Compression of an anomalous single coronary artery from pulmonary artery by banding.

This report describes a case with double outlet right ventricle and doubly committed ventricular septal defect associated with congenital diaphragmatic hernia. The patient underwent pulmonary artery banding and clipping of patent ductus arteriosus after repair of the diaphragmatic hernia. At 6 months, cardiac catheterization revealed anomalous origin of a single coronary artery from the pulmonary artery of the proximal banding. Although ischaemic symptoms had not been observed, the banding had resulted in compression of the coronary ostium. An emergency Rastelli procedure with Damus-Kaye-Stansel anastomosis was successfully performed.

Surgical treatment of ruptured aneurysm of the left sinus of Valsalva caused by Takayasu arteritis.

Takayasu arteritis is a chronic large-vessel vasculitis that is more frequently observed in young women. We report the case of a 29-year-old woman who required an operation for an aneurysm of the left sinus of Valsalva that ruptured into the left ventricle, for aortic regurgitation, and for left main coronary trunk stenosis. The patient had not been previously diagnosed with Takayasu arteritis.

Balloon occlusion of the ascending aorta without hypothermic circulatory arrest in valve surgery for patients with a porcelain aorta.

Severe calcification of the ascending aorta and the aortic arch complicates cardiac surgery. The optimal approach in such patients is unknown. Four valve surgeries were performed with balloon occlusion without hypothermic circulatory arrest. All patients had femoral arterial cannulation, and all 3 patients who required an aortotomy had right axillary artery cannulation as well. A balloon catheter was inserted just proximal to the brachiocephalic artery via a purse-string stitch. Good cardiac arrest was obtained in all cases, and a good bloodless field was obtained in all 3 aortic valve cases. There were no balloon-related complications. The patients all showed good postoperative courses. Balloon occlusion of the ascending aorta without circulatory arrest is effective for performing a rapid and less invasive surgery that is not significantly different from the usual valve surgery.

Edge-to-edge mitral valve repair for anterior leaflet prolapse associated with extensive calcification of the mitral annulus: Report of a case.

Extensive mitral annular calcification remains a technical challenge in mitral valve surgery. Decalcification and reconstruction of the mitral annulus is an established technique, but it is time consuming and technically demanding. This report presents the case of an 88-year-old diabetic female patient in whom edge-to-edge repair was completed quickly, with good early results thus being obtained.

Transapical aortic cannulation via left lateral thoracotomy for descending thoracic and thoracoabdominal aortic surgery.

Two patients underwent surgery for a chronic type B dissection using a total cardiopulmonary bypass (CPB) with transapical arterial cannulation. At surgery, a total CPB was established by cannulating the left femoral artery and the ascending aorta via the ventricular apex. The patients were cooled to 30 degrees C. The proximal anastomosis was done after cross-clamping the aortic arch between the left carotid artery and the left subclavian artery in both cases. In the first case, the entire descending thoracic aorta was replaced, and two pairs of intercostal arteries were reconstructed. The other patient underwent replacement of the proximal descending thoracic aorta. Neither patient experienced any complications. Transapical aortic cannulation is a useful option during descending thoracic and thoracoabdominal aortic surgery. It can provide more stable circulation during the cross-clamping, more gentle manipulation of the aorta by nonpulsatile flow, and more liberty in temperature control.

On-pump beating-heart coronary artery bypass: a propensity matched analysis.

BACKGROUND: It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting surgery (CABG). This study compares early outcomes after on-pump beating-heart CABG and conventional CABG. METHODS: From 2002 to 2005, 114 patients underwent on-pump beating-heart CABG. Multivariate logistic regression revealed five characteristics according to which technique is liable to be used: history of cerebral infarction, urgent or emergent operation, lower ejection fraction, preoperative creatine kinase, and lower number of diseased vessels. The early clinical outcome for these patients was compared against 114 conventional CABG patients, matched using a propensity score constructed with these five significant variables and with two nonsignificant variables: history of diabetes mellitus and hypertension. RESULTS: On-pump beating-heart CABG significantly reduced the duration of operation and cardiopulmonary bypass, total blood loss, and peak creatine kinase (p < 0.05). The number of patients requiring additional intra-aortic balloon pump support was significantly lower in the on-pump beating-heart CABG group (2 versus 13, p < 0.01). No patients required percutaneous cardiopulmonary support after on-pump beating-heart CABG, whereas 4 patients needed it after conventional CABG. Complete revascularization was significantly lower (42.1% versus 77.2%, p < 0.0001), but in-hospital mortality was less in the on-pump beating-heart CABG group (2.6% versus 9.6%, p < 0.05). No significant difference was found in morbidity including stroke, renal failure, mediastinitis, and prolonged ventilation. CONCLUSIONS: On-pump beating-heart CABG can be performed safely, including on high-risk patients. Use of cardiopulmonary bypass and the elimination of cardioplegic arrest may be of most benefit to hemodynamically unstable patients.

Evolution of class switch recombination function in fish activation-induced cytidine deaminase, AID.

Following activation of mammalian B cells, class switch recombination (CSR) and somatic hypermutation (SHM) of the Ig heavy chain (IgH) gene can improve the functions of the expressed antibodies. Activation-induced cytidine deaminase (AID) is the only known B cell-specific protein required for inducing CSR and SHM in mammals. Lower vertebrates have an AID homologue, and there is some evidence of SHM in vivo. However there is no evidence of CSR in the cartilaginous or bony fishes, and this may be due in part to a lack of cis-elements in the IgH gene that are the normal targets of AID-mediated recombination. We have tested whether bony fish (zebrafish and catfish) AID can mediate CSR and SHM in mammalian cells. As expected, ectopic expression of fish AID in mouse fibroblasts resulted in mutations in an introduced SHM reporter gene, indicating that fish AID can mediate SHM. Unexpectedly, expression of fish AID in mouse AID-/- B cells induced surface IgG expression as well as switched transcripts from Ig gene loci, clearly indicating that the fish AID protein can mediate CSR, at least in mouse cells. These results suggest that the AID protein acquired the ability to mediate CSR before the IgH locus evolved the additional exon clusters and switch regions that are the targets of recombination. We discuss how pleiotropic functions of specific domains within the AID protein may have facilitated the early evolution of CSR in lower vertebrates.

A modified oral screen appliance to prevent self-inflicted oral trauma in an infant with cerebral palsy: a case report.

Self-inflicted oral trauma occurs in a number of conditions with different etiologic and clinical characteristics. The management of such trauma also varies depending on the medical history of the patient; the etiology of the behavior; and the severity, frequency, and method of inflicting injury. This case report describes a modified oral screen placed in a 10-month-old female infant with cerebral palsy who had been having feeding problems caused by self-inflicted oral trauma. The modified oral screen effectively protected the wounds against further oral trauma to the lower lip and tongue without being fixed to the dentition.

The current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery.

OBJECTIVE: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. METHODS: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. RESULTS: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5 +/- 3.4 mL/kg. Intraoperative donation was 21.7 +/- 6.1 mL/kg in Group 1 and 12.8 +/- 4.0 mL/kg in Group 2 (p < 0.001). On admission, serum hemoglobin was lower in Group 1 (12.2 +/- 1.0 g/dL versus 13.6 +/- 1.6 g/dL, p < 0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2 +/- 1.4 versus 10.2 +/- 1.1 g/dL, p < 0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p < 0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. CONCLUSION: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.