Browsing by Author "Watanabe, Ryota"

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    Management of coexisting patent foramen ovale and pulmonary arteriovenous malformation: a case report of sequential closure
    (Oxford University Press, 2025-01-29) Yagasaki, Hiroto; Suzuki, Takeki; Watanabe, Keitaro; Watanabe, Ryota; Noda, Toshiyuki; Medicine, School of Medicine
    Background: Concurrent patent foramen ovale (PFO) and pulmonary arteriovenous malformation (PAVM) are rare but can cause paradoxical embolism and platypnoea-orthodeoxia syndrome (POS). Case summary: A 72-year-old female with embolic stroke history developed positional dyspnoea. Evaluation revealed right-to-left shunting through PFO and PAVM in the right middle lobe. Orthodeoxia was confirmed by 6% SpO2 decrease upon position change. A staged approach was adopted: PFO closure with Amplatzer™ Occluder, followed by PAVM embolization 1 month later. Symptoms improved significantly post-procedure. No residual shunting or symptoms have been observed during the 2-year follow-up. Discussion: This case emphasizes thorough evaluation in patients with cryptogenic stroke and POS, especially when symptoms persist. It demonstrates the effectiveness of staged treatment for concurrent PFO and PAVM, highlighting the importance of individualized strategies and long-term follow-up.
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    Successful percutaneous retrieval of a detached MitraClip® in the left atrium via maintained gripper line: a case report
    (Oxford University Press, 2025-03-08) Yagasaki, Hiroto; Suzuki, Takeki; Watanabe, Ryota; Watanabe, Keitaro; Noda, Toshiyuki; Medicine, School of Medicine
    Background: Mitral valve transcatheter edge-to-edge repair (M-TEER) with MitraClip® has become an established treatment for high-risk patients with mitral regurgitation (MR). While device-related complications are known, they typically occur during leaflet grasping or after deployment, with most issues arising from device-tissue interaction. Case summary: A 67-year-old woman with dilated cardiomyopathy underwent M-TEER for severe functional MR. Although resistance was noted during initial device preparation and loading, limited functional testing appeared normal and the procedure was continued. During clip manipulation in the left atrium, mechanical resistance in the arm positioner led to unexpected detachment of the MitraClip, connected only by the gripper line. Through careful traction under echocardiographic and fluoroscopic guidance, we successfully retrieved the clip percutaneously. The procedure was completed with new MitraClip systems, achieving mild residual MR. The patient's symptoms improved from New York Heart Association Classes II and III to I, with sustained improvement during 4.5 years of follow-up. Discussion: This case reveals a novel mechanism of MitraClip detachment through mechanical failure during preparation, where introducer damage led to harness deformation and subsequent clip detachment. Among available retrieval options, we demonstrated the feasibility of direct traction retrieval under specific conditions, offering a less invasive solution when gripper line connection is maintained. This case emphasizes the importance of meticulous device inspection and preparation, while providing insights into both failure mechanisms and retrieval strategies in M-TEER complications.
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    Transcatheter Mitral Valve Repair Improves Conduction and Function in a CRT Candidate
    (Elsevier, 2025) Yagasaki, Hiroto; Suzuki, Takeki; Watanabe, Keitaro; Yoshizane, Takashi; Watanabe, Ryota; Warita, Shunichiro; Iwama, Makoto; Noda, Toshiyuki; Medicine, School of Medicine
    Dilated cardiomyopathy (DCM) with severe mitral regurgitation (MR) and left bundle branch block (LBBB) typically indicates cardiac resynchronization therapy (CRT). However, device-related complications can limit CRT's applicability in some patients. A 77-year-old woman with DCM, severe MR, and LBBB underwent mitral valve transcatheter edge-to-edge repair (M-TEER) because of high risk for CRT-related complications. Post-procedure, she showed marked improvement in symptoms, left ventricular function, and QRS duration. This case highlights M-TEER as a potential initial strategy in selected patients with DCM, severe MR, and LBBB when CRT is high risk. The unexpected reduction in QRS duration following M-TEER warrants further investigation. M-TEER may be considered in DCM patients with severe MR and LBBB for whom CRT poses significant challenges. This approach could lead to both mechanical and electrical reverse remodeling in some cases.