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Takeshi Komoda

Publications and source records attributed to Takeshi Komoda.

5 recordsLinked to original sources
PubMed2006

Role of ventricular assist devices in the German heart allocation system.

The Eurotransplant (ET) allocation algorithm, newly implemented in 2000, gives priority for heart transplantation (HTx) to patients with high urgency (HU) status, but now this status is rescinded upon ventricular assist device (VAD) implantation and only regained if severe complications occur during mechanical circulatory support (MCS). We studied the effects of this change on the patients in our institute who were waiting for HTx with MCS. The median duration of MCS until HTx in adult patients gradually increased from 3.1 months in 1994, reaching a peak of 16.7 months in 2000, and then gradually decreased to 6.0 months in 2003. Among the patients with VAD implantation as a bridge to HTx, two patients were on MCS for more than 1 year (the longest duration of MCS being 1.6 years) at the end of 1999, and this figure increased to nine patients and a maximum MCS duration of 3.7 years at the end of 2003. These data imply that the patients in whom a complication occurred in the early phase of MCS and who had overcome this complication underwent HTx early with HU status, and those who were stable during MCS waited a long time for HTx. Furthermore, the number of patients in the latter group is increasing. The new allocation algorithm imposes on patients with MCS waiting for HTx who are relatively young and free from complications and serious coexisting disease, very long-term MCS without an end to VAD bridging, which is almost equivalent to destination therapy.

Algorithms↗
PubMed2005

Suicidal ideation and alexithymia in patients with alcoholism: a pilot study.

OBJECTIVE: Suicidal incidences are known to be high in patients manifesting alcoholism. We attempted to characterize suicidal ideation in Japanese patients with alcoholism in relation to alexithymia. METHODS: Eighty-five male alcoholic patients, hospitalized in the alcoholics ward of a mental hospital and aged between 40 to 69 (52.9 +/- 8.3 years), and 79 nonalcoholic males in the same age range (54.9 +/- 7.1 years) recruited from a municipal garbage disposal plant were included in the study. The patients were evaluated using the Scale of Suicidal Ideation (SSI) and the Toronto Alexithymia Scale (TAS) during 2002. RESULTS: Of the alcoholic patients, 76.6% belonged to the high-risk group of suicidal ideation (SSI > 2), and 66.6% of the high-risk patients were alexithymic. In contrast, 86.1% of the nonalcoholic controls showed no suicidal ideation and only 17.7% of those without suicidal ideation were alexithymic. When the alcoholic patients with intensive suicidal ideation were compared with nonalcoholic patients without suicidal ideation, the scores of factor 1 and factor 2 were significantly higher in the former group (p < 0.001). CONCLUSIONS: Alcoholic patients with intensive suicidal ideation accompanied with alexithymia are characterized by the inability to communicate feelings. Therefore, the possibility of a suicidal attempt in those patients should always be kept in mind even though no suicide message is expressed.

Adult↗
PubMedDate not supplied

Mitral annulus after mitral repair: geometry and dynamics.

The study of systolic changes in both the inflow and outflow of the left ventricle after mitral repair elucidates the geometric characteristics after surgery. The study included eight normal subjects and six patients after mitral repair without a prosthesis. The left ventricular (LV) base, consisting of both mitral valve annulus (MVA) and left ventricular outflow tract (LVOT) orifice, was reconstructed from magnetic resonance images. The angle between the planes of the MVA and LV base (MB angle), and the proportionate share of the LVOT at the LV base were calculated. After mitral repair, both the MVA and LV base became almost normal in size, showing flexible change (i.e., contraction and dorsiflexion) in the MVA and contraction of the LV base in systole. Compared with the normal heart at 100 ms delay from the electrocardiogram R wave, the hearts of the patients at the same phase had a mean 1.05 cm2 larger LVOT orifice, resulting in a mean 8.0 degree larger MB angle. Furthermore, the LVOT orifice occupied a mean of 49.5% of the LV base (41.9% in normal subjects). We hypothesize that the higher MB angle at early systole may weaken the tension of the chordae of the anterior mitral leaflet.

Adult↗
PubMedDate not supplied

Executive cognitive dysfunction without stroke after long-term mechanical circulatory support.

Among patients who receive heart transplantation (HTx) after long-term mechanical circulatory support (MCS), some show executive cognitive dysfunction without a history of stroke. Fifty HTx patients (19 patients on MCS for longer than 3 months before HTx and 31 patients without MCS as control group) were enrolled in the study. All subjects were men aged between 20 and 59 years without a history of stroke. Patients with MCS were divided into two groups: the AH-Thr group (n = 11), in which thrombus was detected in the left ventricular assist device (LVAD) and quickly removed (mean 3.3 times); and the AH group (n = 8), in which there was no detectable thrombus in the LVAD. The Trail Making Test (TMT) and the Wisconsin Card Sorting Test (WCST) were administered. The AH-Thr group showed poorer cognitive performance both in the TMT part B, with longer completion time (p < 0.05 versus the other two groups), and in the WCST, with more perseverative errors (p < 0.001 versus the other two groups). These data indicate that patients in the AH-Thr group showed executive cognitive dysfunction in set-shifting ability, suggesting frontal lobe damage. The conditions that facilitate thrombus formation in the LVAD may induce executive cognitive dysfunction without stroke.

Adult↗