Evaluation of Left Ventricular Wall Motion in Healthy Children by Intramyocardial Pulsed Doppler Echocardiography : Assessment from Apical Four Chamber View

心筋内パルスドプラ法による小児の左室壁運動の解析─心尖部四腔断面での検討─

Pediatric Cardiology and Cardiac Surgery


静脈およびリンパ管疾患と外科

静脈およびリンパ管疾患と外科


悪性腫瘍による下大静脈症候群の検査，診断，治療方針，治療，予後

悪性腫瘍による下大静脈症候群の検査，診断，治療方針，治療，予後

静脈およびリンパ管疾患と外科

静脈およびリンパ管疾患と外科


人工血管感染に対する再手術症例の検討

人工血管感染に対する再手術症例の検討

Japanese Journal of Cardiovascular Surgery

日本心臓血管外科学会雑誌


Fluctuation of blood free and sulfoconjugate catecholamine in infant cardiopulmonary bypass operation. Examination in Fallot's tetralogy and VSD cases.

小児開心術症例における血中遊離型および硫酸抱合カテコールアミンの変動·ファロー四徴症とVSD症例での検討

Japanese Journal of Clinical Pharmacology and Therapeutics


Effect of docarpamine,a novel orally active dopamine prodrug, on the formation of free and sulfoconjugated dopamine in patients who underwent cardiac surgery.

To evaluate the clinical efficacy of orally active dopamine prodrug, docarpamine [N-(N-acetyl-L-methionyl)-O,O-bis (ethoxycarbonyl) dopamine], we examined its effect on the formation of free and sulfoconjugated dopamine in patients who underwent cardiac surgery. The preoperative values of free and sulfoconjugated dopamine in patients were 216 +/- 52 pg/ml and 4,930 +/- 820 pg/ml, respectively. The plasma level of free dopamine increased to 95.3 +/- 28.3 ng/ml by dopamine infusion after the operation and was sustained at a high level (87.7 +/- 26.5 ng/ml) by concomitant administration of docarpamine in spite of tapering of dopamine infusion. After stopping dopamine infusion, plasma level of free dopamine was 24.5 +/- 17.6 ng/ml maintained by oral administration of docarpamine alone. From these results, docarpamine may be a useful alternative to intravenous dopamine after cardiac surgery. Sulfoconjugated dopamine in plasma increased to 267 +/- 120 ng/ml after the start of dopamine infusion and increased further after oral docarpamine administration to 2,060 +/- 610 ng/ml. Since sulfoconjugated dopamine is thought to be a possible precursor of active free dopamine in plasma, orally administered docarpamine might be stored as a reserve pool for free dopamine in patients who undergo cardiac surgery.


Mechanism of ATP-induted Ca2+ effect from freshly isolated adult rat cardiomyocytes:Possible involvement of Na+/Ca2+ exchange.

Physiological stimulation causes a rise in intracellular Ca2+ concentration in cardiomyocytes. However, it has not yet been elucidated what mechanisms are involved in the reduction of cytosolic free Ca2+ levels, including those which underlie Ca2+ efflux from the cells. In the present study, we examined the effect of extracellular adenosine 5'-triphosphate (ATP) on Ca2+, efflux from freshly isolated adult rat cardiomyocytes. The isolated cardiomyocytes were preloaded with 45CaCl2 for one hour. Then, the fractional release of 45Ca2+ from the cells was measured consecutively. ATP stimulated the efflux of 45Ca2+ from isolated adult rat cardiomyocytes in a concentration-dependent manner (0.01-1 mM). The 45Ca2+ efflux from the cells was also stimulated by adenosine-5'-O-(3-thiotriphosphate) (ATP-gamma S), alpha, beta-methylene-ATP and adenosine 5'-diphosphate (ADP), but not by adenosine 5'-monophosphate (AMP) or adenosine. The effect of ATP was inhibited by a specific purinergic P2-receptor antagonist, but not by a P1-receptor antagonist. From these results, it is conceivable that the effect of ATP on Ca2+ efflux from cardiomyocytes is mediated through P2-purinoceptors. The ATP-stimulated 45Ca2+ efflux was not affected by removal of extracellular Ca2+, but was dependent on the presence of extracellular Na+. Moreover, ATP caused a 22Na+ influx into the cells. These results suggest that ATP stimulates extracellular Na(+)-dependent 45Ca2+ efflux from freshly isolated adult rat cardiomyocytes, probably through its stimulatory effect on plasma membrane P2-purinoceptors which may couple to Na+/Ca2+ exchange.

The Tokushima Journal of Experimental Medicine


Effect of cromakalim on ischemic and reperfused immature heart: Experiments with isolated neonatal New Zealand white rabbit hearts.

To elucidate whether K+ channels are involved in the ischemia-reperfusion injury in immature heart, we examined the effect of cromakalim, a potent opener of ATP-sensitive K+ channel (KATP channel), on the ischemic and reperfused neonatal New Zealand white rabbit heart. The experiments were divided into control group and cromakalim pretreated group. When, the heart was loaded with 10 microM cromakalim preischemically, the recovery of heart rate and left ventricular developed pressure were significantly improved than those of the control group. Pretreatment with cromakalim also decreased lactate excretion in the coronary effluent. Measurements of cation contents with atomic absorption method revealed that intracellular K+ content was lower in cromakalim pretreated group at preischemia, end of ischemia and 20 min after ischemia. Intracellular accumulation of Na+ and Ca2+ at reperfusion period was inhibited by cromakalim pretreatment. From these results, it is assumed that cromakalim might act on KATP channels of plasma membrane and reduces the K+ content of the cardiomyocytes which in turn inhibits Na+ and Ca2+ accumulation during the reperfusion period. Prevention of Na+ and Ca2+ accumulation after ischemia might be a reason for cardioprotective effect of cromakalim on neonatal New Zealand white rabbit heart.


EFFECT OF AMILORIDE ON THE EARLY AND LATE STAGE OF POSTISCHEMIC RECOVERY IN ISOLATED PERFUSED RAT HEARTS --- POSSIBLE INVOLVEMENT OF Na+/H+ AND Na+/Ca2+ EXCHANGE

摘出ラット虚血再灌流心でのNa+/H+交換機構阻害薬，アミロライドの心筋保護効果 --- 再灌流早期及び後期でのNa+/H+,Na+/Ca2+交換機構の関与

The Japanese Journal of Thoracic and Cardiovascular Surgery


SURGICAL EXPERIENCE OF TWO DIFFERENT TYPES OF UNROOFED CORONARY SINUS


Physiological significance of plasma sulfoconjugated dopamine in patients with hypertension: Clinical and experimental studies.


Absence of the inferior vena cava in a patient with omphalocele: tow-dimensional echocardiographic and cineangiographic findings


Effect of extracellular adenosine 5'-triphohphate on Ca2+ effulux freshiy isolated adult rat cariomyocytes.

The effect of extracellular adenosine 5'-triphosphate (ATP) on Ca2+ efflux from freshly isolated adult rat cardiomyocytes was examined. ATP stimulated the efflux of 45Ca2+ from the cells in a concentration-dependent manner (0.01-1 mM). The 45Ca2+ efflux from the cells was also stimulated by adenosine-5'-O-(3-thiotriphosphate)(ATP-gammas) and alpha,beta-methylene-ATP and adenosine 5'-diphosphate, but not by adenosine 5'-monophosphate and adenosine. The ATP-stimulated 45Ca2+ efflux was not affected by deprivation of the extracellular Ca2+, but was dependent on the presence of extracellular Na+. These results indicate that ATP stimulates extracellular Na+-dependent 45Ca2+ efflux from freshly isolated adult rat cardiomyocytes, probably through its stimulatory effect on the plasma membrane P2 purinoceptors which may couple to Na+/Ca2+ exchange.


下大静脈・右心房への腫瘍栓を伴う肝細胞癌の手術

下大静脈・右心房への腫瘍栓を伴う肝細胞癌の手術


多脾症候群に伴う大動脈閉塞の2症例

多脾症候群に伴う大動脈閉塞の2症例


先天性心疾患を合併した胆道閉塞症の1例

先天性心疾患を合併した胆道閉塞症の1例


心タンポナーデにて発症した横紋筋肉種の1乳児例

心タンポナーデにて発症した横紋筋肉種の1乳児例

The Journal of the Japan Pediatric Society


Surgical therapy for prosthetic graft infection

XXX World Congress of the International College of Surgeons


Effect docarpamine on the formation of free and sulfoconjugated dopamine in patients who underwent cardiac operations

開心術後カテコラミン離脱時の塩酸ドカルパミン投与の血中遊離型および抱合型ドーパミン形成に及ぼす影響


Assessment of operability by intraoperative direct measurement of aortic and pulmonary blood flows in patients with severe pulmonary hypertension


Physiological significance of sulfoconjugate dopamine in blood in patient of hypertension.

高血圧患者における血中硫酸抱合型ドーパミンの生理的意義

Japanese Journal of Clinical Pharmacology and Therapeutics


Abence of the inferior vena cava in a patient with omphalocele: Two-dimensional echocardiographic and cineangiographic findings.

We report an unusual form of absence of the inferior vena cava (IVC) in a patient with a repaired omphalocele. Two sets of bilateral paravertebral veins served as the channels of systemic venous return from the lower half of the body. These veins were narrower than typical azygos or hemiazygos continuation in the absence of the IVC, with the result that a catheter from the femoral vein could not reach the right atrium (RA). Other associated venous-side anomalies were present, including a chamber between the hepatic vein (HV) and RA, narrowing and angulation at the junction between the HV and the chamber, and a subaortic innominate vein. All these anomalies were demonstrated by two-dimensional and color Doppler echocardiography. The recognition of these venous anomalies is important for cardiac catheterization or IVC cannulation for cardiopulmonary bypass in patients with omphalocele.


チアノーゼ性心疾患に対する乳児期早期肺動脈絞扼術の検討

チアノーゼ性心疾患に対する乳児期早期肺動脈絞扼術の検討

The early and late results of pulmonary artery banding (PAB) for cyanotic heart defects in early infancy were reviewed. Nine patients were divided into two groups : Group F (five patiens) in which Fontan type repairs were expected as definitive repair in the near future ; Group A (four patients) in which anatomical repairs were programmed in the near future. Six patients had a good early postoperative course, and then consisted of three patients of Group A and three patients of Group F. The band circumference, intraoperative pulmonary-to-systemic systolic pressure ratio and arterial oxygen tension after PAB in the good cases of Group A were 20.0±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.52±0.07 and 46.4±11.3 mmHg respectively. These indices in the good cases of Group F were 21.1±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.55±0.02 and 38.8±1.0 mmHg respectively. The standard deviations of every index for PAB in Group F were small. Three patients of Group A have undergone successful total correction. Intraoperative pulmonary-to-systemic systolic pressure ratio of 0.5 as the index of PAB is preferable to Group A. However, only two patient of Group F were waiting for Fontan type definitive repair. For the patient especially in Group F, careful observation and well-timed staged repair with regard to subaortic stenosis and restrictive atrial septal defect and ventricular septal defect are necessary after accurate PAB as mentioned above.


A Case of Communication Between the Proximal and Distal Pulmonary Arteries After Pulmonary Artery Banding : Echocardiographic Diagnosis of an Unusual Complication After Pulmonary Artery Banding

肺動脈絞扼術後に近位部および遠位部肺動脈間に交通をきたした1小児例–心エコー図診断の有用性–


Technique for constructing the pulmonary trunk for tetralogy Fallot with pulmonary atresia.

In expectation of the growth of a new pulmonary arterial trunk in total correction of tetralogy of Fallot with pulmonary atresia, we used pedicled autologous pericardium combined with left atrial appendage as the posterior wall of a new pulmonary arterial trunk. In cases of long discontinuity between the right ventricular infundibulum and left pulmonary artery, our technique could be recommended for early repair of tetralogy of Fallot with pulmonary atresia.


Achieving optimal pulmonary blood flow in the first-stage of palliation in early infancy for complex cardiac defects with hypoplastic left ventricles


高位腹部大動脈閉塞症の1治験例

高位腹部大動脈閉塞症の1治験例


急速な上方進展を認めた高位腹部大動脈閉塞症の1治験例

急速な上方進展を認めた高位腹部大動脈閉塞症の1治験例


四肢リンパ浮腫に対するリンパ球動注療法の成績と治療効果の判定–111Indium-oxine標識リンパ球とMRIを用いた定量的評価–


大動脈弓閉鎖を伴った大血管転位型 Taussig-Bing 奇形に対する二期的根治手術の経験


Achieving optimal pulmonary blood flow in the first-stage of palloation in early infancy for complex cardiac defects with hypoplastic left ventricles.


僧帽弁逸脱における血中遊離型および硫酸抱合型カテコールアミンの変動

僧帽弁逸脱における血中遊離型および硫酸抱合型カテコールアミンの変動


Hyperuricemia in an infant with Taussig-Bing anomaly and interruption of the aortic arch

Hyperuricemia is commonly recognized in adolescents and adults with cyanotic congenital heart disease. We report a case of a male infant with hyperuricemia, Taussig-Bing anomaly, and interruption of the aortic arch. The patient underwent correction of interrupted aortic arch and pulmonary arterial banding at the age of 7 days. Hyperuricemia appeared when he was 2 months old (max 17.7 mg/dl) and persisted until he underwent a Jatene operation at the age of 10 months. The hyperuricemia improved gradually after the disappearance of hypoxia and polycythemia. The laboratory findings suggest that hyperuricemia can result from uric acid overproduction due to secondary polycythemia, impairment of uric acid excretion by the kidney, or the acceleration of anaerobic metabolism. Allopurinol and benzbromarone together were partially effective treatments for hyperuricemia in this patient with cyanotic congenital heart disease.


僧帽弁兼三尖弁閉鎖不全症術後に著効をみた蛋白漏出性胃腸の1例

僧帽弁兼三尖弁閉鎖不全症術後に著効をみた蛋白漏出性胃腸の1例


大動脈弁輪周囲腫瘍を合併した活動期感染症心内膜炎の外科治療経験–特に腫瘍腔の処置，経過について–

The Japanese Journal of Thoracic and Cardiovascular Surgery


Changes in Protein Components of Lymphedema Fluid after Intraarterial Lymphocyte Injection Therapy


INTRAARTERIAL LYMPHOCYTE INJECTION THERAPY FOR LYMPHEDEMA OF THE EXTREMITIES:AN EXAMINATION USING INDIUM-111 OXINE LABELED AUTOLOGOUS LYMPHOCYTES


僧帽弁逸脱における血中遊離型および硫酸抱合型カテコラミンの変動

僧帽弁逸脱における血中遊離型および硫酸抱合型カテコラミンの変動


ファロー四徴症術後症例における平均加算心電図の研究:時間領域および周波数領域解析併用の有用性について


Abnormal signal averaged ECG after surgical repair of tetralogy of Fallot - a combined analysis in time and frequency domain


乳児期より著明な高尿酸血症を呈したTaussig-Bing奇形·大動脈弓離断の1例


Balloon pulmonary valvuloplasty for infants with severe tetralogy of Fallot.

Balloon pulmonary valvuloplasty was performed in 3 infants with severe tetralogy of Fallot at days 24, 54 and 86 because of progressive hypoxemia. In two patients, the balloon catheter (4 cm long, 5-8 mm diameter) could not pass through the pulmonary valve. This necessitated a smaller balloon and required a two-step procedure. Initially, a coronary artery balloon (2 cm long, 3.5 mm diameter) was used. Following balloon valvuloplasty, arterial oxygen saturation increased from 63 to 83% in case 1, from 69 to 85% in case 2 and 63 to 86% in case 3. Immediate postvalvuloplasty right ventricular cineangiography revealed that the maximal opening diameter of the pulmonary valve leaflets increased from 1-2 mm to 3-4 mm in cases 1 and 3, and from 2-3 mm to 4-5 mm in case 2. No significant complications occurred. Echocardiographic follow-up data showed that the diameter of the right ventricular outflow tract and pulmonary arteries increased with age. The present results show that the pulmonary valvuloplasty is an effective procedure for relief of pulmonary valve stenosis in tetralogy of Fallot and to improve oxygenation and growth of the pulmonary arteries and right ventricular outflow tract without the need of an immediate aortopulmonary shunt.


Abnormal signal averaged ECG after surgical repair of tetralogy of Fallot: A combined analysis in the time and frequency domain.

The clinical significance of abnormal signal averaged ECG (SA-ECG) determined by time and frequency domain analyses was assessed in tetralogy of Fallot patients after surgical repair, and the methods of analysis were compared. SA-ECG was performed in 42 patients (mean age, 9.4 years) after radical surgical repair of tetralogy of Fallot, and in 11 preoperative patients (mean age, 2.6 years). Abnormal SA-ECGs were defined by time domain analysis (vector magnitude method) and frequency domain analysis (fast Fourier transformation). Abnormal SA-ECGs were recognized in 10 postoperative, patients (3 by time domain and 9 by frequency domain, analysis), but in none of the preoperative patients. Three patients with abnormal SA-ECGs had nonsustained ventricular tachycardia, 5 others had premature ventricular contractions, and the remaining 2 had no ventricular tachyarrhythmias documented by 24 h Holter monitoring. Patients with abnormal SA-ECGs more commonly had ST-T segment depression on standard ECG during exercise (8/10 versus 8/32, p < 0.001), a history of resection of a hypertrophic septoparietal muscle band (8/10 versus 2/32, p < 0.001) and histologically documented myocardial fibrosis at radical surgical repair (9/10 versus 5/19, p < 0.002). A Combination of time and frequency domain analyses was necessary to detect abnormal SA-ECGs in postoperative patients because of ventricular conduction disturbance. This technique might increase our ability to identify patients at risk of ventricular tachyarrhythmia, or those with underlying myocardial abnormalities.


CARDIOPROTECTIVE EFFECT OF CROMAKALIM,A K+ CHANNEL OPENER --- ON ISOLATED GLOBALLY ISCHEMIC AND REPERFUSED RAT HEARTS

K+チャネルオープナー，クロマカリムの心筋保護効果 --- 摘出ラット虚血再灌流心での検討


運動負荷前後での血中遊離型および抱合型カテコールアミンの変動 --- 僧帽弁逸脱症例での検討

Japanese Journal of Clinical Pharmacology and Therapeutics


先天性心疾患術後における心室遅延電位の臨床的意義

先天性心疾患術後における心室遅延電位の臨床的意義


乳児期より著明な高尿酸血症を呈したTaussig-Bing奇形，大動脈離断の1例

Pediatric Cardiology and Cardiac Surgery


僧帽弁閉鎖不全症に対する僧帽弁形成術症例の検討

僧帽弁閉鎖不全症に対する僧帽弁形成術症例の検討


Behcet病に合併した胸部大動脈瘤の1手術例

Behcet病に合併した胸部大動脈瘤の1手術例

The Japanese Journal of Thoracic Surgery


当院における破裂性腹部大動脈瘤手術症例の検討

当院における破裂性腹部大動脈瘤手術症例の検討


Changes in plasma dopamine-β-hydoroxylase activity during the perioperative period of cardiac surgery:An index of sympathetic nerve activity.

To evaluate the usefulness of plasma dopamine-beta-hydroxylase (DBH) activity as an index of sympathetic nerve activity during cardiac operations, we examined the serial changes in plasma DBH activity, in relation to the plasma noradrenaline (NA) level and hemodynamic parameters, in patients who underwent cardiac surgery. The plasma DBH activity decreased significantly after cardiopulmonary bypass, and remained low during dopamine (DA) infusion until 72 h after the operation. However, recovery of the hemodynamic parameters, being the mean arterial pressure, heart rate and cardiac index, was seen as early as 1-3 h postoperatively. It was therefore assumed that the plasma DBH activity takes a long time to recover after an operation. The time-course changes in the plasma NA level were quite different from the changes in DBH activity, with an apparent negative correlation being observed between them. Thus, there is a possibility that exogenously administered DA, as well as increased plasma NA, might inhibit DBH activity during cardiac surgery. Moreover, since catecholamines are often administered upon completion of cardiac surgery, measurement of the plasma catecholamine level would be inappropriate for evaluating real sympathetic nerve activity. From the results of this study, it is surmised that measurement of the plasma DBH activity could be useful for estimating the intrinsic sympathetic nerve activity of patients who have undergone cardiac surgery.


A CASE REPORT OF LUCAS-SCHMIDT IIA TYPE COR TRIATRIATUM IN NEONATE

三心房心(Lucas-Schmidt ⅡA型)に対する新生児期の1根治術症例

The Japanese Journal of Thoracic and Cardiovascular Surgery


Intraartereial lymphocyte injection therapy for lymphedema of the leg: An examination using Indium-111 oxine labeled autologous lymphocytes.

A 58-year-old female patient with lymphedema of the left leg was treated by repeated intraarterial lymphocyte-injection therapy. To elucidate whether the injected lymphocytes act at the affected site of the leg, we examined the distribution of the In-111 oxine labeled lymphocytes injected into the proximal artery to the affected leg in comparison with the distribution in the other, healthy, leg. The radioactivity of the affected leg was almost two times higher than that of the healthy leg during the first 30 min after injection, and it remained higher even after 24 hours. The circumference of the affected leg of the patient decreased steadily during her hospital stay. These results, together with the clinical findings, suggest that some of the intraarterially-injected lymphocytes remained in the affected leg at least 24 hours and might play some role in reducing the volume of lymphedematous fluid.

The Tokushima Journal of Experimental Medicine


Clinical significance of late potentials in patients after intracardiac opration for congenital heart disease.

The aim of this study was to evaluate the late potentials (LPs) in postoperative patients with congenital heart disease (CHD) and to study the association with the clinical characteristics in the postoperative patients with LPs. Signal averaged electrocardiogram (SA-ECG) was recorded in 119 postoperative patients aged 4 to 23 years and compared with those in age matched 49 healthy volunteers with and without right bundle branch block. Based on control data, criterias of LP were defined and altered in the presence of bundle branch block. Abnormal SA-ECGS Were not detected in the patients with non-cyanotic CHD. However, abnormal and borderline SA-ECGS were recognized in 5 (12%) of 42 patients after intracardiac operation for tetralogy of Fallot and 3 (30%) of 9 patients after Rastelli's operation. The patients with abnormal and borderline SA-ECGS Were significantly older at the time of operation, and had more frequent ventricular arrhythmias (7/8: 3/111, p<0.01) and depression of the ST-T segment on ECG (7/8: 11/111, p<0.01), compared with the normal SA-ECG group. Abnormal SA-ECGS including those of borderline patients were 50% sensitive and 96% specific for documented ventricular arrhythmias. However, there was no association between anbnormalities of SA-ECGS and cardiomegaly on chest X-ray or left ventricular ejection fraction on echocardiogram. These results indicate that prolonged exposure to hypoxia may be the main cause of the primary role in the development of LPs. And late surgical intervention may result in histological background for the development of LPs.


播種性血管内凝固症候群(DIC)と腎不全を合併した高齢者腹部大動脈瘤の1手術治験例


遠位型大動脈肺動脈中隔欠損の1新生児例

遠位型大動脈肺動脈中隔欠損の1新生児例


CHANGES IN PLASMA SULFOCONJUGATED CATECHOLAMINES DURING PERIOPERATIVE PERIOD OF CARDIAC OPERATIONS --- EFFECT OF CONTINUOUS INFUSION OF DOPAMINE

開心術前後のカテコールアミン硫酸抱合型の動態 --- 術後ドーパミン持続投与の影響


Fallot四徴症に対するRastelli型手術後の再手術の経験–導管周囲の結合組織を利用した再建術–


due to dysfunction of the Medtronic-Hall prosthetic valve in aortic position

特異な大動脈弁逆流を呈した大動脈弁位Medtronic-Hall弁機能不全の1例


贈帽弁逸脱と贈帽弁逆流を伴う肺静脈瘤の1例–特に経食道心エコー法による検討–

贈帽弁逸脱と贈帽弁逆流を伴う肺静脈瘤の1例–特に経食道心エコー法による検討–


A neonatal case of distal aortopulmonary septal defect;the relation to anomalous

遠位型大動脈肺動脈中隔欠損の1新生児例:右肺動脈上行大動脈起始との関連および術式について


Arterial Reconstruction for Femoropopliteal Occlusive Disease Due to Arteriosclerosis. A Retrospective Comperative Study between Endarterectomy and Femoropopliteal Bypass.

大腿動脈閉塞性動脈硬化症に対する外科治療の検討–血栓内膜摘除術とバイパス術–

Japanese Journal of Cardiovascular Surgery

日本心臓血管外科学会雑誌


先天性心疾患外科治療の進歩

先天性心疾患外科治療の進歩


Changes in plasma free and sulfoconjugated catecholamines before and after acute physical exercise:Experimental and clinical studies.

To elucidate whether sulfoconjugated catecholamines in plasma, especially dopamine, serve as a source of free catecholamines, we examined the change in afterload on the deconjugating activity of catecholamines in isolated Langendorff perfused rat hearts. Dopamine-sulfate was administered under ordinary or high-work-load conditions. Free dopamine in the effluent was increased by the high-work-load of the hearts, whereas conjugated dopamine showed an apparent decrease. These results indicate the possibility that deconjugation of sulfoconjugated catecholamines is accelerated by a high-work-load. To obtain further evidence in humans, we also examined the changes in the plasma levels of free and sulfoconjugated catecholamines in healthy volunteers before and after marathon running. Free dopamine increased 1.99-fold from the baseline value after exercise, whereas conjugated dopamine decreased by 12%. Similarly, the plasma levels of free noradrenaline and adrenaline increased after exercise to 2.45- and 1.51-fold their respective baseline values, while conjugated noradrenaline and adrenaline both decreased. These clinical results, as well as those of the experimental studies, suggest that the increase in plasma free catecholamines after exercise is due not only to increased release from the sympathoadrenal system but also to accelerated conversion from sulfoconjugated catecholamines in the plasma.


THE EVALUATION OF THE MODIFIED BLALOCK-TAUSSIG SHUNT WITH A PROSTHESIS OF MICROKNITTED DACRON FOR THE TETRALOGY OF FALLOT IN EARLY INFANCY

We evaluated the surgical results of the modified Blalock-Taussig shunt (MBTS), performed with a prosthesis of microknitted Dacron, for the ductus-dependent tetralogy of Fallot (TOF) in early infancy. Nine MBTSs for eight patients, 4 with and 4 without pulmonary atresia, were performed, and one patient died. The mean age was 30 +/- 27 days, and the mean weight was 3460 +/- 770 g at the initial MBTS. In the initial two cases, the patients experienced convulsions due to severe hypoxia on account of the troubles of the preoperative administration of Prostaglandin E1 (PGE1). Thereafter, in order to prevent brain damage, we performed the MBTS following short-term administration of PGE1 (2-13 days). Consequently, we did not experience brain damage in later cases. Half of the patients with the MBTS with a 5 mm diameter prosthesis experienced postoperative congestive heart failure due to excessive pulmonary flow, and one of them died. The patients with the MBTS with a 4 mm diameter prosthesis had good postoperative courses. The suitable shunt flow in these patients was estimated to be 70-90 ml/kg/min. The MBTS with a 4 mm prosthesis obtained the lower level of this suitable shunt flow, but that a 5 mm prosthesis induced excessive shunt flow. Observing the patients' weight gain and the progress of polycythemia until two years of age, there were no differences between the MBTS with a 4 mm prosthesis and that with a 5 mm prosthesis. From these results, we recommend a 4 mm microknitted Dacron prosthesis for the MBTS of the TOF in early infancy.(ABSTRACT TRUNCATED AT 250 WORDS)

The Japanese Journal of Thoracic and Cardiovascular Surgery


New operative method for distal aortopulmonary spetal defect.

A new technique is described for repairing distal aortopulmonary septal defect with aortic origin of the right pulmonary artery in a 26-day-old neonate. To prevent the narrowing of the proximal right pulmonary artery in the distal aortopulmonary septal defect caused by conventional intraluminal prosthetic patch reconstruction, rerouting of the right pulmonary artery using native aortic wall tissue without artificial material was performed. This method seems to be superior to the conventional method, especially during the neonatal period.


A successful modified Norwood operation for hypoplastic left heart syndrome

左心低形成症候群に対するmodified Norwood手術の1成功例


Optimal pulmonary blood flow in palliative open heart surgery of the early infant with complex cardiac defects.

乳児期早期姑息的開心術における至適肺血流量について

日本心臓血管外科学会雑誌


Microknitted Dacron Graft を用いた乳児期早期ファロー四徴症に対するmodified Blalock-Taussig手術の検討


生後5日後に，永久的ペースメーカー植え込み術を要した先天性完全房室ブロックの一例


完全房室ブロック患者のペース・メーカー植え込み術前・術後の運動時循環動態について


Surgery for complex cardiac defects in early infant.

複合心奇形に対する新生児期手術の検討

日本心臓血管外科学会雑誌


新生児期早期のTGA (I)に対するJatene手術の問題点 とくに術後弁上狭窄について

日本心臓血管外科学会雑誌


新生児期早期のTGA(Ⅰ)に対する動脈スイッチ手術後の大動脈弁上部狭窄について

新生児期早期のTGA(Ⅰ)に対する動脈スイッチ手術後の大動脈弁上部狭窄について

日本胸部外科学会雑誌(-1998)


左心低形成症候群の第一期手術について-Norwood第一期手術成功例を中心に-

左心低形成症候群の第一期手術について-Norwood第一期手術成功例を中心に-

日本胸部外科学会雑誌(-1998)


Intraarterial lymphocyte injection therapy for lyphedema of the extremities


体肺動脈短絡術の至適短絡量の検討・特にファロー四徴症について

体肺動脈短絡術の至適短絡量の検討・特にファロー四徴症について

日本胸部外科学会雑誌(-1998)


経静脈ペースメーカー電極を温存した三尖弁置換術症例

経静脈ペースメーカー電極を温存した三尖弁置換術症例


左心低形成症候群3例の外科治療経験

左心低形成症候群3例の外科治療経験

日本心臓血管外科学会雑誌


開心術後急性期心筋代謝におよぼすnicardipineの影響・術後冠拡張療法の指標のために

Japanese Journal of Cardiovascular Surgery

日本心臓血管外科学会雑誌


開心術後急性期心筋代謝におよぼすニトログリセリンの効果

開心術後急性期心筋代謝におよぼすニトログリセリンの効果

日本心臓血管外科学会雑誌


右室型体心室をもつ複雑心奇形に対するFontan型手術の検討

右室型体心室をもつ複雑心奇形に対するFontan型手術の検討

日本胸部外科学会雑誌(-1998)


縦隔腫瘍と鑑別困難であった胸部大動脈瘤の1例

縦隔腫瘍と鑑別困難であった胸部大動脈瘤の1例

The Japanese Journal of Thoracic Surgery


四肢リンパ浮腫の臨床・その病態と保存的治療法

四肢リンパ浮腫の臨床・その病態と保存的治療法


ファロー四徴症根治手術後の再手術例の検討

ファロー四徴症根治手術後の再手術例の検討


甲状腺悪性リンパ腫3例の検討

甲状腺悪性リンパ腫3例の検討


後腹膜悪性線維性組織球腫の1例

後腹膜悪性線維性組織球腫の1例


Critical Limb Threatening Ischemia Due to Severe Polyarteritis Nodosa-A Case Report

A delayed diagnosis of polyarteritis nodosa may lead to critical limb-threatening ischemia (CLTI). A 74-year-old woman presented with left-foot pain and was treated with oral vasodilators and antiplatelet agents. However, the distal ischemia progressed to CLTI, including gangrene of the fingers and toes, and bilateral foot dropping appeared because of peroneal nerve paralysis. Angiography of the extremities revealed obstruction and stenosis of medium-sized arteries. Based on the progressive distal gangrene, mononeuropathy multiplex, and pathological findings of necrotic vasculitis, polyarteritis nodosa was diagnosed, and the patient's condition improved. A biopsy and neurological examination are essential for the appropriate diagnosis of PAN and immediate treatment.


A case of ureteroarterial fistula after urinary diversion

膀胱全摘術後の腸骨動脈尿管瘻の1例


パネルディスカッション2 急性肺動脈血栓塞栓症

パネルディスカッション2 急性肺動脈血栓塞栓症


日本心臓血管外科学会雑誌


Significance of Peritoneal Fluid Drainage in Management After Repair of Complex Heart Defects in Infancy --- Cytokine Dynamics In Vivo

In vivo redundancy of pro-inflammatory cytokines results in a vicious cycle of systemic inflammatory response syndrome and low cardiac output syndrome (LOS). The purpose of this study was to elucidate the influence of peritoneal fluid (PF) drainage on cytokine dynamics in vivo and the significance of early induction for infants with LOS. Seven infants, who underwent early PF drainage to manage LOS after repair of complex heart defects under cardiopulmonary bypass, were enrolled. The serum and PF levels of the pro- and antiinflammatory cytokines, interleukin (IL)-6, -8, -10 and tumor necrosis factor (TNF)-alpha, were measured during the perioperative period. Clinical outcomes were observed simultaneously. There were no cases of early or late death, or infectious complications. Drainage volume of PF peaked just after operation, and decreased completely. The amount of proinflammatory cytokines in the PF increased for 3 days after operation. Of the proinflammatory cytokines in the PF IL-6 increased the earliest and cleared the fastest. The amount of cleared IL-8 and TNF-alpha peaked on the 3rd postoperative day and resembled the course of C-reactive protein (CRP). Serum levels of CRP and proinflammatory cytokines in patients with PF drainage decreased significantly more than those without PF drainage. Early initiation of PF drainage is useful in the postoperative critical care of infants with LOS by improving cytokine dynamics in vivo, although there are differences between the severity of patients undergoing PF drainage and those who do not.


Extracorporeal perfusion of the meandering mesenteric arterial circulation for an abdominal aortic aneurysm operation eith obstructed visceral branches

主要な腹部臓器血流をmeandering mesenteric arteryから供給された腹部大動 脈瘤の1手術例

A 64 year old man underwent hemodialysis one year ago was detected an infra renal abdominalaortic aneurysm with the occluded lesion of the superior mesenteric(SMA)and the celiacarteries. Abdominal angiogrphy revealed that the branches of the SMA filled reversely from theinferior mesenteric artery through the large meandering mesenteric artery(MMA). Therefore itwas thought that a prolonged clamping time during the aortic reconstruction would possibly resultin visceral ischemic injury, the MMA was perfused by an extracorporeal circulation system duringthe aortic cross-clamping. The postoperative course was uneventful, without visceral ischemiccomplication. Consequently ischemic enterocolitis is a serious complication and a factor of poorprognosis in an operation of abdominal aortic aneurysm, it is important that understood the state ofthe visceral circulation and decided the strategy of the operation with or without the branchesrepaired for preventing ischemia.


A successful transatrial repair in redo surgery of postinfarction inferoposterior ventricular septal rupture

A successful transatrial repair in redo surgery of postinfarction posterior ventricular septal rupture (VSR) was performed after an infarct exclusion technique through left ventriculotomy incision of the infarcted area. For the infarct lesion, this approach provides excellent results with sufficient closure of the VSR and prevention of the ventricular remodeling for five years. A right atrial approach for postinfarction posterior VSR is very useful for avoiding any further ventriculotomy in an already impaired ventricle, securing a stable suture, and preserving the left ventricular geometry and function.

The Journal of Medical Investigation : JMI


Reconstruction of the Pulmonary Valve for Tetralogy of Fallot with Absent Pulmonary Valve

肺動脈弁欠損を伴うファロー四徴症の肺動脈弁再建について

Pediatric Cardiology and Cardiac Surgery


末梢単核球細胞を用いた抹消動脈閉塞症に対する新たな血管新生治療の試み

末梢単核球細胞を用いた抹消動脈閉塞症に対する新たな血管新生治療の試み


胸腺内Tリンパ球の異動制御とケモカイン

胸腺内Tリンパ球の異動制御とケモカイン


Perioperative thyroid storm: a case of urgent coronary artery bypass grafting

甲状腺クリーゼを発症した緊急冠動脈バイパス術の1例


四肢リンパ浮腫に対するリンパ球道注療法の作用機序

四肢リンパ浮腫に対するリンパ球道注療法の作用機序


Angiotensin as a stimulator of Na+-dependent Ca2+ efflux from freshly isolated adult rat cardiomyocytes

In cardiac tissues, angiotensin II causes inotropic and chronotropic effects on the heart. It is indicated that the mechanism of the inotropic effect of angiotensin II is attributed to an increase in cytosolic free calcium ([Ca2+]i) in cardiomyocytes. However, increased [Ca2+]i should be restored to a physiological level because cumulative elevation in [Ca2+]i leads to irreversible injury in cardiomyocytes. Whereas it is known that angiotensin II causes the increase in [Ca2+]i in cardiac cells, little is known about the mechanisms of decrease in [Ca2+]i in cardiomyocytes upon angiotensin II stimulation. In the present study, we examined the effect of angiotensin II on Ca2+ efflux from freshly isolated adult rat cardiomyocytes. Angiotensin II stimulated the efflux of 45Ca2+ from the cells in a concentration-dependent manner (10(-7)-10(-5) M). The 45Ca2+ efflux from the cells was inhibited by type 1 angiotensin II receptor inhibitor. The angiotensin II-stimulated 45Ca2+ efflux was not affected by deprivation of the extracellular Ca2+, but was dependent on the presence of extracellular Na+. These results indicate that angiotensin II stimulates extracellular Na(+)-dependent 45Ca2+ efflux from freshly isolated adult rat cardiomyocytes, probably through its stimulatory effect on the plasma membrane type 1 angiotensin II receptors which may couple to Na+/Ca2+ exchange.


Roles of left atrial appendage for left atrial hemodynamics by left atrial appendage clamping during cardiac surgery.


進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

第18回日本小児心電学会

第18回日本小児心電学会