Two Successful Surgical Experiences of Cardiac Papillary Fibroelastoma-Preferable Early Resection-

General Thoracic and Cardiovascular Surgery.


A case of atopic cough with aphonia showed a prominent response to a histamine H1 receptor antagonist.

-RA, a diagnosis of AC was made. To the best of our knowledge, this is the first report of an AC patient who presented severe cough with aphonia. J. Med. Invest. 70 : 281-284, February, 2023.

The Journal of Medical Investigation : JMI


Clinical significance of fractional exhaled nitric oxide and periostin as potential markers to assess therapeutic efficacy in patients with cough variant asthma.

Our observations indicate the usefulness of FeNO and periostin as potential "therapeutic" markers for CVA. To the best of our knowledge, this is the first report demonstrating the clinical significance of these factors as potential biomarkers to assess therapeutic efficacy in patients with CVA.


The efficacy of mass screening for chronic obstructive pulmonary disease using screening questionnaires in a medical health check-up population.

Mass screening for COPD using screening questionnaires, particularly the COPD-PS questionnaire, might be useful to identify the early stages of COPD in a medical health check-up population.


遺残坐骨動脈により生じた足背部難治性皮膚潰瘍の1例

遺残坐骨動脈により生じた足背部難治性皮膚潰瘍の1例


Pathophysiology and complications during extracorporeal circulation


Accuracy and reliability of continuous blood glucose monitoring during pediatric cardiopulmonary bypass.

The purpose of this study was to assess the accuracy and reliability of a continuous blood glucose monitoring system (artificial endocrine pancreas; STG-55, Nikkiso, Tokyo, Japan) during pediatric cardiopulmonary bypass surgery. Twenty-five pediatric patients scheduled to undergo cardiovascular surgery with cardiopulmonary bypass (age 4 months to 11 years; body weight 5.6-59.7 kg) were enrolled. The glucose sensor line of the artificial endocrine pancreas was connected to the venous side of the cardiopulmonary bypass circuit and used for continuous blood glucose monitoring. We obtained 192 samples for blood gas assessment from the cardiopulmonary bypass circuit, and i-STAT (Abbott, East Windsor, NJ, USA) was used for conventional blood glucose assessment. The accuracies of continuous glucose measurements (STG-55) and conventional intermittent glucose measurements (i-STAT) during cardiopulmonary bypass were compared by means of Clarke error grid analysis. The results were divided into five zones, A, B, C, D, and E, and 78.6% of paired measurements were in zone A, while 21.4% were in zone B. We confirmed that the results of this continuous blood glucose monitoring system for cardiopulmonary bypass during pediatric cardiovascular surgery were highly reliable. An artificial endocrine pancreas may facilitate the safe use of intensive insulin therapy during pediatric cardiovascular surgery.


Differentiation of Primary Cardiac Tumors from Metastatic Tumors by Non-invasive Cardiac Imaging


Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player.

Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.


頸部・体幹部の巨大動静脈形成異常に対する治療戦略

頸部・体幹部の巨大動静脈形成異常に対する治療戦略


Effects of Transplanted Human Cord Blood- Mononuclear Cells on Pulmonary Hypertension in Immunodeficient Mice and Their Distribution.

To investigate the effects of human umbilical cord blood-derived mononuclear cell (hUCB-MNC) transplantation on pulmonary hypertension (PH) induced by monocrotaline (MCT) in immunodeficient mice and their distribution. MCT was administered to BALB/c Slc-nu/nu mice, and PH was induced in mice 4 weeks later. Fresh hUCB-MNCs harvested from a human donor after her delivery were injected intravenously into those PH mice. The medial thickness of pulmonary arterioles, ratio of right ventricular to septum plus left ventricular weight (RV/S+LV), and ratio of acceleration time to ejection time of pulmonary blood flow waveform (AT/ET) were determined 4 weeks after hUCB-MNC transplantation. To reveal the incorporation into the lung, CMTMR-labeled hUCB-MNCs were observed in the lung by fluorescent microscopy. DiR-labeled hUCB-MNCs were detected in the lung and other organs by bioluminescence images. Medial thickness, RV/S+LV and AT/ET were significantly improved 4 weeks after hUCB-MNC transplantation compared with those in mice without hUCB-MNC transplantation. CMTMR-positive hUCB-MNCs were observed in the lung 3 hours after transplantation. Bioluminescence signals were detected more strongly in the lung than in other organs for 24 hours after transplantation. The results indicate that hUCB-MNCs are incorporated into the lung early after hUCB-MNC transplantation and improve MCT-induced PH. J. Med. Invest. 64: 43-49, February, 2017.


Long-term results after open mitral commissurotomy for a one-month-old infant with mitral stenosis.

The strategy for an infant with congenital mitral stenosis should be determined by three important factors: left ventricular volume, the degree of the systemic outflow tract obstruction, and the type of mitral valve dysfunction. A successful staged biventricular repair in early infancy for a patient who had congenital mitral stenosis with short chordae, hypoplastic left ventricle and coarctation of the aorta, and the long-term results are described. There were the following important hemodynamic factors that led to the successful biventricular repair in the patient. Total systemic output was barely supplied through the hypoplastic left ventricle after closure of the ductus arteriosus on admission. The neonate underwent repair of coarctation of the aorta alone as the initial stage at 9 days after birth. Also, spontaneous closure of the foramen ovale following repair of coarctation of the aorta accelerated the progressive left ventricular growth. Open mitral commissurotomy with an interatrial fenestration using the modified Brawley's approach was performed for a 40-day-old infant. Good left ventricular growth and good mitral valve function have been observed for 18 years after open mitral commissurotomy. Appropriate early augmentation of left ventricular inflow through the mitral valve might be effective for growth of a hypoplastic left ventricle. J. Med. Invest. 64: 187-191, February, 2017.


糖転移ヘスペリジン/分散ヘスペレチンの動脈硬化病巣進展に対する抑制効果についての検討

The Journal of Metabolism and Clinical Nutrition


The pathophysiological role of oxidized cholesterols in epicardial fat accumulation and cardiac dysfunction: A study in swine fed a high caloric diet with an inhibitor of intestinal cholesterol absorption, ezetimibe.

Oxidized cholesterols (oxycholesterols) in food have been recognized as strong atherogenic components, but their tissue distributions and roles in cardiovascular diseases remain unclear. To investigate whether accumulation of oxycholesterols is linked to cardiac morphology and function, and whether reduction of oxycholesterols can improve cardiac performance, domestic male swine were randomized to a control diet (C), high caloric diet (HCD) or HCD+Ezetimibe, an inhibitor of intestinal cholesterol absorption, group (HCD+E) and evaluated for: (1) distribution of oxycholesterol components in serum and tissues, (2) levels of oxycholesterol-related enzymes, (3) paracardial and epicardial coronary fat thickness, and (4) cardiac performance. Ezetimibe treatment for 8weeks attenuated increases in oxycholesterols in the HCD group almost completely in liver, but reduced only levels of 4β-hydroxycholesterol in left ventricular (LV) myocardium. Ezetimibe treatment altered the expression of genes for cholesterol and fatty acid metabolism and decreased the expression of CYP3A46, which catabolizes cholesterol to 4β-hydroxycholesterol, strongly in liver. An increase in epicardial fat thickness and impaired cardiac performance in the HCD group were improved by ezetimibe treatment, and the improvement was closely related to the reduction in levels of 4β-hydroxycholesterol in LV myocardium. In conclusion, an increase in oxycholesterols in the HCD group was closely related to cardiac hypertrophy and dysfunction, as well as an increase in epicardial fat thickness. Ezetimibe may directly reduce oxycholesterol in liver and LV myocardium, and improve cardiac morphology and function.


Vegetation in the coronary sinus that concealed the presence of a coronary arteriovenous fistula in a patient with infectious endocarditis.


PPAR-gamma agonist attenuates inflammation in aortic aneurysm patients.

Peroxisome proliferator-activated receptor (PPAR) -γ agonist, which is an anti-diabetes drug and reduces expression of tumor necrosis factor (TNF)-α, reported to have the effects for anti-inflammation in our body. In cardiovascular fields, this PPAR-γ agonist already reported to suppress progression of coronary atherosclerosis. Various cytokines, which is secreted from fat tissues around artery, promote atherosclerosis and/or aneurysmal changes in aorta/artery. Objective of our study is to clarify whether PPAR-γ agonist has anti-inflammatory effects in aorta of patients with aortic aneurysm (AA). The medical ethics committee in Tokushima University Hospital approved protocol for this study. Sixteen patients with AA (more than 5 cm in diameter, scheduled open surgery) were divided into two groups; one is PPAR-γ agonist administrating group [Formula: see text] n = 6, group P[Formula: see text], and another is the without group [Formula: see text] n = 10, group C[Formula: see text]. PPAR-γ agonist, whose dose was 15 mg/day, was administrated in the group P for more than 2 months before aneurysectomy and grafting (mean; 4.2 ± 3.4 months) (Supplemental Table 1). Biopsy specimens were obtained from abdominal subcutaneous fat, greater omentum, retroperitoneal periaortic fat and aneurysmal wall in surgical procedure. Blood examination also achieved before/after procedure. Harvested specimens were analyzed with histology (HE and EVG), immunohistochemistry (macrophage) and RT-PCR (adiponectin, MCP-1, TNF-α, CD68, matrix metalloprotease (MMP)-2, MMP-9). Macrophage infiltration in aortic wall and retroperitoneal periaortic fat among group P was significantly decreased compared to that among group C. Adiponectin expressions in both subcutaneous fat and retroperitoneal periaortic fat among the group P (adiponectin/β-actin) were significantly increased compared to those among the group C [subcutaneous fat; 16.8 ± 13.9 vs. 5.82 ± 2.94 (P = 0.04), retroperitoneal periaortic fat; 21.3 ± 24.1 vs. 2.12 ± 1.69 (P = 0.04)]. On the other hand, expressions of TNF-α, and MMP-9 in both aortic aneurysmal wall and retroperitoneal periaortic fat among group P were significantly decreased. [(Aortic aneurysmal wall; TNF-α; 0.45 ± 0.15 vs. 5.18 ± 3.49 (P = 0.02), MMP-9; 39.6 ± 69.0 vs. 721 ± 741 (P = 0.04)], [retroperitoneal periaortic fat; TNF-α; 1.14 ± 0.36 vs. 26.4 ± 25.0 (P = 0.048), MMP-9; 0.18 ± 0.21 vs. 50.0 ± 41.8 (P = 0.047)]. These data may indicate that PPAR-γ agonist become the way for preventing or delaying aortic aneurysm progression in patients. More studies will be needed to clarify this drug effects in detail.

General Thoracic and Cardiovascular Surgery


Impact of newly developed, next-generation artificial endocrine pancreas

Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter's fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control.

The Journal of Medical Investigation : JMI


Efficacy and Optimal Timing of Endovascular Treatment for Type B Aortic Dissection.


Effects of ezetimibe on oxidized cholesterol components in epicardial fat and myocardium: a gas chromatography-mass spectrometry analysis


[Imaging diagnosis: Q & A. Markedly dilated pulmonary artery (trunk) in association with acute pulmonary hypertension, causing extrusion of the left coronary artery and acute stenosis and unstable angina].

The Japanese Journal of Thoracic Surgery


Reconstruction of Pulmonary Blood Flow in the Norwood Procedure : Blalock-Taussig shunt : from Bench to Surgery

Although the right-ventricle to pulmonary artery( RV-PA) shunt as a source of pulmonary blood supply of Norwood procedure has improved early outcomes, disadvantages including right ventricular dysfunction or arrhythmias have been reported. So it has been still remained controversial whether BT shunt or RV-PA conduit should be selected. We examined the influence of Blalock-Taussig( BT) shunt size on regulation of the pulmonary blood flow in experimental model of a univentricular heart to determine the specific guidelines regarding suitable shunt size in the Norwood procedure. The canine univentricular heart model with the ratio of shunt size to body weight (SS/BW) of 0.8 to 1.1 showed significant negative correlation between the pulmonary/systemic blood flow ratio( Qp/Qs)and arterial PCo2, but those with SS/BW of 1.1 to 1.4 did not. Similar phenomena were shown with the grouped data on relationship between the Qp/Qs and inspired oxygen fraction. These findings imply that when SS/BW is 0.8 to 1.1, the Qp/Qs is controllable by physiologic respiratory manipulations. In the context of our clinical experiences, SS/BW of 0.9 to 1.0 is considered a useful index for suitable BT shunt in the Norwood procedure.


ペースメーカーリード前尖穿通に伴う重症三尖弁閉鎖不全症に対する1手術例

ペースメーカーリード前尖穿通に伴う重症三尖弁閉鎖不全症に対する1手術例


Increased number of Hassall's corpuscles in myasthenia gravis patients with thymic hyperplasia.

The thymus is implicated as an organ that contributes to autoimmunity in myasthenia gravis (MG) patients. Hassall's corpuscles (HCs) are assumed to represent the terminally differentiated stage of medullary thymic epithelial cells (mTECs). By using multicolor immunohistofluorescence analysis, we examined HCs in thymuses that were therapeutically excised from MG (+) and MG (-) patients. We found that the number of HCs per unit area of the thymic medulla was significantly elevated in the thymuses of MG (+) patients with thymic hyperplasia. CCL21 expression increased in the hyperplastic MG thymuses. We speculate that the altered differentiation of mTECs is associated with the thymic hyperplasia and the onset of MG.


Iliac access conduit facilitates endovascular aortic aneurysm repair and ipsilateral iliofemoral bypass.

It may be difficult to access a route to deliver a stent-graft for abdominal aortic aneurysm in high-risk patients with bilateral iliofemoral occlusive disease. These two patients underwent both endovascular aortic aneurysm repair by a modified iliac access conduit technique and sequential ipsilateral iliofemoral artery bypass using the conduit, which provided excellent results. The iliac access conduit facilitates endovascular aortic aneurysm repair and ipsilateral iliofemoral bypass of high-risk patients with abdominal aortic aneurysm and bilateral iliofemoral occlusive disease.


Massive tricuspid regurgitation due to pacemaker-lead puncture of the tricuspid valve: successful diagnosis by 3-dimensional echocardiography.

An 83-year-old woman presented to our echocardiographic center with symptoms of right heart failure. A dual-chamber DDDR pacemaker had been implanted 9 years earlier. Two-dimensional echocardiography revealed right atrial and ventricular enlargement and massive tricuspid regurgitation with immobilization of the anterior leaflet of the tricuspid valve. Three-dimensional transesophageal echocardiography showed that the pacemaker lead had punctured the leaflet. These echocardiographic findings were confirmed during surgery. The pacemaker lead was transected and removed, and pericardial patch closure of the leaflet hole and tricuspid annuloplasty were performed. The mechanism of regurgitation was elucidated by real-time three-dimensional echocardiography, and surgical repair was straightforward.


Azelnidipine suppresses the progression of aortic aneurysm in wild mice model through anti-inflammatory effects.

BACKGROUND: Although systemic hypertension is closely associated with aortic aneurysm (AA) formation, there are many patients with AA without hypertension. In these patients, an inflammation-mediated progression of aneurysmal disease is likely responsible for AA growth and eventual rupture. Unfortunately, there remains no reproducible and durable small animal model of aortic aneurysmal disease, the development of which would enable the investigation of the pathophysiology of this vexing condition. The first aim was to establish a useful wild-type mouse model of AA with low mortality. The second aim was to use this model to assess the protective effect of azelnidipine, a new calcium channel blocker, against the progression of the AA independent of its antihypertensive effect.METHODS: Angiotensin II and -aminopropionitrile (a lysyl oxidase inhibitor) were administrated subcutaneously in 7-week-old C57BL/6J mice using an osmotic minipump for 4 weeks to generate a wild-type mouse model of AA. Concurrently, azelnidipine (a calcium channel blocker) or a placebo was administrated orally for 4 weeks. Mice were humanely killed and assessed at the end of the 4 weeks of pharmacologic manipulation.RESULTS: The combined infusion of angiotensin II and -aminopropionitrile induced degenerative aneurysm of the thoracic and/or abdominal aorta (11/12; 92%). The majority of aneurysms were located in the distal aortic arch and suprarenal abdominal aorta. Although there was no difference in systolic blood pressure between the control and azelnidipine-treated groups, azelnidipine significantly reduced the incidence of AA (2/11; 18%). Azelnidipine treatment reduced the pathologic findings normally associated with aneurysm formation within the aortic wall. Azelnidipine also reduced the number of macrophage antigen-3 (MAC-3)-positive cells in the periaortic adipose tissue and reduced the gene expression levels of tumor necrosis factor-alpha and matrix metalloproteinase-2 and -9 within the aortic wall.CONCLUSIONS: This study demonstrates that combined treatment with angiotensin II and -aminopropionitrile induces degenerative AAs in wild-type mice, and azelnidipine prevents aneurysm progression via its anti-inflammatory effect.

Journal of Thoracic and Cardiovascular Surgery


大動脈弓部全置換術後遠隔期の縦隔炎に対して持続洗浄， 閉鎖陰圧療法及び大胸筋充填治療を行った一例


HMGB1 plays a critical role in vascular inflammation and lesion formation via toll-like receptor 9.

OBJECTIVE: Endogenous ligands such as high-mobility group box 1 (HMGB1) and nucleic acids are released by dying cells and bind to Toll-like receptors (TLRs). As TLR9 is involved in both microbial and sterile inflammation by detecting both bacterial and endogenous DNA, we investigated its role in inflammation and lesion formation in a mouse model of vascular injury.METHODS AND RESULTS: C57BL/6 (WT) and TLR9 KO mice were subjected to wire-mediated vascular injury. Anti-HMGB1 antibody and purified HMGB1 protein were chronically delivered around the injured arteries by gelatin hydrogel, and neointima formation at 4 weeks after injury was evaluated. In addition, the same vascular injury was performed in bone-marrow chimeric mice (WT bone marrow into TLR KO mice; TLR9 KO bone marrow into WT mice). We also evaluated the production of inflammatory cytokines by mouse macrophages in response to HMGB1 and CpG-ODN. In wild-type mice after vascular injury, anti-HMGB1 antibody significantly reduced neointima formation and HMGB1 protein accelerated neointima hyperplasia. HMGB1 failed to accelerate lesion formation in TLR9 KO mice. The bone marrow transplantation study revealed that TLR9 in bone marrow-derived cells played a fundamental role in neointima formation. In vitro, HMGB1 and CpG-ODN synergistically induced the production of inflammatory cytokines by macrophages.CONCLUSIONS: HMGB1 serves as an endogenous mediator of inflammation and lesion formation via the TLR9 pathway in response to vascular injury. Blockade of HMGB1 and/or TLR9 may represent a novel approach to treating atherosclerosis.


Role of macrophage-derived Hypoxia-Inducible Factor (HIF)-1 as a mediator of vascular remodeling

Excessive vascular remodelling leads to progression of a wide range of vasculopathies, and the immune response to intimal injuries is crucial in this process. This vascular remodelling occurs in the hypoxic microenvironment and is closely related to the immune system. Macrophages play a key role in immunological-cell-mediated arterial remodelling. In this study, we clarified the role of macrophage-derived hypoxia-inducible factor (HIF-1α) in vascular remodelling. Wire-induced femoral arterial injury was inflicted in mice lacking the macrophage-specific HIF-1α gene and in their wild-type counterparts. The mutant mice showed both suppressed wire-induced neointimal thickening and decreased infiltration of inflammatory cells in the adventitia, compared with wild-type mice. Studies to clarify the mechanism of restrained vascular remodelling in the mutant mice revealed decreased production of pro-inflammatory cytokines by the activated macrophages and suppressed macrophage migration activity in the mutant mice. Gene expressions of the HIF-1α-deficient macrophages positively correlated with the phenotypic profile of M2 macrophages and negatively correlated with that of M1 macrophages. Our results show that HIF-1α in macrophages plays a crucial role in promoting vascular inflammation and remodelling. As decreasing HIF-1α activity in macrophages may prevent the progression of vascular remodelling, HIF-1α may be a possible therapeutic target in vascular diseases.


Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.


Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt.

A PediaSat™ oximetry catheter (PediaSat: Edwards Lifesciences Co., Ltd., Irvine, CA, U. S. A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock-Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS™ 5100C, Covidien; Boulder, CO, U. S. A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer.

The Journal of Medical Investigation : JMI


Gastrointestinal hemorrhage caused by aortoenteric fistula due to aortic aneurysm


Protective effects of selective mineralocorticoid receptor antagonist against aortic aneurysm progression in a novel murine model.

BACKGROUND: The optimal medical management to delay the progression of aortic aneurysms has not been fully clarified, and the only standard treatment at present is antihypertensive therapy. Previous studies have shown beneficial effects of selective mineralocorticoid receptor (MR) antagonists on cardiovascular remodeling. The aim of the present study was to investigate the effect of a selective MR antagonist on aortic aneurysm progression.METHODS: Seven-week-old C57BL/6J male mice were administered with angiotensin II and -aminopropionitrile for 4 weeks. The mice received either vehicle or eplerenone, a selective MR antagonist (100 mg/kg daily) every day by gavage, starting at 7 weeks of age. The production of inflammatory cytokines in cultures of high mobility group box-1-stimulated macrophages with or without a MR antagonist was also analyzed using an enzyme-linked immunosorbent assay.RESULTS: Although no differences were found in the peak systolic blood pressure between the experimental groups, the mice in the eplerenone group showed a significant reduction in aneurysm development. On histologic analysis, coarse and stretched elastic fibers were markedly improved in the aortic wall in the eplerenone group. Real-time polymerase chain reaction of both aortic wall and perivascular adipose tissue demonstrated the expression of tumor necrosis factor-, interleukin-6, and matrix metalloproteinase-2 was significantly decreased in eplerenone group, and that of monocyte chemoattractant protein-1 in the aortic wall was also significantly decreased. Macrophage infiltration in the aortic wall and perivascular adipose tissue in the eplerenone group was also significantly decreased. The production of tumor necrosis factor- and interleukin-6 in macrophage culture, which was stimulated by high mobility group box-1 and CpG oligodeoxynucleotides, was also significantly decreased in the eplerenone group.CONCLUSIONS: Eprelenone suppressed aortic aneurysm progression through an anti-inflammatory effect. Thus, selective MR antagonists might be effective in preventing the progression of aortic aneurysms.


Epicardial adipose tissue volume and adipocytokine imbalance are strongly linked to human coronary atherosclerosis.

The impact of epicardial adipose tissue (EAT) over abdominal or overall adiposity on coronary artery disease (CAD) is currently unknown. We compared the association among EAT volume (EATV), cytokine/adipocytokine profiles in EAT and subcutaneous fat, and atherogenic CAD. APPROACH AND RESULTS: Paired samples were obtained from EAT and subcutaneous adipose tissue during elective cardiac surgery for CAD (n=50) or non-CAD (n=50). EATV was the sum of cross-sectional EAT areas, and visceral and subcutaneous fat areas were determined at the umbilicus level on computed tomography scans. CD68(+), CD11c(+), and CD206(+) cells were counted using immunohistochemical staining. Cytokine/adipocytokine expression was evaluated using quantitative real-time polymerase chain reaction. Multivariate analysis indicated that male sex, age, diabetes mellitus, high triglycerides, and low high-density lipoprotein cholesterol, and EATV index (EATV/body surface area, cm(3)/m(2)) were significant CAD predictors (corrected R(2)=0.401; P<0.001); visceral fat area, hypertension, smoking, low-density lipoprotein cholesterol (140 mg/dL [3.63 mmol/L]) or statin use were not predictors. The EATV index positively correlated with the CD68(+) and CD11c(+) cell numbers and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3), interleukin-1β, and interleukin-1R expression; and negatively correlated with adiponectin expression in EAT. A multivariate analysis model, including CD68(+) cells and interleukin-1β, and adiponectin expression in EAT strongly predicted CAD (corrected R(2)=0.756; P<0.001). EATV and macrophage and cytokine/adipocytokine signals in EAT strongly correlated with CAD. Our findings suggest that EATV and adipocytokine imbalance are strongly linked to human coronary atherosclerosis.

Arteriosclerosis, Thrombosis, and Vascular Biology


Delayed-onset severe heparin-induced thrombocytopenia after total arch replacement under cardiopulmonary bypass

An extremely rare case with delayed-onset heparin-induced thrombocytopenia (HIT) is described. A 46-year-old man underwent arch replacement for aortic dissection under cardiopulmonary bypass and initial exposure of unfractionated heparin. In post operative 7 days, persistent atrial fibrillation was occurred, so a continuous infusion of heparin (10000 IU/day) and Vitamine K antagonist (Warfarin) taking was started for preventing thrombosis. By 32 days after the operation, his platelet count had fallen (3×10(3)/µL) and oral hematoma and ecchymoma of bilateral lower legs were occurred. The value of HIT antibodies and the IgG antibody was 2.485 and 1.586 on 32-postoperative day, respectively. Heparin was immediately discontinued, and argatroban administrated. Platelet exceeded above 100×10(3)/µL on 12 days of the therapy. To our knowledge, few cases of delayed-onset severe HIT associated with CPB surgery have been reported in Japan.


Exendin-4, a glucagon-like peptide-1 receptor agonist, attenuates neointimal hyperplasia after vascular injury.

Exendin-4 is a glucagon-like peptide-1 receptor agonist that has been used as a drug for treatment of type 2 diabetes. To investigate the effect of exendin-4 on the cardiovascular system, we investigated the impact of exendin-4 on neointimal hyperplasia of the femoral artery after vascular injury. We performed wire-mediated endovascular injury in C57BL/6 mice, followed by administration of exendin-4 24 nmol/kg/day via infusion pump. Four weeks after the injury, exendin-4 treatment significantly attenuated neointimal hyperplasia of the injured artery, although it did not affect glucose metabolism and lipid profile in wild-type mice. Immunofluorescence study revealed abundant expression of GLP-1 receptor on α-smooth muscle actin-positive cells in the injured vessel. Cell proliferation assay using rat aortic smooth muscle cells showed that exendin-4 reduced PDGF-BB induced smooth muscle cell proliferation through the cAMP/PKA pathway. Exendin-4 also inhibited TNFα production by peritoneal macrophages in response to inflammatory stimulus. Our findings indicate that a GLP-1 receptor agonist attenuated neointimal formation after vascular injury. GLP-1 receptor agonists or drugs that raise endogenous GLP-1 level might be effective in the treatment of vascular diseases.


Complete but not partial thymectomy in early infancy reduces T-cell-mediated immune response: three-year tracing study after pediatric cardiac surgery.

The results revealed that complete thymectomy in early infancy reduces the number of circulating T cells and T-cell-mediated immune responses for at least 3 years, suggesting that the thymus should be at least partially preserved during surgery in early infancy to maintain protective immunity.

Journal of Thoracic and Cardiovascular Surgery


Beneficial effect of a synthetic prostacyclin agonist, ONO-1301, in rat autoimmune myocarditis model.

Injury to the heart can result in cardiomyocyte hypertrophy, fibrosis, and cell death. Myocarditis sometimes progresses to dilated cardiomyopathy. We previously reported that ONO-1301, a synthetic prostacyclin agonist with thromboxane-synthase inhibitory activity, promotes production of hepatocyte growth factor (HGF) from various cell types and ameliorates ischemia-induced left ventricle dysfunction in the mouse, rat and pig. Here, we investigated the therapeutic efficacy of ONO-1301 in a rat model of myosin-induced experimental autoimmune myocarditis, in which the heart transits from an acute inflammatory phase to a chronic dilated cardiomyopathy phase. Four weeks after myosin injection to Lewis rats, ONO-1301 (6 mg/kg/day) was orally administered for 4 weeks (ONO-1301 group). Hemodynamic parameters and plasma brain natriuretic peptide (BNP) level were significantly improved by ONO-1301. Histological analysis revealed that capillary density in the myocardium was significantly increased by ONO-1301. ONO-1301 increased circulating endothelial progenitor cells (EPC) as determined by FACS analysis. These beneficial effects of ONO-1301 were partially abrogated by a neutralizing anti-HGF antibody (8 mg/kg/dose). These findings indicate beneficial effects of ONO-1301 in a rat experimental autoimmune myocarditis model.


Gender disparities in the association between epicardial adipose tissue volume and coronary atherosclerosis: A 3-dimensional cardiac computed tomography imaging study in Japanese subjects.

Growing evidence suggests that epicardial adipose tissue (EAT) may contribute to the development of coronary artery disease (CAD). In this study, we explored gender disparities in EAT volume (EATV) and its impact on coronary atherosclerosis. The study population consisted of 90 consecutive subjects (age: 63 ± 12 years; men: 47, women: 43) who underwent 256-slice multi-detector computed tomography (MDCT) coronary angiography. EATV was measured as the sum of cross-sectional epicardial fat area on CT images, from the lower surface of the left pulmonary artery origin to the apex. Subjects were segregated into the CAD group (coronary luminal narrowing > 50%) and non-CAD group. EATV/body surface area (BSA) was higher among men in the CAD group than in the non-CAD group (62 ± 13 vs. 33 ± 10 cm3/m2, p < 0.0001), but did not differ significantly among women in the 2 groups (49 ± 18 vs. 42 ± 9 cm3/m2, not significant). Multivariate logistic analysis showed that EATV/BSA was the single predictor for >50% coronary luminal narrowing in men (p < 0.0001). Predictors excluded were age, body mass index, hypertension, diabetes mellitus, and hyperlipidemia. Increased EATV is strongly associated with coronary atherosclerosis in men.


Autologous Peripheral Blood-Derived Mononuclear Cells Induced by Erythropoietin Improve Critical Ischemic Limbs.

Purpose: Efficient and secure collection of CD34+ cells are crucial for the angiogenic therapies. We have developed autologous peripheral blood-mononuclear cell (MNC) transplantation induced by erythropoietin (rhEPO) for critical ischemic limbs. Methods: Seven patients, including five with arteriosclerosis obliterans, one with Buerger's disease and one with progressive systemic sclerosis, underwent ten cell therapies. The first administration of rhEPO was performed two weeks before apheresis, and the second administration and blood donation were performed one week before apheresis to activate bone marrow. MNCs including CD34+ cells, isolated from peripheral blood by apheresis, were immediately injected intramuscularly into ischemic limbs. Results: The number of peripheral blood-CD34 + cells had significantly increased from 1.32 ± 0.83/microL, before the rhEPO induction, to 1.86 ± 0.94/microL, before the apheresis. The number of transplanted MNCs ranged between 0.5 × 10(9) and 16.5 × 10(9), and that of CD34+ cells, between 0.1 × 10(6) and 12.7 × 10(6), accounting for 0.02%-0.1% of MNCs. There were no serious complications. Finger ulcers with Buerger's disease were significantly improved one month after the transplantations, but the same or other ulcer(s) appeared 2-6 months later. Three patients had an improvement in rest pain, and one patient extended maximum pain-free walking distance. Conclusions: Erythropoietin-induced autologous peripheral blood-MNC transplantation is a useful and safe alternative for ischemic limbs.


再発性・多発性脳塞栓源となった僧帽弁輪石灰化に対する僧帽弁置換術の1例

再発性・多発性脳塞栓源となった僧帽弁輪石灰化に対する僧帽弁置換術の1例

日本心臓血管外科学会雑誌

日本心臓血管外科学会雑誌


Ezetimibe monotherapy ameliorates vascular function in patients with hypercholesterolemia through decreasing oxidative stress.

Ezetimibe, an inhibitor of cholesterol intestinal absorption, is a lipid lowering agent. However, anti-atherogenic effects of ezetimibe have not been fully elucidated. Therefore, the objective in this study was to clarify the vascular protective effects of ezetimibe in patients with hypercholesterolemia. Ezetimibe was administered to 20 patients with hypercholesterolemia (group E), and 20 age- and sex-matched patients with hypercholesterolemia were followed as controls (group C). Difference in metabolic profiles and cardiovascular surrogate markers before ezetimibe treatment and after 12 weeks of ezetimibe treatment were statistically evaluated. Ezetimibe treatment significantly reduced serum levels of low-density lipoprotein cholesterol (LDL-C) and malondialdehyde-modified low-density lipoprotein (MDA-LDL). In addition, the values of body mass index, body weight, waist circumference, plasma HbA1c and urinary albumin were significantly decreased in group E compared to those in group C. On the other hand, high-density lipoprotein cholesterol (HDL-C) and adiponectin levels were significantly increased in group E compared to those in group C. The values of brachial-ankle pulse wave velocity (ba-PWV), mean arterial blood pressure (m-ABP), and % of flow-mediated dilation (FMD) were significantly improved in group E. Furthermore, ultrasonic studies demonstrated amelioration of the vascular stiffness of common carotid arteries in group E but not in group C. These vascular protective effects of ezetimibe were statistically correlated with the decreased values of MDA-LDL and MDA-LDL-to-LDL-C ratio but not with those of LDL-C. Ezetimibe has a lipid lowering-independent vascular protective effect in patients with hypercholesterolemia through decreasing oxidative stress.

Journal of Atherosclerosis and Thrombosis


Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue.

The purpose of this report was to assess the link between macrophage polarization in epicardial adipose tissue and atherosclerosis in patients with coronary artery disease (CAD).

Journal of the American College of Cardiology


Functional restoration of endothelial cells of the cryopreserved heart valve.

Although several approaches have been tried to improve the durability of cryopreserved valves, cellular restoration after thawing remains to be investigated. The aim of our study was to assess the functional restoration of endothelial cells of cryopreserved heart valves by in vitro culture for an alternative step to improving longevity.

General Thoracic and Cardiovascular Surgery


Enhanced inflammation in epicardial fat in patients with coronary artery disease.

It has been hypothesized that epicardial fat, a local visceral fat depot with close proximity to coronary arteries, may serve as a source of inflammatory cytokines and cells in coronary atherosclerotic lesions. Here, we characterized infiltration of inflammatory cells and expression of adipocytokines in epicardial adipose tissue in patients with and without coronary artery disease (CAD). Pare samples were obtained from epicardial and subcutaneous adipose tissue during elective cardiac surgery (CAD, n = 8; non-CAD, n = 9). Inflammatory cell infiltration was investigated by immunohistochemical staining using antibodies against CD3, CD4, CD8 and CD68. Expression of adipocytokines was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. Infiltration of macrophages and CD8-positive T cells in the epicardial adipose tissue in the CAD group was greater than that in the non-CAD group. In contrast, there was no significant difference between the two groups in the number of inflammatory cells in subcutaneous adipose tissue. No statistical difference could be found between the CAD group and the non-CAD group in the expression levels of adiponectin and inflammatory cytokines in epicardial adipose tissue. Our findings suggest that inflammatory cell infiltration is enhanced in epicardial adipose tissue, but not in subcutaneous fat, in patients with coronary artery disease. Chronic inflammation in epicardial fat may influence the pathogenesis of coronary atherosclerosis.


気管切開孔を有する症例の上行∼弓部大動脈へのアプローチ

気管切開孔を有する症例の上行∼弓部大動脈へのアプローチ

The Japanese Journal of Thoracic Surgery


予防できる下肢のむくみと肺塞栓症

予防できる下肢のむくみと肺塞栓症

Virchow triad((1)blood stasis(, 2)changes in the vessel wall, and(3)hypercoagulability)are the major factors responsible for the development of venous thrombosis. This venous thrombosis leads to the pathogenesis of acute pulmonary thrombo-embolism which is known as``Economy Class Syndrome''. A series of pathogenesis is widely recognized as``Venous thrombo-embolism syndrome''. This syndrome occurs suddenly, and occasionally leads to fatal event. So the basic principle of treatment for this syndrome is to prevent deep vein thrombosis(DVT). The prevention consists of three crucial treatments. Firstly, to recognize high-risk patients of DVT is initial step. Secondary, anticoagulation, elastic stocking and foot pump are well established treatments. Thirdly, venous filter is applicable for the most highest-risk patients. In this review, we would like to introduce the latest knowledge for``Venous thrombo-embolism syndrome''.


増え続ける大動脈瘤治療―開胸/開腹手術か，ステントグラフト治療か?-

増え続ける大動脈瘤治療―開胸/開腹手術か，ステントグラフト治療か?-

The treatment of Aortic aneurythm is shifting stent graft treatment from open Surgery. Stent graft treatment is useful for the treatment of thoracic aortic aneurythm if the form is adaptable for the stent graft treatment. Open surgery is useful for the treatment of abdominal aortic aneurythm if the patient have no complication and high operative lisk but if the patint have complication and high operative lisk, Stent graft treatment is very useful because of the quality of life is kept


Undiminished regulatory T cells in the thymus of myathenia gravis patients

The thymus has been implicated as a possible site of origin that triggers autoimmunity in myasthenia gravis (MG). Although several groups have suggested that the decrease in the number of regulatory T (Treg) cells contributes to the onset of MG, the exact role of Treg cells in MG remains unclear. To address this point, we examined the number and distribution of Treg cells in a large number of patients with MG. Immunohistofluorescence analysis of Foxp3 along with CD4 and CD8 was performed in thymic sections of MG (+) (n = 24) and MG (-) patients (n = 27). Circulating CD4(+)CD25(+) cells in the peripheral blood of patients with MG (n = 15) and age-matched healthy subjects (n = 15) were also analyzed. Foxp3(+)CD4(+)CD8(-) cells were predominantly found in the thymic medulla and their number declined with age. There was no significant difference in the number or the distribution of Foxp3(+)CD4(+)CD8(-) cells in the thymus between MG (+) and MG (-) patients. The number of circulating CD4(+)CD25(+) cells in the peripheral blood of patients with MG was not significantly altered compared to that in healthy subjects. The cellularity of Treg cells in the thymus and circulation is not diminished in patients with myasthenia gravis.


Assessment of systemic-pulmonary collateral arteries in children with cyanotic congenital heart disease using multidetector-row computed tomography: Comparison with conventional angiography

The present study aimed to assess the feasibility of multidetector-row computed tomography (MDCT) for the evaluation of systemic-pulmonary collateral (SPC) arteries in children with congenital heart disease associated with reduced pulmonary blood flow. Forty-eight consecutive patients (mean age 9+/-5 months; range, 0-30 months) underwent MDCT angiography of the thorax with a 16-detector row scanner prior to cardiac catheterization and operation. Conventional angiographic findings were used as a gold standard for the detection of SPC vessels. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate depiction of SPC arteries. Quantification of measurements at the SPC artery diameter was evaluated independently on MDCT and conventional invasive angiography. Among the 48 patients, 115 SPC arteries were identified with conventional angiography, and 94 SPC arteries were identified with MDCT. In 89 (77%) vessels, concordant findings were observed with both modalities, with adequate depiction in 53 vessels and suboptimal depiction in 36 vessels. In 26 (23%) vessels, MDCT was unable to identify SPC arteries. Further, CT angiography resulted in the false-positive identification of vessels in 5 cases. There was an excellent correlation between MDCT- and conventional angiography-based measurement of SPC vessel diameter (R(2)=0.83), although a systematic overestimation was observed with MDCT (bias 0.19+/-0.74 mm). This study demonstrates that MDCT is a potentially useful tool, which may have implications for planning percutaneous interventions and surgical repair in the future.


Role of Hypoxia-Inducible Factor 1α in T Cells as a Negative Regulator in Development of Vascular Remodeling

Recent studies have shown that the cellular immune response in the development of vascular remodeling modulates the resulting pathological alterations. We show that hypoxia-inducible factor 1 (Hif-1) (specifically expressed in T cells) is involved in the immune response to vascular remodeling that accompanies arteriosclerosis. To study the role of T cells in the development of vascular remodeling, femoral arterial injury induced by an external vascular polyethylene cuff was examined in mice lacking Hif-1 (specifically in T cells). We found that cuff placement caused prominent neointimal hyperplasia of the femoral artery in Hif-1- (T-cell)-deficient mice compared with that in control mice and that infiltration of inflammatory cells at the adventitia was markedly increased in the mutant mice. Studies to clarify the mechanism of augmented vascular remodeling in the mutant mice showed enhanced production of cytokines by activated T cells and augmented antibody production in response to a T-dependent antigen in the mutant mice. The results of this study revealed that Hif-1alpha in T cells plays a crucial role in vascular inflammation and remodeling in response to cuff injury as a negative regulator of T cell-mediated immune response. Potential new therapeutic strategies that target Hif-1alpha are described.

Arteriosclerosis, Thrombosis, and Vascular Biology


Optimal surgical approach for repair of aortopulmonary window with aortic origin the right pulmonary artery.

Journal of Thoracic and Cardiovascular Surgery


ピオグリタゾン投与による腹部大動脈瘤ぬおける抗動脈硬化作用

ピオグリタゾン投与による腹部大動脈瘤ぬおける抗動脈硬化作用


循環器病診療における最新の診かた，考え方 巻頭言

循環器病診療における最新の診かた，考え方 巻頭言


Successful Implantations of Autologous Peripheral Blood-Derived Mononuclear Cells Pretreated by Erythropoietin and Blood Donation in a Patient with Buerger Disease and Intractable Finger Ulcers

エリスロポエチン誘導末梢血単核球細胞移植が奏功した重症虚血性潰瘍を伴うBuerger病の1例

Japanese Journal of Cardiovascular Surgery

日本心臓血管外科学会雑誌


Autologous Peripheral Blood Mononuclear Cell Implantation for Therapeutic Angiogenesis in a Patient with Buerger's Disease

バージャー病に対する自己末梢血単核球細胞移植による血管新生治療

The Journal of Japan Society for Clinical Anesthesia


Syngeneic bone marrow mononuclear cells improve pulmonary arterial hypertension through vascular endothelial growth factor upregulation.

We investigated the effects and possible mechanism of syngeneic bone marrow mononuclear cell (BM-MNC) transplantation on pulmonary arterial hypertension induced by monocrotaline. Monocrotaline (80 mg/kg body weight) was administrated to C57BL/6 mice, and pulmonary arterial hypertension was induced 4 weeks later. Bone marrow mononuclear cells harvested from syngeneic donor mice were injected intravenously into those mice 4 weeks after monocrotaline administration. The ratio of right ventricular to septum plus left ventricular weight, the number of small pulmonary arteries, and medial thickness of pulmonary arteries were measured. Western immunoblotting of the lung tissue was performed to observe vascular endothelial growth factor and its receptor expression 1 week after BM-MNC transplantation. Vascular endothelial growth factor receptor-2 inhibitor was administered to pulmonary arterial hypertension mice simultaneously with BM-MNC transplantation. The ratio of right ventricular to septum plus left ventricular weight increased, the number of pulmonary arteries decreased, and medial thickness increased significantly 4 weeks after monocrotaline injection compared with those of vehicle-injected mice. These indices of monocrotaline-injected mice improved significantly 4 weeks after BM-MNC transplantation compared with those of mice at 8 weeks after monocrotaline injection (0.22 +/- 0.02 versus 0.31 +/- 0.02; 17.1 +/- 2.6 versus 8.2 +/- 1.7; 7.7% +/- 2.2% versus 20% +/- 2.1%, respectively; p < 0.01). However, BM-MNCs were not incorporated into the lung at 1 week after transplantation, and significant vascular endothelial growth factor upregulation and without receptor expression was observed in lung tissue 1 week after transplantation. Improvement of pulmonary arterial hypertension was inhibited by simultaneous administration of vascular endothelial growth factor receptor-2 inhibitor with BM-MNC transplantation. These results indicate that syngeneic BM-MNC transplantation improves monocrotaline-induced pulmonary arterial hypertension by favorable pulmonary artery remodeling through vascular endothelial growth factor upregulation.


Heparin cofactor II is an independent protective factor against peripheral arterial disease in elderly subjects with cardiovascular risk factors.

AIM: Heparin cofactor II (HCII) specifically inactivates thrombin action at the injured vascular wall. We have reported that HCII is a protective factor against coronary in-stent restenosis and carotid atherosclerosis; however, it is unclear whether there is any correlation between plasma HCII levels and the development of peripheral arterial disease (PAD). METHODS: Plasma HCII activity and the ankle brachial pressure index (ABI) were determined in 494 elderly subjects with cardiovascular risk factors. PAD was diagnosed by ABI below 0.9, and 62 subjects were diagnosed with PAD. The relationship between factors that affect cardiovascular events and the prevalence of PAD was statistically evaluated. RESULTS: Mean HCII activity in PAD subjects was significantly lower than in non-PAD subjects (87.5+/-19.7% v.s. 94.6+/-17.8%, p=0.009). Multivariate logistic regression analysis showed that age (odds ratio [OR]: 1.062, p=0.0016), current smoking (OR 3.028, p=0.002) and diabetes mellitus (OR 2.656, p=0.008) were independent and progressive determinants of PAD. In contrast, HCII was an independent inhibitory factor of PAD (OR: 0.982, p=0.048). CONCLUSIONS: Plasma HCII activity is inversely related to the prevalence of PAD. HCII may function as the sole protective factor against PAD in elderly people with cardiovascular risk factors.

Journal of Atherosclerosis and Thrombosis


腎移植は尿毒症性心の低心機能を著明に改善する

腎移植は尿毒症性心の低心機能を著明に改善する

日本心臓血管外科学会雑誌


Platypnea-orthodeoxia syndrome associated with patent foramen ovale and aortic ectasia.

A 59-year-old man was admitted for dyspnea on exertion and edema. The patient did not have any pulmonary diseases that could cause dyspnea. Transesophageal echocardiography on the tilting bed with contrast infusion revealed a right-to-left shunt through the patent foramen ovale. Therefore, he was diagosed as platypnea-orthodeoxia syndrome due to the patent foramen ovale. Surgical closure was done and all of his symptoms had improved.


Pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device. A case report.

Case report. To describe the case of pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device 5 years after surgery. Case report. A 70-year-old woman was referred to us because of migrated anterior spinal devices and a pseudoaneurysm of the thoracoabdominal aorta. This patient had undergone anterior corpectomy and spinal fusion from Th12 to L2 because of delayed palsy after a burst fracture using a smooth rod Kaneda device (SRK) with bioactive ceramic (apatite-wollastonite containing glass ceramic) at a local hospital. She had persistent low back pain after the surgery. Five years after the initial surgery, the patient was referred to us because of increasing of her low back pain and the migrated SRK devices shown on plain X-ray films. An enhanced computed tomography scan taken in our hospital clearly showed a pseudoaneurysm of the thoracoabdominal aorta surrounding the SRK devices. The pseudoaneurysm was resected, the aortic defect was repaired with an artificial patch, and the migrated SRK devices were removed. The pseudoaneurysm of the aorta can occur secondary to a migrated anterior spinal fixation device and can be successfully treated by revision anterior surgery with vascular repair and implant removal.


Infective endocarditis caused by lactobacillus.

Lactobacillus (LB) is a gram-positive rod-shaped bacterium that inhabits the oral cavity, gastrointestinal tract, vagina and nasal cavity. Although LB plays a role in the prevention of infections caused by pathogenic bacteria, it causes some critical infectious diseases such as infective endocarditis (IE). IE due to LB is rare; however, early diagnosis and early treatment are important because of its high mortality rate. We report the onset of IE after otologic treatment in a heavy drinker of alcohol, the second case of IE due to LB in Japan.


Accurate quantification of pulmonary artery diameter in patients with cyanotic congenital heart diease using multidetector-row computed tomography

The purpose of this study is to assess the feasibility of multidetector-row computed tomography (MDCT) for the quantitative evaluation of pulmonary artery morphology in children with congenital heart disease that is associated with reduced pulmonary blood flow. Quantification of measurements at the pulmonary artery annulus and right and left pulmonary arteries, and detection of stenoses exceeding 30% diameter reduction were evaluated independently on MDCT and conventional invasive angiography in 56 MDCT scans of 44 children. The diameters of the right and left pulmonary arteries were measured just proximal to the first branch and at the site of maximum stenosis. There was an excellent correlation between MDCT and conventional pulmonary angiography in quantifying the diameter of the right and left pulmonary arteries (R2 = 0.85 and 0.82, respectively), although a systematic overestimation was observed on MDCT (bias 0.38 +/- 0.49 and 0.28 +/- 0.54 mm, respectively). The pulmonary artery annulus diameter on MDCT scans moderately correlated with the measurement on conventional angiograms (R2 = 0.48). Multidetector-row computed tomography correctly detected 15 of 16 pulmonary artery stenotic lesions that were detected on invasive angiography. There was an excellent correlation between MDCT and conventional angiograms with respect to evaluation of stenotic sites (R2 = 0.82). Our findings showed a strong correlation of vessel diameter measurements between MDCT and invasive pulmonary angiography. This study demonstrates the feasibility of MDCT in assessing pulmonary artery size and morphology.


Non-cardiac surgery applications of extracorporeal circulation

Although the efficacy of extracorporeal circulation (ECC) is well established for open-heart surgery, application of ECC in other surgical areas has not been given much attention. Advances in the related surgical technique and anesthetic management combined with refinements in the ECC procedure itself have encouraged several institutions to use ECC for complex non-cardiac surgeries. ECC is beginning to be used for circulatory support or tissue oxygenation during surgery on the lung, brain, liver, and kidney as well as in emergency situations. With ECC, difficult and complex surgeries can be performed more safely, and the success rate of certain surgeries has been positively affected. It is important that the surgeon, anesthesiologist, and perfusionist are trained in non-cardiac surgery applications of ECC. Thus, we review here non-cardiac uses that have emerged and summarize the related procedures.

The Journal of Medical Investigation : JMI


Polytetrafluoroethylene graft calcification in patients with surgically repaired congenital heart disease:Evaluation using multidetector-row computed tomography

Noninvasive determination of calcified prosthetic polytetrafluoroethylene (PTFE) is important in improving risk stratification. The purpose of this study is to assess the feasibility of multidetector-row computed tomography (MDCT) for the evaluation of PTFE calcification in patients with surgically repaired congenital heart disease and to evaluate the development and characteristics of calcification for specific surgical procedures. Seventy-six implanted PTFE grafts in 47 patients were evaluated by MDCT (Aquillion 16, Toshiba Corporation, Tokyo, Japan). Explanted PTFE grafts were evaluated histologically in 4 patients who underwent reoperation after MDCT scans. Calcification of prosthetic PTFE was detected in 5 of 29 cases (17%) for ventricular septal defect (VSD) patches, 26 of 32 (81%) for right ventricular outflow tract (RVOT) prosthesis, 2 of 8 (25%) for atrial septal patches of the Fontan procedure, and 7 of 7 (100%) for extracardiac conduits of total cavopulmonary connection. The CT attenuation of PTFE revealed significantly different values for VSD patches (114 +/- 61 Hounsfield units [HU]), RVOT prosthesis (243 +/- 132 HU), atrial septal patches (163 +/- 161 HU), and extracardiac conduits (230 +/- 29 HU) (P < .0001). The CT density value of VSD patches was significantly lower than those of RVOT grafts and extracardiac conduits (P < .05). The MDCT findings were consistent with histologic analysis in the evaluation of calcification. This study demonstrates that MDCT enables the evaluation of prosthetic PTFE graft calcification; PTFE grafts in 4 different implantation sites demonstrated distinctive features and the prevalence of calcification.


Assessment and Management of Thrombus Captured in a Temporary Vena Cava Filter --- Venography and Transesophageal Echography

一時留置型静脈フィルターに捕獲された塞栓の診断と対処 --- 静脈造影法と経食道エコー法の検討

The purpose of this retrospective study is to establish the management guideline for captured thrombus in a temporary vena cava filter. Fourteen patients with high risk of acute pulmonary thromboembolism during surgical treatment underwent implantation of a temporary vena cava filter (AntheorTM) immediately before treatments, and were enrolled in this study.

The captured thrombus was assessed by venography the next day after treatments (group V: 10 patients), by intraoperative transesophageal echography (2 patients), and by no examination (2 patients).

Among patients in group V, a shaded defect of more than 10mm in diameter was shown in 3 cases. The filter captured an old thrombus of 30×15mm, which was removed under general anesthesia, together through right jugular venotomy. Red thrombus of 10 or 15mm in diameter was encased in the filter sheath and removed. A floating tumoral thrombus of 30×20mm of renal cell carcinoma was detected at the just-caudal site of the filter by transesophageal echography, and subsequently removed through IVC-tomy. There was no symptomatic pulmonary thromboembolism during/after the surgical treatment.

In conclusion, a temporary vena cava filter is very useful in preventing catastrophic pulmonary thromboembolism during/after surgical treatment. To assess the problematic thrombus captured in the filter, a venography after treatment or an intraoperative transesophageal echography should be performed according to the individual situation. We think that a potentially fresh thrombus of less than 15 mm in diameter can be safely encased in the filter sheath and removed. However, immediate removal operation is preferable for thrombus more than 30mm in diameter, which is a potentially tumoral thrombus or an old thrombus. The management guideline for captured thrombus with 15-30mm in diameter remains to be determined.

一時留置型下大静脈フィルター抜去時の捕獲塞栓診断法とその対処について，Boston社製AntheorTMを挿入した14例を対象にretrospectiveに検討した．

捕獲塞栓の診断のため，10例で術翌日に静脈造影法を，2例で術中経食道エコー法による評価を施行した．残る腎機能障害を伴う2例は評価せずに抜去した．

静脈造影を行った3例に10mm径以上のフィルター内陰影欠損を認めた．うち30×15mm大の陰影欠損を認めた1例は，全身麻酔下に内頚静脈からフィルターと捕獲塞栓の同時除去術を施行した．10∼15mm径の陰影欠損の2例は新鮮血栓をそのままシース内に収納し抜去した．

術中経食道エコー法で評価した1例にフィルター先端にとどまっている20×30mm大の遊離腫瘍栓を認め，引き続き肝下部下大静脈を開き腫瘍栓を摘出した．

結果として，全例で臨床上問題となるような急性肺塞栓症を予防しえた．

一時型下大静脈フィルターは処置や手術時の急性肺塞栓症予防に極めて有用であった．捕獲塞栓の評価に，経食道エコー法と静脈造影法を症例に応じて使い分けることが安全で推奨される．捕獲塞栓が15mm径以下で，かつ赤色血栓が予想される場合には，シース内に収納可能である．30mm径以上の捕獲塞栓や，15mm径以下でもフィルター収納時に抵抗がある場合，及び腫瘍栓が予測される場合には，速やかに全身麻酔下に内頚静脈からのフィルターと塞栓の同時除去術を施行すべきである．15∼30mm径の捕獲血栓については，今後さらに症例を重ねて検討する必要があると思われる．


収縮性心膜炎とPTFE心膜用シート

収縮性心膜炎とPTFE心膜用シート

Pediatric Cardiology and Cardiac Surgery


Rastelli type repair using Freestyle valved conduit for a 69-year-old woman with tetralogy of Fallot.

A 69-year-old woman visited our hospital with general fatigue and shortness of breath on effort as the chief complaints. She was diagnosed as having tetralogy of Fallot, using cardiac ultrasonography. The cardiac catheterization findings showed that right venticular hypertension was at 114/5 mmHg, which was parallel to the left ventricular pressure, and a pressure gradient of about 100 mmHg was observed between the right ventricle and the pulmonary artery. Coronary artery angiography revealed that the left coronary artery was intact, but the right had an abnormal origin from the left valsalva sinus and was estimated at nearly equal to the single coronary. Therefore, we performed a Rastelli type operation with a valved conduit which we made using a composite Hemashield artificial graft (diameter 20 mm) and Freestyle valve (diameter 21 mm). The postoperative course was uneventful and she was discharged with hemodynamic conditions mostly normalized.

The Japanese Journal of Thoracic and Cardiovascular Surgery


Determination of plasma concentrations of endothelin-1(1-31) and endothelin-1 in healthy subjects and patients with atherosclerosis.

We previously found that human chymase cleaves big endothelins at the Tyr31-Gly32 bond and produces 31-amino-acid endothelins, endothelins(1-31). Endothelin-1(1-31) has been isolated from a number of human organs, including the heart and lungs. As endothelin-1 has been shown to play a significant role in the paracrine regulation of cardiovascular functions in humans, it is possible that endothelin-1(1-31) may also exhibit biological activity on human tissues. We previously reported that synthetic endothelin-1(1-31) exhibits a number of physiological actions on cultured cells in vitro. In the present study, we investigated the plasma concentrations of endothelin-1(1-31) and endothelin-1 in healthy subjects and compared them with those in patients with cardiovascular diseases. Endothelin-1(1-31) and endothelin-1 in human plasma was measured using a sandwich-enzyme-immunoassay system, which was recently described for measurement of endothelin-1(1-31). The plasma concentrations of endothelin-1(1-31) and endothelin-1 in healthy volunteers were 19.24 +/- 5.70 and 15.54 +/- 4.45 pg/ml (n = 5), respectively. We also measured plasma concentrations of endothelin-1(1-31) and endothelin-1 before and after surgery in patients with abdominal aortic aneurysms. Before surgery, plasma concentrations of endothelin-1(1-31) and endothelin-1 in these patients were higher than those in healthy individuals. After surgery, both endothelin-1(1-31) and endothelin-1 in plasma decreased to levels similar to those of healthy subjects. This suggests that endothelin-1(1-31) may have similar physiological significance to endothelin-1 in patients with atherosclerosis.


Suitable shunt size for regulation of pulmonary blood flow in a canine model of the univentricular parallel circulations.

We examined the influence of shunt size on regulation of the pulmonary blood flow in a canine model of a univentricular heart because specific guidelines regarding suitable shunt size in the Norwood operation remain undetermined. Beagle dogs (n = 8) 3 to 7 months old and weighing 3.0 to 5.0 kg were used. Atrial septectomy and patch closure of the tricuspid valve were performed, and a systemic-pulmonary arterial shunt was created by interposing a 3.5- or 4.0-mm graft between the right subclavian artery and main pulmonary artery. After cardiopulmonary bypass, hemodynamic variables including pulmonary and systemic blood flow were measured consecutively according to physiologically respiratory manipulations. The ratio of shunt size to body weight ranged from 0.80 to 1.33 mm/kg (1.08 +/- 0.16 mm/kg). Each dog with a ratio of shunt size to body weight of 0.8 to 1.1 showed significant negative correlation between the pulmonary/systemic blood flow ratio and arterial Pco(2), but those with a ratio of shunt size to body weight of 1.1 to 1.4 did not. Consequently each dog with a ratio of shunt size to body weight of 0.8 to 1.0 got adequate systemic flow, whereas a ratio of 1.0 to 1.4 resulted in inadequate systemic flow and acidic status. Similar phenomena were shown with the grouped data on relationship between the pulmonary/systemic blood flow ratio and inspired oxygen fraction. These findings imply that when the ratio of shunt size to body weight is 0.8 to 1.1, the pulmonary/systemic blood flow ratio is controllable by physiologic respiratory manipulations. Larger shunts make pulmonary blood flow excessive and uncontrollable. We recommend that a ratio of shunt size to body weight of 0.9 to 1.0 be considered a useful index for suitable systemic-pulmonary arterial shunt in the Norwood operation.

Journal of Thoracic and Cardiovascular Surgery


A Case of Fontan-type Operation for Membranous Tricuspid Atresia with Dysplasia of the Right Ventricular Myocardium and Absence of the Pulmonary Valve

肺動脈弁欠如，右室心筋異形成を伴う三尖弁膜様閉鎖に対するFontan型手術の一例


Invited Commentary: Surgical repair of supposedly multiple defects within the apical part of the muscular vemtricular septum.


Collaagen synthesis and collagenase activity of cryopreserved allograft heart valve.

Durability of the valve seems to be dependent on the remodeling ability of the valve itself, which is controlled by both collagen synthesis and collagenolytic activity of valvular fibroblasts and endothelial cells. However, the balance of collagen synthesis and collagenolysis of the cryopreserved valve has not yet been clearly revealed. Thus, we assessed the collagen synthesis and collagenolysis ability of the cryopreserved valve. Twelve valves were divided into 2 groups: freshly harvested valves (n = 6) and cryopreserved valves (n = 6). We measured the collagen content using Sirius red, a dye selective to the collagen. Collagen synthesis was evaluated by means of the tritiated proline incorporation method. Noncollagenase-digestible counts, which represent protein synthesis, and collagenase-digestible counts, which represent collagen synthesis, were estimated. Collagenase activity of the valves was assessed by gelatin zymography. The collagen content of the cryopreserved group was maintained. The noncollagenase-digestible counts of the cryopreserved group decreased from 3862 +/- 1180 counts/mg to 1174 +/- 1362 counts/mg, and the collagenase-digestible counts of the cryopreserved group were 831 +/- 762 counts/mg compared with the value of 1062 +/- 136 counts/mg for the freshly harvested group. The collagenase activity of the cryopreserved group was observed at the same level as that of the freshly harvested group, despite the serious endothelial damage of the cryopreserved valves. Although the collagen synthesis of cryopreserved valves was relatively maintained, the protein synthesis was highly diminished, and the collagenolysis ability was activated immediately after the thawing process. These results imply that the cryopreservation procedure itself may cause the collagen metabolism to be on the degradable side, which will lead to valve failure.


Celluar Biology of Cryopreserved Allograft Valves.

Although analyzing the precise mechanisms of cryopreserved allograft valve failure may be difficult due to a number of crucial reasons and the interrelationships between the overlapping mechanisms, there is some evidence that cryopreservation is currently the best method of storing allograft valves. The present review shows the basic cellular biology of cryopreserved allograft valves for long-term durability, particularly relevant to allograft valve cellular viability, the immune response mainly caused by viable donor cells, and the preservation and regeneration of the intrinsic extracellular matrix. The present findings are as follows. First, cryopreservation produces serious damage to cytosolic and mitochondrial functions of both endothelial cells and fibroblasts, which may cause valve failure after implantation. Second, although the collagen synthesis of cryopreserved valves was relatively maintained, total protein synthesis was highly diminished and the collagenolytic ability was activated immediately after the thawing process. These findings imply that the cryopreservation itself may cause the collagen metabolism to become degradable, which will lead to valve failure. Further examination of collagen metabolism and modulation of the collagenolytic activity will be necessary to improve the tissue preservation for improved clinical use.

The Journal of Medical Investigation : JMI


A Case Report of Pelvic Tumor Resection with a Temporary Inferior Vena Cava Filter

骨盤内腫瘍摘出時に一時留置型下大動脈フィルターが有効であった1例


下肢静脈瘤治療が抹消循環に与える効果について-Air Plethysmographyおよび近赤外線分光法による検討-


無侵襲脳内酸素飽和度からみたOff Pump CABG(OPCAB)の有用性

無侵襲脳内酸素飽和度からみたOff Pump CABG(OPCAB)の有用性


骨盤内腫瘍摘出手術時に一時留置型下大静脈フィルターが有効であった1例

骨盤内腫瘍摘出手術時に一時留置型下大静脈フィルターが有効であった1例


Usefullness of CABG without Cardiopulmonary Bypass in Near-Infrared Spectrophotometry of the Brain

無侵襲脳内酸素飽和度からみたOff Pump CABG(OPCAB)の有用性


Evaluation of High Ligation Effects on Peripheral Circulation in Patients with Primary Varicose Veins --- Evaluation Using Air Plethysmography and Near-Infranred Spectroscopy

下肢静脈瘤治療が末梢循環に与える効果について --- Air Plethysmography および近赤外線分光法による検討


術後早期に急速に肺静脈狭窄を来した混合型肺静脈還流異常症の一例

術後早期に急速に肺静脈狭窄を来した混合型肺静脈還流異常症の一例


Direct intraoperative measurements of aortic and pulmonary blood flows in patients with severe pulmonary hypertension.

Evaluate the significance of direct intraoperative measurements of aortic and pulmonary blood flows by electromagnetic flowmeter as an absolute decision basis for operability in patients with ventricular septal defect/complete atrioventricular septal defect and severe pulmonary artery hypertension. Prospective study. Institutional practice. Patients: Eight patients with marginal operability based on preoperative Doppler echocardiography and cardiac catheterization (pulmonary-to-systemic flow ratio=1.1-2.3, pulmonary-to-systemic resistance ratio=0.34-0.91, and pulmonary vascular resistance=4.6-18.2 units x m2) underwent direct intraoperative measurements of aortic and pulmonary blood flows by electromagnetic flowmeter. Operation would be performed according to the results of direct intraoperative measurements in every patient. Aortic flow by direct intraoperative measurements ranged from 0.9 to 3.2 L/min/m2, and pulmonary blood flow from 4.1 to 8.4 L/min/m2. Pulmonary-to-aortic flow ratio was calculated at 2.1-6.6. Pulmonary vascular resistance ranged from 2.6 to 7.7 units x m2. We assessed that all patients still had operability, and performed corrective operations. Postoperative courses corresponded with the data from the direct intraoperative measurements. When some clinical findings, particularly Doppler echocardiographic findings, of these patients are slightly in favor of reversibility of pulmonary vascular disease despite discrepant data of preoperative cardiac catheterization under a tight control of carbon dioxide tension, we recommend that direct intraoperative measurement of aortic and pulmonary blood flows is especially useful in decision making for the operability of patients with severe pulmonary artery hypertension.


So-called mesothelial/monocytic incidental cardiac excrescences obtained during valve replacement surgery: report of three cases and literature review.

We present three cases of so-called mesothelial/monocytic incidental cardiac excrescences (MICE) of the heart and a brief review of related literature. Case 1 was a 51-year-old woman who underwent mitral- and aortic-valve replacement. A tissue sample was submitted as a thrombus attached to the left atrial endocardium. Case 2 was a 69-year-old woman who underwent mitral-valve replacement. The sample was incidentally obtained as whitish clot-like fragments, but its exact origin was not known. Case 3 was a 68-year-old woman who underwent mitral-valve replacement for suspected infective endocarditis. The sample adherent to the pericardium was removed after valvular surgery. Histologically, these lesions were composed of a mixture of plump histiocytoid cells, a papillary arrangement of cuboidal cells, various sized vacuoles, and fibrin. The nests of cuboidal cells resembled cancer cells but showed features of mesothelial cells and no proliferative activity, immunohistochemically or ultrastructurally. In all cases, a suction tube placed in the left atrium was occasionally used to remove overflowing intrapericardial fluid during the surgery. The tip of the suction tube was covered with spiral wire, which is likely to transfer the stripped pericardial mesothelial cells to the left atrium. The significance of MICE is their possibility of being misdiagnosed as metastatic carcinoma by pathologists and a risk of arterial embolization by mesothelial debris clinically.


Evolving Fontan Strategy:hemi-Fontan procedure and its clinical application.

Annals of Thoracic and Cardiovascular Surgery


Hepatocelluar carcinoma with extension into the right atrium: report of a successful liver resection by hepatic vascular exclusion using cardiopulmonary bypass,

We report a successful liver resection using cardiopulmonary bypass with, total hepatic vascular exclusion (THVE) for hepatocellular carcinoma (HCC), with extension into the right atrium. A 61-year-old man with a cirrhotic liver was referred to our department with HCC in the medial segment of the left lobe of the liver, and tumor thrombus extending into the right atrium. During surgery, a left lobe and caudate lobe of the liver were transected leaving the left lobe of the liver connected to the inferior vena cava (IVC) by only the left and middle hepatic trunks, and then the intracaval tumor thrombus and the left lobe of the liver were removed en bloc using cardiopulmonary bypass with total hepatic vascular exclusion (THVE). Cardiac arrest was not performed during THVE, and the patient had an uneventful postoperative course and was discharged from the hospital 2 months following surgery. He died of multiple pulmonary metastases 4 years and 8 months after surgery; however, imaging showed no evidence of recurrence in the remnant liver during that period. In conclusion, by performing dissection of the hepatic parenchyma to the hepatic vein prior to removal of the tumor thrombus, the period of extracorporeal circulation, duration of warm ischemic time to the liver, and intraoperative blood loss were all reduced and a radical operation could be performed safely without scattering tumor cells during extirpation of the tumor.


IN-VITRO ANALYSIS OF OPTIMAL PUMPING OF NATIONAL CARDIOVASCULAR CENTER PULSATILE VENTRICULAR ASSIST DEVICE (NVAD) ON HEMOLYSIS.


Viability of Cryopreserved Semilunar Valves: An Evaluation of Cytosolic and Mitochondrial Activities


effects of sevoflurane on regional myocardial blood flow distribution --- Quantification with myocardial contrast echocardiography

Using myocardial contrast echocardiography, the authors tried to determine whether sevoflurane causes myocardial blood maldistribution in humans and dogs. In animal experiments, 15 mongrel dogs were organized into dipyridamole (n = 6) and sevoflurane (n = 9) groups. Sonicated albumin was infused into the left main coronary artery. The peak gray level corrected for background was analyzed at the following intervals: (1) at baseline, (2) after stenosis of the left circumflex coronary artery (blood flow reduced by 40%), (3) after administration of dipyridamole (1 mg/kg given intravenously) or sevoflurane (1 minimum alveolar concentration) during stenosis, and (4) after phenylephrine during stenosis and administration of dipyridamole or sevoflurane. In human studies, nine patients undergoing coronary artery bypass grafting were studied. During partial extracorporeal circulation, the peak gray level was analyzed before and 20 min after sevoflurane (1 minimum alveolar concentration). In animal experiments, dipyridamole decreased significantly the inner:outer ratio of the peak gray level in the ischemic area and the ischemic:normal ratio of the peak gray level. After arterial pressure was restored with phenylephrine, neither the inner:outer ratio nor the ischemic:normal ratio improved. In contrast, after sevoflurane administration, the inner:outer ratio and the ischemic:normal ratio remained unchanged, but these increased with phenylephrine. In human studies, sevoflurane did not change the inner:outer ratio in the area supplied by the most stenotic coronary artery. These results suggest that dipyridamole, a potent coronary vasodilator, produces maldistribution of coronary blood flow in our dog models, whereas sevoflurane does not do this in animal or human studies.


Surgical management of infants with mitral valve stenosis or atresia without diminutive ascending aorta

The surgical strategy in infants with mitral valve stenosis or atresia without diminutive ascending aorta remains to be established, including the potential for biventricular repair as a definitive operation. Our surgical experience of six infants with mitral valve stenosis (4 patients) or atresia (2 patients) without diminutive ascending aorta was evaluated based on three important factors: left ventricular volume; the nature of the systemic outflow obstruction; and the type of mitral valve anomaly. Two patients with systemic outflow tract diameter less than 65% of normal underwent systemic outflow tract reconstruction, and the other patients with outflow tract diameter more than 68% of normal were able to maintain systemic circulation without repair. Only one patient with mitral valve stenosis without left ventricular outflow tract obstruction underwent a successful open mitral valvotomy as a biventricular repair after first-stage palliation. The left ventricle of the other patients did not grow after first-stage palliation. Due to progressive subaortic narrowing, pulmonary artery banding should be avoided in patients with mitral atresia due to absent atrioventricular connection who are future Fontan candidates. Most patients with this lesion can be expected to become candidates for safe Fontan-type repair.

The Journal of Medical Investigation : JMI


Investigation of the mechanism of lymphocyte injection therapy in treatment of lymphedema with special emphasis on cell adhesion molecule(L-selectin).


Complex Physical Therapy for Lymphedema of the Unilateral Lower Limbs

下肢片側性リンパ浮腫に対する複合的理学療法の有効性の検討


A CASE OF REOPERATION 24 YEARS AFTER REPAIR OF ABSENT PULMONARY VALVE SYNDROME WITH ANOMALOUS ORIGIN OF THE LEFT PULMONARY ARTERY

左肺動脈起始異常を伴う肺動脈弁欠損症候群に対する遠隔期再手術の経験


Endothelin-1 stimulates sodium-dependent calcium efflux from bovine adrenal chromaffin cells in culture.


Changes in plasma free and sulfoconjugated dopamine in patients with congenital heart disease who underwent cardiac opreation,

It has been suggested that plasma sulfoconjugated dopamine (DA) may serve as a source or reservoir for free DA in plasma. Moreover, it has also been reported that the plasma levels of conjugated DA may be used as an index predicting heart failure in patients with heart disease. Therefore, in the present study, we have measured the plasma levels of free and sulfoconjugated DA in patients with congenital heart disease who underwent total corrective operations. The patients were divided into two groups with (6 patients with tetralogy of Fallot, TOF) or without (5 patients with ventricular septal defect without pulmonary hypertension, VSD) cyanosis (mean age of 2.11 years). Blood samples were collected before and after operation from the patients, and plasma free and sulfoconjugated DA levels were measured using high performance liquid chromatography. Preoperative levels of free DA in patients in both groups were higher than the level in age matched control subjects. The plasma level of conjugated DA in TOF was higher than that in the controls and was the highest in VSD before operation. DA infusion early after operation caused a rise in plasma free and conjugated DA, however, the levels of increased free DA were lower in the VSD than in the TOF group. After discontinuing DA infusion, the plasma levels of free DA remained higher, while those of conjugated DA decreased to a level lower than the preoperative values in both groups. As the plasma levels of free and sulfoconjugated DA vary with hemodynamics, it was assumed that the difference in the plasma sulfoconjugated DA level between the groups before operation was due to the influence of pulminary blood flow on catecholamine homeostasis. Since the decrease in conjugated DA has been postulated to be an index of sustained heart failure, it is conceivable that it takes a long time for patients who underwent cardiac operations in infancy to recover from heart failure.

The Japanese Journal of Thoracic and Cardiovascular Surgery


Effect of Amiloride on Ischaemia and Reperfusion Injury in Isolated,Perfused Rat Hearts


Effect of amiloride on ischemia and reperfusion injury in isolated, perfused rat hearts.


Analysis of Myocardial Wall Velocity by Pulsed Doppler Tissue Imaging in Patients with Duchenne Muscular Dystrophy

組織パルスドプラ法による進行性筋ジストロフィーの左室壁運動パターンの分析

Pediatric Cardiology and Cardiac Surgery


Techniques and results in the management of multiple ventricular septal defects

The Journal of Thoracic and Cardiovascular Surgery


Techniques and results in the management of multiple ventricular septal defects.

The management of patients with multiple ventricular septal defects remains controversial. Primary closure, interventional catheter techniques, and palliative surgery all may have a role, and specific management guidelines remain undefined. We reviewed the records of all 33 patients with multiple ventricular septal defects undergoing repair between January 1988 and October 1996. Pulmonary artery hypertension was present in 21 patients (group 1), and pulmonary stenosis was present in the remaining 12 (group 2). Closure was accomplished from a right atriotomy alone in most patients, although an apical left ventriculotomy was used for apical defects. Among group 1 patients, the mean age at repair was 5.9 +/- 0.9 months. Major associated anomalies included coarctation (n = 6), straddling tricuspid valve (n = 1), and critical aortic stenosis (n = 1). Reoperation was performed in two patients for residual ventricular septal defects. Among group 2 patients, the mean age at repair was 6.6 +/- 3.2 years. Major associated anomalies included tetralogy of Fallot (n = 2), pulmonary stenosis (n = 4), double-outlet right ventricle with hypoplastic left ventricle (n = 1), and isolated left ventricular hypoplasia (n = 1). Three required reoperation for residual ventricular septal defect. There were no early or late deaths, no episodes of heart block, and no significant residual ventricular septal defects among group 1 patients. All group 1 patients remain free of significant residual cardiovascular conditions at a mean of 23.4 +/- 5.1 months. Among group 2 patients, there was one early death in a patient with double-outlet right ventricle and left ventricular hypoplasia. Complete heart block occurred in two patients and one required late mitral valve replacement. There were no late deaths, seven remain alive without significant residual defects at a mean of 36.2 +/- 8.0 months, and two required transplantation for left ventricular failure. Primary repair for infants with multiple ventricular septal defects is associated with good late outcomes. The right atrial approach is satisfactory for most muscular defects, although limited apical left ventriculotomy was used for apical defects. Pulmonary artery banding should be limited to patients with complex associated defects.

Journal of Thoracic and Cardiovascular Surgery


Extracellulary administered lysophosphatidylcholine causes Ca2+ efflux from freshly isolated adult rat cardiomyocytes

It has previously been reported that ischemia and reperfusion of the heart cause accumulation of lysophosphatidylcholine (LPC) within the myocardium. While it is known that LPC causes the transient increase of intracellular free Ca2+ concentration ([Ca2+]i) during contraction of cardiac cells, little is known about the mechanism for decreasing [Ca2+]i in cardiomyocytes during LPC accumulation. Since cumulative elevation in [Ca2+]i leads to irreversible injury to cardiomyocytes, elevated [Ca2+]i must be restored to an unstimulated level to maintain cell functions. In the present study, we therefore examined the effect of LPC on Ca2+ efflux from freshly isolated adult rat cardiomyocytes. LPC stimulated the efflux of 45Ca2+ from the cells in a concentration-dependent manner (10(-7)M-10(-5)M). Other lysophospholipids, which are generated from phospholipids of the cell membrane, failed to induce 45Ca2+ efflux from the cells. Dilazep and K-7259, which are known to inhibit the increase in [Ca2+]i caused by LPC, likewise reduced 45Ca2+ efflux caused by LPC addition. Furthermore, the LPC-stimulated 45Ca2+ efflux was not affected by removal of extracellular Ca2+, but was dependent on the presence of extracellular Na+. On the other hand, inhibitors of Na+/Ca2+ exchange, amiloride and 5-(N,N-dimethyl)-amiloride, inhibited LPC induced 45Ca2+ efflux. These results suggest that LPC stimulates extracellular Na(+)-dependent 45Ca2+ efflux from freshly isolated adult rat cardiomyocytes, probably through Na+/Ca2+ exchange on the plasma membrane of the cells.


Effect of Angiotensin II on Ca2+ Efflux from Freshly Isolated Adult Rat Cardiomyocytes --- Possible Involvement of Na+/Ca2+ Exchanger


Role of left atrial appendage in left atrial reservoir function as evaluated by left atrial appendage clamping during cardiac surgery.


下大静脈内腫瘍栓を伴う悪性腫瘍の外科治療

下大静脈内腫瘍栓を伴う悪性腫瘍の外科治療


Changes in plasma free and sulfoconjugated catecholamines during the perioperative period of cardiac surgery:Effect of continuous infusion of dopamine.


Extracellulary administered lysophosphatidylcholine causes Ca2+ efflux from freshly isolated adult rat cardiomyocytes.


下大動脈内腫瘍栓を伴う悪性腫瘍の外科治療

下大動脈内腫瘍栓を伴う悪性腫瘍の外科治療


左肺動脈起始異常を伴う肺動脈弁欠損症候群に対する遠隔期再手術の経験

左肺動脈起始異常を伴う肺動脈弁欠損症候群に対する遠隔期再手術の経験


Extracellulary administered Iysophosphatidylcholine causes Ca2+ effulux from freshly isolated adult rat cardiomyocytes


Extracelluar adenosine 5'-triphosphate induces Ca2+ effulux from freshly isolated adult rat cardiomyocytes:Possible involvement of Na+/Ca2+ exchange mechanism.


Effect of evodiamine on catecholamine secretion from bovine adrenal medulla.

The effect of evodiamine on catecholamine secretion from bovine adrenal medulla was investigated. Evodiamine, a bioactive component isolated from dry unripened fruit of Evodia rutaecarpa Bentham, was found to stimulate the secretion of catecholamine from perfused bovine adrenal medulla at a concentration of 10 microM and its effect persisted for at least 30 min. This stimulatory effect of evodiamine was abolished by omission of Ca2+ from the perfusion fluid. Evodiamine (0.1-10 microM) markedly enhanced the secretion of catecholamine from the adrenal medulla induced by acetylcholine (100 microM or high K+(56 mM). The secretion of catecholamine was promptly enhanced by acetylcholine or high K+, but returned to the control level on treatment for 20 min. However, when evodiamine was added to the perfusion fluid after acetylcholine or high K+ stimulation for 10 min, the secretion of catecholamine again increased greatly. These results indicate that evodiamine not only stimulated the secretion of catecholamine from bovine adrenal medulla but also reversed insensitivity of these cells to acetylcholine or high K+ stimulation.

The Journal of Medical Investigation : JMI


四肢リンパ浮腫に対するリンパ球動注療法の作用機序

四肢リンパ浮腫に対するリンパ球動注療法の作用機序


リンパ浮腫 --- 発生頻度·症状·検査·診断

リンパ浮腫 --- 発生頻度·症状·検査·診断

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


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

日本心臓血管外科学会雑誌

日本心臓血管外科学会雑誌


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


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


Atrial natriuretic peptide stimulates Na+-dependent Ca2+ effulux from freshly isolated adult rat cardiomyocytes.


Neuropeptide Y as a stimulator of Na+-dependent Ca2+ effulux from freshly isolated adult rat cardiomyocytes


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

The Tokushima Journal of Experimental Medicine


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


SURGICAL EXPERIENCE OF TWO DIFFERENT TYPES OF UNROOFED CORONARY SINUS

The Japanese Journal of Thoracic and Cardiovascular Surgery


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.


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


Surgical therapy for prosthetic graft infection

XXX World Congress of the International College of Surgeons


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


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


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

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


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.


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


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


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–


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–


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


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.


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


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–


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


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


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


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


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


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


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


Balloon pulmonary valvuloplasty for infants with severe tetralogy of Fallot.


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


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


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


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–


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–


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


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–

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–

日本心臓血管外科学会雑誌

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.


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

The Tokushima Journal of Experimental Medicine