Giant coronary artery aneurysm associated with medial mucoid degeneration.

A 52-year-old man underwent surgical repair for coronary arteriovenous fistula including patch closure of two exitus of the fistula, double ligation of the dilated right coronary artery, and coronary bypass grafting to the right coronary artery with saphenous vein graft at the age of 25. Then, twenty-seven years later, a multi-detector computed tomographic scan revealed an aneurysmally dilated right coronary artery (4.8 cm), fistula, and saphenous vein graft.

Extensive patch angioplasty of the left main ostial stenosis using a rhombic-shaped pulmonary autograft.

A rhombic shaped pulmonary autograft patch was applied to enlarge an ostial stenosis of the left main coronary artery (LMCA) in a 25-year-old woman diagnosed with vasculitis syndrome. The patch increased the width of the ostial stenosis and made a funnel-shaped connection. At eighteen months of follow-up, a coronary angiogram by computed tomography showed no restenosis at the LMCA.

Transatrial repair of submitral left ventricular pseudoaneurysm.

In a 57-year-old man with Wolff-Parkinson-White syndrome, a left ventricular pseudoaneurysm developed, induced by the pop phenomenon, after radiofrequency catheter ablation of the posterolateral accessory pathway. The pseudoaneurysm was positioned at the atrioventricular groove with moderate pericardial adhesions, and the rupture site was located just below the P3 annulus of the posterior mitral leaflet. With this anatomy and in the presence of adhesions, we repaired the rupture site from within the heart through an incision made in the posterior mitral leaflet.

Long-term results of modified Bentall procedure using flanged composite aortic prosthesis and separately interposed coronary graft technique.

We have selected the flanged composite aortic prosthesis and separately interposed coronary graft technique for the aortic root replacement over seven years. We sought to evaluate the long-term results of aortic root replacement with this technique. Between April 1996 and September 2003, 71 patients (mean age 46.

Completely pulsatile high flow circulatory support with a constant-speed centrifugal blood pump: mechanisms and early clinical observations.

Objective: Various types of rotary blood pumps (axial flow, centrifugal) have been introduced into clinical use recently. These pumps have different pressure-flow characteristics, and some investigators have noted that a limited pump flow rate and less pulsatility are the problems with the axial flow devices.

Methods: A new implantable centrifugal blood pump was developed that has an extremely flat pressure-flow curve and is able to produce a significantly high pump flow rate of 20 l/min at a low pressure of 10-30mmHg.

Leukocyte-platelet aggregates and monocyte tissue factor expression in bovines implanted with ventricular assist devices.

Infection and thromboembolism remain significant complications associated with ventricular assist device (VAD) support, including the newer rotary VADs, limiting wider adoption of this promising technology. These complications persist in spite of extensive preclinical testing in large animal models. The amount of biocompatibility information collected during preclinical trials is limited due to a lack of available assays.

Preclinical biocompatibility assessment of the EVAHEART ventricular assist device: coating comparison and platelet activation.

Thromboembolism and bleeding remain significant complications of ventricular assist device (VAD) support. Increasing the amount of biocompatibility data collected during preclinical studies can provide additional criteria to evaluate device refinements, while design changes may be implemented before entering clinical use. Twenty bovines were implanted with the EVAHEART centrifugal VAD for durations from 30 to 196 days.

Effects of left ventricular assist device support and outflow graft location upon aortic blood flow.

Although continuous flow (CFVAD) and pulsatile (PVAD) ventricular assist devices (VADs) are being clinically used, their effects upon aortic blood flow as a measure of overall blood distribution remain unclear. The objective of this study was to compare the effects of CFVAD and PVAD support for ascending (AscA) and descending (DA) aorta outflow cannulation upon mean aortic blood flow and waveform morphology. Six experiments were conducted in a normal, acute calf model, in which an inflow cannula was implanted in the left ventricle apex and outflow cannulae were anastomosed to both the AscA and DA.

Distal thoracic aorta hemodynamics during exercise with continuous flow left ventricular assist system.

Objectives: Continuous flow left ventricular assist systems (LVAS) are being discussed as a destination therapy. LVAS patients will have expanded activity of daily life, including exercise. In this study, we analyzed the effects of exercise on blood flow in the distal thoracic aorta of LVAD implanted animals.

In vivo evaluation of a MPC polymer coated continuous flow left ventricular assist system.

The aim of this study was the evaluation of the thrombogenicity and the biocompatibility of the SunMedical EVAHEART left ventricular assist system (LVAS) coated with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer compared to a diamond-like carbon (DLC) coating. Four calves were implanted with the MPC polymer-coated LVAS. Eight calves were implanted with DLC coated LVAS.

Effects of continuous flow left ventricular assist device support on skin tissue microcirculation and aortic hemodynamics.

Continuous flow ventricular assist devices (CFVADs) are thought to be the next generation of circulatory assist devices. With many now in various stages of development or clinical trial, it is important that the physiologic aspects of these pumps be critically analyzed. In this study, 15 calves were divided into two groups.

Smooth muscle cell hypertrophy of renal cortex arteries with chronic continuous flow left ventricular assist.

Background: Pathophysiology of long-term continuous flow left ventricular assist is not well described. With many of these devices becoming available, it is important to examine for possible pathologic effects. In this study we examined the relationship between diminished pulsatility and pathologic changes in renal cortical arteries.

EVAHEART: an implantable centrifugal blood pump for long-term circulatory support.

Objective: We developed "EVAHEART": a compact centrifugal blood pump system as an implantable left ventricular assist device for long-term circulatory support. The 55 x 64 mm pump is made from pure titanium, and weighs 370 g. The entire blood-contacting surface is covered with an anti-thrombogenic coating of diamond like carbon (DLC) or 2-methacryloyloxyethyl phosphorylcholine (MPC) to improve blood compatibility.

Extracorporeal membrane oxygenation and left ventricular assist device: a case of double mechanical bridge.

A 14-year-old boy with dilated cardiomyopathy with cardiac arrest was successfully implanted with a left ventricular assist device (LVAD) after 6-day extracorporeal membrane oxygenation (ECMO). He had multiple organ failure at the initiation of ECMO, but the failed organs recovered during assisted circulation, leading to LVAD implantation. This case showed the advantages of the "double bridge" such as: (1) quick and easy installation for acute cardiogenic shock, (2) providing intervention time for complications refractory to LVAD implantation, and (3) providing evaluation time for potential LVAD implantation and transplant candidates.

Effects of milrinone for right ventricular failure after left ventricular assist device implantation.

Right ventricular failure after left ventricular assist device implantation sometimes requires additional mechanical right ventricular support. The effectiveness of nitrates, prostaglandin, or nitric oxide inhalation in such cases has already been reported. However, there are few reports on the administration of phosphodiesterase inhibitor for right ventricular failure after left ventricular assist device implantation.