First jejunal artery, an alternative graft for right hepatic artery reconstruction.

Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision and safe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely.

Tricuspid regurgitation after mitral valve repair for degenerative mitral regurgitation.

Purpose: We examined changes of TR (tricuspid regurgitation) after mitral valve repair for degenerative mitral regurgitation (MR) and investigated their contributing parameters.

Methods: We divided 205 patients undergoing mitral valve repair for degenerative MR into 3 groups: up-grade (n = 65), down-grade (n = 29), and no-change (n = 111) of TR during postoperative follow-up. Preoperative, immediate postoperative, and mid-term postoperative parameters included MR grade, right ventricular (RV) pressure, RV Tei index, left ventricular Tei index, and presence of atrial fibrillation.

Should mitral annuloplasty be performed for patients with mild ischemic mitral regurgitation?

Purpose: We investigated whether mitral annuloplasty (MAP) should be performed for mild ischemic mitral regurgitation (IMR).

Methods: We selected 57 patients with preoperatively mild IMR. Twenty-eight patients who previously had moderate MR or more, underwent MAP (group 1) while 29 patients with persistent mild MR, did not (group 2).

Functional mitral stenosis after surgical annuloplasty for ischemic mitral regurgitation: importance of subvalvular tethering in the mechanism and dynamic deterioration during exertion.

Objective: Diastolic subvalvular mitral leaflet tethering by left ventricular remodeling that restricts leaflet opening in the presence of annular size reduction by surgery for ischemic mitral regurgitation potentially causes functional mitral stenosis in the absence of organic leaflet lesions. Exercise, known to worsen systolic tethering and ischemic mitral regurgitation, might also dynamically exacerbate such mitral stenosis by increasing tethering. This study evaluates the mechanism and response of such mitral stenosis to exercise.

Left ventricular reconstruction with or without mitral annuloplasty.

Objectives: The aim of this study was to review characteristics of patients undergoing left ventricular reconstruction (LVR) with or without mitral annuloplasty (MAP) for postinfarction ventricular remodeling.

Patients And Methods: Forty-seven patients were divided into two groups: LVR (LVR group, n = 22) and LVR with MAP (LVRM group, n = 25). Echocardiographic parameters including left ventricular (LV) dimensions, LV end-diastolic and end-systolic volume indexes, and LV ejection fraction (LVEF) at immediate and midterm postoperative stages were evaluated.

Abnormal Tei index predicts poor left ventricular mass regression and survival after AVR in aortic stenosis patients.

Background: A Tei index is known to reflect overall cardiac performance including systolic and diastolic function in a variety of heart disease. We investigated the relationship between preoperative Tei index and postoperative left ventricular (LV) mass regression and survival after aortic valve replacement (AVR) for aortic valve stenosis (AS).

Methods: One hundred fifty-four patients with AS were classified into a group with abnormal (Abn) LV function (n=47, 0.

Protective effect of sivelestat sodium hydrate (ONO-5046) on ischemic spinal cord injury.

Prevention of paraplegia remains an important issue in repair of descending thoracic and thoracoabdominal aneurysms. Therefore, we investigated the protective effect of sivelestat sodium hydrate (ONO-5046) on ischemia-induced spinal cord damage in a rabbit model. Twenty New Zealand white rabbits were divided into two equal groups; ONO-5046 (1.

Impact of subvalvular procedure for ischemic mitral regurgitation on leaflet configuration, mobility, and recurrence.

Background: Procedures on the subvalvular apparatus are an etiology-based treatment for ischemic mitral regurgitation (IMR).

Methods And Results: Fifty-nine patients with IMR were divided into 3 groups: mitral annuloplasty (MAP) (M group, n=27), MAP+left ventricular reconstruction (LVR) (LV group, n=18), and MAP+LVR+subvalvular procedure (S group, n=14). Tenting height and area, angle between the annular line and the line connecting leaflet base to the bending- or tip-point of either the anterior or posterior leaflet, and leaflet mobility were measured echocardiographically preoperatively and at immediate- and mid-term postoperative follow-up.

Intervalvular fibrosa pseudoaneurysm with projectile shunt flow to left atrium.

We report a case of intervalvular fibrosa pseudoaneurysm, causing massive shunt flow from the left ventricle below the left coronary cusp to the left atrium above the anterior mitral annulus, which was clearly demonstrated on preoperative three-dimensional transesophageal echocardiography. Superior extension of the right-sided left atriotomy toward the pseudoaneurysm, combined with transection of aorta and main pulmonary artery, provided its sufficient exposure. Its opening to the left ventricle was closed with a patch, leaving no residual shunt flow.

Radical repair of cor triatriatum with partially unroofed coronary sinus and persistent left superior vena cava 35 years after operation for tetralogy of Fallot.

We report a rare case of simultaneous repair for Cor triatriatum (CT), partially unroofed coronary sinus (CS) with persistent left superior vena cava (PLSVC), moderately severe tricuspid regurgitation, and atrial flutter 35 years after radical operation for tetralogy of Fallot (TOF). A 40-year-old woman underwent patch closure of atrial septal defect as to drain blood from left SVC to right atrium (RA), excision of diaphragm in left atrium (LA), tricuspid annuloplasty, and cryoablation. Postoperative course was uneventful with successful anatomical correction.

Preoperative advanced left ventricular remodeling predisposes to recurrence of ischemic mitral regurgitation with less reverse remodeling.

Background And Aim Of The Study: The recurrence of ischemic mitral regurgitation (IMR) after mitral annuloplasty is a major determinant of patient survival. The study aim was to investigate, retrospectively, the characteristics of patients with postoperative recurrence of IMR.

Methods: Twenty patients who had no regurgitation immediately after mitral annuloplasty, were allocated to either recurrence (n = 8) or non-recurrence (n = 12) groups.

Modified septal myectomy for small patients with hypertrophic obstructive cardiomyopathy.

For successful myectomy for hypertrophic obstructive cardiomyopathy, it is essential that a sufficient amount of muscle be excised under adequate surgical exposure. In addition to the method of standard transaortic myectomy, supplemental use of a flexible endoscope and a hand-made blade knife, which are available in any institution, can provide successful myectomy, especially for small patients, easily and safely.

Papillary muscle elevation: an alternative subvalvular procedure for selective relocation of displaced posterior papillary muscle in posteroinferior infarction.

Several subvalvular procedures have been developed for relocating one or both displaced papillary muscles. We describe an original procedure--papillary muscle elevation--in which we relocated the posterior papillary muscle selectively, through a small inferior ventriculotomy, and reduced the coaptation depth from 5 mm to zero. Our procedure can be considered for cases of posteroinferior infarction, which is a frequent cause of ischemic mitral regurgitation.

Subvalvular procedure for functional mitral regurgitation in a patient with dilated-phase hypertrophic cardiomyopathy.

Surgical correction of the subvalvular apparatus to reduce tethering, along with mitral annuloplasty, has recently been highlighted in the treatment of functional mitral regurgitation. However, because of anatomical differences in the subvalvular apparatus between cases of progressive cardiomyopathy, a uniform procedure to reduce tethering has not been established. We report a case-specific reconstructive method consisting of procedures mainly on papillary muscles for a rare case of dilated-phase hypertrophic cardiomyopathy with moderately severe mitral regurgitation.

Mid-term changes of left ventricular geometry and function after Dor, SAVE, and Overlapping procedures.

Background: The aim of this study was to investigate the mid-term changes of left ventricular (LV) geometry and function after Dor, septal anterior ventricular exclusion (SAVE), and Overlapping ventricular remodeling procedures.

Methods: Forty-three patients who underwent LV reconstruction for end-stage ischemic heart disease, were divided into three groups, undergoing Dor (n=15), SAVE (n=12), and Overlapping procedures (n=16). Coronary artery bypass grafting and mitral annuloplasty were performed concomitantly when indicated.

Intraoperative infusion of epoprostenol sodium for patients with heparin-induced thrombocytopenia undergoing cardiac surgery.

Prevention of catastrophic thromboembolic complications during surgery in patients with heparin-induced thrombocytopenia (HIT) remains a challenging problem during cardiac surgery. We infused an increasing dose of epoprostenol sodium, which is one of three anti-HIT regimens available in Japan, ahead of administration of heparin and performed a mitral valve operation for a patient with type II HIT. The absence of thromboembolic events and platelet consumption during cardiopulmonary bypass, together with considerable reduction of platelet adhesion to the fibers of the membrane oxygenator, support the efficacy and safety of our strategy.

Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering.

Background: Surgical annuloplasty can potentially hoist the posterior annulus anteriorly, exaggerate posterior leaflet (PML) tethering, and lead to recurrent ischemic/functional mitral regurgitation (MR). Characteristics of leaflet configurations in late postoperative MR were investigated.

Methods And Results: In 30 patients with surgical annuloplasty for ischemic MR and 20 controls, the anterior leaflet (AML) and PML tethering angles relative to the line connecting annuli, posterior and apical displacement of the coaptation and the MR grade were measured by echocardiography before, early after, and late after surgery.

New surgical approach to reduce tethering in ischemic mitral regurgitation by relocation of separate heads of the posterior papillary muscle.

The surgical treatment of chronic ischemic mitral regurgitation remains a challenging issue. Several procedures have been developed to correct displacement of the papillary-ventricular complex and to reduce tethering-induced regurgitation. We report a geometric approach to relocate the laterally displaced posterior papillary muscle towards the mitral annulus.

Vasodilator resistant lethal spasm after uncomplicated off-pump coronary surgery.

We report a case of lethal spasm of non-grafted coronary arteries after an uncomplicated off-pump coronary artery bypass grafting in a patient with no predisposing factors other than smoking. Transcatheter intraluminal injection of several vasodilators failed to relieve the spasm. The patient remained in profound cardiogenic shock due to broad acute myocardial infarction and died of multiple organ failure.

Emergent mitral valvuloplasty with an autologous pericardial patch in an octogenarian with active infective endocarditis.

An 83-year-old woman with suppurative spondylitis was referred to our hospital due to active infective endocarditis with an expanding mobile vegetation and a high echoic mass on the posterior mitral leaflet. During the operation, the high echoic mass was found to be a chronically organized abscess, which was located at the base of the vegetation on the posterior leaflet and extended toward the annulus. The patient underwent a successfully emergent resection of the vegetation and mass, and valvuloplasty using an autologous pericardial patch with an excellent outcome.

Characteristic changes in cerebral perfusion during on-pump and off-pump coronary artery surgery.

Objective: We investigated the cerebral perfusion status during on-pump or off-pump coronary artery bypass grafting (CABG).

Methods: We monitored somatosensory evoked potential (SEP) and regional cerebral oxygen saturation (rSO2) as parameters of cerebral perfusion in an on-pump group (n=10) and an off-pump group (n=16). The percent changes from control values were calculated before, during, and after aortic clamping, and after weaning from cardiopulmonary bypass, in the on-pump group.

Bilateral coronary arteriovenous fistulas with an oversize left coronary aneurysm.

We experienced an interesting case of bilateral coronary arteriovenous fistulas with coronary aneurysms (50 mm in the left and 10 mm in the right) developed in a 66-year-old woman. The pathological findings of both left and right aneurysms were quite similar. Etiological and surgical considerations about coronary aneurysm based on this case are discussed.

Ruptured pseudoaneurysm of the aorta with encapsulated mediastinal abscess after coronary artery bypass grafting.

Rupture of pseudoaneurysm of the aorta with chronic active mediastinitis after cardiac surgery is a catastrophic complication. We report a case of one-stage operation of urgent repair for ruptured pseudoaneurysm under deep hypothermic circulatory arrest, debridement of mediastinum, and omental transfer, with an uneventful postoperative course.

Comparative Hemolysis Study of Clinically Available Centrifugal Pumps.

Centrifugal pumps have become important devices for cardiopulmonary bypass and circulatory assistance. Five types of centrifugal pumps are clinically available in Japan. To evaluate the blood trauma caused by centrifugal pumps, a comparative hemolysis study was performed under identical conditions.