High-Tc nodeless s±-wave superconductivity in (Y,La)FeAsO(1-y) with Tc=50 K:75As-NMR study.

We report on an (75)As-NMR study on the Fe-pnictide high-T(c) superconductor Y(0.95)La(0.05)FeAsO(1-y) (Y(0.95)La(0.05)1111) with T(c)=50 K that includes no magnetic rare-earth elements. The measurement of the nuclear-spin lattice-relaxation rate (75)(1/T(1)) has revealed that the nodeless bulk superconductivity takes place at T(c)=50 K while antiferromagnetic spin fluctuations develop moderately in the normal state. These features are consistently described by the multiple fully gapped s(±)-wave model based on the Fermi-surface nesting. Incorporating the theory based on band calculations, we propose that the reason that T(c)=50 K in Y(0.95)La(0.05)1111 is larger than T(c)=28 K in La1111 is that the Fermi-surface multiplicity is maximized, and hence the Fermi-surface nesting condition is better than that in La1111.

Possibility of valence-fluctuatsion-mediated superconductivity in Cd-doped CeIrIn(5) probed by In NQR.

We report on a pressure-induced evolution of exotic superconductivity and spin correlations in CeIr(In(1-x)Cd(x))(5) by means of in-nuclear-quadrupole-resonance (NQR) studies. Measurements of an NQR spectrum and nuclear-spin-lattice-relaxation rate 1/T(1) have revealed that antiferromagnetism induced by Cd doping emerges locally around Cd dopants, but superconductivity is suddenly induced at T(c)=0.7 and 0.9 K at 2.34 and 2.75 GPa, respectively. The unique superconducting characteristics with a large fraction of the residual density of state at the Fermi level which increases with T(c) differ from those for anisotropic superconductivity mediated by antiferromagnetic correlations. By incorporating the pressure dependence of the NQR frequency pointing to the valence change of Ce, we suggest that unconventional superconductivity in the CeIr(In(1-x)Cd(x))(5) system may be mediated by valence fluctuations.

Antiferromagnetic spin fluctuations and unconventional nodeless superconductivity in an iron-based new superconductor (Ca4Al2O(6-y))(Fe2As2): 75As nuclear quadrupole resonance study.

We report 75As nuclear quadrupole resonance studies on (Ca4Al2O(6-y))(Fe2As2) with T(c) = 27 K. Measurement of nuclear-spin-relaxation rate 1/T1 has revealed a significant development of two-dimensional antiferromagnetic spin fluctuations down to T(c) in association with the smallest As-Fe-As bond angle. Below T(c), the temperature dependence of 1/T1 without any trace of the coherence peak is well accounted for by a nodeless s(±)-wave multiple-gaps model. From the fact that its T(c) is comparable to T(c) = 28 K in the optimally doped LaFeAsO(1-y) in which antiferromagnetic spin fluctuations are not dominant, we remark that antiferromagnetic spin fluctuations are not a unique factor for enhancing T(c) among Fe-based superconductors, but a condition for optimizing superconductivity should be addressed from the lattice structure point of view.

Spin susceptibility of noncentrosymmetric heavy-fermion superconductor CeIrSi3 under pressure: 29Si Knight-shift study on single crystal.

We report 29Si NMR study on a single crystal of the heavy-fermion superconductor CeIrSi3 without an inversion symmetry along the c axis. The 29Si Knight-shift measurements under pressure have revealed that the spin susceptibility for the ab plane decreases slightly below T(c), whereas along the c axis it does not change at all. The result can be accounted for by the spin susceptibility in the superconducting state being dominated by the strong antisymmetric (Rashba-type) spin-orbit interaction that originates from the absence of an inversion center along the c axis and it being much larger than superconducting condensation energy. This is the first observation which exhibits an anisotropy of the spin susceptibility below T(c) in the noncentrosymmetric superconductor dominated by strong Rashba-type spin-orbit interaction.

Structure and electrical properties of the new pyrochlore-type protonic solid electrolyte K(0.88)Nb2O(7.58)H(4.28).

Single-crystal, synchrotron powder X-ray diffraction and neutron powder diffraction studies of the novel pyrochlore-type compound with the structural formula K(0.88)(OH)(0.54)H(1.66)(H(2)O)(1.04)Nb(2)O(6) suggests that the water molecules are located in 32e sites, and the hydroxide ions and potassium ions are located in 16d sites with a significant amount of 'free' protons in 96g sites. The total weight loss at temperatures up to 773 K is only about 8%, suggesting the oxygen escape from 48f sites can be excluded and 'free' protons must be preserved in the structure. The bulk conductivity in ambient air reaches 10(-2) S cm(-1) at 623 K. Owing to the extended stability range and resistance to water solubility, the compound can be considered as a candidate for intermediate temperature solid-oxide fuel-cell applications.

[Myers technique and patch enlargement of ascending aorta for diffuse supravalvular aortic stenosis].

A 6-year-old boy was diagnosed with aggravation of diffuse supravalvular aortic stenosis (SVAS). The pressure gradient between the sinus of Valsalva and ascending aorta was 48 mmHg. The diameter of the sino-tubular junction was 7 mm and the ascending aorta was hypoplastic. We performed Myers operation because 3 sinus reconstructions had resulted in superior hemodynamics and reductions in both mortality rate and need for reoperation. We avoided using autologous pericardium because of the possibility of shrinkage and aneurysm. We could easily perform patch enlargement of the ascending aorta by selective cerebral perfusion. The postoperative course was excellent and there was no SVAS or aortic regurgitation (AR). A catheterization showed the pressure gradient was 5 mmHg with trivial AR upon follow-up at 1 year.

[Primary biventricular repair for interrupted aortic arch with left ventricular outflow tract obstruction and tricuspid valve regurgitation; report of a case].

An interrupted aortic arch was diagnosed in a 10-day-old girl weighing 3.3 kg, as was perimembranous ventricular septal defect (VSD) and severe tricuspid valve regurgitation (TR). The subaortic diameter was 3.6 mm and the aortic valve (3.7 mm in diameter) was bicuspid. We chose definitive repair, modified Yasui procedure, because of severe TR and no straddling of mitral valve. In primary biventricular repair, we undertook extended aortic arch anastomosis. Left ventricular outflow tract reconstruction consisted of intracardiac rerouting from the VSD to the pulmonary artery by using expanded-polytetrafluoroethylene (ePTFE) and Damus-Kaye-Stansel (DKS) anastomosis. Right ventricular outflow tract reconstruction was performed by the Rastelli procedure with an ePTFE valved conduit. Moreover, we carried out semicircular annuloplasty for severe TR.

Mechanism of procainamide-induced prevention of spontaneous wave break during ventricular fibrillation. Insight into the maintenance of fibrillation wave fronts.

BACKGROUND: Ventricular fibrillation (VF) is maintained by 2 mechanisms: first by reentry formation and second by spontaneous wave break or wave splitting. We hypothesized that spontaneous wave break results from a critical shortening of the action potential duration (APD) during VF and that its prevention by procainamide eliminates spontaneous wave break. METHODS AND RESULTS: The endocardial surfaces of 7 isolated, perfused swine right ventricles were mapped with a 3.2x3.8 cm plaque with 477 bipolar electrodes. Activation pattern during VF was visualized dynamically while simultaneously recording epicardial action potentials with a glass microelectrode. APD restitution curves were constructed during VF (dynamic) and during S(1)S(2) protocols. At baseline, VF was maintained by 5.3+/-1 wavelets. Procainamide (PA) at 10 microgram/mL decreased the number of wavelets to 3.5+/-1 (P<0.05). At baseline VF was maintained by spontaneous wave break and by new reentrant wave front formation. PA eliminated spontaneous wave break during VF while having no effect on reentry formation. PA increased the cycle length of the VF (148.5+/-41.2 ms vs 81+/-10 ms, P<0.01) and the core area of the reentry from 5.8 to 14.5 mm(2) (P<0.05). Dynamic APD restitution curve during VF showed that PA eliminated the initiation of activation with APDs shorter than 30 ms. The effects of PA on cellular properties and wave front dynamics were reversed during 60 minutes of drug-free perfusion. CONCLUSIONS: Critically short APDs during VF promote spontaneous wave break. Their elimination with PA, however, maintains VF by generating new reentrant wave front.

Pulmonary veins and ligament of Marshall as sources of rapid activations in a canine model of sustained atrial fibrillation.

BACKGROUND: In dogs, chronic rapid pacing may result in sustained atrial fibrillation (AF). However, activation patterns in pacing-induced sustained AF are unclear. METHODS AND RESULTS: We induced sustained AF (>48 hours) in 6 dogs by rapid pacing for 139+/-84 days. We then performed computerized atrial epicardial mappings and recorded the activations in the ligament of Marshall (LOM) and the pulmonary veins (PVs). During AF, mean activation cycle length in the right atrial free wall (126+/-17 ms) was significantly longer than that in the left atrial free wall (96+/-5 ms, P:=0.006). In addition, mean activation cycle length in the left atrial free wall was significantly longer than that in the LOM (84+/-5 ms, P:<0.001), the left inferior PV (81+/-4 ms, P:=0.001), and the left superior PV (85+/-7 ms, P:=0.003). Similarly, the dominant frequency was highest in the LOM and the PVs (range 11.2 to 13.3 Hz), followed by the left and right atria (P:<0.001). In all dogs studied, rapid and complicated electrograms were consistently observed at the LOM and the PVs. During AF, both wandering wavelets and organized reentry were present. There were more wave fronts in the left atrium than in the right atrium (P:<0.001). CONCLUSIONS: In chronic pacing-induced sustained AF, the LOM and the PVs are the sources of rapid activations. The mechanism by which the left atrium activates faster and has more wave fronts than the right atrium may relate to the fact that the left atrium is closer to the sources of rapid activations.

Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia.

BACKGROUND: The mechanism of the adrenergic atrial tachyarrhythmia is unclear. We hypothesize that the ligament of Marshall (LOM) is sensitive to adrenergic stimulation and may serve as a source of the adrenergic atrial tachyarrhythmia. METHODS AND RESULTS: We performed computerized mapping studies in isolated-perfused canine left atrial tissues from normal dogs (n=9) and from dogs with chronic atrial fibrillation (AF) induced by 10 to 41 weeks of rapid pacing (n=3). Before isoproterenol, spontaneous activity occurred in only one normal tissue (cycle length, CL >1300 ms). During isoproterenol infusion, automatic rhythm was induced in both normal tissues (CL=578+/-172 ms) and AF tissues (CL=255+/-29 ms, P<0.05). The origin of spontaneous activity was mapped to the LOM. In the AF tissues, but not the normal tissues, we observed the transition from rapid automatic activity to multiple wavelet AF. Ablation of the LOM terminated the spontaneous activity and prevented AF. Immunocytochemical studies of the LOM revealed muscle tracts surrounded by tyrosine hydroxylase-positive (sympathetic) nerves. CONCLUSIONS: We conclude that the LOM is richly innervated by sympathetic nerves and serves as a source of isoproterenol-sensitive focal automatic activity in normal canine atrium. The sensitivity to isoproterenol is upregulated after long-term rapid pacing and may contribute to the development of AF in this model.

Role of papillary muscle in the generation and maintenance of reentry during ventricular tachycardia and fibrillation in isolated swine right ventricle.

BACKGROUND: The role of papillary muscle (PM) in the generation and maintenance of reentry is unclear. METHODS AND RESULTS: Computerized mapping (477 bipolar electrodes, 1.6-mm resolution) was performed in fibrillating right ventricles (RVs) of swine in vitro. During ventricular fibrillation (VF), reentrant wave fronts often transiently anchored to the PM. Tissue mass reduction was then performed in 10 RVs until VF converted to ventricular tachycardia (VT). In an additional 6 RVs, procainamide infusion converted VF to VT. Maps showed that 77% (34 of 44) of all VT episodes were associated with a single reentrant wave front anchored to the PM. Purkinje fiber potentials preceded the local myocardial activation, and these potentials were recorded mostly around the PM. When PM was trimmed to the level of endocardium (n = 4), sustained VT was no longer inducible. Transmembrane potential recordings (n = 5) at the PM revealed full action potential during pacing, without evidence of ischemia. Computer simulation studies confirmed the role of PM as a spiral wave anchoring site that stabilized wave conduction. CONCLUSIONS: We conclude that PM is important in the generation and maintenance of reentry during VT and VF.

Obstacle-induced transition from ventricular fibrillation to tachycardia in isolated swine right ventricles: insights into the transition dynamics and implications for the critical mass.

OBJECTIVES: The study was done to test the hypothesis that an artificial anatomical obstacle prevents the maintenance of ventricular fibrillation (VF) by stabilizing reentrant wavefronts (RWF) and increases the critical mass (CM) of myocardium required to sustain VF. BACKGROUND: Artificial obstacles can anchor RWF in simulated models of VF. Whether an artificial obstacle affects multiple-wavelet VF in real tissue is unclear. METHODS: The endocardial surfaces of seven isolated, perfused swine right ventricles were mapped using a plaque of 477 bipolar electrodes with 1.6-mm resolution. An 8-mm hole was punched in the tissue. The CM was reached by tissue mass reductions, at which VF converted to periodic activity (ventricular tachycardia, VT). RESULTS: After the creation of the obstacle, the VF cycle length increased from 71.6+/-18.4 ms to 87.5+/-13.0 ms (p<0.05). The obstacle, together with the papillary muscle, facilitated the transition from VF to VT by serving as attachment sites for the RWF. When one RWF attaches to the obstacle and another attaches to the papillary muscle, it may result in stable VT with figure-eight patterns. The CM for VF in the presence of an 8-mm hole (28.7+/-3.8 g) was higher than in the control group (swine right ventricles without holes, 24.0+/-3.4 g, p<0.05). CONCLUSIONS: An artificial anatomical obstacle induces slowing and regularization of VF, impairs the persistence of VF as judged by an increase of the CM, and can convert VF to VT by serving as an attachment site to reentrant excitation.

Progressive action potential duration shortening and the conversion from atrial flutter to atrial fibrillation in the isolated canine right atrium.

OBJECTIVES: We sought to evaluate the effects of progressive shortening of the action potential duration (APD) on atrial wave front stability. BACKGROUND: The mechanisms of conversion from atrial flutter to atrial fibrillation (AF) are unclear. METHODS: Isolated canine right atria were perfused with 1 to 5 micromol/l of acetylcholine (ACh). We mapped the endocardium by using 477 bipolar electrodes and simultaneously recorded transmembrane potentials from the epicardium. The APD(90) was measured during regular pacing (S(1)) with cycle lengths of 300 ms. Atrial arrhythmia was induced by a premature stimulus (S(2)). RESULTS: At baseline, only short runs of repetitive beats (<10 cycles) were induced. After shortening the APD(90) from 124 +/- 15 ms to 72 +/- 9 ms (p < 0.01) with 1 to 2.5 micromol/l of ACh, S(2) pacing induced single, stable and stationary re-entrant wave fronts (307 +/- 277 cycles). They either anchored to pectinate muscles (5 tissues) or used pectinate muscles as part of the re-entry (4 tissues). When ACh was raised to 2.5 to 5 micromol/l, the APD(90) was further shortened to 40 +/- 12 ms (p < 0.01); S(2) pacing induced in vitro AF by two different mechanisms. In most episodes (n = 13), AF was characterized by rapid, nonstationary re-entry and multiple wave breaks. In three episodes with APD(90) <30 ms, AF was characterized by rapid, multiple, asynchronous, but stationary wave fronts. CONCLUSIONS: Progressive APD shortening modulates atrial wave front stability and converts atrial flutter to AF by two mechanisms: 1) detachment of stationary re-entry from the pectinate muscle and the generation of multiple wave breaks; and 2) formation of multiple, isolated, stationary wave fronts with different activation cycle lengths.

[Fontan operation for tricuspid atresia with dysplasia of the right ventricular myocardium and absence of pulmonary valve].

We report a case of successful staged repair of tricuspid atresia with dysplasia of the right ventricular myocardium and absence of the pulmonary valve. The patient underwent the modified Blalock-Taussig shunt operation at 1 month the bidirectional Glenn procedure at 11 months, and the total cavopulmonary connection procedure using extracardiac graft at 2 years. It is important to prevent the left ventricular outflow tract obstruction (LVOTO) caused by the non-functioning right ventricle when the Fontan completion. We were safely able to disconnect the pulmonary trunk from the right ventricle using the transesophageal echocardiography to evaluate the LVOTO during operation.

[Sandwich technique for closing of the large muscular Swiss-cheese type ventricular septal defects].

A 9-year-old girl, who has had a diagnosis as a Taussig-Bing anomary, underwent an original Jatene procedure (o-J) 2 months after birth. This time, she had a diagnosis of the muscular multiple ventricular septal defects (mVSD) and pulmonary stenosis after o-J. The mVSD was Swiss-cheese type and was large from the proximal of the infundibular septum to the apex and posterior of the septum. It was closed by the sandwich technique using a pair of felt patches, which of one was placed at right ventricular side and the other was at left ventricular side, slightly larger than the whole area of the mVSD. The patch fixation was placed with 1 stitch at the center between the patches and a few stitches around the right ventricular side patch to the ventricular septum. Postoperative cardiac function was uneventful regardless of the very large patches placed at the ventricular septum and the cardiac catheterization after 1 year postoperatively showed the pulmonary/systemic blood flow ratio was 1.0. This technique for the closure of the large Swiss-cheese type mVSD can be considered to be very effective.

Pharmacokinetics of landiolol hydrochloride, a new ultra-short-acting beta-blocker, in patients with cardiac arrhythmias.

OBJECTIVES: To elucidate pharmacokinetics and pharmacodynamics of landiolol hydrochloride, newer developed ultra-short-acting beta-blocker, in patients with various cardiac tachyarrhythmias. BACKGROUND: The short duration of action and titratability of landiolol hydrochloride make it ideal for use in patients with a clinical need for beta-blockers. METHODS: In a total of 31 examinations we infused the drug in 19 patients (mean age, 55 +/- 14 years). After the persistence of the tachyarrhythmias was confirmed, continuous infusion was started at rates of 0.005, 0.01, 0.02, 0.04, and 0.08 mg/kg/min for 5 minutes (for paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, and ventricular tachycardia) or 15 minutes (for ventricular premature complex). We analyzed the pharmacokinetics of 16 examinations. A one-compartment model provided a close fit for each blood concentration-time curve. RESULTS: The maximum blood concentrations obtained clearly showed the dose dependency and revealed very short half-lives (range, 2.3 to 4.0 minutes). Area under the blood concentration-time curves also increased, showing dose dependency. In paroxysmal atrial fibrillation, landiolol hydrochloride reduced the heart rate from 111 +/- 20 to 90 +/- 10/min. Sinus rhythm was restored, without any adverse effects, in three of five patients with paroxysmal supraventricular tachycardia and one patient with ventricular tachycardia. There was no significant change in peripheral blood pressure. CONCLUSIONS: Landiolol hydrochloride has a shorter elimination half-life than any other beta-blocker, and it can be administered safely to patients with various tachyarrhythmias.

Processing and mechanical properties of hydroxyapatite reinforced with hydroxyapatite whiskers.

Hydrothermally synthesized HAp fine crystals/HAp whiskers mixtures have been used for the preparation of HAp/0-30% (whiskers) composites. The composites have been fabricated by pressureless sintering and hot-pressing. The best mechanical properties and the highest densities have been achieved for composites hot pressed at 1000 degrees C (2 h, 30 MPa in flowing Ar). Their density was in the range of 90-97% of the theoretical density. Fracture toughness (Klc) of the composites reflected their microstructure and had the value of 1.4 MPa m1/2 (as compared with Klc = 1.0 MPa m1/2 for the non-reinforced HAp matrix). Compressive prestressing of the HAp matrix and crack deflection (both derived from the residual stress field) contributed to the increase of fracture toughness. Other toughening mechanisms have not been observed. HAp/HAp (whiskers) composites exhibited improved toughness without degradation of biocompatibility, because the HAp whiskers acted both as a reinforcement and as a biocompatible phase. Problems related to biocompatibility and mechanical properties of available HAp-based composites were also discussed.

Hydroxyapatite ceramics with selected sintering additives.

Several sintering additives for hydroxyapatite (HA) have been tested in order to enhance its sinterability without decomposing the HA and/or decreasing bioactivity and biocompatibility, additionally providing a weak interface for HA ceramics. The ion species of sintering additives were selected from those in the mineral constituents of hard tissues and bioactive glasses. After investigation of phase diagrams in the CaO-P2O5-additive systems, and analysis of physiochemical properties of the additives, several sintering aids for HA have been chosen. Subsequently, densification, phase composition, grain growth and fracture behaviour of HA containing 5 wt% of each additive, sintered at 1000-1100 degrees C, have been studied. H3BO3, CaCl2, KCl, KH2PO4, (KPO3)n and Na2Si2O5 did not enhance densification of HA. K2CO2, Na2CO3, KF and sodium phosphates improved the densification significantly. Expect for KCl and some sodium phosphates, all the additives caused formation of large quantities of undesired beta-tricalcium phosphate or CaO; therefore, they are not appropriate for HA. In the case of sodium phosphate additives, it was possible to avoid formation of CaO or beta-tricalcium phosphate by control of the additive quantity and chemical composition. beta-NaCaPO4 has been found to be an effective sintering agent which causes neither decomposition of HA nor formation of other undesired phases.

Delayed diagnosis of anomalous origin of the left coronary artery 16 years after mitral valve replacement.

Mitral insufficiency caused by ischemia is frequently found in anomalous origin of the left coronary artery from the pulmonary artery. We report a case of a 25-year-old woman who was diagnosed to have anomalous origin of the left coronary artery from the pulmonary artery and had successful left internal mammary artery bypass grafting 16 years after mitral valve replacement for mitral insufficiency of an unknown cause in her childhood.

Time course of endothelin-1 and nitrate anion levels after cardiopulmonary bypass in congenital heart defects.

BACKGROUND: The endothelium-derived vasoconstrictor endothelin-1 (ET-1) may be involved in pulmonary hypertension (PH), but production of the endothelium-derived vasodilator nitric oxide (NO) after cardiopulmonary bypass (CPB) in congenital heart disease is unclear. METHODS: Twenty patients (age, 4 months to 12 years) were divided into three groups: severe PH (mean pulmonary-to-systemic arterial pressure ratio > 0.5) and high pulmonary flow (n = 8), mild PH (mean pulmonary-to-systemic arterial pressure ratio < 0.35) and high pulmonary flow (n = 6), and no PH and low pulmonary flow (n = 6). The mean pulmonary-to-systemic arterial pressure ratio was calculated and blood samples were taken, and NO3-, an NO metabolite, was measured. RESULTS: Levels of ET-1 in the group with severe PH and high pulmonary flow were higher than in the other groups until 6 hours after CPB, and NO3- was not changed significantly in the group with severe PH and high pulmonary flow and or the group with mild PH and high pulmonary flow during CPB. Endothelin-1 in the group with no PH and low pulmonary flow was higher than in the group with mild PH and high pulmonary flow after CPB, and NO3- in the group with no PH and low pulmonary flow significantly decreased after CPB. A positive correlation was obtained between mean pulmonary-to-systemic arterial pressure ratio and ET-1 (r = 0.742 before CPB; r = 0.689 after CPB). CONCLUSIONS: Imbalance between increased ET-1 and constant NO after CPB in the group with severe PH and high pulmonary flow could contribute to dominant effects of ET-1, which may injure the lung. The increased ET-1 and the decreased NO after CPB in the group with no PH and low pulmonary flow may induce a mechanism of protective vasoconstriction against an acute increase in pulmonary flow.