Prosthetic Valve Endocarditis due to <i>Corynebacterium striatum</i> / 日本心臓血管外科学会雑誌

There are few reports of prosthetic valve endocarditis due to <i>Corynebacterium striatum</i>. Here we report a case of prosthetic valve endocarditis after mitral valve replacement. A 77-year-old woman, who underwent mitral valve replacement and tricuspid valve annulo-plasty 4 months previously, was admitted to our hospital because of shock and loss of consciousness. A transthoracic echocardiogram showed severe mitral regurgitation due to dehiscence of the prosthetic mitral valve. We used the percutaneous cardiopulmonary support system for the management of circulatory collapse and, performed emergency mitral valve replacement. We detected <i>C. striatum </i>in preoperative blood and vegetation cultures. Antibiotic therapy was continued for 6 weeks, and the patients recovered without any complications.

A Case of Double Valve Replacement due to Prosthetic Valve Dysfunction after Infective Endocarditis / 日本心臓血管外科学会雑誌

A 56-year-old woman was admitted due to a cerebral hemorrhage two years after undergoing aortic valve replacement, mitral valve annuloplasty, and tricuspid valve annuloplasty. During treatment, she developed infective endocarditis. Although this was successfully treated conservatively, a surgical approach was subsequently adopted due to progressive mitral stenosis. Echocardiography revealed gradual proliferation of abnormal tissue overhanging the mitral valve around the prosthetic mitral annularring, as well as increased flow velocity in the artificial aortic valve. The cause of the increased flow velocity could not be determined on echocardiography. However, multidetector computed tomography revealed abnormal subprosthetic tissue that obstructed the opening and closing of the prosthetic aortic valve. Resection of the abnormal tissue and double valve replacement were performed. Prosthetic valve dysfunction due to pannus proliferation is relatively rare (around 1-2%), but it should be considered as a potential long-term postoperative complication. Though turbulent flow has been suggested as a potential cause, the exact etiology remains unknown. Furthermore, the disease course may be fulminant or gradual and symptomatic, leading to difficulties with diagnosis. A case of double valve replacement conducted for valve dysfunction due to abnormal tissue proliferation occurring two years after aortic valve replacement, mitral valve annuloplasty, and tricuspid valve annuloplasty followed by infective endocarditis is reported, along with a review of the related literature.

A Case of Quadricuspid Aortic Valve Complicated by Infectious Endocarditis / 日本心臓血管外科学会雑誌

We report a case of quadricuspid aortic valve concomitant with infective endocarditis. A 73-year-old woman was admitted to our hospital because of general fatigue, loss of body weight and high fever. Transthoracic echocardiography showed moderate aortic regurgitation and left ventricle-right atrium fistulae with vegetation. Infectious endocarditis was diagnosed. Since her fever and hemolytic anemia were not controlled by antibiotics, we operated and the aortic valve had four cusps and there were vegetations on the aortic valve and left ventricle outflow tract. Perforation of the membranous septum was observed. Complete debridement and aortic valve replacement with patch repair of a left ventricle-right atrium (LV-RA) fistula was performed. Although she needed a permanent pacemaker due to complete AV block, her postoperative course was uneventful.

Earthworm fibrinolytic enzyme: anti-tumor activity on human hepatoma cells in vitro and in vivo / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The earthworm fibrinolytic enzyme (EFE) is a complex protein enzyme that is widely distributed in the earthworm's digestive cavity. Possessing strong protein hydrolysis activity, EFE not only has a direct effect on fibrin, but also can activate plasminogen. Its therapeutic and preventative effects on thrombosis-related disease have been confirmed clinically. Recently, there has been increased interest in the anti-tumor activity of EFE. In this study, the anti-tumor activity of EFE, isolated from Eisenia foetida, on human hepatoma cells was evaluated in vitro and in vivo. The potential mechanisms involved were also studied.</p><p><b>METHODS</b>In vitro experiments were performed in four human hepatoma cell lines: HLE, Huh7, PLC/PRF/5 and HepG2. After treatment with EFE in various concentrations, the inhibition of the rate of cell proliferation was measured. For the in vivo studies, tumor-bearing models xenografted with Huh7 cells were developed in nude mice, and then the mice were fed with EFE once a day for 4 weeks, and the control group received only saline. An inhibitory effect on tumor growth was observed. Also, apoptosis was observed with flow cytometric assay and fluorescent dye staining with acridine orange and ethidium bromide (AO/EB). The expression of matrix metalloproteinase 2 (MMP-2) were detected by Western blotting assay.</p><p><b>RESULTS</b>After treatment with various concentrations of EFE, the proliferation of all hepatoma cell lines was suppressed to varying degrees in vitro. The IC(50) for HLE, Huh7, PLC/PCF/5 and HepG2 were 2.11, 5.87, 25.29 and 17.30 uku/ml, respectively. After administration of EFE orally for 4 weeks, the growth of tumor xenograft of Huh7 cells in nude mice was significantly inhibited in vivo. The tumor inhibitory rates in the EFE 500 uku/(kgxd) and 1000 uku/(kgxd) groups were 46.08% (compared with control group, P = 0.026) and 57.52% (compared with control group, P = 0.002) respectively. Meanwhile, the average weight of body, spleen or thymus did not show any remarkable differences among the various groups. The population in sub-G(1) stage was more in the EFE treated groups than in the control group according to flow cytometric assay. After treatment with EFE 0, 5, 10 uku/ml for 72 hours, the apoptotic rates were 3.5%, 10.9% and 12.3% in HLE cells, and 5.0%, 24.7% and 34.5% in Huh7 cells respectively. Under fluorescent staining with AO/EB, the apoptotic morphological changes could be detected more significantly in the EFE treated groups than in the untreated groups. After treatment with EFE in doses of 0, 5, 10 uku/ml for 72 hours, the apoptotic rates were 3.02%, 8.76%, 10.54% in HLE cells, and 3.95%, 18.27%, 30.89% in Huh7 cells respectively. The apoptosis-inducing effects of EFE occurred in a dose dependent manner. Western blotting assay showed that, after treatment with EFE, the secretions of MMP-2 were significantly inhibited in HLE and Huh7 cells.</p><p><b>CONCLUSIONS</b>EFE showed significant anti-tumor activity in hepatoma cells both in vitro and in vivo, which may be because EFE could induce apoptosis of hepatoma cells and inhibit the expression of MMP-2. This suggests that EFE has a potential role in the treatment of hepatoma.</p>

Cerebrospinal Fluid Drainage as a Useful Treatment to Relieve Paraplegia Caused by Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

We report a rare case of acute type A aortic dissection with paraplegia which was reversed using cerebrospinal fluid drainage (CFD). The patient was a 80-year-old man who was admitted with acute back pain and paraplegia. Computed tomographic scans showed an acute type A aortic dissection. Four hours after onset of paraplegia, CFD was initiated by inserting an intrathecal catheter at L3-L4. Cerebrospinal fluid was drained freely by gravity whenever the pressure exceeded 10cmH₂O. After 32h, the neurological deficit was completely resolved. CFD can be considered a useful treatment in patients with paraplegia after acute aortic dissection.

A Case of Buerger's Disease Associated with Angina Pectoris and Carotid Stenosis / 日本心臓血管外科学会雑誌

A 60-year-old male who had a history of Buerger's disease was admitted due to chest pain on exertion. Coronary angiography showed severe double vessel disease (the left anterior descending artery and the right coronary artery). Carotid angiography showed severe stenosis of the left internal carotid artery associated with brain ischemia. In addition, angiography of the lower extremities showed segmental occlusion and collateral arteries resembly a “corkscrew” appearance. We implanted a stent in the carotid artery followed by revascularization surgery of the left lower leg and simultaneous coronary artery bypass surgery. The postoperative course was excellent.

Simultaneous Surgery for Angina Pectoris and Abdominal Aortic Aneurysm with Bilateral Iliac Artery Occlusion in a Chronic Hemodialysis Patient / 日本心臓血管外科学会雑誌

A 74-year-old man with renal failure had been treated with maintenance hemodialysis for 1.5 years at another hospital. The patient had an abdominal aortic aneurysm, bilateral iliac artery occlusion and coronary artery stenosis with a lesion in the left main trunk, but had been under observation because of the high risk of surgery. The patient elected to have surgery and was admitted to our hospital. We performed simultaneous surgery for severe coronary artery stenosis and abdominal aortic aneurysm with a maximum diameter of 85mm. The postoperative course was generally uneventful, but the patient required treatment of arrhythmia. We conclude that simultaneous surgery for angina pectoris and abdominal aortic aneurysm is feasible even in hemodialysis patients. It is important to pay attention to arrhythmia in the management of such patients, especially those with decreased cardiac function.

Surgical Treatment of Patent Ductus Arteriosus and Aortic Stenosis in a Patient with a Porcelain Aorta / 日本心臓血管外科学会雑誌

This paper reports on a case in which a heavily-calcified so-called “porcelain aorta” (including the ductus arteriosus) was observed, together with a patent ductus arteriosus and aortic stenosis associated with a bicuspid aortic valve. A 76-year-old man had been referred to our hospital on a diagnosis of aortic stenosis. Since angiography revealed slight contrast in an area on the right side of the heart, echocardiography was performed and revealed patent ductus arteriosus. Severe circumferential calcification of the ascending aorta and aortic arch was observed on CT scans. Almost no calcification was observed in other areas. Aortic valve replacement and closure of the ductus arteriosus (transpulmonary approach) were performed by means of a balloon to temporarily occlude the aorta, as surgical clamping was impossible due to calcification. Hypothermic systemic perfusion and antegrade selective cerebral perfusion were used. The postoperative progress of the patient was good. Bicuspid aortic valve and patent ductus arteriosus are highly likely to be present in combination in cases of congenital cardiac anomaly, and it is therefore necessary to be particularly attentive when diagnosing such cases. It was considered that our patient, an adult suffering patent ductus arteriosus, was a rare case in which the calcified ductus arteriosus was observed and the calcification had spread to the ascending aorta.

Early and Mid-Term Results of Endovascular Stent-Graft Placement for the Treatment of Abdominal Aortic Aneurysms / 日本心臓血管外科学会雑誌

We performed endovascular stent-graft placement on 39 patients with abdominal aortic aneurysms between 1996 and March 2002-a period of approximately 5 years (first half: until the end of June 1998, second half: July 1998 onward). Three patients in the first half of the period and 8 patients in the second half were 80 years or older. Two cases of mycotic aneurysm were observed. During the second half, we encountered high-risk cases in which the patients had complications such as coronary artery disease (5 patients), COPD (1 patient) and thoracic aortic aneurysm (4 patients). Although we had to switch to surgery in 3 patients during the first half of the period, we successfully placed stent-grafts in the other 36 cases (92%). Endoleaks were observed in 6 patients, and dissection of the iliac artery was observed in 5 patients (stents had been placed in all patients). In 50% of all cases in the first half of the period and 89% of all cases in the second half, stent-graft placement was successful and no endoleak was observed. During the follow-up period, 3 cases required additional treatment, and another 4 cases required surgery. Four patients died in hospital during the first half of the period, and 3 patients died during the following 3 years. The 3-year survival rate was 82%. It was considered that stent-graft placement for abdominal aortic aneurysms is particularly effective for high-risk patients, and that the results of this type of therapy will improve in the future.

Clinical and Thermographic Findings in the Late Postoperative Period after Coronary Artery Bypass Surgery Using the Radial Artery / 日本心臓血管外科学会雑誌

We evaluated the relation of changes in skin temperature, measured by thermography, to clinical symptoms and findings in patients who underwent coronary artery bypass surgery using the radial artery. All had a negative Allen test before operation. Ten consecutive patients who underwent surgery at least 3 months prior to the study were selected. Left radial artery grafts were harvested in all patients. Skin temperature was measured twice, before and after exercise. Two patients had a cold sensation at the arterial harvest site at rest. Three, including these two, complained of pain along the harvest site after exercise. No differences in temperature were observed before and after exercise in the ulnar aspects of the palm or forearm on either the left or right side. On the other hand, the increase in radial aspect temperature on the left side was smaller than that on the right. Skin temperature was clearly decreased after loaded exercise in 3 patients. We believe that the indications of grafting should be carefully considered because patients can show findings associated with circulatory disturbance at arterial harvest sites.