Biomedical subjects

Kei Inai

Publications and source records attributed to Kei Inai.

5 recordsLinked to original sources

PubMed2005

Clinical correlation and prognostic predictive value of neurohumoral factors in patients late after the Fontan operation.

AIMS: We tested the hypothesis that neurohumoral activation could correlate with exercise tolerance and have a prognostic value in patients late after Fontan operation. METHODS AND RESULTS: We studied 50 consecutive patients after the Fontan operation and 10 age-matched normal controls. We measured brain and atrial natriuretic peptides, norepinephrine (NE), plasma rennin activity, aldosterone, angiotensin II, and endothelin and investigated the relationship of neurohumoral factors with exercise tolerance and central hemodynamics. We also evaluated the prognostic predictive value of these factors. All factors were significantly higher in the patients than in controls, but no factor correlated with peak oxygen consumption (peak VO2). There were significant correlations of atrial natriuretic peptide with cardiac index, NE with left ventricular ejection fraction (LVEF), and pulmonary arterial wedge pressure. After 4 years' follow-up, univariate Cox proportional hazards analysis showed that peak VO2 and LVEF could significantly predict the long-term event-free ratio. In multivariate analysis, LVEF and NE have a significant predictive value. In Kaplan-Meier event-free curves, NE combined with peak VO2 showed a significant predictive value. CONCLUSIONS: Activated neurohumoral factors are not determinants of exercise tolerance in patients late after the Fontan operation. The plasma level of NE combined with peak VO2 has a prognostic predictive value in these patients.

Adolescent↗

PubMed2005

The use of pethidine as pre-medication to prevent anoxic spells in patients with tetralogy of Fallot.

OBJECTIVE: The aim of this study was to determine whether morphine-HCl or pethidine-HCl differ as pre-medication to prevent anoxic spell in patients with tetralogy of Fallot (TOF) at catheterization. METHODS: A 3 year retrospective case notes review study of 46 consecutive patients who underwent cardiac catheterization from 1998 to 2001 was conducted. In a prospective 1 year randomized control study, 10 patients diagnosed as TOF and admitted to Tokyo Women's Medical University, The Heart Institute of Japan, Tokyo, in 2002 were randomized to receive morphine or pethidine as pre-medication for cardiac catheterization. The incidence of anoxic spell before and after cardiac catheterization was investigated in both studies. RESULTS: In the case notes review, a total of 10 out of the 46 patients showed anoxic spell study: eight out of 24 patients in the morphine group and two out of 22 in the pethidine group. The difference in the incidence was statistically significant (P < 0.05, Fisher's exact test). Four patients in the prospective study showed anoxic spell: three out of six in the morphine group and one out of four in the pethidine group (odds ratio = 3.0). Overall, 14 out of 56 patients had anoxic spell: 11 out of 30 in the morphine group and three out of 26 in the pethidine group (P = 0.03). CONCLUSION: The incidence of hypoxic spells in patients with TOF undergoing cardiac catheterization is reduced by the use of pethidine-HCl as pre-medication compared to morphine. This has important clinical implications.

Cardiac Catheterization↗

PubMed2005

Monitoring of cerebral oxygenation during hypoxic gas management in congenital heart disease with increased pulmonary blood flow.

In the preoperative management of congenital heart disease (CHD) with increased pulmonary blood flow, hypoxic gas management to control pulmonary blood flow is useful. However, the cerebral oxygenation state has rarely been studied, and there is concern about neurologic development. In eight infants with CHD accompanied by increased pulmonary blood flow, hypoxia was induced after a 1-h baseline period in room air (FiO2, 0.21). The infants were simultaneously monitored in both the front-temporal region and the right-brachial region for 90 min using near-infrared spectroscopy (NIRS). The minimum SaO2 (pulse oximetry) after hypoxic gas administration was 80.8 +/- 2.9% when the minimum FiO2 was 16.2 +/- 1.1%. With a decrease in SaO2, oxy-Hb (O2Hb) decreased and total Hb [cHb: O2Hb + deoxy-Hb (HHb)] increased in both regions in the majority of infants. HHb increased in both regions with a decrease in SaO2. The maximum change in the tissue oxygenation index (TOI: O2Hb/cHb x 100) was -8.3 +/- 2.6% in the front-temporal region and -3.6 +/- 2.3% in the right-brachial region. Cerebral oxygenation decreased despite an increase in cerebral blood flow during hypoxic gas management. The change in TOI was < or =10% when the SaO2 was > or =80%. Safer control of SaO2 should be maintained over 80% for hypoxia management in CHD based on the results of the present study.

Brain↗

PubMed2004

Skeletal muscle hemodynamics and endothelial function in patients after Fontan operation.

To elucidate the relation between exercise capacity and peripheral hemodynamics in patients after the Fontan operation, near-infrared spectroscopy was performed on the vastus lateralis muscle, and flow-mediated vasodilation of the brachial and posterior tibial arteries was done with high-resolution ultrasonography. In Fontan patients, diminished exercise capacity was related to a reduced blood flow supply and an attenuated post-exercise oxygen resaturation of the working skeletal muscle, which also was related to impaired endothelium-dependent vasodilation.

Adolescent↗

PubMed2004

Left ventricular diastolic dysfunction in Ebstein's anomaly.

This study was performed to evaluate left ventricular (LV) diastolic function in patients with Ebstein's anomaly using Doppler echocardiography. We found that LV abnormal relaxation in this anomaly cannot be explained by right ventricular volume overload alone. Furthermore, LV diastolic dysfunction persists even after intracardiac repair.

Cardiac Catheterization↗