Toshinobu Kazui

Interests

Teaching

Teaching surgical skills,Surgical judgement during surgery,Current topic of surgical management of patients

Research

Assess cardiac function (left and right ventricle also left and right atrial function) under atrial fibrillation, pre and post LVAD implantApplying medical imaging technologies (echo, CT scan) to cardiac surgical treatment (LVAD pump thrombosis and surgical technique, cardiac function after mitral valve repair)Clinical outcome analysisDeveloping medical equipment and devicesApplication of new technologies to surgical treatment

Courses

Scholarly Contributions

Chapters

• Kazui, T., Pilikian, T., Lagrand, D., Smith, R., Yacoub, M., & Khalpey, Z. (2015). The translational pathway. In Mechanical Circulatory Support. International Society for Cardiovascular Translational Research, Part II, II.9.
• Kazui, T., & Itoh, A. (2014). Cannulation strategy for VA ECMO. In Emergency and Intensive Care Medicine. December 2014: Emergency and Intensive Care Medicine.

Journals/Publications

• Cosgrove, R. H., Basken, R. L., Smith, R. G., Hsu, C. H., Kazui, T., Martinez, B. K., Burt, R. W., Crawford, E. S., Lick, S. D., & Khalpey, Z. (2018). Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients. ASAIO journal (American Society for Artificial Internal Organs : 1992).
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  Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure. Enoxaparin 0.5 mg/kg SC q12hrs or fondaparinux 2.5-5 mg SC daily were compared with an initial UFH rate of 5 units/kg/hr and titrated to stated n-TEG goal range. The anticoagulant groups UFH, enoxaparin, and fondaparinux were found to be statistically similar with regard to frequency in n-TEG goal range, above range (hypercoagulability), or below range (hypocoagulability). Clinical outcomes were similar among groups with three gastrointestinal bleeds in UFH, one in enoxaparin, and one in fondaparinux groups. Device thrombosis occurred in one UFH patient, while UFH and fondaparinux groups had one ischemic cerebrovascular accident event each. These strategies provided comparable n-TEG results and clinical outcomes when compared with intravenous UFH. Low-dose enoxaparin or fondaparinux may provide an alternative anticoagulant bridging option in MCS patients presenting with subtherapeutic INR.
• Kazui, T., Lin, T. M., & Lick, S. D. (2018). Coronary Sinus Rupture Repair: Patency Is Important. The Annals of thoracic surgery.
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  We report a case of coronary sinus (CS) injury with a retrograde cardioplegia catheter and repair compromising CS patency. This resulted in acute global cardiac dysfunction shortly after weaning from bypass, which reversed after patch repair with confirmed CS patency. The case shows that acute CS occlusion may not be tolerated in some humans.
• Avery, R., Day, K., Jokerst, C., Kazui, T., Krupinski, E., & Khalpey, Z. (2017). Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison. Journal of cardiothoracic surgery, 12(1), 89.
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  Advanced heart failure treated with a left ventricular assist device is associated with a higher risk of right heart failure. Many advanced heart failures patients are treated with an ICD, a relative contraindication to MRI, prior to assist device placement. Given this limitation, left and right ventricular function for patients with an ICD is calculated using radionuclide angiography utilizing planar multigated acquisition (MUGA) and first pass radionuclide angiography (FPRNA), respectively. Given the availability of MRI protocols that can accommodate patients with ICDs, we have correlated the findings of ventricular functional analysis using radionuclide angiography to cardiac MRI, the reference standard for ventricle function calculation, to directly correlate calculated ejection fractions between these modalities, and to also assess agreement between available echocardiographic and hemodynamic parameters of right ventricular function.
• Avery, R., Kazui, T., Krupinski, E. A., & Khalpey, Z. I. (2017). Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison. J Cardiothorac Surg, 10(12), 89.
• Ferng, A., Connell, A., Nunez, M., Johnson, K., Braunhut, B., Lick, S., Desai, A., Kazui, T., Runyan, R., & Khalpey, Z. (2017). Cardiac Regeneration in the Human Left Ventricle After CorMatrix Implantation. The Annals of thoracic surgery, 104(3), e239-e241.
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  CorMatrix is an organic extracellular matrix (ECM) derived from porcine small intestine submucosa and is used for pericardial closure and cardiac tissue repair. During explantation of a HeartMate II (Thoratec Corp, Pleasanton, CA) left ventricular assist device (LVAD) because of infection, CorMatrix was used to repair the left ventricular apex and aorta. Three months later, a HeartWare HVAD (HeartWare International, Inc, Framingham, MA) was implanted for recurrent heart failure. Excised apical CorMatrix samples showed cardiac tissue remodeling with viable cardiomyoblasts similar to native myocardium. Excised CorMatrix from the aorta showed organization of collagen and elastin similar to native aortic tissue.
• Kazui, T., Khalpey, Z. I., Konhilas, J. P., Runyan, R. B., Runyan, R. B., Konhilas, J. P., Khalpey, Z. I., & Kazui, T. (2017). A dual therapy of off-pump temporary left ventricular extracorporeal device and amniotic stem cell for cardiogenic shock. J Cardiothorac Surg, 7(12), 80.
• Kazui, T., Tran, P. L., Pilikian, T. R., Marsh, K. M., Runyan, R., Konhilas, J., Smith, R., & Khalpey, Z. I. (2017). A dual therapy of off-pump temporary left ventricular extracorporeal device and amniotic stem cell for cardiogenic shock. Journal of cardiothoracic surgery, 12(1), 80.
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  Temporary mechanical circulatory support device without sternotomy has been highly advocated for severe cardiogenic shock patient but little is known when coupled with amniotic stem cell therapy.
• Khalpey, Z., Rawashdeh, B., Kazui, T., & Lick, S. (2017). Bileaflet Foldoplasty in Barlow’s Disease. The Journal of heart valve disease, 26(3), 355-357.
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  Mitral valve repair is a feasible and preferable option for the treatment of Barlow's disease. Complex valve repair techniques, in contrast, often lead to increased cross-clamp times and low cardiac output syndrome. A simple, fast, and reproducible foldoplasty technique to reduce anterior and posterior mitral leaflet heights may improve coaptation and reduce mitral regurgitation. Accordingly, herein are described minimally invasive, successful trans-septal and robotic approaches for a bileaflet foldoplasty technique in two patients with Barlow's disease.
• Natt, B., Hypes, C., Basekn, R., Malo, J., Kazui, T., & Mosier, J. M. (2017). The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. Journal of Extra Corporeal Technology, 49(1), 54-58.
• Natt, B., Hypes, C., Basken, R., Malo, J., Kazui, T., & Mosier, J. (2017). Suspected Heparin-Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation. The journal of extra-corporeal technology, 49(1), 54-58.
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  Heparin-induced thrombocytopenia (HIT) is an immune reaction usually secondary to unfractionated heparin. Anticoagulation management is critical in patients while on extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and for the optimal functioning of the circuit. We identified five patients with respiratory failure at our hospital managed with ECMO in the last 2 years that were treated for HIT. A brief clinical course and their management are discussed. We also briefly review the literature for best evidence for management of such patients.
• Natt, B., Knepler, J., Kazui, T., & Mosier, J. M. (2017). The Use of Extracorporeal Membrane Oxygenation in the Bronchoscopic Management of Critical Upper Airway Obstruction. Journal of bronchology & interventional pulmonology, 24(1), e12-e14.
• Schipper, D. A., Palsma, R., Marsh, K. M., O'Hare, C., Dicken, D. S., Lick, S., Kazui, T., Johnson, K., Smolenski, R. T., Duncker, D. J., & Khalpey, Z. (2017). Chronic Myocardial Ischemia Leads to Loss of Maximal Oxygen Consumption and Complex I Dysfunction. The Annals of thoracic surgery, 104(4), 1298-1304.
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  Cardiomyocytes rely heavily on mitochondrial energy production through oxidative phosphorylation. Chronic myocardial ischemia may cause mitochondrial dysfunction and affect ATP formation. Metabolic changes due to ischemia alters cardiac bioenergetics and hence myocardial function and overall bioenergetic state. Here, we evaluate differences in functional status of respiratory complexes in mitochondrial isolates extracted from left atrial appendage tissue (LAA) from patients undergoing cardiac surgery, with and without chronic ischemia.
• Watanabe, Y., Schill, M. R., Kazui, T., Melby, S. J., Schuessler, R. B., & Damiano, R. J. (2017). Strategies to Improve the Efficacy of Epicardial Linear Ablation on the Beating Heart. Innovations (Philadelphia, Pa.), 11(6), 414-419.
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  Creating transmural linear lesions on the beating heart is an important component of minimally invasive surgical ablation for atrial fibrillation. Animal studies have shown poor efficacy for surface bipolar radiofrequency ablation (RFA). Clinicians have developed strategies including multiple device applications and vena caval occlusion (VCO) to improve ablation efficacy. These techniques were evaluated in an acute porcine model.
• Iwanski, J., Kazui, T., Le Tran, P., Basken, R., Wong, R. K., & Khalpey, Z. (2016). Novel method using rotational thromboelastography analysis for intraoperative management of device patient with heparin-induced thrombocytopenia. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.
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  Heparin-induced thrombocytopenia (HIT) is a prothrombotic disease in response to previous heparin exposure. Direct thrombin inhibitors are suitable candidates for the prophylaxis of thrombosis in patients with HIT. Currently activated clotting time and activated partial thromboplastin time are used to guide dosing and monitor anticoagulation. These assays provide a measure of clot initiation and only account for a small fraction of the coagulation pathway. In this case study we performed rotational thromboelastography (ROTEM) analysis on a patient with HIT implanted with a continuous-flow CentriMag device for left ventricular support. ROTEM evaluation confirmed a decline in activated clotting time values and provided information regarding intrinsic and extrinsic clotting times. Monitoring ROTEM parameters aided in the detection of coagulopathies and the decision to administer platelet or fresh frozen plasma products. Utilizing ROTEM can guide clinical decisions in transfusions, particularly in patients with HIT, where platelet and fibrinogen levels can be safely maintained to prevent thrombosis.
• Iwanski, J., Tran, P. L., Jerman, C., Smith, R., Kazui, T., & Khalpey, Z. (2016). Off-pump left ventricular assist device exchange via re-do left mini-thoracotomy with original outflow graft preservation. Perfusion.
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  Complications associated with long-term left ventricular assist device (LVAD) use may require pump exchange due to device thrombosis or thromboembolism. Minimally invasive off-pump procedures represent an advantageous alternative to standard full sternotomy exchanges and those performed with the use of cardiopulmonary bypass. By mitigating surgical invasion and trauma to the central chest, the potential for post-operative bleeding, transfusions and complications can be reduced. This case report describes the successful off-pump exchange of a HeartWare LVAD via left re-do-thoracotomy with the re-use of the original outflow graft.
• Kazui, T. (2016). A comparison of right ventricular function calculated by first-pass radionuclide angiography and cardiac magnetic resonance for ventricular assist device pre-procedural planning.. Zenodo.
• Kazui, T. (2016). Novel hybrid therapy: Stem cell liquid matrix and negative pressure therapy promote sternal wound healing. EC Microbiology.
• Kazui, T., Itoh, A., & Silvestry, S. C. (2016). Abdominal wall perforation caused by left ventricular assist device driveline insertion: Potential lethal complication. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 35(3), 394-5.
• Kazui, T., Nicole, S., Friedman, M., Kim, S. S., Lick, S., & Khalpey, Z. I. (2016). A modified Park's stitch to correct aortic insufficiency for bioprosthetic valve at time of left ventricular assist device implant: a case report.. Journal of Cardiothoracic Surgery, 11(1), 161.
• Kazui, T., Sydow, N., Friedman, M., Kim, S., Lick, S., & Khalpey, Z. (2016). A modified Park's stitch to correct aortic insufficiency for bioprosthetic valve at time of left ventricular assist device implant: a case report. Journal of cardiothoracic surgery, 11(1), 161.
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  Aortic valve insufficiency (AI) at the time of left ventricular assist device (LVAD) insertion needs to be corrected, however there is little known about how to manage bioprosthetic valvular AI.
• Kazui, T., Tran, P. L., Echeverria, A., Jerman, C. F., Iwanski, J., Kim, S. S., Smith, R. G., & Khalpey, Z. I. (2016). Minimally invasive approach for percutaneous CentriMag right ventricular assist device support using a single PROTEKDuo Cannula. Journal of cardiothoracic surgery, 11(1), 123.
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  Right ventricular failure is a serious complication after left ventricular assist device placement.
• Kazui, T., Zhang, A., Greenberg, J., Itoh, A., Tran, P. L., Keith, A. D., Ewald, G. A., Damiano, R. J., & Silvestry, S. C. (2016). Left Ventricular Assist Device Inflow Angle and Pump Positional Change Over Time Adverse Impact on Left Ventricular Assist Device Function. The Annals of thoracic surgery.
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  This study investigates the impact of left ventricular assist device (LVAD) inflow cannula angulation, pump positional change over time, and the incidence of thrombotic pump dysfunction in a large cohort of HeartMate II (HM2) patients.
• Khalpey, Z., Kazui, T., Ferng, A. S., Connell, A., Tran, P. L., Meyer, M., Rawashdeh, B., Smith, R. G., Sweitzer, N. K., Friedman, M., Lick, S., Slepian, M. J., & Copeland, J. G. (2016). First North American 50 cc Total Artificial Heart Experience: Conversion from a 70 cc Total Artificial Heart. ASAIO journal (American Society for Artificial Internal Organs : 1992), 62(5), e43-5.
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  The 70 cc total artificial heart (TAH) has been utilized as bridge to transplant (BTT) for biventricular failure. However, the utilization of 70 cc TAH has been limited to large patients for the low output from the pulmonary as well as systemic vein compression after chest closure. Therefore, the 50 cc TAH was developed by SynCardia (Tucson, AZ) to accommodate smaller chest cavity. We report the first TAH exchange from a 70 to 50 cc due to a fit difficulty. The patient failed to be closed with a 70 cc TAH, although the patient met the conventional 70 cc TAH fit criteria. We successfully closed the chest with a 50 cc TAH.
• Khalpey, Z., Smith, R., Echeverria, A., le Tran, P., & Kazui, T. (2016). A novel minimally invasive off-pump biventricular assist device insertion technique. The Journal of thoracic and cardiovascular surgery, 151(1), e5-7.
• Lick, S. D., Tran, P. L., Kazui, T., Smith, R. G., & Khalpey, Z. I. (2016). Total Artificial Heart, Augmented by Veno-Venous Extracorporeal Membrane Oxygenation. ASAIO journal (American Society for Artificial Internal Organs : 1992).
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  Shortly after SynCardia Total Artificial Heart (TAH) implant, veno-venous extra-corporeal membrane oxygenation (ECMO) via a 31-French Avalon cannula was used for profound hypoxic lung dysfunction. Immediately after starting ECMO, TAH flow increased by 1.5-2.0 liters/minute, presumably due to augmented TAH filling by the ECMO jet.
• Saint, L. L., Lawrance, C. P., Okada, S., Kazui, T., Robertson, J. O., Schuessler, R. B., & Damiano, R. J. (2016). Performance of a novel bipolar/monopolar radiofrequency ablation device on the beating heart in an acute porcine model. Innovations (Philadelphia, Pa.), 8(4), 276-83.
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  Although the advent of ablation technology has simplified and shortened surgery for atrial fibrillation, only bipolar clamps have reliably been able to create transmural lesions on the beating heart. Currently, there are no devices capable of reproducibly creating the long linear lesions in the right and left atria needed to perform a Cox-Maze procedure. This study evaluated the performance of a novel suction-assisted radiofrequency device that uses both bipolar and monopolar energy to create lesions from an epicardial approach on the beating heart.
• Kazui, T., Henn, M. C., Watanabe, Y., Kovács, S. J., Lawrance, C. P., Greenberg, J. W., Moon, M., Schuessler, R. B., & Damiano, R. J. (2015). The impact of 6 weeks of atrial fibrillation on left atrial and ventricular structure and function. The Journal of thoracic and cardiovascular surgery, 150(6), 1602-1608.e1.
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  The impact of prolonged episodes of atrial fibrillation on atrial and ventricular function has been incompletely characterized. The purpose of this study was to investigate the influence of atrial fibrillation on left atrial and ventricular function in a rapid paced porcine model of atrial fibrillation.
• Kazui, T., Henn, M., Watanabe, Y., Kovacs, S., Lawrance, C., Greenberg, J., Moon, M., Schussler, R., & Damiano, R. (2015). The impact of six weeks of atrial fibrillation on left atrial and ventricular structure and function.. J Thorac Cardiovasc Surg.
• Kazui, T., Khalpey, Z., Smith, R., Echeverria, A., & Tran, P. L. (2015). A novel minimally invasive off-pump biventricular assist device insertion technique.. J Thorac Cardiovasc Surg.
• Kazui, T., Tran, P. L., Perovic, V., Mikail, P., Smith, R., Wong, R., Slepian, M., & Khalpey, Z. I. (2015). Case report: Inaccurate HeartMatell Left Ventricular Assist Device Flow in the Patient with Extensive Ventricles Repair. The American Academy of Cardiovascular Perfusion.
• Saint, L. L., Lawrance, C. P., Okada, S., Kazui, T., Robertson, J. O., Schuessler, R. B., & Damiano, R. J. (2015). Performance of a novel bipolar/monopolar radiofrequency ablation device on the beating heart in an acute porcine model. Innovations (Philadelphia, Pa.), 8(4), 276-83.
  More info

  Although the advent of ablation technology has simplified and shortened surgery for atrial fibrillation, only bipolar clamps have reliably been able to create transmural lesions on the beating heart. Currently, there are no devices capable of reproducibly creating the long linear lesions in the right and left atria needed to perform a Cox-Maze procedure. This study evaluated the performance of a novel suction-assisted radiofrequency device that uses both bipolar and monopolar energy to create lesions from an epicardial approach on the beating heart.
• Tran, P. L., Kazui, T., Perovic, V., Mikail, P., Lick, S., Smith, R., Betterton, E. W., Venkat, R., Iwanski, J., Wong, R. K., Slepian, M. J., & Khalpey, Z. (2015). Case Report: Disparate flow in HeartMate II patient with extensive left ventricle repair. Perfusion.
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  This case study reports the operative management of a 63-year-old male patient following implantation of the HeartMate II (HMII) left ventricular assist device (LVAD), with a non-compliant left ventricle (LV) and a reduced right ventricular (RV) end-diastolic volume. Intraoperatively, the patient had a thin, fragile LV wall with laminated clot; a ventricular septal defect was encountered during removal of the clot. Along with an aortic valve repair, the LV and the septum were reconstructed with multiple bovine pericardium patches, thus, moderately reducing the RV and LV stroke volume. A difference in cardiac output via a Swan-Ganz catheter (approximately 1.5 l/min) was observed as opposed to the HMII's estimated flow. The result was later replicated and verified in vitro via the Donovan Mock Circulation System (DMCS), where about 2 l/min lower flow on the HMII system was observed. In conclusion, the HMII flow rate displayed can be inaccurate and should only be used for trending.
• Tran, P. L., Pietropaolo, M., Valerio, L., Brengle, W., Wong, R. K., Kazui, T., Khalpey, Z. I., Redaelli, A., Sheriff, J., Bluestein, D., & Slepian, M. J. (2015). Hemolysate-mediated platelet aggregation: an additional risk mechanism contributing to thrombosis of continuous flow ventricular assist devices. Perfusion.
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  Despite the clinical success and growth in the utilization of continuous flow ventricular assist devices (cfVADs) for the treatment of advanced heart failure, hemolysis and thrombosis remain major limitations. Inadequate and/or ineffective anticoagulation regimens, combined with high pump speed and non-physiological flow patterns, can result in hemolysis which often is accompanied by pump thrombosis. An unexpected increase in cfVADs thrombosis was reported by multiple major VAD implanting centers in 2014, highlighting the association of hemolysis and a rise in lactate dehydrogenase (LDH) presaging thrombotic events. It is well established that thrombotic complications arise from the abnormal shear stresses generated by cfVADs. What remains unknown is the link between cfVAD-associated hemolysis and pump thrombosis. Can hemolysis of red blood cells (RBCs) contribute to platelet aggregation, thereby, facilitating prothrombotic complications in cfVADs? Herein, we examine the effect of RBC-hemolysate and selected major constituents, i.e., lactate dehydrogenase (LDH) and plasma free hemoglobin (pHb) on platelet aggregation, utilizing electrical resistance aggregometry. Our hypothesis is that elements of RBCs, released as a result of shear-mediated hemolysis, will contribute to platelet aggregation. We show that RBC hemolysate and pHb, but not LDH, are direct contributors to platelet aggregation, posing an additional risk mechanism for cfVAD thrombosis.
• Tran, P., Kazui, T., Pervic, V., Mikail, P., Lick, S., Smith, R., Betterton, E., Venkat, R., Iwanski, J., Wong, R., Slepian, M., & Khalpey, Z. (2015). Case Report: Disparate flow in HeartMate II patient with extensive left ventricular repair.. Perfusion.
• Watanabe, Y., Schill, M. R., Kazui, T., Melby, S. J., Schuessler, R. B., & Damiano, R. J. (2015). Strategies to Improve the Efficacy of Epicardial Linear Ablation on the Beating Heart. Innovations (Philadelphia, Pa.), 11(6), 414-419.
  More info

  Creating transmural linear lesions on the beating heart is an important component of minimally invasive surgical ablation for atrial fibrillation. Animal studies have shown poor efficacy for surface bipolar radiofrequency ablation (RFA). Clinicians have developed strategies including multiple device applications and vena caval occlusion (VCO) to improve ablation efficacy. These techniques were evaluated in an acute porcine model.
• Watanabe, Y., Weimar, T., Kazui, T., Lee, U., Schuessler, R. B., & Damiano, R. J. (2014). Epicardial ablation performance of a novel radiofrequency device on the beating heart in pigs. The Annals of thoracic surgery, 97(2), 673-8.
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  Only bipolar clamps create reliable transmural lesions on the beating heart. This study evaluated the performance of a new radiofrequency (RF) device on the beating heart in an acute porcine model.
• Weimar, T., Watanabe, Y., Kazui, T., Lee, U. S., Montecalvo, A., Schuessler, R. B., & Moon, M. R. (2013). Impact of differential right-to-left shunting on systemic perfusion in pulmonary arterial hypertension. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 81(5), 888-95.
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  This study aimed at identifying the ideal right-to-left shunt-fraction to improve cardiac output (CO) and systemic perfusion in pulmonary arterial hypertension (PHT).
• Weimar, T., Watanabe, Y., Kazui, T., Lee, U. S., Moon, M. R., Schuessler, R. B., & Damiano, R. J. (2012). Differential impact of short periods of rapid atrial pacing on left and right atrial mechanical function. American journal of physiology. Heart and circulatory physiology, 302(12), H2583-91.
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  Current techniques to describe atrial function are limited by their load dependency and hence do not accurately reflect intrinsic mechanical properties. To assess the impact of atrial fibrillation on atrial function, combined pressure-volume relationships (PVR) measured by conductance catheters were used to evaluate the right (RA) and left (LA) atrium in 12 isoflurane-anesthetized pigs. Biatrial PVR were recorded over a wide range of volumes during transient caval occlusion at baseline sinus rhythm (SR), after onset of rapid atrial pacing (RAP), after 1 h of RAP, after conversion to SR, and after 1 h of recovery. Cardiac output decreased by 16% (P = 0.008) with onset of RAP. Mean LA and RA pressures increased by 21 and 40% (P < 0.001), respectively, and remained elevated during the entire recovery period. RA reservoir function increased from 51 to 58% and significantly dropped to 43% after resumption of SR (P = 0.017). Immediately after RAP, a right shift of LA end-systolic PVR-intercept for end-systolic volume required to generate an atrial end-systolic pressure of 10 mmHg (24.4 ± 4.9 to 28.1 ± 5.2 ml, P = 0.005) indicated impaired contractility compared with baseline. Active LA emptying fraction dropped from 17.6 ± 7.5 to 11.7 ± 3.7% (P < 0.001), LA stroke volume and ΔP/Δt(max)/P declined by 22% (P = 0.038 and 0.026, respectively), while there was only a trend to impaired RA systolic function. Stiffness quantified by the ratio of pressure to volume at end-diastole was increased immediately after RAP only in the RA (P = 0.020), but end-diastolic PVR shifted rightward in both atria (P = 0.011 LA, P = 0.045 RA). These data suggest that even short periods of RAP have a differential impact on RA and LA function, which was sustained for 1 h after conversion to SR.
• Kazui, T., Niinuma, H., Tsuboi, J., & Okabayashi, H. (2011). Changes in left ventricular twist after mitral valve repair. The Journal of thoracic and cardiovascular surgery, 141(3), 716-24.
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  We performed echocardiographic tissue tracking to investigate whether mitral valve repair preserves left ventricular function.
• Yamasaki, M., Watanabe, S., Abe, K., Kazui, T., & Kawazoe, K. (2011). A staged total aortic replacement with combined endovascular and open surgery: report of a case. Annals of vascular diseases, 4(4), 340-3.
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  For a 75 year-old man with extensive aortic aneurysm, who had undergone a previous infra-renal abdominal Y-graft, a staged replacement of remaining segments was performed. A hybrid procedure of open-laparotomy debranching of visceral branches and endovascular stentgraft insertion in the thoracoabdominal aorta was performed first, followed by subsequent direct replacement between the proximal ascending and distal arch using cardiopulmonary bypass. Three months thereafter dissection of enlarged proximal descending aorta occurred, for which we performed an emergent endovascular stentgraft deployment which bridged "elephant trunk" of the arch graft and the previous stentgraft. Consequently total aortic replacement was successfully accomplished without any neurological sequela.
• Kazui, T., Kin, H., Tsuboi, J., Yoshioka, K., Okabayashi, H., & Kawazoe, K. (2008). Perioperative dynamic morphological changes of the aortic annulus during aortic root remodeling with aortic annuloplasty at systolic and diastolic phases. The Journal of heart valve disease, 17(4), 366-70.
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  The study aim was to determine the three-dimensional motion of the semilunar attachment of leaflets (annulus) and the aortic root in annuloaortic ectasia with aortic insufficiency (AI).
• Nakajima, T., Kawazoe, K., Kataoka, T., Kin, H., Kazui, T., Okabayashi, H., & Niinuma, H. (2007). Midterm results of aortic repair using a fabric neomedia and fibrin glue for type A acute aortic dissection. The Annals of thoracic surgery, 83(5), 1615-20.
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  Controversy exists concerning the optimal surgical treatment of acute type A aortic dissection to reduce mortality rate and the need for reoperation. The goal of the present study was to evaluate midterm results of repair using a fabric and fibrin glue for acute type A aortic dissection.
• Izumoto, H., Kawazoe, K., Oka, T., Kazui, T., Kawase, T., & Nasu, M. (2006). Aortic valve repair for aortic regurgitation: intermediate-term results in patients with tricuspid morphology. The Journal of heart valve disease, 15(2), 169-73; discussion 173.
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  Surgical results after aortic valve repair in patients with aortic regurgitation (AR) of tricuspid valve morphology and with no evidence of aortic root disease have not yet been clarified.
• Kazui, T., Doi, H., Suzuki, M., Okamoto, T., Koshima, R., Sugiki, K., & Ohno, T. (2006). Initial clinical experience with the Heartstring. The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai zasshi, 54(10), 424-8.
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  The Heartstring is one of the devices that enable proximal anastomosis without clamping the aorta. We have applied the device not only to low-risk patients with normal aortas but also to high-risk patients with diseased aortas. The purpose of this study was to investigate the initial outcomes of using this device.
• Kazui, T., Izumoto, H., Yoshioka, K., & Kawazoe, K. (2006). Dynamic morphologic changes in the normal aortic annulus during systole and diastole. The Journal of heart valve disease, 15(5), 617-21.
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  The three-dimensional motion of semilunar attachment of the leaflet 'annulus' remains obscure. It has been suggested that the aortic root is distensible and moves during the cardiac cycle. In the present study, the aortic root was evaluated using two dimensions. The aortic root, notably motion of the aortic annulus, was evaluated using multidetector computed tomography (MDCT), and a three-dimensional reconstruction of the aortic annulus was performed.
• Nakajima, T., Kawazoe, K., Izumoto, H., Kataoka, T., & Kazui, T. (2005). Effective use of fibrin glue for acute aortic dissection. The Annals of thoracic surgery, 79(5), 1793-4.
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  The use of gelatin-resorcine-formalin (GRF) glue for reconstruction of the vascular wall in the context of acute aortic dissection has become more common. However, anecdotal evidence suggests that use of the GRF glue results in higher rates of postoperative redissection. We describe an alternative method of reinforcing the dissected aorta with fibrin glue that may avoid this complication. A fabric sheet is presoaked in fibrinogen solution and then placed within the false lumen. Thrombin solution is then applied to the fabric sheet. That results in obliteration of the false lumen and effective reinforcement of the dissected wall.
• Kazui, T., Izumoto, H., Nasu, M., & Kawazoe, K. (2004). Perioperative changes in dynamic aortic root morphology after Yacoub's root remodeling and concomitant aortic annuloplasty. Interactive cardiovascular and thoracic surgery, 3(3), 465-9.
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  We have performed aortic root remodeling concomitant with aortic annuloplasty (subvalvular circular annuloplasty: it tightens the aortic annulus, using Gore-Tex strip (N.L. Gore and Associates, Arizona, USA)) in patients with AAE and AR. We examined morphologic changes in the aortic root during cardiac cycles, using pre- and post-operative echocardiography. Twelve patients were underwent the procedure. Their grade of AR was 3.2+/-1.0. Five adults with normal aortic roots were studied as controls. The systolic and diastolic radius of each cusp was measured at the annulus, the Valsalva and the STjunction level. The ratio of diastolic radius to systolic radius in the control, pre-operative data and post-operative data was obtained. In the controls, the rate of diameter change during the cardiac cycle was largest at the annulus level (Right coronary cusp (RCC), Left coronary cusp (RCC), Noncoronary cusp (NCC); 1.00+/-0.2, 1.12+/-0.1, 1.23+/-0.2), second largest at Valsalva level (RCC, LCC, NCC; 0.96+/-0.6, 1.07+/-0.2, 0.97+/-0.2), and smallest at the ST junction (RCC, LCC, NCC; 0.95+/-0.4, 1.03+/-0.2, 0.93+/-0.2). Pre-operative data showed that it was largest at the Valsalva level. Post-operative data showed that the rate of change at each level was not significantly different from the control data. All patients were in NYHA class I and the grade of AR was 0.4+/-0.7 at the latest follow-up. Subvalvular circular annuloplasty did not interfere with annulus motion during the cardiac cycle. Aortic root remodeling and concomitant aortic annuloplasty restored near normal cyclic aortic root motion and morphology on the short-term.
• Kazui, T., Kin, H., Izumoto, H., Nakajima, T., Ishihara, K., & Kawazoe, K. (2003). Combined aortic and mitral valve repair. Asian cardiovascular & thoracic annals, 11(4), 319-22.
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  Six patients, median age 63.3 years (range, 54 to 68 years), underwent concomitant mitral and aortic valve repair from January 2000 to August 2001. Surgical reports and general clinical data were reviewed retrospectively. All patients had degenerative valvular disease, although one patient also had annuloaortic ectasia. There were no surgical complications. The 30 day survival rate was 100%, and the New York Heart Association classification score improved from 2.2 (range, 1 to 2) preoperative, to 1.0 (all patients) postoperatively (p = 0.03) As measured by intraoperative transesophageal echocardiography, the left ventricular end-diastolic diameter decreased from 6.0 cm (range, 5.4 to 6.3 cm) to 4.7 cm (range, 4.0 to 5.2 cm) and the left ventricular end-systolic diameter decreased from 3.7 cm (range, 3.4 to 4.1cm) to 3.1 cm (range, 2.9 to 3.7 cm). No patient developed endocarditis, thromboembolism or hemorrhage. There was no valve related morbidity during a 1 year follow up. Double valve repair is an acceptable alternative to valve replacement in selected patients with some types of valvular disease. Longer term follow up with greater numbers of patients is needed.
• Kazui, T., Koizumi, J., Kataoka, T., Okada, O., Mukaida, M., Kawase, T., Izumoto, H., Nakajima, T., Ishihara, K., & Kawazoe, K. (2002). [Redo coronary artery bypass grafting using the patent left internal thoracic artery graft as an in flow with composite internal thoracic artery Y grafting; report of a case]. Kyobu geka. The Japanese journal of thoracic surgery, 55(10), 891-4.
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  In redo coronary artery bypass grafting (CABG), graft selection and revascularization methods are major problems. We experienced a redo-CABG with occluded previous vein grafts. These grafts were to the circumflex artery and right coronary artery. We conducted operation using cardiopulmonary bypass. We at this operation, chose right internal thoracic artery (RITA) as a conduit and anastomosed it to the side of functioning left internal thoracic artery (LITA) graft, and then diogonal branch, posterolateral branch, and atrioventricular branch were revascularized with the RITA. Post operative course was uneventful. Internal thoracic artery (ITA) is superior to vein graft and other arterial graft as to long term patency. We believe composite Y graft with the use of bilateral ITA can be one of the revascularization strategy in redo CABG.

Presentations

• Hsu, C., Malo, J., Mosier, J. M., Natt, B., Hypes, C., Lick, S. D., & Bull, D. A. (2019, May/). Duration and Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation Support in Acute Respiratory Distress Syndrome: Results from ELSO database. American association for thoracic surgery 99th annual meeting. Toronto: American association for thoracic surgery.
• Kazui, T., Lick, S. D., Hsu, C., & Bull, D. A. (2019, January). Does use of bilateral mammary arteries increase short-term risk in diabetic patients? Results from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. 55th STS annual meeting. San Diego: STS.
• Kazui, T. (2016, April). Thromboelastographic Evidence for Reduced Dose Enoxaparin or Fondaparinux Bridge Therapy in Mechanical Circulatory Support Patients with Sub-therapeutic INR. ISHLT 36th annual meeting and Scientific Sessions. Washington, DC: International Society for Heart & Lung Transplantation (ISHLT).
• Kazui, T. (2016, June). Caval Occlusion Improves Performance of Beating Heart Epicardial Radiofrequency Ablation. ISMICS 16th Annual Scientific Meeting. Montreal Quebec, Canada: International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS).
• Kazui, T. (2016, March). Simple and Rliable Bileaflet Foldoplasty in Barlow's Disease: Report of 2 Cases. 2nd annual meeting Heart Valve Conference. New York City, NY: Heart Valve Society.
• Kazui, T. (2015, January). The benefits of learning hTEE as a CV Surgery Fellow. 51st STS annual meeting. San Diego, California: Society of Thoracic Surgeons (STS).
• Kazui, T. (2015, October). The initial experience of off pump biventricular assist device placement in acute biventricular failure. Annual meeting of the Japanese Association for Thoracic Surgery in Kobe, Japan.
• Kazui, T., Day, K., Jokerst, C., & Avery, R. (2015, November). The Total Artificial Heart: Historical Perspectives, Current Applications, Future Directions. Radiological Society of North America. Chicago, IL: Radiological Society of North America.
• Kazui, T., Slivestry, S. C., Keith, A., & Itoh, A. (2015, January). Long-Term Progression of Aortic Insufficiency Is Less in Patients Supported with HVAD LVADs Compared to HeartMate II Patients. 51st STS annual meeting. San Diego CA: Society of Thoracic Surgeons (STS).
• Kazui, T., Tran, P. L., Perovic, V., Mikail, P., Smith, R., Wong, R., Slepian, M., & Khalpey, Z. (2015, February). Case Report: Inaccurate HeartMate II Left Bentricular Assist Device Flow in the Patient with Extensive Ventricles Repair. The American Academy of Cardiovascular Perfusion. San Antonio, Texas: The American Academy of Cardiovascular Perfusion.
• Kazui, T., Watanabe, Y., Weimar, T., Lee, U., Schuessler, R. B., & Damiano, R. J. (2015, January). The Impact of Prolonged Atrial Fibrillation on Atrial and Ventricular Function in a Porcine Model. 51st STS annual meeting. San Diego, California: Society of Thoracic Surgeons (STS).
• Kazui, T., Zhang, A., Greenberg, J., Keith, A. D., Itoh, A., Ewald, G. A., Damiano, R. J., & Silvestry, S. C. (2015, January). Left Ventricular Assist Device Inflow Position and Pump Migration Adversely Impact LVAD Function. 51st STS annual meeting. San Diego, California: Society of Thoracic Surgeons (STS).
• Kevin, D., C, J., Avery, R. J., Khalpey, Z. I., Oliva, I. B., Kazui, T., & Desai, V. (2015, Novemeber). The Total Artificial Heart: Historical Perspectives, Current Applications, Future Directions. RSNA 101st Scientific Assembly and Annual Meeting. Chicago, Illinois: Radiologic Society of North America.
• Kazui, T. (2013, October). Current LVAD therapy for severe heart failure. Annual meeting of the Japanese Association for Thoracic Surgery in Sendai, Japan.
• Kazui, T. (2010, February). Surgical treatment of nonocclusive mesenteric ischemia after cardiovascular surgery. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2009, April). Short term results of atrial fibrillation surgery m;ainly using cut and sew technique. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2007, February). Aortic root morphology and aortic valve functions after aortic annuloplasty with aortic root remodeling. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2007, May). Aortic root remodeling with subvalvular circular annuloplasty: midterm results. Annual meeting of the Japanese Society of Vascular Surgery.
• Kazui, T. (2006, April). The impact of aortic annuloplasty in the aortic root remodeling. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2005, April). What type of aortic root operation do we choose?: Aortic valve sparing operation or aortic root replacement. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2004, February). Myectyomy and myotomy for HOCM. Annual meeting of the Japanese Society for Cardiovascular Surgery.
• Kazui, T. (2004, October). Effectiveness of subvalvular circular annuloplasty for the aortic root remodeling. Annual meeting of the Japanese Association for Thoracic Surgery.
• Kazui, T. (2002, October). Short term result of aortic root remodeling. Annual meeting of the Japanese Association for Thoracic Surgery.

Poster Presentations

• Kazui, T., Hsu, C., Lick, S. D., & Bull, D. A. (2019, October). Venovenous extracorporeal membrane oxygenation and risk factors for adverse outcomes in acute respiratory distress syndrome: Results from the extracorporeal life support organization database. 2nd Annual Scientific Meeting of the Japanese Association for Thoracic Surgery. Kyoto, Japan: Japanese Association for Thoracic Surgery.
• Cosgrove, R., Basken, R., Kazui, T., Smith, R., Finger, J., Lick, S. D., & Khalpey, Z. I. (2017, Oct). A “Goldilocks” experience with various enoxaparin bridge doses reflected by thromboelastogram results in total artificial heart patients. The 2017 ISMCS Conference. Tucson: ISMCS.
• Cosgrove, R., Finger, J., Kazui, T., Smith, R., Basken, R., Lick, S. D., & Khalpey, Z. I. (2017, Oct). Heparin induced thrombocytopenia in left ventricular assist device patients: Therapeutic considerations. The 2017 ISMCS Conference. Tucson: ISMCS.
• Kazui, T., Crabbe, S., Malo, J., Natt, B., Khalpey, Z., Roy-Chaudhury, A., Mosier, J., & Hypes, C. (2017, November). Duration of Mechanical Ventilation and Patient Outcomes for Extracorporeal Membrane Oxygenation. Junior Investigator Poster Forum. Tucson Arizona: College of Medicine - Tucson Founders' Week Event.
• Kazui, T., Crabbe, S., Malo, J., Natt, B., Khalpey, Z., Roy-Chaudhury, A., Mosier, J., & Hypes, C. (2017, November). Evaluation of the RESP Score for Survival Prediction in Venovenous Extracorporeal Membrane Oxygenation. Junior Investigator Poster Forum. Tucson Arizona: College of Medicine - Tucson Founders' Week Event.
• Kazui, T., Kazui, T., Lick, S. D., Lick, S. D., Avery, R., Avery, R., Juneman, E. B., Juneman, E. B., Cook, J., Cook, J., Sweitzer, N. K., Sweitzer, N. K., Khalpey, Z. I., & Khalpey, Z. I. (2017, Oct). Minimally invasive off-pump HVAD vs full sternotomy on-pump LVAD placement: comparison of clinical outcomes. The 2017 ISMCS Conference. Tucson: ISMCS.
• Kazui, T., Lick, S. D., Avery, R., Juneman, E. B., Cook, J., Sweitzer, N. K., & Khalpey, Z. I. (2017, Oct). The effectiveness of minimally invasive off pump HVAD placement in redo patients. The 2017 ISMCS Conference. Tucson: ISMCS.
• Baalachandran, R., Trutter, L., Raz, Y., Mosier, J. M., Kazui, T., & Malo, J. (2016, Spring). Successful Use of Extracorporeal Membrane Oxygenation in a Patient with Pulmonary Coccidioidomycosis-Related Acute Respiratory Distress Syndrome.. American Thoracic Society Annual Meeting. San Francisco, CA.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, August). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.
• Natt, B., Natt, B., Malo, J., Malo, J., Hypes, C., Hypes, C., Kazui, T., Kazui, T., Basken, R., Basken, R., Mosier, J. M., & Mosier, J. M. (2016, August/Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.

Case Studies

• Kazui, T., Niinuma, H., Yamasaki, M., Abe, K., Watanabe, S., & Kawazoe, K. (2012. Septal myectomy and myotomy attenuate left ventricular hyper-contractility in a child with hypertrophic obstructive cardiomyopathy(pp 162-5).
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  Septal hyper-contractility is thought to be the principal cause of significant left ventricular outflow tract obstruction (LVOT) and systolic anterior motion (SAM) of the mitral valve by making the distance between the mitral valve and papillary muscle shorter. A seven-year-old patient with severe hypertrophic obstructive cardiomyopathy underwent direct interventricular septal myectomy/myotomy using the resection/crush method to modify hyper-contractility. The procedure successfully reduced the pressure gradient from 180 mmHg to 7.6 mmHg, and systolic anterior movement of the mitral leaflet disappeared. Mitral regurgitation improved from grade 2 to grade 0. Postoperative echocardiographic vector velocity imaging (VVI) study revealed a reduced twist angle, depicting attenuated ventricular contraction power from a maximum twist 17.9° to 7.9°. Perioperative VVI revealed that interventricular septal myectomy/myotomy is useful, not only in reducing LVOT obstruction, but also in reducing hyper-contractility, which increases the distance from the mitral valve to the papillary muscle and relieves SAM.
• Kazui, T., Yamasaki, M., Abe, K., Watanabe, S., & Kawazoe, K. (2012. Non-obstructive mesenteric ischemia: a potentially lethal complication after cardiovascular surgery: report of two cases(pp 56-60).
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  We report two cases of non-obstructive mesenteric ischemia (NOMI), a rare but potentially lethal complication after cardiovascular surgery, which was successfully managed. In both cases (a 74-year-old chronic hemodialysis patient who underwent emergency aortic valve replacement and coronary artery bypass graft (CABG), and a 74-year-old patient who underwent emergency abdominal aortic aneurysm operation), NOMI occurred early postoperatively (on day 8 and 22, respectively). They suffered from severe abdominal pain, confusion, and metabolic acidosis. Contrast-enhanced multi-detector CT (MDCT) scan and subsequent selective mesenteric angiography revealed characteristic signs of NOMI, for which selective papaverine infusion through the angiography catheter was performed. It was effective in both cases to halt progressive bowel ischemia and bided our time to perform a hemicolectomy of the necrotic segment. Contrast-enhanced MDCT scan and subsequent selective angiography are vital for diagnosis. If the condition does not improve after selective papaverine infusion, exploratory laparotomy and resection of necrotic intestinal segment should be performed immediately.
• Kazui, T., Mitsunaga, Y., Nakajima, T., & Okabayashi, H. (2010. Bentall operation with saphenous vein graft for a Takayasu's aortitis patient(pp 373-5).
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  Takayasu's aortitis patients present a variety of symptoms, including angina pectoris, aortic valve regurgitation, and aortic branch stenosis. The case described in this paper primarily presented with angina pectoris. Close investigation revealed a left coronary artery ostium lesion, an aortic root aneurysm, and a mild aortic regurgitation. The patient underwent a modified Bentall operation with saphenous vein graft (SVG) replacement of the left main trunk. The postoperative course was uneventful, and the patient received oral steroid therapy. SVG is a useful option in treating aortic root aneurysm with an ostium lesion.
• Kazui, T., Mitsunaga, Y., Fukuhiro, Y., Nakajima, T., & Okabayashi, H. (2008. Aortic root reimplantation using a Valsalva graft for postoperative pseudoaneurysm after acute aortic dissection(pp 339-42).
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  We report a reoperative case in which a Valsalva graft was utilized on a 64-year-old woman who had previously undergone emergency repair of a DeBakey type I acute aortic dissection. On follow-up computed tomography (CT), she was found to have pseudoaneurysms of both proximal and distal anastomoses. We performed valve-sparing aortic root replacement (VSRR) with the reimplantation technique and total arch replacement, since we felt that a graft with pseudosinuses helps to prevent torsion of the coronary arteries. The postoperative course was uneventful, and postoperative echocardiography revealed no significant aortic valve regurgitation. The pathology results raised the hypothesis that pseudoaneurysm formation might have been related to the use of gelatin-resorcinol-formaldehyde (GRF) glue at the time of the initial intervention.
• Nakai, K., Kazui, T., Okabayashi, H., Hayashi, R., Fukushima, A., & Suwabe, A. (2008. [Development of three-dimensional analysis of current density distribution by 64-ch magentocardiography and clinical application](pp 1118-24).
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  Magnetocardiography (MCG) using a SQUID sensor is characterized by three dimensional cardiac electrical phenomena from magnetic fields, because it is hard to be affected by organ constitution of lungs and torso configuration. We have developed three-dimensional (3D) electric current density distribution analysis by a spatial filter method. At this symposium, we report clinical utility of 64-channel (64-ch) MCG. Subjects consisted of 20 normal volunteers, 10 cases with old myocardial infarction, 13 cases with atrial fibrillation (AFIB) who received surgical pulmonary (PV) isolation, and representative case with fetus premature ventricular complex (PVC). We recorded 10-min MCG data of magnetic field composition (a Bz ingredient) which was perpendicular to body surface in a magnetism shield, using 64-ch SQUID sensors (17.5 x 17.5 cm) built-in in MCG instrumentation(sampling; 500ms, total frequency characteristic; 0.1-200 Hz). We conducted 3D heart outline from electric current density calculated by magnetic field distribution. We also generated 3D functional images of the RT (activation recovery time) dispersion and spatial spectral distribution of a fibrillation wave. Increased fluctuation on RT dispersion map corresponded with space location of myocardial infarction. The mean frequency of 3D spectral map in persistent AFIB showed a higher value than that with restored a sinus rhythm (7.7 +/- 0.5 Hz vs. 6.5 +/- 0.7 Hz). We also demonstrated a fetus PVC. We concluded that 64-ch MCG can evaluate 3D spatial location of myocardial injury, 3D spectral map and characteristic frequency, and fetus arrhythmia. In future, further technical development in the fields of MCG measurement would be necessary for avoiding the used of unshielded room or liquid He.
• Okamoto, T., Doi, H., Kazui, T., Suzuki, M., Koshima, R., Yamashita, T., Sugiki, K., & Ohno, T. (2006. Aortic valve myxoma mimicking vegetation: report of a case(pp 927-9).
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  We report a case of cardiac myxoma of the aortic valve. To our knowledge, this represents only the seventh such case ever documented. A 61-year-old woman underwent an echocardiography to screen for hypertensive-diabetic cardiac complications, which showed a mass on her aortic valve. Although she had not experienced a fever, the mass closely resembled a vegetation, resulting in an initial diagnosis of infective endocarditis. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.
• Kazui, T., Nagumo, T., Izumoto, H., Komoda, K., Tanita, T., & Kawazoe, K. (2004. [Surgically repaired bilateral giant bullae after long-time follow-up; report of a case](pp 253-7).
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  A 44-year-old male was admitted to our hospital owing to severe dyspnea of sudden onset. Chest X-ray disclosed bilateral giant bullae. His pulmonary function was severely depressed. VC (%) was 2.61 l (66.3%) and FEV1% (%) was 1.47 l (64.5%). Indication of surgical repair of giant bullae are; space occupying lesion more than 25-50% in 1 thorax, progressive dyspnea, enlargement over time irrespective of symptoms, and expectation that re-expand the normal lung. He was conducted two-staged bullectomy using video-assisted thoracoscopic surgery (VATS) with small incisions. First operation was performed to left lung. Pulmonary function improved. VC (%) increased 3.02 l (76.8%) and FEV1% (%) 2.36 l (76.6%). After second operation, which was performed to right lung, VC (%) was 2.40 l (60.5%) and FEV1% (%) was 2.21 l (92.1%). Hugh-Jones grade improved class IV to class I. Postoperative course was uneventful and he was discharged 15 days after second operation. Two-staged bullectomy was appropriate in this case, because he might have suffered from re-expansion pulmonary edema after first surgery. The extent of recovery of pulmonary function was unpredictable. And performing right lung bullectomy just after the left bullectomy may be dangerous, because the patient have to receive anesthesia with his resected left lung. There is some possibility that patient who has bilateral giant bullae shows severe dyspnea during the progress, care should be taken to conduct operation as soon as possible.

Others

• Reddy, S., Reddy, S., Lotun, K., Lotun, K., Shetty, R., Shetty, R., Lee, K. S., Lee, K. S., Kazui, T., & Kazui, T. (2017, October). Successful Treatment of Staphylococcus Aureus 28 X 11 mm Mycotic Aneurysm of the Proximal Left Anterior Descending Artery with Endovascular Coiling in High Risk Surgical Patient.. TCT 2017.
• Reddy, S., Reddy, S., Lotun, K., Lotun, K., Shetty, R., Shetty, R., Lee, K. S., Lee, K. S., Kazui, T., & Kazui, T. (2017, October). Transcutaneous Aortic Valve Replacement Within a Previously Placed Surgical and Transcutaneous Prosthetic Valves Under Peripheral Extracorporeal Membrane Oxygenation Support (TandemLife) Hemodynamic Support in a High Risk Patient.. TCT 2017.
• Kazui, T., Doi, H., Suzuki, M., Okamoto, T., Koshima, R., Sugiki, K., & Ohno, T. (2009). [Surgical treatment for infective endocarditis]. Kyobu geka. The Japanese journal of thoracic surgery.
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  Surgery for infective endocarditis (IE) is technically demanding, especially the one for active IE.
• Kazui, T., Tsuboi, J., Izumoto, H., Nakajima, T., Ishihara, K., & Kawazoe, K. (2007). Aortic root remodeling with aortic annuloplasty: mid-term results. Circulation journal : official journal of the Japanese Circulation Society.
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  A retrospective study was performed to determine the appropriateness of aortic root remodeling with aortic annuloplasty (m-Yacoub operation).
• Kazui, T., & Kawazoe, K. (2004). [Acute mitral valve insufficiency caused by chordae rupture]. Kyobu geka. The Japanese journal of thoracic surgery.
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  The common causes of mitral valve chordae rupture are myxomatous valve disease, infective endocarditis. Acute mitral valve insufficiency from chordae rupture, severe clinical symptoms such as dyspnea and shock are observed. Diagnosis is made with clinical symptoms, chest X-ray and echocardiography. Echocardiography is very useful to evaluate the exact lesions. First, inotropic agents, dilators and intraaortic balloon pumping (IABP) are used to stabilize hemodynamic status. Once hemodynamic status becomes unstable in spite of such therapy, surgical correction of mitral regurgitation (MR) is considered. Mitral valve repair should be the first choice of surgical repair, because it preserves left ventricular function, avoids anti-coagulation therapy. Quadrangular resection and suture, annuloplasty and artificial chordae are reliable surgical techniques. If mitral valve repair is difficult, mitral valve replacement is another option. From 1994 to 2002, there were 12 patients who underwent emergency mitral valve surgery because of chordae rupture. There were 7 men and 5 women with mean age of 52.7+/-14.3 years old. Nine of them received mitral valve repair. Two patients were infective endocarditis. Preoperative MR grade was 4.0+/-0.0. Postoperative MR grade was 0.2+/-0.2. Mean follow-up period was 3.8 years. There were no cardiac events and reoperations. Repair technique is quite reliable even in patients with multiple lesions, and the surgical results were almost same as single lesion patients. Repair technique should be the first choice to treat acute MR caused by chordae rupture.