Kagoshima University · Graduate School of Medical and Dental Sciences

Research keywordsPediatric cardiac surgery・Fontan circulation・Surgical site infection・Congenital heart disease・Pediatric cardiorenal interactions

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• Takahashi Y., Ueno K., Shiokawa N., Nakae K., Kawamura J., Morita Y., Hazeki D., Okamoto Y. . Successful coil embolization for pediatric internal mammary artery aneurysm after the Fontan proce2022 · 記述言語： 日本語 出版者・発行元： Journal of Cardiology Cases We herein describe the first pediatric case of an internal mammary artery (IMA) aneurysm caused by a median sternotomy. He was a 2-year-old with tricuspid atresia who underwent an extracardiac conduit Fontan procedure. On the 36th postoperative day, an asymptomatic left IMA aneurysm was detected via contrast computed tomography, which was successfully treated with coil embolization. The patient had no underlying disease such as vasculitis, connective tissue disease, or other hereditary diseases, and there were no episodes of infection or hypertension before or after the onset of the IMA aneurysm. Because the left IMA ran medially to the periphery and was in a vulnerable position during median sternotomy, we considered the IMA aneurysm was caused by the median sternotomy. We pediatric cardiologists should be aware that IMA aneurysms can occur in pediatric cardiac surgery, and we should be proactive in performing postoperative imaging studies in cases where the preoperative internal thoracic artery runs medially toward the periphery. Learning objective: Internal mammary artery (IMA) aneurysm is a rare vascular disease, especially in children. One-third of adult IMA aneurysms have been reported to be caused by sternotomy, but not in children. We report the first pediatric case of an IMA aneurysm caused by sternotomy. We should recognize that there is a potential risk of IMA aneurysms in pediatric cardiac surgery as well. DOI： 10.1016/j.jccase.2022.05.016 Scopus PubMed
• Takahashi Yoshihiro, Ueno Kentaro, Shiokawa Naohiro, Nakae Koji, Kawamura Junpei, Morita Yasuko, Hazeki Daisuke, Okamoto Yasuhiro2022 · 記述言語： 英語 出版者・発行元： (一社)日本心臓病学会
• Takahashi Y., Ueno K., Nakae K., Kawamura J., Matsuba T., Okamoto Y. . Preoperative and Intraoperative Risk Factors for Surgical Site Infection in Pediatric Cardiac Surgery . Pediatric2011 · 記述言語： 日本語 出版者・発行元： Pediatric Infectious Disease Journal Background: Surgical site infection (SSI) is a major complication of pediatric cardiac surgery. If the risk of developing SSI can be predicted based on the patient's preoperative background, appropriate preoperative management to prevent the development of SSI can be achieved. Methods: We retrospectively studied cases for patients younger than 7 years of age among surgeries performed through a median sternotomy at Kagoshima University Hospital from April 2011 to March 2021. SSI was diagnosed according to the Centers for Disease Control and Prevention guidelines and classified into 3 types: superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI) and mediastinitis. Results: Of the 765 consecutive pediatric cardiac surgeries, 597 were included in the analysis based on the exclusion criteria. Of these, 17 (2.8%) developed SSI (3 SiSSI cases, 2 DiSSI cases and 12 mediastinitis cases), with Staphylococcus aureus as the major pathogen. Univariate analysis revealed that low preoperative serum protein (P = 0.049) and low serum albumin levels (P = 0.023) were risk factors for the development of SSI. No findings suggested impaired hepatic synthesis, inflammatory disease or protein loss from the kidney or intestinal tract. We concluded that malnutrition caused low serum protein and albumin levels. Conclusions: Low preoperative serum protein and albumin levels are risk factors for SSI development of SSI. Nutritional status should be regularly assessed in children scheduled for cardiac surgery, and interventions, such as nutritional guidance, should be considered if malnutrition is suspected. DOI： 10.1097/INF.0000000000004039 Scopus PubMed
• Ueno K., Shimozono T., Takahashi Y., Nakae K., Kawamura J., Okamoto Y. . Association of albuminuria with kidney function and hemodynamic disturbance in pre-school children who undergo congenit2011 · 記述言語： 日本語 出版者・発行元： Pediatric Nephrology Background: We validated the prevalence of albuminuria and its association with kidney function and hemodynamics in pre-school children who underwent surgery for congenital heart disease (CHD). Methods: From 403 patients who had undergone surgery for CHD at least 6 months before pre-school and were admitted to our hospital between 2011 and 2015, 75 who underwent blood and urine tests and cardiac catheterization were included in this study. The urinary albumin-to-creatinine ratio (ACR) was quantified, and the relationship of ACR with physical and laboratory findings and hemodynamics assessed using cardiac catheterization was analyzed. Results: The study cohort was divided into three groups: Fontan group (n = 25), tetralogy of Fallot (TOF) group (n = 18), and control group (other biventricular CHDs; n = 32). The median age of patients was 5.9 years. ACR was higher in the Fontan group than in the TOF and control groups (median: 15.0 vs. 5.0 and 0.0 mg/g, p < 0.001). Moreover, albuminuria (ACR > 30 mg/g) was observed in 20.0% of Fontan patients, while ACR was associated with potential complicating factors of Fontan circulation: high central venous pressure, high mean pulmonary artery pressure, and worse than moderate atrioventricular regurgitation. ACR showed a moderate correlation with the cystatin C-based estimated glomerular filtration rate (r = − 0.725, p < 0.001). Conclusions: Measurement of albuminuria in Fontan patients before they join elementary school is useful because it reflects kidney function and hemodynamic factors that can worsen their condition. Identification and management of patients with albuminuria may facilitate early therapeutic intervention for worsening Fontan factors, eventually delaying the deterioration of kidney function. Graphical abstract: [Figure not available: see fulltext.]. DOI： 10.1007/s00467-023-06130-6 Scopus PubMed

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