boston/Dordrecht/London. Kluwer Academic Publishers 2003;491-501

１２５．Tambara K, Sakakibara Y, Nishina T, Nomoto T, Fanglin Lu, Ikeda T, Nishimura K, Komeda M. Transplanting cells for the treatment of cardiomyopathy. Matsumori A (Eds). Cardiomyopathies and Heart Failure? Biomolecular, Infectious and Immune Mechanisms. Kluwer Academic Publishers? 2003;481-9

１２６．Ueyama K, Nishimura K, Ikai A, Koyama T, Nishina T, Ikeda T, Komeda M. Pharmacological assessment of composite arterial conduits using angiography early in the postoperative period. Jpn J Thorac Cardiovasc Surg? 2004;52(6):279-285

１２７．Doi K, Hasegawa K, Fujita M, Yamazato A, Yamanaka K, Watanabe M, Tambara K, Komeda M. Clinical characteristics relevant to myocardial cell apoptosis: analysis of pericardial fluid.Interactive Cardiovascular and Thoracic Surgery 2004;3(2):359-362

１２８．Soga Y, Takai S, Koyama T, Okamoto Y, Ikeda T, Nishimura K, Miyazaki M, Komeda M. Attenuation of adhesion formation after cardiac surgery with a chymase inhibitor in a hamster model. J Thorac Cardiovasc Surg? 2004;127(1):72-78

　
１２９．Miwa S, Nishina T, Ueyama K, Kameyama T,Ikeda T, Nishimura K, Komeda M. Visualization of intramuscular left anterior descending coronary arteries during off-pump bypass surgery Ann Thorac Surg 2004;77(1):344-346

１３０．Yamauchi R, Tanaka M, Kume N, Minami M, Kawamoto T, Togi K, Shimaoka T, Takahashi S, Yamaguchi J, Nishina T, Kitaichi M, Komeda M, Manabe T,Yonehara S, Kita T. Upregulation of SR-PSOX/CXCL16 and recruitment of CD8+ T cells in cardiac valves during inflammatory valvular heart disease.? Arterioscler Thromb Vasc Biol 2004;24(2):282-287

１３１．Tambara K, Fujita M, Miyamoto S, Doi K, Nishimura K, Komeda M. Pericardial fluid level of heart-type cytoplasmic fatty acid-binding protein (H-FABP) is an indicator of severe myocardial ischemia. Int J Cardiol 2004;93(2-3):281-284

　
１３２．Tambara K, Fujita M, Sumita Y, Miyamoto S, Sekiguchi H, Eiho S, Komeda M. Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: simultaneous recording of ambulatory electrocardiogram and posture. Clin Cardiol 2004;27(5):300-303

１３３．Tambara K, Tabata Y, Komeda M. Factors related to the efficacy of skeletal muscle cell transplantation and future approaches with control-released cell growth factors and minimally invasive surgery.? Int J Cardiol 2004;95(Suppl.1):S13-15

１３４．Ueyama K, Bing G, Tabata Y, Ozeki M, Doi K, Nishimura K, Suma H, Komeda M. Development of biologic coronary artery bypass grafting in a rabbit model: Revival of a classic concept with modern biotechnology.? J Thorac Cardiovasc Surg? 2004;127(6):1608-1615

１３５．Ikai A, Shirai M, Nishimura K, Ikeda T, Kameyama T, Ueyama K, Komeda M. Hypoxic pulmonary vasoconstriction disappears in a rabbit model of cavopulmonary shunt. J Thorac Cardiovasc Surg. 2004;127(5):1450-1457

１３６．Ueyama K, Nishimura K, Nishina T, Nakamura T, Ikeda T, Komeda M. PMEA coating of pump circuit and oxygenator may attenuate the early systemic inflammatory response in cardiopulmonary bypass surgery. ASAIO J 2004;50(4):369-372

１３７．Nakajima H, Sakakibara Y, Tambara K, Iwakura A, Doi K, Marui A, Ueyama K, Ikeda T, Tabata Y, Komeda M. Therapeutic angiogenesis by the controlled release of basic fibroblast growth factor for ischemic limb and heart injury: toward safety and minimal invasiveness. J Artif Organs 2004;7(2):58-61

１３８．Yamazaki K, Miwa S, Ueda K, Tanaka S, Toyokuni S, Oriyanhan W, Nishimura K, Komeda M.? Prevention of myocardial reperfusion injury by poly (ADP-ribose) synthetase? inhibitor,3-aminobenzamide, in cardioplegic solution:in vitro study of isolated rat heart model. Eur J Cardiothorac Surg? 2004;26(2):270-275

１３９．Tsuneyoshi H, Nishina T, Nomoto T, Kanemitsu H, Kawakami R, Oriyanhan W, Nishimura K, Komeda M. Atrial natriuretic peptide helps prevent late remodeling after left ventricular aneurysm repair. Circulation2004;110(11 Suppl 1):II174-179

１４０．Kanematsu A, Marui A, Yamamoto S, Ozeki M, Hirano Y, Yamamoto M, Ogawa O, Komeda M, Tabata Y. Type I collagen can function as a reservoir of basic fibroblast growth factor. J Control Release? 2004;99(2):281-292

１４１．Torrent-Guasp F, Kocica MJ, Corno A, Komeda M, Cox J, Flotats A, Ballester-Rodes M, Carreras-Costa F. Systolic ventricular filling.Eur J Cardiothorac Surg.2004;25(3):376-386

１４２．Miwa S,Yamazaki K, Suong-Hyu Hyon, Komeda M. A novel method of "preparative"myocardial protection using green tea polyphenol in oral uptake. Interactive CardioVascular and Thoracic Surgery (ICVTS) 2004;3(4):612-615

１４３．Horii T, Tambara K, Nishimura K, Suma H, Komeda M. Residual fibrosis affects a long-term result of left ventricular volume reduction surgery for dilated cardiomyopathy in a rat experimental study. Eur J Cardio-Thorac Surg? 2004;26(6):1174-1179

１４４．Kubo S, Tadamura E, Yamamuro M, Motooka M, Nakashima Y, Tambara K, Komeda M, Konishi J. Primary cardiac lymphoma demonstrated by delayed contrast-enhanced magnetic resonance imaging. J Comput Assist Tomogr? 2004;28(6):849-51

１４６．Kawamura T, Hasegawa K, Morimoto T, Iwakura A, Nishina T, Nomoto T, Komeda M. Down-regulation of Endothelin-1 and Alteration of Apoptosis Signaling Following Left Ventricular Volume Reduction Surgery in Heart Failure of Adult Rats. J Cardiovasc Pharmacol. 2004 Nov;44 Suppl 1:S366-71.

１４７．Tambara K, Sakakibara Y, Sakaguchi G, Tabata Y, Komeda M. Administration of control-released basic fibroblast growth factor-Is it a more effective angiogenic therapy than bone marrow cell transplantation for severely ischemic hearts?? Matsuzawa Y, Kita T, Nagai R, Teramoto T（Eds.）. International Congress Series 1262 Internal Medicine Atherosclerosis XIII. ELSEVIER,Amsterdam, Netherlands 2004:356-9

１４８．Ikai A, Shirai M, Nishimura K, Ikeda T, Kameyama T, Ueyama K, Komeda M.? Maintenance of pulmonary vasculature tone by blood derived from the inferior vena cava in a rabbit model of cavopulmonary shunt. J Thorac Cardiovasc Surg. 2005 Jan;129(1):199-206.

１４９．Marui A, Kanematsu A, Yamahara K, Doi K, Kushibiki T, Yamamoto M, Itoh H, Ikeda T, Tabata Y, Komeda M. Simultaneous application of basic fibroblast growth factor and hepatocyte growth factor to enhance the blood vessels formation. J Vasc Surg. 2005 Jan;41(1):82-90.

１５０．Yamamuro M, Tadamura E, Kubo S, Toyoda H, Nishina T, Ohba M, Hosokawa R, Kimura T, Tamaki N, Komeda M, Kita T, Konishi J. Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. Radiology. 2005 Feb;234(2):381-90.

１５１．Torrent-Guasp F, Kocica MJ, Corno AF, Komeda M, Carreras-Costa F, Flotats A, Cosin-Aguillar J, Wen H. Towards new understanding of the heart structure and function.Eur J Cardiothorac Surg. 2005 Feb;27(2):191-201. Review.

１５２.Tsuneyoshi H, Oriyanhan W, Kanemitsu H, Shiina R, Nishina T, Ikeda T, Nishimura K, Komeda M. Heterotopic transplantation of the failing rat heart as a model of left ventricular mechanical unloading toward recovery. ASAIO J. 2005 Jan-Feb;51(1):116-20.

１５３．Chen F, Fukuse T, Hasegawa S, Bando T, Hanaoka N, Kawashima M, Sakai H, Komeda M, Wada H. Living-donor lobar lung transplantation for pulmonary and abdominopelvic lymphangioleiomyomatosis. Thorac Cardiovasc Surg. 2005 Apr;53(2):125-7.

１５４．Terai H, Tamura N, Yuasa S, Nakamura T, Shimizu Y, Komeda M. An experimental model of Stanford type B aortic dissection. J Vasc Interv Radiol. 2005 Apr;16(4):515-9.

１５５．Sakaguchi G, Tambara K, Sakakibara Y, Ozeki M, Yamamoto M, Premaratne G, Lin X, Hasegawa K, Tabata Y, Nishimura K, Komeda M. Control-released hepatocyte growth factor prevents the progression of heart failure in stroke-prone spontaneously hypertensive rats. Ann Thorac Surg. 2005 May;79(5):1627-34.

１５６．Butany J, Leong SW, Carmichael K, Komeda M. A 30-year analysis of cardiac neoplasms at autopsy.Can J Cardiol. 2005 Jun;21(8):675-80.

１５７．Tambara K, Premaratne GU, Sakaguchi G, Kanemitsu N, Lin X, Nakajima H, Sakakibara Y, Kimura Y, Yamamoto M, Tabata Y, Ikeda T, Komeda M. Administration of control-released hepatocyte growth factor enhances the efficacy of skeletal myoblast transplantation in rat infarcted hearts by greatly increasing both quantity and quality of the graft.Circulation. 2005 Aug 30;112(9 Suppl):I129-34.

１５８．Tsuneyoshi H, Oriyanhan W, Kanemitsu H, Shiina R, Nishina T, Matsuoka S, Ikeda T, Komeda M. Does the beta2-agonist clenbuterol help to maintain myocardial potential to recover during mechanical unloading? Circulation. 2005 Aug 30;112(9 Suppl):I51-6.

１５９．Lin X, Jo H, Sakakibara Y, Tambara K, Kim B, Komeda M, Matsuoka S. {beta}-adrenergic stimulation does not activate Na+-Ca2+ exchange current in guinea-pig, mouse and rat ventricular myocytes. Am J Physiol Cell Physiol. 2005 Oct 5; [Epub ahead of print]

１６０．Koyama T, Nishina T, Ono N, Sakakibara Y, Nemoto S, Ikeda T, Komeda M. Early and mid-term results of left ventricular volume reduction surgery for dilated cardiomyopathy.J Card Surg. 2005 Nov-Dec;20(6):S39-42.

１６１．Kawaguchi AT, Suma H, Konertz W, Gradinac S, Bergsland J, Dowling RD, Komeda M, Kitamura S, Ohashi H, Chang BC, Linde LM, Batista RJ; International and Regional Registry Task Force, The Society for Cardiac Volume Reduction. Left ventricular volume reduction surgery: The 4th International Registry Report 2004.J Card Surg. 2005 Nov-Dec;20(6):S5-11.

１６２．Oriyanhan W, Yamazaki K, Miwa S, Takaba K, Ikeda T, Komeda M. Taurine prevents myocardial ischemia/reperfusion-induced oxidative stress and apoptosis in prolonged hypothermic rat heart preservation.Heart Vessels. 2005 Nov;20(6):278-85.

１６３．Komeda M. Volume reduction surgery for dilated left ventricle--is it time for another progress report? J Card Surg. 2005 Nov-Dec;20(6):S3-4.

１６４．Tsuneyoshi H, Komeda M. Update on mitral valve surgery.? J Artif Organs. 2005;8(4):222-7. Review.

１６５．Marui A, Doi K, Tambara K, SakakibaraY, Ueyama K, Iwakura A, Yamamoto M, Ikeda T, Tabata Y, Komeda M. Basic fibroblast growth factor and angiogenesis　Cardivascular Regeneration Therapies Using Tissue Engineering Approaches. Mori H, Matsuda H (Eds.) Springer-Verlag, Tokyo, Japan　2005:145-156

　
１６６．Oriyanhan W, Miyamoto TA, Yamazaki K, Miwa S, Takaba K, Ikeda T, Komeda M. Regionally perfused taurine. Part I. Minimizes lactic acidosis and preserves CKMB and myocardial contractility after ischemia/reperfusion. Adv Exp Med Biol. 2006;583:271-88.

１６７．Soga Y, Takai S, Okabayashi H, Nagasawa A, Yokota T, Nishimura K, Miyazaki M, Komeda M. Human gastroepiploic artery has greater chymase activity than the internal thoracic artery.? Eur J Cardiothorac Surg. 2006 Dec;30(6):877-80. Epub 2006 Oct 27.

１６８．Yamamuro M, Tadamura E, Kanao S, Okayama S, Okamoto J, Urayama S, Kimura T, Komeda M, Kita T, Togashi K. Cardiac functional analysis by free-breath real-time cine CMR with a spatiotemporal filtering method, TSENSE: comparison with breath-hold cine CMR.J Cardiovasc Magn Reson. 2006;8(6):801-7.

１６９．Marui A, Nishina T, Tambara K, Saji Y, Shimamoto T, Nishioka M, Ikeda T, Komeda M. A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results. J Thorac Cardiovasc Surg. 2006 Nov;132(5):1047-53.

１７０．Kanemitsu N, Tambara K, Premaratne GU, Kimura Y, Tomita S, Kawamura T, Hasegawa K, Tabata Y, Komeda M. Insulin-like growth factor-1 enhances the efficacy of myoblast transplantation with its multiple functions in the chronic myocardial infarction rat model.? J Heart Lung Transplant. 2006 Oct;25(10):1253-62. Epub 2006 Sep 7.

１７１．Takaba K, Jiang C, Nemoto S, Saji Y, Ikeda T, Urayama S, Azuma T, Hokugo A, Tsutsumi S, Tabata Y, Komeda M. A combination of omental flap and growth factor therapy induces arteriogenesis and increases myocardial perfusion in chronic myocardial ischemia: evolving concept of biologic coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2006 Oct;132(4):891-99. Epub 2006 Aug 30.

１７２．Hirose K, Fujita M, Marui A, Arai Y, Sakaguchi H, Huang Y, Chandra S, Tabata Y, Komeda M. Combined treatment of sustained-release basic fibroblast growth factor and sarpogrelate enhances collateral blood flow effectively in rabbit hindlimb ischemia.Circ J. 2006 Sep;70(9):1190-4.

１７３．Premaratne GU, Tambara K, Fujita M, Lin X, Kanemitsu N, Tomita S, Sakaguchi G, Nakajima H, Ikeda T, Komeda M. Repeated implantation is a more effective cell delivery method in skeletal myoblast transplantation for rat myocardial infarction.Circ J. 2006 Sep;70(9):1184-9.

１７４．Hirose K, Marui A, Arai Y, Nomura T, Inoue S, Kaneda K, Kamitani T, Fujita M, Mitsuyama M, Tabata Y, Komeda M. Sustained-release vancomycin sheet may help to prevent prosthetic graft methicillin-resistant Staphylococcus aureus infection.J Vasc Surg. 2006 Aug;44(2):377-82.

１７５．Kubo S, Tadamura E, Yamamuro M, Hosokawa R, Kimura T, Kita T, Komeda M, Togashi K. Thoracoabdominal-aortoiliac MDCT angiography using reduced dose of contrast material. Am J Roentgenol. 2006 Aug;187(2):548-54.

１７６．Kanemitsu H, Takai S, Tsuneyoshi H, Nishina T, Yoshikawa K, Miyazaki M, Ikeda T, Komeda M. Chymase inhibition prevents cardiac fibrosis and dysfunction after myocardial infarction in rats.Hypertens Res. 2006 Jan;29(1):57-64.

１７７．Marui A, Hirose K, Maruyama T, Arai Y, Huang Y, Doi K, Ikeda T, Komeda M. Prostaglandin E2 EP4 receptor-selective agonist facilitates sternal healing after harvesting bilateral internal thoracic arteries in diabetic rats.J Thorac Cardiovasc Surg. 2006 Mar;131(3):587-93.

１７８．Tadamura E, Yamamuro M, Kubo S, Kanao S, Harada M, Nakao K, Komeda M, Togashi K. Images in cardiovascular medicine. Hibernating myocardium identified by cardiovascular magnetic resonance and positron emission tomography.Circulation. 2006 Feb 21;113(7):e158-9

１７９．Nakajima H, Yamanaka K, Horii T, Nishina T, Ikeda T, Komeda M. A more comprehensive left ventricular repair for severely dilated cardiomyopathy. J Card Surg. 2006 Jan-Feb;21(1):62-4; discussion 65.

１８０．Yamanaka K Fujita M, Doi K, Tsuneyoshi H, Yamazato A, Ueno K, Zen E, Komeda M. Multislice computed tomography accurately quantifies left atrial size and function after the MAZE procedure. Circulation 2006;114(1 Suppl):I5-9

１８１．Nakao MKuroda T, Oyama H, Sakaguchi G, Komeda M. Physics-based simulation of surgical fields for preoperative strategic planning. J Med SystJ 2006;30(5):371-80.

１８２．Lin X, Fujita M, Kanemitsu N, Kimura Y, Tambara K, Premaratne GU, Nagasawa A, Ikeda T, Tabata Y, Komeda M. 　Sustained-release erythropoietin ameliorates cardiac function in infarcted rat-heart without inducing polycythemia. Circ J. 2007 Jan;71(1):132-7.

１８３．Morishima A, Marui A, Shimamoto T, Saji Y, Tambara K, Nishina T, Komeda M. Successful aortic valve replacement for Heyde syndrome with confirmed hematologic recovery.Ann Thorac Surg. 2007 Jan;83(1):287-8.

１８４．Nemoto S, Umehara E, Ikeda T, Itonaga T, Komeda M. 　Oral sildenafil ameliorates impaired pulmonary circulation early after bidirectional cavopulmonary shunt.Ann Thorac Surg. 2007 May;83(5):e11-3.

１８５．Yamamuro M, Tadamura E, Kanao S, Wu YW, Tambara K, Komeda M, Toma M, Kimura T, Kita T, Togashi K. 　Coronary angiography by 64-detector row computed tomography using low dose of contrast material with saline chaser: influence of total injection volume on vessel attenuation.　J Comput Assist Tomogr. 2007 Mar-Apr;31(2):272-80.

１８６．Doi K, Ikeda T, Marui A, Kushibiki T, Arai Y, Hirose K, Soga Y, Iwakura A, Ueyama K, Yamahara K, Itoh H, Nishimura K, Tabata Y, Komeda M. 　Enhanced angiogenesis by gelatin hydrogels incorporating basic fibroblast growth factor in rabbit model of hind limb ischemia.　Heart Vessels. 2007 Mar;22(2):104-8. Epub 2007 Mar 23.

１８７．Fukuoka M, Nonaka M, Masuyama S, Shimamoto T, Tambara K, Yoshida H, Ikeda T, Komeda M. 　Chordal "translocation" for functional mitral regurgitation with severe valve tenting: an effort to preserve left ventricular structure and function.? J Thorac Cardiovasc Surg. 2007 Apr;133(4):1004-11. Epub 2007 Feb 26.

１８８．Wu YW, Tadamura E, Kanao S, Yamamuro M, Marui A, Komeda M, Toma M, Kimura T, Togashi K. 　Myocardial viability by contrast-enhanced cardiovascular magnetic resonance in patients with coronary artery disease: comparison with gated single-photon emission tomography and FDG position emission tomography. Int J Cardiovasc Imaging. 2007 Mar 16;

１８９．Arai Y, Fujita M, Marui A, Hirose K, Sakaguchi H, Ikeda T, Tabata Y, Komeda M. Combined treatment with sustained-release basic fibroblast growth factor and heparin enhances neovascularization in hypercholesterolemic mouse hindlimb ischemia.Circ J. 2007 Mar;71(3):412-7.

１９０．Oriyanhan W, Tsuneyoshi H, Nishina T, Matsuoka S, Ikeda T, Komeda M. Determination of optimal duration of mechanical unloading for failing hearts to achieve bridge to recovery in a rat heterotopic heart transplantation model.J Heart Lung Transplant. 2007 Jan;26(1):16-23.

１９２．Koyama T, Soga Y, Unimonh O, Nishimura K, Komeda M.? Mitral annuloplasty as a ventricular restoration method for the failing left ventricle--- A pilot study? J Heart Valve Dis. 2007 Mar;16(2):195-9.

１９３．Komeda M, Shimamoto T. Cutting secondary chordae and placing taut stitches between anterior mitral fibrous annulus and each head of papillary muscles can treat ischemic mitral regurgitation without deteriorating left ventricular function. (letter)　J Thorac Cardiovasc Surg 2008;135:226-7.

１９４．Shimamoto T, Tambara K, Marui A, Yamanaka K, Komeda M. LV restoration surgery for isolated left ventricular noncompaction (IVNC) ? report of the first successful case. (letter) J Thorac Cardiovasc Surg 2007 Jul;134(1):246-7.

１９５．Marui A, Tabata Y, Kojima S, Yamamoto M, Tambara K, Nishina T, Saji Y, Inui K, Hashida T, Yokoyama S, Onodera R, Ikeda T, Fukushima M, Komeda M. A novel approach to therapeutic angiogenesis for patients with critical limb ischemia by sustained release of basic fibroblast growth factor using biodegradable gelatin hydrogel: an initial report of the phase I-IIa study. Circ J. 2007 Aug;71(8):1181-6.

１９６．Marui A, Tambara K, Tadamura E, Saji Y, Sasahashi N, Ikeda T, Nishina T, Komeda M.A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium. Eur J Cardiothorac Surg. 2007 Aug;32(2):308-12. Epub 2007 Jun 18.

１９６．Soga Y, Takai S, Koyama T, Okamoto Y, Ikeda T, Nishimura K, Miyazaki M, Komeda M. Attenuating effects of chymase inhibitor on pericardial adhesion following cardiac surgery. J Card Surg. 2007 Jul-Aug;22(4):343-7.

１９７．Nakajima H, Komeda M. Intraoperative Graft Evaluation in Coronary Artery Bypass Grafting Using a 15-MHz High-Frequency Linear Transducer: Maintaining the Comprehensive Quality of Coronary Surgery.? Arterial Grafting for Coronary Artery Bypass Surgery, 2006: 285-288 Springer

１９８．Tambara K, Sakakibara Y, Nishina T, Nomoto T, Fanglin Lu, Ikeda T, Nishimura K, Komeda M. Transplanting cells for the treatment of cardiomyopathy. Matsumori A (Eds). Cardiomyopathies and Heart Failure? Biomolecular, Infectious and Immune Mechanisms. Kluwer Academic Publishers? 2003;481-9　

１９９．Marui A, Doi K, Tambara K, SakakibaraY, Ueyama K, Iwakura A, Yamamoto M, Ikeda T, Tabata Y, Komeda M. Basic fibroblast growth factor and angiogenesis　Cardivascular Regeneration Therapies Using Tissue Engineering Approaches. Mori H, Matsuda H (Eds.) Springer-Verlag, Tokyo, Japan? 2005:145-156　

２００．Kubo S, Tadamura E, Yamamuro M, Kanao S, Kataoka ML, Takahashi M, Kimura T, Kita T, Komeda M, Togashi K. Multidetector-row computed tomographic angiography of thoracic and abdominal aortic aneurysms: comparison of arterial enhancement with 3 different doses of contrast material. J Comput Assist Tomogr. 2007 May-Jun;31(3):422-9.

２０１．Baba S, Heike T, Yoshimoto M, Umeda K, Doi H, Iwasa T, Lin X, Matsuoka S, Komeda M, Nakahata T. Flk1(+) cardiac stem/progenitor cells derived from embryonic stem cells improve cardiac function in a dilated cardiomyopathy mouse model.Cardiovasc Res. 2007 Oct 1;76(1):119-31. Epub 2007 May 17.

２０２．Chin K, Takahashi K, Ohmori K, Toru I, Matsumoto H, Niimi A, Doi H, Ikeda T, Nakahata T, Komeda M, Mishima M. Noninvasive ventilation for pediatric patients under 1 year of age after cardiac surgery. J Thorac Cardiovasc Surg. 2007 Jul;134(1):260-1.

２０３．Wu YW, Tadamura E, Yamamuro M, Kanao S, Marui A, Tanabara K, Komeda M, Togashi K. Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease. J Nucl Med. 2007 Jul;48(7):1096-103.

２０５．Hirose K, Marui A, Arai Y, Nomura T, Kaneda K, Kimura Y, Ikeda T, Fujita M, Mitsuyama M, Tabata Y, Komeda M. A novel approach to reduce catheter-related infection using sustained-release basic fibroblast growth factor for tissue regeneration in mice. Heart Vessels. 2007 Jul;22(4):261-7. Epub 2007 Jul 20.　

２０６．Hirose K, Marui A, Arai Y, Fujita M, Nomura T, Mitsuyama M, Tabata Y, Komeda M.Sustained-release form of basic fibroblast growth factor prevents catheter-related bacterial invasion in mice. Interact Cardiovasc Thorac Surg. 2005 Dec;4(6):526-30. Epub 2005 Sep 15.

２０７．Sasahashi N, Harada H, Saji Y, Marui A, Nishina T, Komeda M. Aortic valve replacement for aortic regurgitation in a patient with antiphospholipid antibody syndrome.
Gen Thorac Cardiovasc Surg. 2007 Jul;55(7):293-6.

２０８．Wu YW, Tadamura E, Yamamuro M, Kanao S, Okayama S, Ozasa N, Toma M, Kimura T, Komeda M, Togashi K. Estimation of global and regional cardiac function using 64-slice computed tomography: A comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonance. Int J Cardiol. 2007 Aug 8

２０９． Handa N, Magata Y, Mukai T, Nishina T, Konishi J, Komeda M. Quantitative FDG-uptake by positron emission tomography in progressive hypertrophy of rat hearts in vivo. Ann Nucl Med. 2007;21:569-76. Epub 2007 Dec 25.

２１０． Kanemitsu H, Takai S, Tsuneyoshi H, Yoshikawa E, Nishina T, Miyazaki M, Ikeda T, Komeda M. Chronic chymase inhibition preserves cardiac function after left ventricular repair in rats. Eur J Cardiothorac Surg 2008;33:25-31. Epub 2007 Nov 28.

２１１． Wang J, Marui A, Ikeda T, Komeda M. Partial left ventricular unloading reverses contractile dysfunction and helps recover gene expressions in failing rat hearts. Interact Cardiovasc Thorac Surg. 2007 Nov 15; [Epub ahead of print]

２１２． Esaki J, Marui A, Tabata Y, Komeda M. Controlled release systems of angiogenic growth factors for cardiovascular diseases. Expert Opin Drug Deliv. 2007 Nov;4(6):635-49.

２１３． Wu YW, Tadamura E, Kanao S, Yamamuro M, Okayama S, Ozasa N, Toma M, Kimura T, Kita T, Marui A, Komeda M, Togashi K. Left Ventricular Functional Analysis Using 64-Slice Multidetector Row Computed Tomography: Comparison with Left Ventriculography and Cardiovascular Magnetic Resonance. Cardiology. 2008;109(2):135-42. Epub 2007 Aug 22.

２１４． Sakaguchi H, Marui A, Hirose K, Nomura T, Arai Y, Bir SC, Huang Y, Esaki J, Tabata Y, Ikeda T, Komeda M.　Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin. J Thorac Cardiovasc Surg. 2008;135:25-31.

２１５．Marui A, Saji Y, Nishina T, Tadamura E, Kanao S, Shimamoto T, Sasahashi N, Ikeda T, Komeda M. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function.
J Thorac Cardiovasc Surg 2008;135:1297-305. Epub 2008 May 5.

２１６．Shimamoto T, Marui A, Takagi T, Komeda M. Significance of morphological and electrophysiological left ventricular restoration in idiopathic dilated cardiomyopathy. Interact Cardiovasc Thorac Surg 2008 Jun 6. [Epub ahead of print]

２１７．Shimamoto T, Marui A, Oda M, Tomita S, Nakajima H, Takeuchi T, Komeda M.
A case of peripartum cardiomyopathy with recurrent left ventricular apical thrombus. Circ J. 2008;72:853-4.

２１８．Komeda M. Treatment of atrial fibrillation: is it really going to be a surgical market? Ann Thorac Cardiovasc Surg (Editorial) 2008;14:63-5.

２１９．Bir SC, Fujita M, Marui A, Hirose K, Arai Y, Sakaguchi H, Huang Y, Esaki J, Ikeda T, Tabata Y, Komeda M. New therapeutic approach for impaired arteriogenesis in diabetic mouse hindlimb ischemia. Circ J. 2008;72:633-40.

２２０．Morimoto T, Sunagawa Y, Kawamura T, Takaya T, Wada H, Nagasawa A, Komeda M, Fujita M, Shimatsu A, Kita T, Hasegawa K. The dietary compound curcumin inhibits p300 histone acetyltransferase activity and prevents heart failure in rats. J Clin Invest. 2008;118:868-78.

（7.1. 2008）

3. aortic disease

Komeda — 2008-08-10T10:52:59+09:00

Q: What kinds of Aortic diseases need surgery ?

A: True aneurysm and Aortic dissection (so-called Dissecting Aortic aneurysm) are representative ones.
True aortic aneurysm is a disease where aortic wall becomes weakened and bulge outward; recently it seems increasing in its incidences. If it ruptures, the patient will die quickly, and if thrombi develops in the aneurysm and if it occludes the distal vessels, major problems can happen. For example, if the embolism develops in brain, it results in stroke and is often fatal.

Q: What is Aortic dissection?

A: Aortic dissection is a disease where Aortic wall detaches into 2 (outside layer and inside layer), and the patient suffers from severe chest/back pain when the dissection develops or extends. In Japan, famous actor Mr. Yujiro Ishihara years ago and more recently Mr. Cha Kato had surgery for the disease.

There are 2 types of disease in Aortic dissection: Stanford Type A and B. Stanford type A dissection has dissection near the heart as shown in the figure, and it requires emergency surgery. Without surgery, half of the patients die within 2 days after the onset of dissection.

In Stanford type B (Figure) dissection as shown in the figure, the patient usually needs medical treatment to control blood pressure etc.. However, if the Aorta with type B dissection is about to rupture, surgery is necessary.
Here, first we will discuss true Aortic aneurysm.

Q: What types of diseases are there in the true Aortic aneurysm?

True thoracic Aortic aneurysms have 3 types in location: ascending aortic aneurysm, aortic arch aneurysm, and descending aortic aneurysm.

They often develop together; for example, in the figure, left panel shows ascending-proximal arch aneurysm and right panel distal arch aneurysm.

In thoracic Aortic aneurysm, if its diameter reaches 6cm the patient needs surgery because of otherwise high chance of rupture. In patients with Marfan’s syndrome, even aneurysm with the diameter of 5cm often has indication for surgery, because it can rupture. In order to avoid “too late” situation, it is recommended to check CT scan periodically; it does not cause pain for the patient.

In surgery for thoracic aneurysm, aneurysm part of the aorta is replaced by artificial graft usually made of Dacron; depending on the location of the aneurysm, cardiac, brain and/or other organs protection is necessary. If the aneurysm is localized in the ascending Aorta, the aneurysmal part can be replaced by artificial graft under cardiopulmonary bypass and Aortic cross-clamp. However, if the aneurysm extend distal to the ascending aorta, some kind of hypothermia (just like bear’s hibernation in winter) under cardiopulmonary bypass and additional brain/heart protection is necessary. Ascending Aortic aneurysm is usually approached from front, while descending Aorta from left side of the chest. Aortic arch aneurysm can be approached from front or left side, depending on the situation.

Q: How Aortic arch aneurysm can be operated?

Among thoracic aortic aneurysms, Arch aneurysm needs relatively big surgery (Figure, total arch replacement).

We put emphasis on prevention of embolism/stroke and spinal chord injury, and employ Stepwise Arch First technique with relatively deep hypothermia (Aortic Case 1).

For patients with less risk of cerebral embolism, we use selective antegrade cerebral perfusion and with a little higher body temperature; the method helps effective hemostasis thereafter.

The figures shows a method to handle Aortic aneurysm which extends from ascending aorta through aortic arch and descending aorta. The method is called “elephant trunk” because it resembles.

The elephant trunk often is stabilized as time passes and protect aneurismal part of aorta, but when necessary surgery or stent graft can be applied to the elephant trunk and the descending aorta.

Patients with Aortic aneurysm with large size die of its rupture if left without surgery, and if rupture develops the patient’s mortality will be eventually 100%.

Thus, we operate even sick patients (e.g., senile or with other organ diseases) by using variety of techniques including organs’ protection.

In acute type A Aortic dissection, eventually all the patients need emergency surgery in which ascending Aorta with/without aortic arch is replaced. The figure shows a popular method for acute aortic dissection (Hemiarch replacement for proximal arch and ascending aortic replacement).

The way to protect brain and heart is just the same as for true aneurysm. Aortic tissue in patients with Aortic dissection is fragile and more careful handling is necessary (Aortic Case 2).

When Aortic root (i.e., part of ascending Aorta close to heart) is dissected, aortic regurgitation (leaking valve) often develops. It is another reason of emergency surgery for acute Aortic dissection.

Aortic (valve) regurgitation caused by Aortic dissection usually has a good indication for aortic valve repair surgery, which benefit the patient in many ways. In my personal experiences in the previous hospital, all 20 patients with acute Aortic dissection survived except for one patient who had heart arrest before the surgery; We believe that if the patient had come to the operation half an hour earlier (i.e., before the heart stops), he could have been saved, and therefore we keep making effort to do public education as well as shape-up the efficient system of treatment.
In type B dissection where descending Aorta etc. is dissected, usually conservative treatment such as control of blood pressure by intravenous drip infusion or medication etc. is recommended. However, if the aorta is dilated, surgery is necessary at least before the aorta ruptures. If the patient is operated by experienced team before rupture it is almost always successful, but if the operation is done after rupture, the results are not good, because of very poor general condition of the patient.

Q: Is stent graft useful?

Treatment by using stent graft as a joint project with cardiologists is effective in selected patients.

With this method, folded artificial graft is inserted to Aorta not by surgery but by catheter, and the graft is deployed and fixed in the scheduled part of the Aorta.

It is meritorious for aged patients or patients with other organs’ diseases. There remains room for improvement for this method, it is accumulating excellent results for patients who don’t have physical power to undergo surgery.

If descending aorta is not stabilized by the elephant trunk as shown in the figure, stent graft as a second procedure helps a lot. When the aorta does not fit the stent graft, another operation is carried out.

Q: What is the “hybrid” surgery for Aortic disease?

Stent graft is relatively new method of treatment, and is making significant progress recently. For example, those patients who are not indicated for stent graft or surgery, we started hybrid procedure which combined the above 2 methods for sick patients with thoracoabdominal aneurysm especially ruptured one. In the hybrid method, surgical team makes bypass surgery for major arterial branches in the abdomen, and then stent graft can just fix the aorta without worrying about its branches. In my previous hospital we treated 6 critical patients by the hybrid method, and all successful and went home in better condition. The hybrid method will help many patients who are too sick for conventional treatment (Aortic case 3). As shown above, the hybrid method works well in thoracoabodominal aortic aneurysm, descending aortic aneurysm, and whole thoracic aneurysm after total arch replacement surgery etc.; it decreases invasiveness of treatment for patients.

Q: What is important to save more patients with aortic aneurysm or dissection?

In the past we saw many patients who had ruptured aneurysm before coming to the hospital; they were eventually dead before the treatment. We try to cooperate with general physicians, internists, cardiologists and ER people so that the patient can reach hospital before the rupture. Especially Aortic dissection needs prompt action because of the very fast progression of the disease; diagnosis and surgery in time can save the patient. True aortic aneurysms usually have no obvious symptoms except for hoarseness, but when it is rupturing, strong back/lumber pain may develop; also, it is important to check chest X-ray and abdominal palpation as a screening.

profile

Komeda — 2008-08-05T18:55:56+09:00

Name, Masashi KOMEDA, M.D., Ph.D.
(E-mail: komeda@heart-center.or.jp)

Education :
1981. 3. M.D., cum laude, Kyoto University, Faculty of Medicine

Professional Training and Employment:

2008.10- Present: Vice President and Chief Cardiovascular Surgeon, Nagoya Heart Center, Nagoya, Japan

2007.9.- Present: Supervisor & Surgeon of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi Japan and Yamato Seiwa Hospital, Yamato, Japan

1998.4. to 2007.9. : Professor and Chairman, Director and Chief Surgeon, Cardiovascular Surgery, Kyoto University Hospital, Kyoto, JAPAN

1996.9. to 1998.3. : Staff Surgeon (Consultant), Cardiovascular Surgery (Professor: Brian Buxton), Austin and Repatriation Medical Centre, University of Melbourne, AUSTRALIA

1993.5. to 1996.8. : Carl and Leah McConnel Cardiovascular Surgical Research Fellow (Prof. D. Craig Miller), Cardiothoracic Surgery, Stanford University, Stanford, California, USA

1987.9. to 1993.4. : Clinical and Research Fellow, Cardiovascular Surgery, Toronto (General) Hospital (Prof. Tirone E. David), University of Toronto, Toronto, Ontario, CANADA

1983.4. to 1987.8. : Senior Resident/Staff Surgeon in Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, JAPAN

Membership of Learned Societies:

American Association of Thoracic Surgery (AATS): Member
The European Association of Cardiothoracic Surgery: International Member
The Society of Thoracic Surgeons: International Member
American Heart Association: Professional Member, invited grading reviewer
The Asian Society for Cardiovascular Surgery: Member and Councillor

2008/8/10 Masashi Komeda, M.D., Ph.D.

INDEX

Komeda — 2008-08-05T14:36:00+09:00

2008 August 04

Komeda — 2008-08-04T23:18:03+09:00

Synopsis of Cardiovascular Sugery, 1. Valvular Heart Disease is up.

6. Infectious Endocarditis (IE)

Komeda — 2008-08-04T19:20:35+09:00

One of the heart diseases that may affect patients of any age is infectious endocarditis (IE). In IE, heart valve(s) are destroyed by bacteria etc. IE may develop in patients with no obvious heart diseases, but often develops in patients with some underlying heart disease. For example, ventricular septal defect (VSD), mitral valve prolapse (the valve dislocates to the left atrium), mitral regurgitation, or bicuspid aortic valve (normally aortic valve has 3 cusps), and others may make underlying causes. IE develops often after tooth extraction, some injury or infection, drug user especially when the same needle is used for 2 people or more.

Q: Why is infectious endocarditis (IE) dangerous?

In patients with IE, depending on the responsible bacteria, antibiotics is not necessarily effective, and if the vegetation (fragile mass of bacterial body etc.) breaks and migrates to the brain, serious problems such as cerebral embolism (stroke) will develop. Moreover, if the patient needs emergency surgery when the bacteria are still alive and active (i.e., active IE), sometimes surgeons have to put artificial materials such as sutures or artificial valves to the site which was infected.

Thus, during the surgery, we do thorough debridement (i.e., removal of infected tissue and bacteria), reconstruct the damaged valve, and when necessary apply artificial valve.

Taking advantage of experiences in valve repair surgery or LV restoration surgery, we succeeded in saving most patients with IE (VHD case 4).
Valve cusps or leaflets can be repaired. Using the LV restoration techniques, even when the base of the aortic or mitral valve is destroyed by the infection, it can be reconstructed so that the valve can be repaired or replaced thereafter (Figure).

Q: What if an artificial valve develops endocarditis ?

Prosthetic valve endocarditis (PVE), which is endocarditis of artificial valve(s), is one of the serious conditions among IE. We aggressively do surgery for patients with PVE.
PVE is not easy to treat medically, but surgery is often demanding, which requires experienced and skillful hands. Surgery for PVE needs more techniques and considerations than for usual valve surgery.

It is in part because surgeons often have to reconstruct not only the valve but also its base (e.g., mitral annulus or aortic ring), and in part because cares should be taken to bleeding tendency, infection, multiple organ protection etc.

Figure shows an example of aortic ring reconstruction for PVE with aortic root abscess (see bibliography).

If you or your patient has PVE, please consult a specialist of cardiovascular surgery, at latest before major complications develop such as cerebral embolism of vegetation or mycotic aneurysm or its rupture.

5. Redo (Reoperation)

Komeda — 2008-08-04T19:06:34+09:00

Q: When reoperation (another open-heart surgery) is necessary?

Long-term after the surgery such as 5-30 years, artificial valve maybe worn out, or the patient’s tissue around the valve grows and interferes the valve motion, and reoperation may become necessary. Sometimes other valves or vessels are diseased, which makes reoperation necessary.

Q： What kinds of concerns are there in the reoperation?

During the reoperation, the heart adheses (sticks to) the surrounding tissue or organs and surgeons have to dissect the heart safely before entering the heart. Thus, reoperation identifies experiences and skills of the surgeons more than initial surgery. Experienced surgeons and teams can do reoperations nearly as safely as initial surgery, but inexperienced team often suffer from problems. In addition to the adhesion, patients who undergo reoperation usually have long-term heart diseases and even other organs’, and thus they are more fragile than the patients with initial heart surgery. That is why more skillful surgery and treatment is necessary for patients with reoperation.

For years we put higher priority to reoperations and we have achieved very good results of reoperations including 3rd time or 4th time ones. For example, about 9 years ago, we did 4th time operation for patients who came from Korea and we replaced 3 valves at the same time. She had had 2 heart surgery in USA years before. We reported the case in the meeting in 2000.

4. Tricuspid Valve Disease

Komeda — 2008-08-04T01:13:37+09:00

Q: What kinds of disease are there in Tricuspid Valve? How are they fixed?

Tricuspid valve disease (mostly regurgitation) is usually associated with mitral valve disease. For the disease, valve repair surgery especially annuloplasty surgery which makes the annulus (i.e., base of the valve leaflets) smaller is effective. For tricuspid annuloplasty, there are a few methods including: DeVega method that makes the tricuspid annulus smaller by sutures around the annulus, and Ring annuloplasty that employs some kind of ring (rigid or flexible, 2D or 3D shape, etc.). Generally, DeVega is easy and quick method while ring annuloplasty takes a little longer time, but more effective and longer lasting.

We use the ring for severe tricuspid regurgitation and DeVega method for mild-moderate regurgitation. Some patients who had a few surgeries in the long time period and developes just tricuspid regurgitation; we just open the right chest and open the right atrium without taping the venae cavae using some techniques, and make the surgery less invasive.

Q: Can Pacemaker cables cause tricuspid regurgitation?

Cables of permanent pacemaker are known to cause tricuspid regurgitation. When there are 2 or more cables across the valve, chances of tricuspid regurgitation become higher and chances for valve repair less. We fix the problem by not only valve repair but also relocating the pacer cables and employing artificial chordae when necessary. To date, long-term results of tricuspid replacement remains unknown, and therefore we believe such sophisticated repair method beneficial for the patients.

2. Mitral valve disease and Atrial Fibrillation

Komeda — 2008-08-04T00:41:57+09:00

Q: What is mitral valve repair surgery for mitral regurgitation (MR) and how is it done?

In mitral valve diseases especially mitral regurgitation, there are various causes and patterns. In mitral valve surgery, the valve is reconstructed or replaced by taking the cause of the disease into consideration.

In surgery for MR, valve repair surgery is usually the first choice (VHD Case 1).

In mitral valve repair surgery, the patient's own valve is reconstructed by using various surgical techniques without using artificial valves. Thus, various potential problems of artificial valves can be avoided. We perform not only simple repair of the valve but also complex repair, and most of the patients with MR enjoy the good results of repair surgery. (VHD Case 2 and 3)

After having lots of experiences of valve surgery especially repair one in North America and Australia, I experienced more than 200 cases of mitral valve repair surgery after coming back to Japan. We repair the valve for elderly patients, athletes or young patients, or those who wish to have babies in the future. Thanks to valve repair surgery, the patients can come back to sports activities including martial arts or pregnancy/delivery or occupation with higher chance of injury. (VHD Case 4)

Q: How the mitral valve is repaired in patients with ischemic mitral regurgitation (IMR)?

Among MR, ischemic MR often is reported to be very difficult to repair and prognosis is poor. When the mitral valve has strong "tenting (tethering)", the repair surgery is reported to be difficult. For the type of patients, we repair not only the valve but also the left ventricle (LV) when necessary, and we developed a new surgical method to reconstruct the secondary chordae to fix the tenting and protect the LV. As a result, we succeeded in repairing the valve with IMR in most patients. (VHD Case 5)

In IMR, the disease is not a simple valve disease, but LV disease where LV itself is damaged by myocardial infarction. Thus, when the IMR is resistant to conventional surgery such as mitral annuloplasty, it is important to fix the LV. By fixing the LV, the patient can be free from MR and may have more chance of long-term survival. In fact, data which shows treatment of the valve alone does not prolong patients' life are reported from North America and Europe.

Q: When is mitral valve replaced ?

When the mitral valve is not suitable for repair surgery (i.e., when the valve is calcified or infected badly, or when the surgery should be completed in limited time), the valve is replaced. In other words, the patient's own valve is excised and artificial valve is sewn. Even when the valve has to be replaced, the patient's papillary muscles are preserved and good LV function is secured after the surgery. LV function after the surgery is as good as the one after repair surgery. (VHD Case 6)

In mitral stenosis (the valve becomes narrow), mitral leaflets usually become diseased, solid, and thick. Thus, valve repair surgery cannot give stable results for a long time. As a result, mitral valve is often replaced with preserving papillary muscles and the results of the surgery is very stable and reproducible.

Q: What type of artificial valves are available?

Artificial valve which is employed in the valve replacement surgery has mechanical valve (i.e., metal valve) and tissue valve (i.e., bioprosthesis, tissue valve made of pig or cow's material).

Mechanical valve is made of metal and last long, but it requires the patient to take Warfarin (i.e., blood thinner) for life time. Tissue valve (artificial valve which is made of cow or pig's tissue) last about 10 years in young patients, but last about 20 years in old patients. It does not require the patient to take Warfarin, and therefore the patient has less chance of cerebral bleeding etc. (Note: Warfarin is different from Baffarin)

Which valve is suitable for patients? To make the best possible choice for a patient, we have to consider patient's age, genaral/heart condition, life style, occupation and so forth and after discussion we can choose the best valve in total for the patient. For example, if the patient want to martial arts or hard sports such as rubgy, when the valve is not feasible for repair surgery, tissue valve will be the choice. If the patient is young female and if she wishes to have baby in the future, tissue valve will be the choice. If the patient works mainly in the office, and if he or she wants to play tennis or golf, mechanical valve will be the choice. We try to discuss the plan with the patient and family until satisfaction. Another important point of implanting tissue valve for relatively young patient is how to make the possible future redo safe. As a rule, we reconstruct the tissue around the heart before closing the chest, and therefore the heart will not stick to the organs around, and the possible redo surgery in the future will be safer. We have confirmed the idea correct in our experiences of redo surgery for patients who had had surgery in the past in our unit.

Q: How dangerous is atrial fibrillation (AF) and why? Is there a way to fix it?

Patients with mitral valve disease often have arrhythmias (rhythm disturbances) especially atrial fibrillation (AF). When AF develops, heart has a power down and often thrombi (clots) grow in the heart chamber. If the thrombi moves along blood stream and if it reaches brain, cerebral embolism (stroke) will develop. When AF occurs in On-and-Off fashion, there will be more chance of the embolism.

Mr. Nagashima, the famous Japanese baseball player, Mr. Oshim, the soccer leader, and late Mr. Obuchi, former prime minister in Japan, are reported to suffer from cerebral embolism in the same mechanism. However, AF can be treated together with mitral valve or coronary bypass surgery etc.. AF can be cured by Maze procedure which stops abnormal electrical pathways in the heart. When the valve or coronary arteries is intact (e.g., lone AF), catheter ablation is usually employed, except when large or mobile thrombi is seen in the left arium or ventricle.

We developed "Volume Reduction (Atrial Reduction) Maze procedure (VHD case 7), and it successfully fix the "inoperable" AF in 90% of the patients that were beyond surgical indication.

With the volume reduction Maze procedure, patients beyond the indication for conventional Maze or catheter ablation (such as huge left atrium or AF more than 10-20 years duration) usually defibrillated successfully. EBM shows us that the larger the atrium is, the more difficult to defibrillate it. From the viewpoint, our volume reduction Maze procedure makes sense and reasonable. Moreover, it improves intra-atrial blood flow pattern. If AF is fixed, late survival or QOL will improve as shown in EBM.

Q: To what extent does the heart improve in function by volume reduction Maze procedure?

It improves not only left atrial function (when AF is fixed) but also left ventricular function (see bibliography). It may decrease the problems which are associated with enlarged atrium.

For example, the left figure shows 62 year-old woman who has long-standing mitral stenosis and tricuspid regurgitation, and as a result, huge left atrium, heart failure, and of course AF. Because of the huge left atrium, she was told that surgery is too dangerous and came to us. After (atrial) volume reduction Maze procedure, mitral valve replacement, tricuspid annuloplasty, she improved dramatically and even the AF was cured. Her heart function improved considerably and heart failure has gone. The figure shows echocardiography before and after the surgery. LA means left atrium. Among heart chambers, especially LA has become very much smaller.

1. Valvular Heart Disease, In general

Komeda — 2008-08-03T17:29:24+09:00

Q: What is "Valvular Heart Disease"?

Valvular Heart Disease (VHD) is the disease where mitral valve, aortic valve, and/or tricuspid valve (occasionally pulmonary valve) is broken.
VHD has 2 types of diseases: insufficiency or regurgitation (leak) where blood goes backward through the valve, and stenosis where valve orifice becomes narrow and hard for blood to go through it. In either case, some part of the heart (e.g., left ventricle, left atrium, right ventricle, or right atrium) suffers from burden.

Q: What are causes of valvular heart disease? What type of causion we have to have?

In VHD, rheumatic one used to be dominant. Recently, we see more and more atherosclerotic or degenerative (i.e., aging). Also we see more infectious endocarditis (IE, a disease where bacteria grows on/around the valve and destroy it). In total, the incidence of VHD is increasing.

When a VHD is mild, oral medication and/or controlling the degree of excersise is enough to keep the heart and general condition in a good shape. But, once the VHD becomes bad enough to give a burden to the heart, in many cases operation is recommended to stop progression of the disease and secondary problems. In some cases, by the time when a patient has an obvious symptoms, the heart becomes damaged badly. It is beneficial to consult specialists of the heart at earlier stage.
In infectious endocarditis (IE), bacteria often move from the valve/heart and go to brain or other important organs, causing emboli and damage to the organs. In such cases, early sutgery is necessary, since otherwise the patient may suffer from cerebral embolism (i.e., stroke) or other organ damage which may become serious or even fatal. After myocardial infarction, mitral valve often develop leaking (i.e., ischemic mitral regurgitation) and it is increasing in number.

Q: What types of surgery are there for VHD?

In surgery for VHD, valve repair or plasty fixes the diseased valve, and valve replacement eventually replace the diseased valve by artificial one. We try to repair the valve as much as possible since it is more natural and its results more favorable for patients. Patients who have mechanical valve (i.e., metal valve) have to take Warfarin (Coumadin, the blood thinner) for life which prevents thrombi formation. Warfarin is an excellent drug when used properly. But, if it is taken in a wrong way, it becomes dangerous drug. Another problem is Warfarin occasionally causes problems such as cerebral bleeding (brain hemorrhage) even though a patient takes it properly.?