[Effects of pre-operative administration of steroids on the serum interleukin (IL)-6, IL-8 and organ injuries in replacement of thoracic aorta].

To investigate whether pre-operative steroids administration decreases the post-operative serum IL-6, IL-8 and prevents organ injuries, we prospectively studied patients undergoing elective replacement of thoracic aorta using an extracorporeal circulation. Six of 10 patients (group S) were pretreated with methylprednisolone 500 mg 2 hours before operation while the other 4 patients (group C) were not. Though post-operative serum IL-6, IL-8, C-reactive protein and amylase elevated in group C, the elevations were significantly decreased in group S (p < 0.

[Single-stage correction of coarctation of the aorta with aortic regurgitation].

A successful single-stage correction of coarctation of the aorta with aortic regurgitation is reported. A 39-year-old man was referred for angina, ankle swelling, and numbness of lower extremities. Aortogram revealed severe aortic regurgitation and coarctation of the aorta with 2.

Development and evaluation of totally implantable ventricular assist system using a vibrating flow pump and transcutaneous energy transmission system with amorphous fibers.

We have developed a vibrating flow pump (VFP) that can generate oscillated blood flow with a relatively high frequency (10-50 Hz) for a totally implantable ventricular assist system (VAS). To evaluate the newly developed VAS, left heart bypasses, using the VFP, were performed in chronic animal experiments. Hemodynamic parameters were recorded in a data recorder in healthy adult goats during an awake condition and analyzed in a personal computer system through an alternating-direct current converter.

Selective motor neuron death and heat shock protein induction after spinal cord ischemia in rabbits.

Paraplegia is a serious complication that sometimes results from operation on the thoracic aorta. The mechanism of spinal cord injury has been thought to involve tissue ischemia, and spinal motor neurons are suggested to be vulnerable to ischemia. The exact mechanism, however, is not fully understood.

Stent angioplasty for renovascular disease associated with acute aortic dissection.

Aortic replacement was performed in a patient with acute type A aortic dissection originating from the descending thoracic aorta. Postoperatively, a persistent false lumen resulted in severe stenosis of the right renal artery. Percutaneous stent angioplasty improved renovascular hypertension and renal function.

Operation for nondissecting aneurysm in the descending thoracic aorta.

Background: Little is known about the risks of mortality and morbidity after descending thoracic aortic aneurysm repair using left heart bypass and temporary arterioarterial bypass.

Methods: A multicenter, retrospective study was performed on 120 patients who were admitted to one of nine cardiovascular centers between January 1988 and December 1993 and underwent operation for nondissecting thoracic aortic aneurysm. The present series included 10 patients with ruptured aneurysm.

Aortic arch operation using selective cerebral perfusion for nondissecting thoracic aneurysm.

Background: Risks of increasing mortality and disability in aortic arch operations using the selective cerebral perfusion method for nondissecting aneurysm have not yet been determined. A multicenter, retrospective study was employed.

Methods: The subjects were 143 patients who were admitted to one of the nine cardiovascular centers between January 1988 and December 1993, including 15 with ruptured aneurysm.

Dissociation of HSP72 and HSC73 heat shock mRNA inductions after spinal cord ischemia in rabbit.

The inductions of HSP72 and HSC73 mRNAs were investigated with Northern blot and immunohistochemical analyses for up to 7 days of the reperfusion after 5 or 15 min ischemia in rabbit spinal cord. Following 15 min ischemia, HSP72 mRNA was induced at 8 h of reperfusion, while HSC73 mRNA continuously remained at the control level. Immunoreactivity of HSP72 protein was slightly induced at 8 h of reperfusion selectively in motor neurons, and the majority of motor neuron showed selective cell death at 7 days of reperfusion.

Extracardiac conduit composed of gutter-shaped prosthesis and pedicled pericardial valved patch for pulmonary trunk reconstruction.

A conduit for reconstruction of the pulmonary trunk is presented. A Gelseal vascular prosthesis (Vascutek Ltd, Inchinnan, Scotland) was split longitudinally in two halves, and one half was used as a posterior wall of the conduit like a gutter. The anterior wall was constructed by a pedicled pericardial valved patch.

Inductions of Cu/Zn superoxide dismutase- and nitric oxide synthase-like immunoreactivities in rabbit spinal cord after transient ischemia.

The distributions and inductions of Cu/Zn superoxide dismutase (SOD), neuronal and endothelial nitric oxide (NO) synthase (nNOS and eNOS), and nitrotyrosine (NT) were immunohistochemically examined in rabbit spinal cords after 5 and 15 min of transient ischemia. The neurons in the anterior horns (AH) were selectively lost 7 days after 15-min ischemia as compared with those of sham-operated controls. In the normal spinal cords, a number of neurons in the AHs were positive for the nNOS, and only slightly positive for the Cu/Zn SOD and the eNOS.

Left ventricular function following conventional mitral valve replacement in patients with chronic mitral regurgitation.

Conventional mitral valve replacement (MVR) for patients with chronic mitral regurgitation (MR) is usually associated with decrease in left ventricular (LV) ejection fraction (EF). This study investigated the effect of preoperative LV size on LV performance and examined loading conditions before and after conventional MVR. Echocardiographic study was performed on 13 and 9 patients with LV end-systolic dimension of less than 26 mm/m2 (group A) or greater than 26 mm/m2 (group B), respectively.

Extracting 1/f fluctuation from the arterial blood pressure of an artificial heart.

We have studied the fluctuations of an artificial circulation for the analysis of the physiological aspects; however, the conventionally used fast Fourier transform (FFT) method cannot separate harmonic oscillations, such as respiratory and Mayer waves, from the 1/f fluctuation, which has been though to represent underlying fractal dynamics. Fractal structure was shown in the strange attractor with chaotic dynamics, which is thought to be a flexible and intelligent system. In this study, the coarse-graining spectral analyzing (CGSA) method was utilized to quantitatively evaluate the proportion of the 1/f fluctuation in the total power in the frequency domain and to analyze artificial circulation in the whole system.

Fluctuations of the hemodynamic derivatives during left ventricular assistance using oscillated blood flow.

To analyze the autonomic nervous system during left heart bypass with a vibrating flow pump (VFP), fluctuations in hemodynamic derivatives were evaluated by the spectral analysis method using fast fourier transform methodology. After the left pleural cavity was opened through the fourth intercostal space under general anesthesia, a VFP was implanted as the left heart bypass device in chronic animal experiments using 3 healthy adult goats. Hemodynamic parameters with and without VFP assistance were recorded on magnetic tape in awake animals and were analyzed by computer through an analog to digital convertor.

Spectral analysis of hemodynamics during left ventricular assistance.

In order to analyze the autonomic nervous system during left ventricular (LV) assistance, fluctuations in hemodynamic derivatives were evaluated by a spectral analyzing method using a fast fourier transform (FFT) methodology. After the left pleural cavity was opened through the fourth intercostal space under general anesthesia, a pneumatically driven ventricular assist system was implanted as in left heart bypasses in chronic animal experiments, using three healthy adult goats. Hemodynamic parameters with and without LV assistance were recorded on a magnetic tape in the awake condition then analyzed in a computer system through an A-D convertor.

Fluctuations of the Hemodynamic Derivatives During Left Ventricular Assistance Using Oscillated Blood Flow.

To analyze the autonomic nervous system during left heart bypass with a vibrating flow pump (VFP), fluctuations in hemodynamic derivatives were evaluated by the spectral analysis method using fast fourier transform methodology. After the left pleural cavity was opened through the fourth intercostal space under general anesthesia, a VFP was implanted as the left heart bypass device in chronic animal experiments using 3 healthy adult goats. Hemodynamic parameters with and without VFP assistance were recorded on magnetic tape in awake animals and were analyzed by computer through an analog to digital convertor.

Strange hemodynamic attractor parameter with 1/R total artificial heart automatic control algorithm.

To evaluate the automatic control algorithm of the total artificial heart (TAH) as an entity, and not just as parts, a non-linear mathematical analyzing technique including chaos theory was utilized. Chronic experiments on the biventricular bypass type artificial heart implantation were performed in healthy adult goats after the natural ventricles were removed. Hemodynamic time series data were recorded under the awake standing condition with TAH 1/R and fixed driving.

Successful surgical repair of left atrial dissection after mitral valve replacement.

A rare case of left atrial dissection after mitral valve replacement is reported. Low output syndrome developed in the immediate postoperative period. Cardiac catheterization showed marked elevation of the pulmonary wedge pressure, and left ventriculography revealed massive paraprosthetic leakage with left atrial dissection.

[Acute aortic dissection with leg ischemia].

From January of 1987 to July of 1994, 83 patients with acute aortic dissection were treated at our institution. Of these, 7 patients (8%) sustained acute leg ischemia. Angiography showed that one patient had arterial occlusion at the abdominal aorta, three had occlusion at the right common iliac artery, and one had severe right common iliac artery stenosis.

Aneurysm of a patent ductus arteriosus in an adult.

An adult patient with a spontaneous aneurysm of a patent ductus arteriosus was successfully treated. The lumen of the aneurysm communicated with the distal aortic arch and the pulmonary artery. Closure of the pulmonary arterial orifice of the ductus arteriosus and replacement of the inferior wall of the distal aortic arch and proximal descending aorta with prosthetic graft were performed under partial cardiopulmonary bypass using a centrifugal pump.

[Surgical management of vascular ring in 5 cases].

Five cases of vascular ring are presented. Three cases have double aortic arch and two cases have right aortic arch with aberrant left subclavian artery. Other congenital heart diseases are complicated in four cases.

[Supra-annular mitral valve replacement for a patient with prosthetic valve endocarditis].

Supraanular mitral valve replacement with a 29 mm CarboMedics prosthetic valve was performed for a 58-year-old patient of prosthetic valve endocarditis. He has received mitral valve replacement 2 years ago, and was admitted because of high fever and severe heart failure diagnosed mitral regurgitation due to valve dehiscence. An annular abscess was observed and the new 29 mm CarboMedics prosthetic valve was sutured to the left atrial wall approximately 10 mm above the original annulus in order to secure the firm suturings for valve implantation and to left the infected annulus intact.

[Dislodgement of the ringed-graft--a case report].

A 70-year-old man underwent replacement of the distal aortic arch which contained a huge aneurysm using a ringed graft. He died suddenly of hemoptysis 54 months following the operation. An autopsy revealed dislodgement of the spool on the posterior aspect of the aorta.