Persistent fifth aortic arch associated with type A aortic arch interruption. Histological study and morphogenesis.

A male infant, having a persistent fifth aortic arch and interruption of the aorta distal to the left subclavian artery, underwent successful surgical treatment. A histological study of the excised segment of the aorta showed that the ductal tissue extended to the junction between the fifth arch and the descending aorta with consequent narrowing in the corresponding region. The ductal tissue, however, did not contribute to occlusion in the fourth aortic arch. The morphogenesis of this combination of aortic arch anomalies was also discussed.

Identification of human CPI-17, an inhibitory phosphoprotein for myosin phosphatase.

CPI-17 is a phosphorylation-dependent inhibitor of myosin phosphatase. cDNA clones encoding CPI-17 were isolated from a human aorta library. Overlapping clones indicated two isoforms: CPI-17alpha was 147 residues and mass of 16.7 kDa; CPI-17beta (120 residues, mass 13.5 kDa) resulted from a deletion in the alpha-isoform of 27 residues, sequence 68-94. N-terminal 67 residues of all CPI-17 isoforms (human, porcine, rat and mouse) were highly conserved (for the human and porcine isoforms the identity was 91%). The presence of the two human isoforms was detected from cDNA sequences amplified by RT-PCR and by Western blots on human aorta. The cloned human CPI-17 gene indicated 4 coding exons and CPI-17beta was an alternative splice variant due to deletion of the second exon. FISH analysis located the human CPI-17 gene on chromosome 19q13.1.

[A case of total cavopulmonary connection by utilization of coronary sinus as a hepatic venous return].

A 2-year-old boy with polysplenia, double outlet right ventricle after pulmonary banding and unilateral bidirectional shunt was operated on. A modified total cavopulmonary connection was done by utilization of coronary sinus as a retrograde route for the hepatic venous return. Left SVC was transected and its distal end was anastomosed to the left pulmonary artery after PA angioplasty. An equine pericardial patch was placed over the ostia of the hepatic vein and coronary sinus. Two ostia of the coronary veins were excluded from the created route. The proximal end of the left SVC was anastomosed to the inferior side of the left pulmonary artery. Postoperative course was uneventful. The postoperative angiogram showed smooth hepatic venous return through the coronary sinus and no pressure gradient was recorded between hepatic vein and pulmonary artery.

[A case of repeated surgical intervention for pulmonary venous obstruction after repair of total anomalous pulmonary venous connection].

A 3-month-old boy showed pulmonary venous obstruction after repair of total anomalous pulmonary venous connection. He was treated with a novel method of stureless in situ pericardium repair. Six weeks after this operation, he showed recurrence of venous obstruction and the same procedure was performed. Another six weeks after this operation, stenosis of the left pulmonary vein necessitated the same procedure again. Although he suffered from pneumonia and died of sepsis, this procedure revealed effectiveness for at least three months. This report showed clinical course after repeated stureless in situ pericardium repair. More experience will be necessary to evaluate the effectiveness of this procedure.

[A case of lateral femoral circumflex artery as a free graft for coronary artery bypass surgery].

A 46-year-old man had a three-vessel coronary disease. We performed quadruple coronary artery bypass grafting (CABG) with the left internal thoracic artery (LITA), right gastroepiploic artery (RGEA), saphenous vein and lateral femoral circumflex artery (LFCA). Postoperative coronary angiogram showed that the LFCA bypass graft was patent and supplied sufficient blood to the anastomosed vessel. There was no stenosis at the anastomotic site. However, the LFCA graft showed a string sign. Long-term follow-up and angiographic studies is necessary to establish the use of LFCA as an arterial free graft for coronary revascularization.

Implantation of a mechanical valve within the orifice of a mitral bioprosthesis in a case with severely calcified left atrium--a case report.

The case of a 61-year-old woman with deterioration of mitral bioprosthesis and severe left atrial calcification is presented. Although the implantation of a mechanical valve within the orifice of a mitral bioprosthesis was tried, we found a major pitfall in this method was exact orifice matching.

[Acute myocardial infarction due to traumatic hemorrhagic shock with open fracture: a case report of staged amputation and CABG].

A 55-years-old man was admitted to an emergent hospital with hypovolemic pre-shock and open fracture of the right lower extremity. CPR was needed for myocardial infarction induced by hemorrhagic shock. Wound infection and bacteremia (Enterococcus SP) were noted 10 days after admission. Severe three vessel disease was demonstrated by preoperative (amputation) evaluation, he was also referred for CABG. For a control of infectious focus before using cardiopulmonary bypass, two-stage-operation (amputation and CABG) were selected. Both perioperative courses were uneventful and the patient recovered well after rehabilitation.