Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method. Materials and Methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions. Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

Hybrid Technologies for Reconstruction of Proximal Aortic Dissection.

The aim of the study is to evaluate the efficacy of various types of hybrid technology in compare to the classical repair of the aortic arch of type I aortic dissection treatment in the in-hospital period. Materials and Methods: A retrospective observational study has been conducted, the results of surgical treatment of 213 patients with DeBakey type I aortic dissection operated on within the period from 2001 to 2017 were compared. Patients were divided into three groups: in group 1, patients undergone a hemiarch type of aortic repair or the total arch replacement (n=121); in group 2, a hemiarch aortic reconstruction and implantation of bare metal stent was performed (n=55); in group 3, a frozen elephant trunk technique was used (n=37). Taking into consideration the retrospective character of the investigation and nonequivalence of the groups by separate characteristics, they were equalized to improve the reliability of the results using the PSM (propensity score matching) pseudorandomization method. As a result, three groups of comparison were formed which were equalized by the PSM method and called PSM 1, 2, and 3. The mortality and complication rate in the in-hospital period, as well as the frequency of false lumen thrombosis development depending on the treatment method, have been analyzed. Results: The mortality rate in the PSM 1 group was 15 patients: group 1 (standard technique) - 10 patients (9%), group 2 (uncoated stents) - 5 patients (11%). A significant difference was found in the number of major bleedings (group 1 - 8%, group 2 - 21%, p=0.031) and cases of bowel ischemia (group 1 - 1%, group 2 - 9%, p=0.028). Complete false lumen thrombosis of the thoracic aorta was observed significantly more often in group 1 than in group 2 (22% vs 5%, p=0.015).In the examined group PSM 2, hospital mortality rate was 4 patients: group 1 - 3 patients (12%), group 3 - 1 patient (3%). No differences between the groups were found in the number of complications. In group 3, complete false lumen thrombosis of the thoracic aorta was observed in 59% of cases, whereas in group 1 it was found only in 4% of patients (p<0.001).In comparison group PSM 3, the mortality was 8 patients: group 2 - 5 patients (11%), group 3 - 3 patients (9%). The number of neurological complications differed significantly: in group 2 - 27%, in group 3 - 6% (p=0.019). Besides, 3% of cases of complete false lumen thrombosis were found in group 2, while there appeared 55% (p<0.001) of such patients in group 3. Conclusion: The comparative analysis showed that the use of bare metal stents and hybrid prostheses demonstrated a comparable low level of in-hospital mortality compared to the standard surgical technique of aortic arch reconstruction. At the same time, the use of the bare metal stents is associated with a higher rate of perioperative complications (bleeding, postoperative bowel ischemia, neurological complications) compared to the standard treatment and repair of the aortic dissection using hybrid prostheses. Complete thrombosis of the false lumen occurred significantly less commonly in case of using bare metal stents than with standard treatment and hybrid prostheses.

[Aberrant birth of a radial artery in the upper third of the forearm: A case report]. / Naissance aberrante d'une artère radiale au tiers supérieur de l'avant-bras : à propos d'un cas.

We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.

Hybrid surgery in chronic thoracoabdominal aortic dissection. / Gibridnaia khirurgiia pri khronicheskom rassloenii torakoabdominal'nogo otdela aorty.

The authors describe and analyse their experience gained in performing prosthetic repair of the thoracoabdominal portion of the aorta, combined with open aortic stenting using the Djumbodis uncovered metal stent. Over the period from 2013 to 2015 we performed a total of 16 hybrid interventions. All patients were found to have type B aortic dissection, with their false and true lumens patent. All patients underwent reconstruction of the thoracoabdominal aorta combined with open implantation of the Djumbodis uncovered metal stent into the area of lower thoracic and visceral arteries. The patients underwent either isolated prosthetic repair of the thoracic aortic portion - type A correction, or prosthetic repair of the thoracic and infrarenal portions - type B correction. In the postoperative period we performed MSCT angiography of the thoracic and abdominal aortic portions in order to control patency of the true and false lumens, patency of visceral arteries, to assess the diameter of the aorta, presence or absence of thrombosis. All five patients subjected to type B correction (100% of the total number of this type operation) were found to develop thrombosis of the false lumen, and eight patients undergoing type A correction (72.7% of the total number of operations of this type) were diagnosed with false channel thrombosis. There was 1 (6.3%) lethal case registered at the hospital stage in the group of patients with type A correction. There were no cases of neurological deficit, malperfusion of visceral organs or lower-limb ischaemia. Our experience shows that using hybrid technologies in surgery of the thoracoabdominal portion of the aorta is (appears to be) optimal from the point of view of decreasing intraoperative trauma, reducing the complications rate and without detriment to the radicality.

Heart donation after cardiac death: preliminary study on an isolated, perfused swine heart after 20 minutes of normothermic ischemia.

BACKGROUND: We measured the functional and metabolic status of hearts submitted to normothermic ischemia before preservation through the use of an ex vivo pig heart model to assess the feasibility of donation after cardiac death (DCD) in heart transplantation. METHODS: Ten pigs were separated into 2 groups: control (n = 6, brain-dead group) and DCD (n = 4, heart donation after cardiac death). In the control group, hearts were excised 20 minutes after the brachiocephalic trunk cross-clamping and were immediately reperfused. In DCD, hearts were excised 20 minutes after exsanguination and asphyxia, stored in the Centre de Résonance Magnétique Biologique et Médicale (CRMBM) solution for 2 hours, and then were reperfused. Cardioplegic arrest was induced with the use of 1 L of CRMBM solution (4°C) and the heart was reperfused for 60 minutes through the use of an ex vivo perfusion system in Langendorff mode with normothermic autologous blood. During reperfusion, functional parameters were analyzed. Biochemical assays were performed in myocardial effluents and freeze-clamped hearts. RESULTS: No electromechanical activity was found in DCD compared with control. Creatine kinase (CK) was higher at 2 minutes of reperfusion in DCD versus control (P = .005). Adenosine triphosphate was lower in DCD versus control (P = .0019). Malondialdehyde, an oxidative stress index, was present only in DCD. The nitric oxide (NO) pathway was impaired in DCD versus control, with lower eNOS expression (P < .0001) and total nitrate concentration content (P = .04). CONCLUSIONS: We reported no cardiac functional and metabolic recovery in the DCD group after normothermic ischemia and reperfusion, which indicates that a single immersion of the cardiac graft during storage does not provide an optimal protection. New strategies in heart preservation are necessary for recruiting heart donation after cardiac death.

Early experience with the DJUMBODIS system: what did we observed, what can we expect? Part 2.

The authors describe their experience with the Djumbodis system, reporting the findings of a comparative study focussing on the outcomes of surgical management of patients presenting with real type I aortic dissection. The most common feature observed in patients receiving a 9 or 14 cm stent into the proximal descending aorta was stabilization of the dissected thoracic segments. Clinical outcomes were, however, comparable between the groups of stented patients and controls. This clinical result is to be shared with other endovascular devices used in acute dissections and which might require a hybrid operating room, since they might compromise blood flow in collateral arteries. Carefully analysing our data and current literature we propose to consider real type I aortic dissections complicated by dynamic malperfusion symptoms or for which the diameter of the proximal descending aorta is already noticeably dilated as justified indications according to the current knowledge about stenting of acute dissections.

Anticoagulation monitoring during extracorporeal circulation with the Hepcon/HMS device.

OBJECTIVE: The objective of our study was to compare the standard protocol of anticoagulation to the Hepcon/HMS. METHOD: This study included forty-four patients who underwent coronary bypass grafting surgery (CABG), or biological aortic valve replacement (AVR). Unfractionated heparin (UH) was used for patients who underwent operations in the control group (n = 22) (300U/Kg of UH with a goal of an ACT of 400s). The heparin was antagonized dose/dose by protamine. For the patients who underwent operations in the HMS group (n = 22), the heparin and protamine doses were assessed by the Hepcon/HMS device. RESULTS: The sex ratio amounted to 1.93 (29 men and 15 women) and the mean age was 70 ± 11 years. The patients in the HMS group had a chest closure time that was significantly shorter than patients in the control group. The times were, respectively, 42 ± 15 minutes and 68 ± 27 minutes (p = 0.001). The protamine/heparin ratio was significantly lower in the HMS group (0.62 ± 0.13 vs. 1 ± 0.11) (p = 0.0001). The postoperative bleeding amounted to 804 ± 729 ml in the HMS group versus 1416 ± 1103 in the control group (p = 0.016). In multivariate linear regression analysis, only two independent factors were significantly associated with bleeding: the Hepcon/HMS (OR = 0.1-p = 0.03) and the preoperative hemoglobin rate (OR = 1.4 - p = 0.05). Postoperatively, within 72 hours, the red blood cell transfusion was 1.04 ± 1.5 units for the HMS group and 2.1 ± 1.87 units for the control group (p = 0.05). CONCLUSION: During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.

[Influence of open chest conditions on pulse pressure variations]. / Influence de l'ouverture du thorax par sternotomie sur les variations respiratoires de la pression pulsée.

OBJECTIVES: Pulse pressure variations are used to assess fluid responsiveness in mechanically ventilated patients. The accuracy of this index in open chest conditions remained unclear. The aim of the study was to evaluate the effect of open chest conditions on pulse pressure variations. STUDY DESIGN: Non-interventional prospective study. METHODS AND PATIENTS: Twenty-eight mechanically ventilated patients scheduled for open-heart surgery were included. Pulse pressure variations, peak aortic velocity, and stroke volume were measured before and after thoracotomy with pericardotomy. Measurements were made at each step and compared. RESULTS: Neither pulse pressure variation nor peak aortic velocity and nor stroke volume variation were modified by open chest conditions (median=5% [interquartile range=6] vs 4% [6], p=NS), (20% [11] vs 17% [12], p=NS and 11% [7] vs 10% [3], p=NS) respectively. Pulse pressure variations were correlated to stroke volume before thoracotomy (r'=-0.432; p=0.02) and after thorocatomy (r'=-0.433, p=0.02). CONCLUSION: In these studied patients, preload dependancy indices were not modified by open chest conditions. Pulse pressure variations remained correlated to stroke volume even after thoracotomy.

Clinical characteristics and outcome of infective endocarditis in adults with bicuspid aortic valves: a multicentre observational study.

OBJECTIVE: To analyse characteristics and outcomes of infective endocarditis (IE) on bicuspid aortic valves (BAV) and to compare the risk of death according to the presence or absence of BAV. DESIGN: 5-year observational study. SETTING: Population of 856 patients with definite IE according to the Duke criteria from two tertiary centres (Amiens and Marseille, France). PATIENTS: 310 consecutive patients with definite native aortic valve IE enrolled between 1991 and 2007. INTERVENTIONS: Patients underwent transthoracic and transoesophageal echocardiography during hospitalisation. Surgery was performed on a case-by-case basis according to conventional guidelines. MAIN OUTCOME MEASURES: In-hospital mortality and 5-year overall mortality. RESULTS: Patients with BAV IE (n=50, 16%) were younger, had fewer comorbidities and a higher frequency of aortic perivalvular abscess (50%). Presence of BAV (OR 3.79 (1.97-7.28); p<0.001) was independently predictive of abscess formation. Early surgery was performed in 36 BAV patients (72%) with a peri-operative mortality of 8.3%, comparable to that of patients with tricuspid aortic valve IE (p=0.89). BAV was not independently predictive of in-hospital mortality (OR 0.89 (0.28-2.85); p=0.84) or 5-year survival (HR 0.71 (0.37-1.36); p=0.30). Age, comorbidities, heart failure, Staphylococcus aureus and uncontrolled infection were associated with increased 5-year mortality in BAV patients. CONCLUSION: BAV is frequent in adults with native aortic valve IE. Patients with BAV IE incur high risk of abscess formation and require early surgery in almost three-quarters of cases. IE is a severe complication in the setting of BAV and warrants prompt diagnosis and treatment.

Expression of the three nitric oxide synthase isoforms and nitric oxide level in the rat heart during cold storage and blood reperfusion.

Maintenance of nitric oxide (NO) homeostasis is an important concept for myocardial protection. Here, we have investigated the NO pathway by analysing total nitrate concentration (NOx) and NO synthase (NOS) isoforms expression as well as the myocardial integrity by lactate dehydrogenase and creatine kinase contents in the rat heart graft arrested by CRMBM solution, submitted to 3 hr cold ischemia in the same solution and 24 hr blood reperfusion following heterotopic abdominal heart transplantation. NOx level was similar to baseline value after ischemia and significantly increased after 24 hr reperfusion. NOS isoforms expression was highly modulated after cold ischemia followed by blood reperfusion. Endothelial NOS expression was decreased after ischemia but restored after 24 hr reperfusion. Neuronal NOS expression was drastically decreased after ischemia and 24 hr reperfusion. Inducible NOS protein was present only after 24 hr reperfusion. Cold ischemia induced a severe loss of creatine kinase without any modification after blood reperfusion. In conclusion, we show here that CRMBM solution did not increase NO production during ischemia but induced an enhanced synthesis of NO during reperfusion which may be related to restoration of endothelial NOS expression and/or induction of inducible NOS expression.

[Biometric and histological study of human, porcine and sheep internal thoracic arteries (reflections on their use in revascularization of arteries of less than four millimetres diameter)]. / Etude biométrique et histologique comparative des artères thoraciques internes de l'homme, du porc et du mouton (application en chirurgie de revascularisation des artères de moins de quatre millimètres de diamètre).

In order to enhance the knowledge of the internal thoracic arteries of pig, sheep, and man, allowing to constitute a fundamental basis as for the current and later applications in the interventions in surgery of revascularization of the arteries of less than four millimetre of diameter, a biometric and histological comparative study of these arteries was carried out. Forty human corpses, 27 men and 13 women (mean age 75+/-6 years) were dissected, alike with three pigs respectively weighing 80 kg, 80 kg and 84 kg and four sheep weighing 70 kg each. The left and right internal thoracic arteries were harvested: exposure over the entire length and remote dissection before excision. At the same time their internal lengths and gauges were measured. The internal thoracic artery (ITA) of human has an average useful length of 18 cm and an average internal gauge close to 1.5 mm. ITA of the pig has an average length of 27 cm and an average internal gauge close to 2.8 mm. The ITA of the sheep has an average length of 18 cm with an average internal gauge close to 1 mm. The porcine Internal Thoracic Artery is an elastic artery like its human counterpart. Many elastic fibres and few smooth muscle cells are present in the media. On the other hand, the internal thoracic artery of the sheep has a mixed structure. Its media contains more smooth muscle cells than elastic fibres.

El modelo psicobiológico de Cloninger en dependientes de opiáceos / Cloninger’s psychobiological model in opiate dependent individuals

Objetivo. Estudiar las relaciones entre las dimensiones de personalidad de Cloninger y el consumo de sustancias en una muestra de drogodependientes. Material y métodos. Estudio transversal. Los 196 sujetos del estudio se obtuvieron por muestreo consecutivo entre los pacientes dependientes de opiáceos que ingresaban en una Unidad de Desintoxicación Hospitalaria. A los sujetos se les evaluó con un Cuestionario de Consumo de Sustancias y el Temperament and Character Inventory. Tras el estudio descriptivo de las variables, se realizaron pruebas de diferencia de medias en las dimensiones de Cloninger comparando por un lado el grupo de politoxicómanos y el grupo de los que dependían de una sola sustancia, y por otro, varios grupos con diferentes patrones de consumo. También se estudió la correlación entre las dimensiones de Cloninger y el número de sustancias de las que dependían los sujetos y se creó un modelo de regresión lineal para evaluar si las dimensiones de personalidad permitían predecir el número de sustancias de las que dependían los sujetos. Resultados. Los resultados sugieren que la elección de las sustancias de abuso podría estar influida por variables temperamentales, mientras que la gravedad de la adicción, en concreto, el hecho de depender de una o más sustancias estaría más relacionado con variables caracteriales. Conclusiones. Recomendar la realización de más estudios, especialmente longitudinales, para confirmar las relaciones entre las dimensiones de la personalidad y la dependencia de sustancias, pues, atendiendo a los resultados expuestos, la personalidad y el abuso de sustancias están etiopatogénicamente interrelacionados

Objetive. To study the relationship between Cloninger’s personality dimensions and drug misuse in opiate dependents sample. Material and methods. Cross-sectional study. 196 subjects were obtained from consecutive sampling among opiate dependents that were admitted in a detoxification unit in a General Hospital. The sample was analysed by a Drug Abuse Questionnaire and the Temperament and Character Inventory. After the descriptive analysis of variables, mean differences tests were used for the Cloninger’s dimensions comparing multiple-substance dependents with single-substance ones, and between different groups attending to the consumption pattern. Also, the correlation between Cloninger’s dimensions and the number of substance dependences were analysed, and a lineal regression model was obtained to evaluate how those dimensions of personality could predict the number of substances for dependence. Results. Results suggest that substance’s type could be influenced by temperament variables, while the addiction’s severity, mainly the dependence to one or more substances, could be influenced more by character ones. Conclusions. More studies are needed, mainly longitudinal, to confirm the relationship between personality dimensions and substances dependence, because the results of this study suggest that the personality and the substances dependence are etio-pathologically inter-related

Nitric oxide pathway after long-term cold storage and reperfusion in a heterotopic rat heart transplantation model.

Recent studies have suggested the involvement of the nitric oxide (NO) pathway in ischemia-reperfusion injury related to cardiac transplantation. Herein, we assessed the NO pathway by quantifying endothelial (e) and inducible (i) nitric oxide synthase (NOS) expression and total NOS activity in a rat heart transplant model during cold ischemia with Celsior cardioplegia and reperfusion. Experiments were performed using a modified Lewis-Lewis heterotopic abdominal heart transplantation with 3 or 6 hours of ischemia with or without 1 hour of blood reperfusion. NOS expression and activity were determined using Western blotting and colorimetric assays, respectively, on freeze-clamped hearts after ischemia without (n = 10) or with reflow (n = 12) compared with basal values. Hearts submitted to 3 hours of ischemia and 1 hour of reperfusion showed a postischemic rate pressure product of 5190 +/- 3047 mm Hg/min (reversible ischemia), but no contractility was observed after 6 hours of ischemia. eNOS protein levels were lower after 3 hours of ischemia compared with the basal value (P = .0005) and were further decreased after 6 hours of ischemia (P < .0001 versus basal value and P = .0018 versus 3 hours of ischemia). Reperfusion did not further decrease eNOS protein levels. iNOS protein was not detected in any condition. NOS activity was increased after 3 hours of ischemia versus basal value (P = .0065) but not after 6 hours of ischemia without any effect of reperfusion. We concluded that eNOS expression was altered during ischemia and the amplitude of the alteration depended on the duration of ischemia. Reversible ischemia was associated with increased NOS activity at the end of ischemia with no variation at reperfusion.

Modulation of the NO pathway during short or prolonged blood reperfusion following ischaemia in a heterotopic rat heart transplantation model.

Ischemia-reperfusion injury plays a major role in graft dysfunction following transplantation. Extensive research has demonstrated that nitric oxide (NO) plays a fundamental role to protect the heart against this injury. Consequently, we quantified NO synthase (NOS) isoform protein levels in a rat heart transplant model during short and prolonged reperfusion following ischemia. Experiments were performed using a modified Lewis to Lewis heterotopic abdominal heart transplantation with a total ischemic time of 3 hours followed by 1 or 24 hours of blood reperfusion (n = 12). Heart function, as represented by the rate pressure product, increased from 7912 +/- 489 to 27067 +/- 9982 mm Hg/min (mean +/- SEM, short vs prolonged reperfusion, P = .0027). NOS isoform protein levels determined using Western blotting of freeze-clamped hearts were compared to baseline values. eNOS protein levels were significantly lower during short reperfusion compared to the basal value (P = .0077) or to prolonged reperfusion (P = .004), returning to the basal value after 24 hours of reflow. iNOS protein was not detected in the basal condition or after 1 hour of reflow, but was present after 24 hours of reflow (P = .0001 vs basal value and 1-hour reflow). nNOS protein was 69% lower after 1 hour of reflow compared with the baseline value (P = .0001), it was not restored after 24 hours of reflow (P = .002). These results suggest involvement of the NO pathway in ischemia-reperfusion injury with distinctive roles of NOS isoforms during short and prolonged reperfusion following ischemia.

Increased plasma levels of pro-brain natriuretic peptide in patients with cardiovascular complications following off-pump coronary artery surgery.

OBJECTIVE: To compare N-terminal pro-brain natriuretic peptide (NT-pro-BNP), procalcitonin (PCT), and troponin I (Tn I) concentrations during and after coronary artery surgery in patients with or without cardiovascular complications. DESIGN AND SETTING: Prospective, comparative study of 12 months in the cardiovascular intensive care unit in a university hospital. PATIENTS: 60 adult patients undergoing coronary artery bypass grafting with the off-pump technique. MEASUREMENTS AND RESULTS: Plasma NT-pro-BNP, PCT, and Tn I levels were measured before and immediately after the end of operation and on PODs 1, and 2 and 3. We defined complicated postoperative course as myocardial infarction, cardiogenic shock, arrhythmias, congestive heart failure, and death occurring after the fourth postoperative hour. Receiver operating characteristic (ROC) curve cutoff values were used to assess the ability of the three markers to predict future cardiac events. The area under ROC curve (AUC) using NT-pro-BNP to detect a cardiovascular complicated course was 0.780 at the preoperative time and 0.850 at the end of surgery. A preoperative NT-pro-BNP value of 397 pg/ml had a sensitivity of 76%, specificity of 67%, and accuracy of 74% for predicting a subsequent cardiovascular complication. An immediate postoperative NT-pro-BNP value of 430 pg/ml had a sensitivity of 80%, specificity of 77%, and accuracy of 76%. Patients with preoperative NT-pro-BNP levels less than 275 pg/ml had an excellent postoperative prognosis. Other two markers were less appropriate. CONCLUSIONS: NT-pro-BNP levels measured before and immediately after off-pump coronary artery bypass seem to be predictive of postoperative cardiac events.

Protective effect of a low K+ cardioplegic solution on myocardial Na,K-ATPase activity.

Long duration ischemia in hypothermic conditions followed by reperfusion alters membrane transport function and in particular Na,K-ATPase. We compared the protective effect of two well-described cardioplegic solutions on cardiac Na,K-ATPase activity during reperfusion after hypothermic ischemia. Isolated perfused rat hearts (n = 10) were arrested with CRMBM or UW cardioplegic solutions and submitted to 12 hr of ischemia at 4 degrees C in the same solution followed by 60 min of reperfusion. Functional recovery and Na,K-ATPase activity were measured at the end of reperfusion and compared with control hearts and hearts submitted to severe ischemia (30 min at 37 degrees C) followed by reflow. Na,K-ATPase activity was not altered after 12 hr of ischemia and 1 hr reflow when the CRMBM solution was used for preservation (55 +/- 2 micromolPi/mg prot/hr) compared to control (53 +/- 2 micromol Pi/mg prot/hr) while it was significantly altered with UW solution (44 +/- 2 micromol Pi/mg prot/hr, p < 0.05 vs control and CRMBM). Better preservation of Na,K-ATPase activity with the CRMBM solution was associated with higher functional recovery compared to UW as represented by the recovery of RPP, 52 +/- 12% vs 8 +/- 5%, p < 0.05 and coronary flow (70 +/- 2% vs 50 +/- 8%, p < 0.05). The enhanced protection provided by CRMBM compared to UW may be related to its lower K+ content.

Molecular diagnosis of Granulicatella elegans on the cardiac valve of a patient with culture-negative endocarditis.

We herein report one case of culture-negative infectious endocarditis (IE) where the organism, Granulicatella elegans, was identified by molecular analysis using broad-range PCR primers complementary to the 16S rRNA gene on the removed valve. The results and utility of this method are discussed.

Budd-Chiari syndrome secondary to intracardiac extension of hepatocellular carcinoma. Two cases treated by radical resection.

Two young women presenting Budd-Chiari syndrome as the primary manifestation of hepatocellular carcinoma with intracardiac extension were treated by debulking of the atrium and inferior vena cava under extracorporeal circulation and major hepatectomy. The first patient who was treated in a single procedure died during the immediate postoperative period. The second patient who was treated in two steps died of meningeal and pulmonary metastases 12 months later. Clinical findings and surgical strategy for this rare condition are discussed in the light of 6 previously reported surgical cases.