[Graft Kink with Hemolytic Anemia Caused by Enlargement of the Residual False Lumen in the Aortic Root:Report of a Case].

A 67-year-old male underwent ascending aortic replacement for Stanford type A acute aortic dissection four years ago. Residual false lumen in the aortic root and mild to moderate aortic regurgitation were noted postoperatively. Two and a half years later, he presented with hemolytic anemia and shortness of breath.

Hemoptysis.

Hemoptysis is a rare complication of acute aortic dissection. A 77-year-old woman was admitted to our department with epigastralgia and hemoptysis. Computed tomography showed Stanford A acute aortic dissection and massive posterior mediastinal hematoma which extended along the right pulmonary artery.

[Resection for the Recurrence of Hepatocellular Carcinoma in the Inferior Vena Cava and Right Atrium under Deep Hypothermic Circulatory Arrest].

A 77-year-old man underwent extended right lobectomy of the liver for rupture of hepatocellular carcinoma. Recurrence in the inferior vena cava andright atrium was noted 30 months after surgery. We performedextirpation of this tumor thrombosis under retrograde cerebral perfusion during deep hypothermic circulatory arrest.

Momentary and wide aortic regurgitation as an indicator of aortic dissection.

A 55-year-old female with a history of hypertension was admitted for dyspnea, epigastralgia and nausea. A chest X-ray showed pulmonary congestion. Transthoracic echocardiography (TTE) revealed severe left ventricular dysfunction with akinesis of the infero-posterior wall and Doppler color-flow mode showed mild aortic regurgitation (AR).

Uncertainty of axillary artery perfusion during surgery for acute aortic dissection.

We treated a patient with acute aortic dissection, which affected the innominate and carotid arteries. Although the true lumen was adequately wide and cerebral malperfusion deemed unlikely, extracorporeal circulation through the femoral artery caused right cerebral malperfusion, and addition of right axillary artery perfusion was ineffective. Several minutes after innominate artery snaring, cerebral blood flow was suddenly restored and the clinical outcome was favorable.

[Persistent cerebral malperfusion following central aortic repair for acute aortic dissection involving the right carotid artery; efficacy of direct carotid artery cannulation].

A 61-year-old man suddenly developed transient left hemiplegia and consciousness disturbance. Computed tomography showed acute Stanford type A aortic dissection. Dissection affected the entire right common carotid artery, and its false lumen extremely compressed the true lumen.

Extremely localized aortic dissection and intussusception of the intimal flap into the left ventricle.

Stanford type A aortic dissection frequently deforms the aortic root and causes aortic regurgitation (AR). On the rare occasion, massive AR can occur due to circumferential intimal disruption and prolapse of the cylinder-shaped intimal flap into the left ventricle. Because of the critical, general, and hemodynamic state of such patients, surgery for this condition carries a high risk.

[Refractory pulmonary hypertension following mitral valve repair necessitating percutaneous cardiopulmonary support].

A 37-year-old woman underwent semi-emergency mitral valve plasty for severe mitral regurgitation and congestive heart failure. Although repair was successfully performed and the left ventricular function was maintained, refractory pulmonary hypertension precluded cessation of cardiopulmonary bypass. Inhalation of nitric oxide was ineffective, and assist circulation was required.

[Aortic valve replacement without blood transfusion in a patient with osteogenesis imperfecta].

Osteogenesis imperfecta (OI) is a hereditary systemic connective tissue disorder that is rarely associated with valvular heart diseases. Cardiovascular surgery for patients with OI carries high morbidity and mortality, which mostly results from bleeding tendencies caused by tissue and capillary fragility. We report a 47-year-old male with isolated aortic regurgitation, who underwent aortic valve replacement (AVR) with a mechanical prosthesis without blood transfusion.

Overexpression of integrin-linked kinase induces cardiac stem cell expansion.

Objective: Recent evidence suggests that the adult heart contains stem cells that are capable of self-renewal as well as multilineage differentiation. However, their inherent capacity for self-renewal is limiting to cell replacement applications. Integrin-linked kinase is a multifunctional protein kinase that activates Wnt target genes implicated in the symmetric replication of embryonic stem cells.

Integrin-linked kinase expression is elevated in human cardiac hypertrophy and induces hypertrophy in transgenic mice.

Background: Although numerous signaling pathways are known to be activated in experimental cardiac hypertrophy, the molecular basis of the hypertrophic response inherent in human heart diseases remains largely unknown. Integrin-linked kinase (ILK) is a multifunctional protein kinase that physically links beta-integrins with the actin cytoskeleton, suggesting a potential mechanoreceptor role.

Methods And Results: Here, we show a marked increase in ILK protein levels in hypertrophic ventricles of patients with congenital and acquired outflow tract obstruction.

Cardioprotective stress response in the human fetal heart.

Objective: We propose that the fetal heart is highly resilient to hypoxic stress. Our objective was to elucidate the human fetal gene expression profile in response to simulated ischemia and reperfusion to identify molecular targets that account for the innate cardioprotection exhibited by the fetal phenotype.

Methods: Primary cultures of human fetal cardiac myocytes (gestational age, 15-20 weeks) were exposed to simulated ischemia and reperfusion in vitro by using a simulated ischemic buffer under anoxic conditions.

[Pseudoaneurysm of the left ventricle following suppurative pericarditis and sepsis due to Staphylococcus aureus: a case report].

A 35-year-old diabetic man presented with a left ventricular aneurysm very close to the mitral valve annulus. He had been conservatively treated for suppurative pericarditis and sepsis due to Staphylococcus aureus during the previous 3 weeks. The left ventricular aneurysm rapidly enlarged (6 cm in diameter) and the patient underwent emergent surgery.

Mid-term results of aortoplasty for dilated ascending aorta associated with aortic valve disease.

Background: Dilatation of the ascending aorta concomitant with aortic valve disease is occasionally associated with progressive enlargement of the ascending aorta or acute aortic dissection (AAD). However, surgical procedure of choice for the aorta and its indication are controversial.

Patients And Methods: From July 1995 to August 2001, 10 patients with a moderately dilated ascending aorta (mean diameter, 52+/-4.