Extra-anatomical bypass with EPTFE graft for residual pulmonary artery stenosis in Tetralogy of Fallot.

We describe the case of 35-year old woman who had undergone radical surgery to correct Tetralogy of Fallot malformation at the age of nine admitted to our hospital because of palpitation and exertional dyspnea. Angiography revealed 90% re-stenosis of the right pulmonary artery and grade IV tricuspid regurgitation. Right lung was perfused only 16.

Hepatic microcirculation during transient hepatic venous occlusion--intravital microscopic observation using hepatic vein clamp model in the mouse.

The purpose of this experiment was to evaluate the etiology of hepatic dysfunction in patients difficult to wean from cardiopulmonary bypass. We hypothesized that increased central venous pressure and subsequent hepatic congestion during weaning from cardiopulmonary bypass would lead to hepatic dysfunction. To induce hepatic congestion in mice, we clamped the hepatic vein for fifteen min, and observed the microcirculation of the liver using an intravital microscope during clamping and the following 30 min of reperfusion.

Results of surgical treatment for thoracoabdominal aneurysm using cardiopulmonary bypass under moderate hypothermia and selective visceral artery perfusion.

From 1994 to 1997, 11 consecutive patients with thoracoabdominal aneurysms underwent surgery using cardiopulmonary bypass under moderate hypothermia (33 degrees C) and selective visceralartery perfusion for spinal cord and visceral organ protection. Distal perfusion pressure was maintained above 60 mmHg (mean) during cardiopulmonary bypass. In the four patients, one or two pairs of large intercostal arteries between Th10 and L2 were reimplanted.

Structure, evolution, and liver-specific expression of sterol 12alpha-hydroxylase P450 (CYP8B).

The rat CYP8B cDNA encoding sterol 12alpha-hydroxylase was cloned and sequenced. The amino acid sequence of the heme-binding region of CYP8B was close to those of CYP7A (cholesterol 7alpha-hydroxylase) and CYP7B (oxysterol 7alpha-hydroxylase). Molecular phylogenetic analysis suggests that CYP8B and the CYP7 family derive from a common ancestor.

Usefulness of postoperative percutaneous cardiopulmonary support using a centrifugal pump: retrospective analysis of complications.

Between January 1992 and December 1997, we employed percutaneous cardiopulmonary support (PCPS) using a centrifugal pump in 25 patients. In 21 of them, PCPS was used postcardiotomy. These patients could not be weaned from cardiopulmonary bypass due to profound ventricular failure.

The effect of direct lidocaine injection into the clamped aortic segment on the spinal evoked potential: early diagnosis for spinal cord ischemia.

Purpose: The aim of this study was to identify a method to determine whether segmental artery reconstruction was indicated during aortic clamping.

Method: Spinal cord evoked potential (SCEP) and regional spinal blood flow were studied in 24 adult dogs. Using the left heart bypass technique, aortic clamping divided the aorta into thoracic, abdominal, and terminal segments.

Efficacy of initial controlled perfusion pressure for ischemia-reperfusion injury in a 24-hour preserved lung.

In lung transplantation, the safety period of the ischemic time of the graft is within 6 hours. Because of the problem of donor shortage, it is essential to extend the safety period of the preservation time of the donor lung. However, the longer the preservation time is, the more severe is the resulting ischemia-reperfusion injury.

Mild hypothermia for temporary brain ischemia during cardiopulmonary support systems: report of three cases.

Recovery without residual neurological damage after cardiac arrest with temporary cerebral ischemia is rare. Therefore, it is most important that every effort is made to prevent brain damage occurring immediately after successful cardiopulmonary resuscitation. We report herein the cases of three patients who suffered either cardiogenic or hypovolemic shock and were resuscitated by a cardiopulmonary support system followed by mild hypothermia.

Reoperation after repair of type A and B dissecting aneurysm.

Background: In the late postoperative period after repair of an aortic dissection or dissecting aneurysm, reoperations may be required. The interval to reoperation, size and location of intimal tear, and results of reoperation were evaluated.

Methods: Between January 1982 and April 1997, 138 patients underwent surgery for Stanford type A (90 patients) or type B (48 patients) dissections of the aorta.

Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus.

Unlabelled: Aggressive surgical treatment in renal cell carcinoma is still controversial. The aim of this paper is to assess inferior vena caval (IVC) reconstruction for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus. Twelve patients with suprahepatic vena caval thrombus from renal cell carcinoma who underwent surgical repair with cardiopulmonary bypass were evaluated.

Increased portal endothelin-1 level is associated with the liver function after cardiopulmonary bypass in rabbits: influence of hypothermia on the damage.

The purpose of this study was to prove the hypothesis that ET-1 production is increased in the splanchnic-hepato circulation during cardiopulmonary bypass (CPB) with or without hypothermia and this greatly affects hepatocellular function after surgery. Twelve Japanese white rabbits were used. In group I (n = 6), the rectal temperature was kept at 37.

Clear cell sarcoma of kidney with tumor extension into the right atrium.

A 28-year-old man with a Wilms tumor extending into his right atrium was successfully treated using cardiopulmonary bypass. Histologic examination revealed clear cell sarcoma with invasion of the inferior vena cava. This case represents the oldest patient with clear cell sarcoma of the kidney ever published in the English literature.

Surgical results for thoraco-abdominal aneurysm by modified DeBakey method using centrifugal biopump and renal cryopreservation.

Background: In this paper, we report the surgical results of our DeBakey and Crawford combined method.

Methods: From 1985 to 1995, 22 consecutive patients with thoraco-abdominal aneurysms underwent a modified DeBakey and Crawford combined procedure to minimize the ischemic time for the spinal cord and visceral organs. The extent of aneurysm as classified by Crawford was as follows: Group I, 12; Group II, 4, Group III, 3; Group IV, 3.

Repeat tricuspid valve replacement for acquired valvular heart disease: report of a case.

A patient was admitted to our hospital for investigation of exertional dyspnea and liver dysfunction, 10 years after undergoing mitral valve replacement (MVR) and tricuspid valve replacement (TVR) using a Bjork-Shiley mechanical valve and a Carpentier-Edwards bioprosthesis, respectively. Echocardiographic examinations, magnetic resonance imaging (MRI), and cardiac catheterization subsequently revealed severe degenerative changes of the artificial tricuspid valve. Thus, a repeat TVR with plication of his enlarged right atrium that was compressing the right lung was performed.

Successful surgical treatment of an Edwards type IIIB right aortic arch aneurysm: report of a case.

A true aneurysm of the right aortic arch which accompanies various branching characteristics is very rare. We report herein the successful surgical treatment of an elderly patient found to have an Edwards type IIIB right aortic arch aneurysm encircling and compressing the trachea. The complete right aortic arch and right subclavian artery were reconstructed through the inside of the aneurysm using selective cerebral perfusion.

Pulmonary circulatory parameters as indices for the early detection of acute rejection after single lung transplantation.

We investigated the relationship between the changes in the pulmonary blood flow and histology during acute rejection following single lung transplantation. In single lung transplantation using adult mongrel dogs, immunosuppression with cyclosporine and azathioprine was discontinued after postoperative day 14 to induce rejection. Doppler flow probes were placed adjacent to the ascending aorta and the left pulmonary artery to measure the blood flow on a daily basis.

[Early and late surgical mortality of acute type A aortic dissections by open distal anastomosis with deep hypothermic retrograde cerebral perfusion].

We have analyzed the operative results and the long-term prognosis of Stanford type A acute aortic dissections. Between 1981 and 1997, 57 patients underwent surgical repairs of acute type A aortic dissection. In the earlier period (1981-1990; n = 21), almost all the operations were performed under aortic cross-clamping with conventional cardiopulmonary bypass, while in the later period (1991-1997; n = 36), radical resections and graft replacements under open distal anastomosis with deep hypothermic retrograde cerebral perfusion (RCP) were performed in 24 patients (66.

Surgical results of composite graft replacement of the aortic root aneurysm.

From 1986 to 1996, 20 patients underwent aortic root replacement. All of the patients had annulo aortic ectasia (AAE); Six had DeBakey type I aortic dissection, three were acute dissections associated with Marfan's syndrome; three had previously undergone the Koster-Collins operation. During 11 years, the original Bentall procedure (1986-91), the Cabrol procedure (1991-), and the modified Bentall procedure (Carrel patch or Piehler technique) were performed.

[Continuous nebulization with terbutaline sulfate under tent inhalation. Evaluation of the efficacy in children 2 to 5 years of age in asthmatic crises].

This study investigated the efficacy of a system for continuous nebulization of terbutaline sulphate in the treatment of acute asthmatic crises in children. The equipment consisted of a condensation nebulizer attached to a 40 liter acrylic tent placed around the patient's head. A prospective, randomized and open clinical trial was conducted.

Role of endogenous endothelin in the development of graft arteriosclerosis in rat cardiac allografts: antiproliferative effects of bosentan, a nonselective endothelin receptor antagonist.

Background: The purpose of this study was to determine whether endothelin-1 (ET-1) contributes to the development of graft arteriosclerosis and whether the orally active nonpeptide endothelin receptor antagonist bosentan, which blocks both ETA and ETB receptors, can protect against this pathologic damage.

Methods And Results: Recipient male Lewis rats were divided into three groups; group 1 received heterotopic heart transplantations from Lewis donors and groups 2 and 3 received transplantations from Brown-Norway donors; group 3 recipients also received bosentan orally at the dose of 20 mg/kg per day for 120 days. All recipients were given cyclosporine and were euthanized at examination 120 days after transplantation.

Neonatal erythema infectiosum.

A report is presented of a patient with neonatal erythema infectiosum who developed petechiae, transient thrombocytopenia and transient cardiac failure due to transplacental transmission of human parvovirus B19 (HPV B19) infection. It is suggested that the thrombocytopenia was caused by platelet-associated IgG produced by the patient, and that the cardiac failure may have been caused by direct entry of HPV B19 into the cardiac tissue.

Impact of retrograde cerebral perfusion with posterolateral thoracotomy on distal arch aneurysm repair.

Background: Repair of distal aortic arch aneurysms is difficult to accomplish through a median sternotomy or left thoracotomy, and stroke and respiratory disorders often become lethal complications with the use of circulatory arrest. We investigated the use of retrograde cerebral perfusion with a posterolateral thoracotomy in the repair of distal arch aneurysms.

Methods: Thirty-eight patients underwent repair of a distal arch aneurysm.

Surgical treatment for transvenous tumor extension into the heart: four cases.

From 1984 to 1996, four patients with transvenous intracardiac tumor extension underwent operations in the Kobe University Hospital. The primary tumors of two were intravenous leiomyomatoses originating from the uterus; a third patient had invasive thymoma, and the fourth patient had clear cell sarcoma of the kidney. In 1985, one patient had a curative, staged resection.

Cerebral complications and distal false lumen in the repair of aortic dissection with retrograde cerebral perfusion.

Background: In aortic dissection, patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of an open distal anastomosis under retrograde cerebral perfusion.

Methods: During a 15-year period (1981-1995), 51 patients with type A dissection underwent 59 surgical repairs.