Retrieving a lost needle in the descending aorta during hemi-arch replacement.

A 73-year-old man diagnosed with moderate aortic insufficiency and dilatation of the aortic root and ascending aorta underwent a modified Bentall procedure and hemi-arch aortic replacement. During open distal anastomosis of the ascending aorta, the surgical needle was lost. Because of circulatory arrest, the operation was continued; before closing the chest, radiography and a transesophageal echo were located in the needle in the descending aorta.

A modified technique for supra-annular implantation of prosthetic tricuspid valve.

In conventional tricuspid valve replacement, there is a risk of valve detachment because stitches are placed on relatively fragile tissues. In the supra-annular implantation technique, stitches are placed lateral to the triangle of Koch and the coronary sinus instead of the anterior and septal leaflets as in conventional tricuspid valve replacement. This procedure relieves stress at the antero-septal commissural area, as well as avoids injury to the conduction system.

[Total Arch Replacement with Frozen Elephant Trunk for Treatment of Traumatic Aortic Injury with Stanford Type A Aortic Dissection].

An 83-year-old woman was injured in a traffic accident. Enhanced computed tomography (CT) showed aortic injury on the isthmus, Stanford type A aortic dissection and intracranial hemorrhage. Neurological deficit was not noted.

Migrations and Catalytic Action of Water Molecules in the Ionized Formamide-(HO) Cluster.

Isomerization dynamics involving the migrations, proton transfer reaction, and catalytic actions of water molecules upon vertical ionization of the formamide (FA)-(HO) cluster is investigated by the infrared spectroscopy and theoretical reaction path search calculation. The infrared spectroscopic result indicates the [FA-(HO)] cation has the hydrogen-bonded structure of the enol isomer cation of formamide and the water dimer. This structure is formed by proton transfer from the CH bond to the carbonyl group through the catalytic action of the water molecules.

Saphenous Vein Graft Aneurysm Repaired with Radial Artery Graft Pre-Sewn Vascular Prosthesis Patch.

Saphenous vein graft aneurysms are rare but are potentially fatal and their optimal management is not clearly established. Herein, we report a case of a saphenous vein graft aneurysm that was successfully treated with surgical intervention, including aneurysmal resection and re-grafting. The aneurysm, detected 36 years after coronary artery bypass grafting, was located at the proximal part of the saphenous vein graft to the posterolateral branch; the flow of the left anterior descending coronary artery was limited due to compression of the left internal thoracic artery by the adjacent aneurysm.

Implementation of bundled interventions greatly decreases deep sternal wound infection following cardiovascular surgery.

Objective: Surgical site infection (SSI), particularly deep sternal wound infection (DSWI), is a serious complication after cardiovascular surgery because of its high mortality rate. We evaluated the effectiveness of an SSI bundle to reduce DSWI and identify the risk factors for DSWI.

Methods: During the period January 2004 to February 2012, 1374 consecutive patients undergoing cardiovascular surgery via sternotomy were included.

Retrograde cardioplegia revisited: open technique for long aortic cross clamping.

Background: The efficacy of retrograde cardioplegia for myocardial protection is still controversial. In our institution, we exclusively use intermittent administration of tepid, undiluted blood supplemented with potassium and magnesium for the cases with aortic insufficiency, requiring aortotomy, or undergoing mitral valve repair. In using this retrograde technique, we make a point of cannulating a retrograde perfusion catheter under direct vision following right atriotomy.

[Surgical strategy for mitral regurgitation in ischemic cardiomyopathy].

Objective: Surgical strategy for the mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) still remains controversial. The purpose of this study is to evaluate the operative outcome and long-term survival in patients with ICM, MR.

Methods: Perioperative data and surgical results of 35 patients with ischemic MR were collected.

Pathogenesis of paravalvular leakage as a complication occurring in the late phase after surgery.

Paravalvular leakage (PVL) remains an unavoidable late complication after valve surgery. We indicate surgery only cases with progressive congestive heart failure and/or hemolytic anemia. We review our clinical experiences of PVL surgery.

Long-range migration of a water molecule to catalyze a tautomerization in photoionization of the hydrated formamide cluster.

The dynamics on the vacuum-ultraviolet one-photon ionization of a formamide-water cluster is investigated by a combination of theoretical reaction-path search and infrared spectroscopic methods. A keto-enol tautomerization of the formamide moiety occurs after photoionization by a catalytic action of the water molecule accompanied with its long-distance migration; the water molecule in the cluster migrates almost one turn around the formamide moiety. During the migration, the water molecule abstracts the proton of CH in the formamide moiety and carries it to the O atom side in the carbonyl group through a "catch and release"-type catalytic action.

Management of intraoperative aortic dissection with a direct cannulation on the intimal flap.

We report a case of severe aortic stenosis in which intraoperative aortic dissection developed from aortic cross-clamp. The patient showed symptoms of malperfusion, but was successfully managed by direct inflow cannulation on the intimal flap into the true lumen. She then recovered well without further incident.

On-pump beating-heart coronary artery bypass: a propensity matched analysis.

Background: It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting surgery (CABG). This study compares early outcomes after on-pump beating-heart CABG and conventional CABG.

Methods: From 2002 to 2005, 114 patients underwent on-pump beating-heart CABG.

Hyperkalemic cardioplegia-induced myocyte swelling and contractile dysfunction: prevention by diazoxide.

Background: Hyperkalemic cardioplegia (9 degrees C) results in significant myocyte swelling and reduced contractility, representing a possible mechanism of myocardial stunning. Adenosine triphosphate-sensitive potassium channel (KATP) openers have been shown to ameliorate stunning. This study evaluated the hypothesis that a KATP opener would prevent hyperkalemic cardioplegia-induced myocyte swelling and reduced contractility.

Myocyte volume and function in response to osmotic stress: observations in the presence of an adenosine triphosphate-sensitive potassium channel opener.

Background: Hypothermic hyperkalemic cardioplegia results in significant myocyte swelling and impaired contractility. These detrimental effects may be eliminated by the addition of an adenosine triphosphate-sensitive potassium (KATP) channel opener. This study evaluated the hypothesis that a KATP channel opener (diazoxide) would benefit volume homeostasis by limiting volume and subsequent contractility changes during osmotic stress.

Progress towards a more physiologic approach to donor heart preservation: the advantages of hyperpolarized arrest.

Background: The University of Wisconsin (UW) solution is the gold standard for heart preservation but has limitations in terms of both duration and adequacy of protection. Our laboratory has been interested in a more physiologic approach to heart preservation by maintaining the heart at its resting membrane potential (hyperpolarized arrest) with the K(ATP) channel agonist pinacidil. This study compared our extracellular solution (WashU) with the UW intracellular depolarizing solution and quantified the protective effect of pinacidil in both solutions.

The value of caval division in the maze procedure with valve surgery.

Operative predictors for successful elimination of atrial fibrillation (AF) following the maze procedure are not yet known. We have often divided the superior vena cava (SVC) during the maze procedure, not to eliminate AF but in order to explore the mitral valve. However, in multivariate analysis of 79 patients, the division of SVC, as well as the duration of AF, was found to be the strongest predictor of AF elimination.

Optimal size of prostheses for functioning of the aortic prosthetic valve in aortic and mitral valve replacement with annular enlargement through Manouguian's technique.

There is not yet agreement about the optimal size of the prostheses in aortic and mitral valve replacement with Manouguian's technique. In this technique, the aortic prosthetic valve can be pushed upon the mitral prosthesis which may cause dysfunction of the aortic prosthetic valve. The aim of this study was to clarify the size of the prostheses needed to avoid dysfunction of the aortic prosthetic valve.

Repetitive atrial flutter as a complication of the left-sided simple maze procedure.

Background: Of 41 patients who had undergone a left-sided simple maze procedure, 4 (9.8%) developed repetitive tachycardia due to atrial flutter, and required radiofrequency catheter ablation. Linear ablation of the right atrial isthmus was effective to treat atrial flutter.