Factors influencing glomerular filtration rate as estimated using preoperative creatinine and cystatin C levels.

OBJECTIVES: Estimated glomerular filtration rate (eGFR) using serum creatinine (Cr) is commonly used to evaluate renal function. However, it can be influenced by other factors, which can risk the overestimation of the true GFR. Impaired renal function prior to cardiovascular surgery reportedly increases mortality and the incidence of postoperative complications. Thus, overestimation of renal function may affect the assessment of postoperative complication risks. Therefore, we aimed to compare the eGFR calculated from serum Cr and cystatin C (Cys-C) levels to assess preoperative renal function and to investigate factors affecting renal function overestimation. MATERIALS AND METHODS: 88 patients admitted for cardiovascular surgery who had preoperative serum Cr and Cys-C measurements were included in the study. Correlations between factors associated with eGFR calculated from serum Cr (eGFRcre) and Cys-C (eGFRcys) and their ratio (eGFRcre/eGFRcys) were examined using multiple regression analysis. RESULTS: Multiple regression analysis revealed that eGFRcre/eGFRcys was significantly negatively correlated with the Short Physical Performance Battery score (SPPB). A clinically significant difference in renal function overestimation was defined as GFRcre/eGFRcys > 1.2, with a cutoff value of 9 points for the SPPB score. The chair stand test, a component of the SPPB, had the same discriminative power as the SPPB for identification of renal function overestimation. CONCLUSION: The SPPB can be used to identify likely GFR overestimation in patients. Additionally, the chair stand test may be used as an alternative to the SPPB for the identification of renal function overestimation when the SPPB is difficult to perform.

[Amiodarone-induced Ventricular Tachycardia after Coronary Artery Bypass Grafting;Report of a Case].

A 57-year-old man on maintenance hemodialysis was admitted to a hospital after suffering from cardiac arrest. He had collapsed soon after hemodialysis and was restored to sinus rhythm after receiving direct-current shocks. Further examination revealed old myocardial infarction with triple-vessel disease, and he was referred to our hospital for surgical treatment. Soon after performing coronary artery bypass grafting, we started the patient on intravenous amiodarone for frequent ventricular tachycardia. However, incessant ventricular tachycardia occurred frequently which necessitated several countershocks. Although ventricular tachycardia disappeared by replacing intravenous amiodarone with intravenous nifekalant, it reappeared when we initiated oral amiodarone instead of intravenous nifekalant. So therefore, we stopped using any anti-arrhythmic drug except bisoprolol fumarate, whereby ventricular tachycardia ceased once again. Amiodarone is known as relatively safe anti-arrhythmic drug that is often used after cardiovascular surgery. However, we should pay close attention to the possibility of amiodarone-induced arrhythmia.

Fetal mesenchymal stem cells ameliorate acute lung injury in a rat cardiopulmonary bypass model.

BACKGROUND: Systemic inflammation after prolonged cardiopulmonary bypass (CPB) can cause serious multiorgan system dysfunction. Mesenchymal stem cells (MSCs) are reported to reduce inflammation and attenuate immune response. We have focused on fetal membrane (FM) as a source to provide a large number of MSCs (FM-MSCs). Allogeneic administration of FM-MSCs has been reported to mitigate autoimmune myocarditis or glomerulonephritis. The aim of this study was to investigate whether allogeneic FM-MSCs attenuate systemic inflammatory responses and lung injury in a rat CPB model. METHODS: Male Lewis rats (major histocompatibility complex haplotype: RT-1l) were divided randomly into 3 groups (n = 7 each): cannulation alone (sham group), CPB alone (control group), and CPB + MSC (MSC group). An experimental rat CPB model was established, and CPB was maintained for 30 minutes. In the MSC group, MSCs (1 × 106 cells) derived from the FM of ACI rats with a different major histocompatibility complex haplotype (RT-1a) were administrated intravenously before CPB initiation. RESULTS: Serum concentrations of tumor necrosis factor-α, interleukin-6, and interleukin-1ß in the MSC group were significantly lower compared with the control group after CPB. Similarly, mRNA expression of proinflammatory cytokines in the lung was lower in the MSC group. Allogeneic administration of FM-MSCs remarkably decreased the lung injury score, protected alveolar structure, inhibited neutrophil infiltration to the lung interstitium, and stimulated cytoprotective cytokine production in the lung. CONCLUSIONS: Allogeneic transplantation of FM-MSCs may be a potent strategy to prevent CPB-induced systemic inflammation and acute lung injury by suppressing the expression of inflammatory cytokines and promoting protective factors in the lung.

Tricuspid Atresia IIc With a Vascular Ring: Novel Approach for Fontan Completion.

We report a successful Fontan completion in a 22-month-old boy with tricuspid atresia (TA) IIc with a vascular ring. The patient was referred at 1 month of age and was diagnosed with TA IIc using echocardiography. Subsequent 3-dimensional computed tomography revealed a vascular ring. We describe a reconstructive approach for such a heart defect, involving a Damus-Kaye-Stansel (DKS) anastomosis reduction plasty combined with a bidirectional cavopulmonary shunt (BCPS) created by end-to-end suturing of the right superior vena cava (SVC) to the left central pulmonary artery (PA), called the SVC translocation technique.

Green Tea Polyphenol Prevents Diabetic Rats From Acute Kidney Injury After Cardiopulmonary Bypass.

BACKGROUND: Acute kidney injury (AKI) is a common complication accompanying cardiopulmonary bypass (CPB) and is independently associated with increased morbidity and death. Diabetes mellitus increases the risk for AKI after CPB. Epigallocatechin-3-gallate (EGCG) is a major component of the polyphenolic fraction of green tea, which possesses cardioprotective activities, as previously reported. We hypothesized that EGCG also possesses a renoprotective effect through its diverse biochemical properties and assessed the effect on renal function after CPB for diabetic rats. METHODS: Goto-Kakizaki rats developing type 2 diabetes mellitus were randomly assigned to one of the following groups: sham (n = 10), CPB (CPB alone, n = 9), or EGCG (CPB + EGCG, n = 10). CPB was conducted for 30 minutes at a flow rate of 100 mL/kg/min in the CPB and EGCG groups. Rats assigned to the EGCG group were administrated EGCG solution orally for 2 weeks before CPB. We evaluated renal biochemical or histologic changes at 24 hours after CPB. RESULTS: Compared with the CPB group, the EGCG group exhibited milder tubular injury histologically (p < 0.0001) and reduced expression of kidney injury molecule-1, a biomarker for renal tubular injury (p < 0.0001) and 8-hydroxy-2'-deoxyguanosine (p < 0.01), indicating attenuated oxidant stress. CONCLUSIONS: Preoperative oral administration of EGCG ameliorates AKI in a CPB model of diabetic rats through antioxidative properties. This simple method could be applied in a clinical setting as a prophylactic renal protection against AKI after CPB, especially for high-risk patients with diabetes mellitus.

[Adult congenital aortic coarctaion;report of a case].

A 63-year-old man with a history of hypertension from 20-year-old complained of dyspnea on effort. He was diagnosed as an adult congenital aortic coarctaion by computed tomography (CT). The CT showed the many collaterals from the subclavian artery, the internal thoracic artery and the intercostal artery to the descending aorta. The coarctation was totally replaced with prosthetic graft through 3rd left thoracotomy under partial cardiopulmonary bypass. The operation was successful and the postoperative course was uneventful. To avoid postoperative paradoxical hypertension, total prosthetic replacement is preferable.

Primary cardiac malignant fibrous histiocytoma with abdominal wall metastasis.

We present a rare case of cardiac malignant fibrous histiocytoma (MFH; undifferentiated pleomorphic sarcoma); to date, fewer than 100 cases of cardiac MFH have been reported. In this case, transthoracic echocardiography revealed cardiac tumors in the left atrium (LA) of a 53-year-old woman with a 3-month history of worsening dyspnea; the largest tumor was found to protrude through the mitral valve in diastole, causing stenosis. Three of the four tumors were resected during emergency surgery; however, the residual tumor extension into the left pulmonary vein could not be removed. Histological findings of the resected tumors, such as organized thrombus and myxomatous tissue changes, indicated that the tumors were benign. After 3 months, the patient underwent total resection for a small mass that developed on her right abdominal wall, which was revealed histologically to be MFH; additionally, the residual mass in the LA had enlarged progressively. After undergoing radiation therapy without further surgery, she died of cerebral bleeding 6 months after cardiac surgery. Postmortem examination revealed that the tumor in the LA was an MFH. Thus, cardiac MFH should be considered as a differential diagnosis for tumors on the posterior wall of the LA. .