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

General Thoracic and Cardiovascular Surgery.


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


Intrathymic Plasmablasts Are Affected in Patients With Myasthenia Gravis With Active Disease.

Our findings confirmed a correlation between increased frequency of intrathymic plasmablasts and disease activity before thymectomy. We postulate that activated intrathymic plasmablasts endow pathogenic capacity in MG.

Neurology® Neuroimmunology & Neuroinflammation


Development of acquired intrapulmonary venous anastomosis contributing to establishment of Fontan circulation.

Pulmonary venous (PV) obstruction is associated with a poor prognosis, as well as a high risk of recurrence, following surgical treatment. It can also interfere with the successful completion of Fontan circulation in patients with complex congenital heart disease. A case of a patient who had right isomerism (also known as asplenia syndrome), total anomalous pulmonary venous connection (TAPVC), and a single right ventricle is presented. Although bilateral total occlusion of the inferior PVs was identified postoperatively, the formation of the anastomosis and collateral vessels into the superior and middle PVs enabled successful completion of Fontan circulation. Anastomoses and collateral flow of the PVs were found largely in the interlobar pleura and not in the lung parenchyma.


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.

The Journal of Medical Investigation : JMI


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.


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


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.

The Japanese Journal of Thoracic Surgery


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


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.


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


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.


Gastrointestinal hemorrhage caused by aortoenteric fistula due to aortic aneurysm


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.


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


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


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


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.


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


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


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.


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.


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．


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.


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.


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


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.


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


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


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


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


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


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


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.


僧帽弁弁輪部周囲腫瘍 --- 循環器症候群 ーその他の循環器疾患を含めてー Ⅱ

僧帽弁弁輪部周囲腫瘍 --- 循環器症候群 ーその他の循環器疾患を含めてー Ⅱ

Nihon Rinsho. Japanese Journal of Clinical Medicine


Surgical therapy for prosthetic graft infection

XXX World Congress of the International College of Surgeons


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

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


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


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


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


A case of ureteroarterial fistula after urinary diversion

膀胱全摘術後の腸骨動脈尿管瘻の1例


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

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


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

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

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


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

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

The Journal of Medical Investigation : JMI


甲状腺クリーゼを発症した緊急冠動脈バイパス術の1例

甲状腺クリーゼを発症した緊急冠動脈バイパス術の1例


進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

第18回日本小児心電学会

第18回日本小児心電学会