[Indocyanine green injection method for evaluating blood flow of gastric tube on esophageal cancer surgery].

The blood flow of esophageal substitute has been subjectively evaluated by surgeons. HyperEye Medical System (HEMS) allows for the visualization of the fluorescent image of indocyanine green (ICG) enhanced by near-infrared light among the surrounding vivid color images. We applied HEMS for evaluating the blood flow of right gastroepiploic artery and tissue blood flow of whole gastric tube during operation. Quantification of arterial blood flow and venous return has also been now developing for objective evaluation. We hope HEMS contributes to development of surgical results on various fields by establishing quantification of blood flow and clinical application.

[The distal pancreatic resection with spleen preservation: which collaterals can we rely on?].

The spleen preservation by distal pancreatic resection can be performed either with spleen vessels preservation or with the ligation of the least. The experiment evolved ligation of all gastric arteries but the short gastric arteries in 20 cadaveric organocomplexes, followed by ink perfusion through the left gastric and left gastro-epiploic arteries. The study was amplified with the intraoperative dopplerography of portal arteries of the spleen after crossclamping of the left gastro-epiploic and short gastric arteries. Ten patients after distal pancreatic resection with spleen preservation and splenic vessels ligation had the CT-angiography before and after the surgery. All the conducted studies demonstrated the incapability of short gastric arteries to supply the satisfactory spleen perfusion. The left gastro-epiploic artery proved to be the main source of splenic blood supply after splenic vessels ligation.

Radial artery as a graft for coronary artery bypass grafting.

The radial artery (RA) graft was revived in late 1980 s when it was found that the graft was patent 13-18 years after coronary artery bypass grafting (CABG) after improvement of the technique in harvesting and the use of calcium-channel blockers. Recently, the RA became a reasonable alternative to the saphenous vein (SV) graft with the trend toward complete arterial revascularization and more frequent off-pump CABG to avoid aortic manipulation. To improve the quality of the RA conduit, harvesting technique and topical and systemic antispasmodic medication are important. The RA should be grafted to severe proximal stenosis (>90%) in the native coronary arteries to avoid flow competition, especially in the right coronary territory. The RA graft could be used as an aortocoronary or composite configuration with similar graft patency. Early graft patency of the RA conduit was as good as other arterial grafts, and better than SV graft in the circumflex and right coronary territories, in many studies, especially in diabetic patients. Long-term results of graft patency and cardiac-event-free survival compared with SV graft are still controversial in randomized controlled trials, probably because the incidence of flow competition and the definition of graft patency varied.

Transplantation of the free gastroepiploic artery graft for myocardial revascularization: long-term clinical and angiographic results.

BACKGROUND: Use of the free gastroepiploic artery (GEA) graft for coronary revascularization is not very popular because of its tendency to vasospasm. We hypothesize that the cause of free GEA spasm is graft damage caused by an interruption of venous drainage from the graft. To overcome this problem, we anastomosed the accompanied gastroepiploic vein to the right atrial appendage simultaneously with the GEA grafting in the aortocoronary position. We here assess the clinical result and the angiographic patency of the free GEA graft in our method in the late postoperative period. METHODS: Between January 1997 and April 2001, 57 patients underwent coronary artery grafting with a free GEA using our method. A total of 169 distal anastomoses (average 2.96) were constructed. The free GEA grafts were anastomosed to the main right coronary artery in 26 patients, right coronary artery branch in 27, left anterior descending artery in 1 patient, high lateral branch in 2 patients, and circumflex branch in 2. The mean clinical follow-up is 77 months (range, 35 to 110) in 57 cases, and the angiographic follow-up averages 77 months (range, 37 to 110) in 46 cases. RESULTS: There was no cardiac death, and all patients were in Canadian Cardiovascular Society class II or less. The mean 77-month patency rate of the free GEA in our method was 95.7%. The patency rates of internal thoracic artery, radial artery, and saphenous vein graft in the same period were respectively 93.2%, 100%, and 81.3%. CONCLUSIONS: Free GEA grafting with venous drainage for myocardial revascularization provided excellent long-term performance.

Midterm results for use of the skeletonized gastroepiploic artery graft in coronary artery bypass.

BACKGROUND: To improve the long-term results of coronary artery bypass grafting (CABG), several arterial conduits have been used, including the skeletonized right gastroepiploic artery (GEA) graft. METHODS AND RESULTS: The skeletonized GEA graft was used for CABG in 223 patients over a 6-year period (208 males, 15 females, mean age 64 years). 1-, 2- and 3-vessel and left main trunk disease was noted in 1, 28, 122 and 72 patients, respectively. Internal thoracic artery, radial artery and saphenous vein grafts were concomitantly used in 217 (97%), 73 (33%) and 41 (18%) patients, respectively, and the mean number of grafts was 3.5. The sites of GEA grafting were 1 anterior descending, 10 diagonal, 97 circumflex, and 185 right coronary arteries, with 154 single in-situ, 33 free and 36 composite grafts, including 56 sequential grafts. There was 1 (0.4%) operative death. New Q wave was noted in 2 (0.9%) patients. Postoperative angiography revealed 97.6% early postoperative (within 1 month) and 91.5% midterm (mean 27 months) patency rates for GEA grafts. The cumulative 4-year patency rate of the skeletonized GEA graft was 86.4%. CONCLUSION: The skeletonized GEA is a safe and effective arterial conduit for CABG.

Flow dynamic comparison of in-situ internal thoracic and gastroepiploic arterial conduits: experimental study.

OBJECTIVE: We tried to experimentally clarify the flow dynamic differences under flow competitive conditions between the internal thoracic artery (ITA) and gastroepiploic artery (GEA) as in-situ arterial bypass conduits. METHODS: The ITA and the GEA were anastomosed close together to the left anterior descending artery (LAD) in 8 pigs. Flow characteristics of the ITA and the GEA were analyzed using a transit time flowmeter under the following flow competitive conditions; condition A: the ITA, GEA and LAD were left open, condition B: either of the ITA or GEA were clamped and the LAD was left open, condition C: the ITA and GEA were open but the proximal LAD was clamped, condition D: either of the ITA or GEA were clamped and the proximal LAD was also clamped. RESULTS: The flow volume of the ITA was significantly (p<0.001) greater than that of the GEA in condition A (27 +/- 11 ml/min vs. -4 +/- 9 ml/min), B (26 +/- 17 ml/min vs. -1 +/- 14 ml/min) and C (38 +/- 14 ml/min vs. 0 +/- 4 ml/min), but did not differ (p=0.685) in condition D (29 +/- 6 ml/min vs. 31 +/- 14 ml/min). Retrograde flow in systole and antegrade flow in diastole was seen in the GEA in condition A, B and C. CONCLUSION: Under flow competitive conditions, flow of the GEA was inferior to that of the ITA. These data suggested that the GEA is more sensitive to competitive flow than the ITA. This may be due to anatomical differences between these in-situ bypass conduits.

Hybrid surgical angiogenesis: omentopexy can enhance myocardial angiogenesis induced by cell therapy.

BACKGROUND: The conditions at the injection site are important in cell transplantation for severe ischemic heart disease. The omentum is both a well-vascularized tissue and a source of angiogenic factors. We examined the effectiveness of autologous bone marrow-derived mononuclear cells (BM-MNCs) with or without omentopexy in a large animal model. METHODS: Myocardial infarction was generated in the lateral wall by ligation of coronary artery branches in miniswine. Animals received BM-MNC injection with or without omentopexy. Controls received saline only. Three weeks after surgery, regional myocardial blood flow and contractility were measured, and density of arterioles was evaluated immunohistologically. Angiography and postmortem examinations were performed to determine collateral communication. RESULTS: Regional myocardial contractility was significantly improved by BM-MNC transplantation both with and without omentopexy (0.29 +/- 0.02 vs 0.11 +/- 0.03, p < 0.01, 0.30 +/- 0.02 vs 0.12 +/- 0.01, p < 0.01, respectively). Relative regional myocardial blood flow in the combined omentopexy group was significantly higher than the controls both at rest (1.05 +/- 0.11 vs 0.57 +/- 0.07, p < 0.01) and under stress (1.09 +/- 0.08 vs 0.40 +/- 0.10, p < 0.01). The number of arterioles (< 50 microm) in both groups were higher than the controls (88.1 +/- 5.00 vs 38.1 +/- 8.99, p < 0.01 and 109.2 +/- 9.91 vs 38.1 +/- 8.99, p < 0.01, respectively). The number of large arterioles (> 50 microm) in the combined omentopexy group was significantly higher than in both BM-MNC alone (26.9 +/- 2.4 vs 17.6 +/- 1.8, p = 0.011) and controls (26.9 +/- 2.4 vs 10.0 +/- 1.3, p < 0.01). Collateral communication between the omentum and myocardium was demonstrated by angiography and postmortem injection. CONCLUSIONS: The BM-MNC transplantation may attenuate cardiac contractile dysfunction, and omentopexy may enhance angiogenesis induced by BM-MNC transplantation.

Differential pharmacologic sensitivities of phosphodiesterase-3 inhibitors among human isolated gastroepiploic, internal mammary, and radial arteries.

UNLABELLED: Systematic investigations of the actions of phosphodiesterase (PDE)-3 inhibitors on different human vascular tissues have not been performed. We investigated the effects of specific PDE-3 inhibitors (olprinone, milrinone, and amrinone) on contracted human gastroepiploic arteries (n = 70), internal mammary arteries (n = 72), and radial arteries (n = 70) harvested from a total of 134 patients, all of whom were undergoing coronary artery bypass surgery. Each of these PDE-3 inhibitors dose-dependently diminished the contractile responses to 10(-6) mol/L norepinephrine and to either 10(-9) or 10(-8) mol/L of the thromboxane A2 analog U46619. In inducing vasorelaxations, these inhibitors were significantly more potent in norepinephrine-contracted rings than in those contracted with U46619. Further, at concentrations similar to the maximum therapeutic plasma concentrations (10(-7) mol/L olprinone; 10(-6) mol/L milrinone; 10(-5) mol/L amrinone) olprinone and milrinone were more potent at inducing relaxations than amrinone in gastroepiploic arteries and radial arteries, whereas in internal mammary arteries milrinone was more potent than the others. These results suggest different activities for the three PDE-3 inhibitors among human arteries located in different regions and may be informative about the effectiveness of these inhibitors in preventing spasms in the various arterial grafts used in revascularization. IMPLICATIONS: Because three phosphodiesterase-3 inhibitors (milrinone, olprinone, and amrinone) differed in their vasodilator potencies (against the contractile response to either norepinephrine or a thromboxane A2 analog) among human arteries removed from different parts of the body, their vascular relaxation profiles should be considered before they are used clinically.

Purinergic and adrenergic cotransmission in canine isolated and perfused gastroepiploic arteries.

1. The vasoconstrictor responses of canine gastroepiploic artery to periarterial electrical nerve stimulation (PNS; 30 s trains of pulses at a frequency of 2, 4 or 8 Hz) were observed in a frequency dependent manner. The PNS-induced vasoconstrictions were abolished by tetrodotoxin (1 micromol/L) and mostly depressed but not completely by guanethidine (10 micromol/L). 2. Vasoconstrictor responses to administered noradrenaline were antagonized significantly by prazosin (0.1 micromol/L), an alpha1-adrenoceptor antagonist, but were not significantly affected by suramin (100 micromol/L), a P2 purinoceptor antagonist, or alpha,beta-methylene ATP (1 micromol/L), a P2X receptor desensitizing agent. Exogenous ATP-induced responses were clearly depressed by suramin or alpha,beta-methylene ATP, but were not significantly affected by prazosin. 3. The vasoconstrictor responses to PNS at a low frequency (2 and 4 Hz) of stimulation were markedly inhibited by suramin (100 micromol/L) and by alpha,beta-methylene ATP (1 micromol/L). The remaining responses after suramin or alpha,beta-methylene ATP were abolished by subsequent application of prazosin (0.1 micromol/L). At a high frequency (8 Hz) of stimulation, the vascular response was not significantly inhibited by suramin or alpha,beta-methylene ATP, but it was abolished by prazosin. 4. Injection of xylazine (0.3-30 nmol/L), an alpha2-adrenoceptor agonist, did not induce any clear vasoconstriction. The exposure of tissues to rauwolscine (0.1-0.3 micromol/L), an alpha2-adrenoceptor antagonist, dose-dependently increased PNS-induced vasoconstrictions at all frequencies tested. 5. The present results indicate that ATP acts as a cotransmitter with noradrenaline and is responsible for post-junctional vasoconstrictor responses at low frequencies of sitmulation, whereas the effect of noradrenaline is dominant at high-frequency stimulation in canine gastroepiploic artery. Prejunctional alpha2-adrenoceptor autoinhibition may modulate the release of either noradrenaline or ATP from sympathetic nerve terminals.