Effectiveness of the taut-line hitch knot in accurately determining the length of artificial chordae during repair for degenerative mitral insufficiency.

Taut-line hitch, a type of ropework used in outdoor activities, was adopted to tie the artificial chordae during mitral valve repair for degenerative mitral insufficiency. This knot-tying technique facilitated artificial chordae length determination during surgery. Nineteen patients with degenerative mitral insufficiency were successfully treated using this technique.

Effects of M-1, a Major Metabolite of Sarpogrelate, on 5-HT-Induced Constriction of Isolated Human Internal Thoracic Artery.

Sarpogrelate, a selective 5-hydroxytryptamine (5-HT)2A receptor antagonist, inhibits 5-HT-induced platelet aggregation and vasoconstriction. It improves ischemic symptoms in patients with arteriosclerosis obliterans. M-1 is a major metabolite of sarpogrelate, and has been reported to show a higher affinity for the 5-HT2A receptor on platelets than sarpogrelate. However, the effects of M-1 on 5-HT-induced constrictive response in human blood vessels have not been investigated. The internal thoracic artery (ITA) is the key conduit for coronary artery bypass grafting (CABG). 5-HT has been implicated as playing an important role in the pathogenesis of vasospasm. Thus, in the present study, the effects of M-1 on 5-HT-induced vasoconstriction were examined in isolated human endothelium denuded ITA. M-1 inhibited 5-HT-induced vasoconstriction in a concentration-dependent manner. At the highest concentration, M-1 almost completely inhibited the 5-HT-induced vasoconstriction. Expression of 5-HT2A and 5-HT1B receptor proteins in the membrane fraction of ITA smooth muscle cells was confirmed by Western blot analysis. Individually, supramaximal concentrations of sarpogrelate and SB224289, a selective 5-HT1B receptor antagonist, only partially inhibited the 5-HT-induced vasoconstriction. However, simultaneous pretreatment with both these antagonists almost completely inhibited the 5-HT-induced vasoconstriction. The inhibitory effect of M-1 pretreatment mimicked the inhibitory effect of simultaneous pretreatment with sarpogrelate and SB224289. These results suggest that M-1 has antagonistic effects not only on the 5-HT2A receptor but also on the 5-HT1B receptor in human ITA smooth muscle cells. M-1 may be useful as a lead compound for the development of drugs for the treatment of 5-HT-induced vasospasms in CABG.

Mitral valve repair in Barlow's disease by chordal reconstruction using the adjustable slip-knot technique.

The adjustable slip-knot technique-a procedure for facilitating repair of the mitral valve prolapse-was first performed and reported by us in 2015. This technique comprises six steps: anchor institution in the papillary muscle, flexible band positioning, saline injection to confirm the prolapsing site, neochorda setting between the anchor and leaflet, fine adjustment of the neochordal length, and knot-fixing to confirm repair. Here, we have described the first case of successful mitral valve repair using the adjustable slip-knot technique in a 51-year-old man with Barlow's disease.

Antiproteinuric effects of renin-angiotensin inhibitors in lung cancer patients receiving bevacizumab.

PURPOSE: The objective of this study was to investigate the effect of renin-angiotensin system inhibitors (RASIs) on bevacizumab (BV)-induced proteinuria in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of NSCLC patients receiving BV between 2008 and 2014 at 11 hospitals. The patients were categorized into three groups according to their antihypertensive drug use: RASI user, non-RASI user, and non-user groups. The primary outcome was a proteinuria event of any grade during the first 6 cycles of BV treatment. RESULTS: A total of 211 patients were included, 89 of whom received antihypertensive drugs. Of these 89 patients, 49 were in the RASI user group, and 40 were in the non-RASI user group. The non-user group comprised 122 patients. The occurrence of proteinuria in the RASI user group was significantly lower than that in the non-RASI user group (P = 0.037) but was not significantly lower than that in the non-user group (P = 0.287). Patients using RASIs had a lower rate of proteinuria than those who did not use RASIs according to multivariate analysis (odds ratio 0.32; 95% confidence interval 0.12-0.86; P = 0.024). CONCLUSION: Our study suggests that RASI administration reduces the risk of proteinuria in patients receiving BV.

Diabetes Mellitus Induces Hyperreactivity of 5-Hydroxytryptamine (5-HT)-Induced Constriction in Human Internal Thoracic Artery and Is Associated with Increase in the Membrane Protein Level of 5-HT2A Receptor.

Studies indicate that 5-hydroxytryptamine (5-HT) released from activated platelets in coronary artery bypass grafting (CABG) induces 5-HT2A receptor-mediated graft spasm. We previously reported that 5-HT-induced constriction of human endothelium-denuded saphenous vein (SV) was significantly augmented in patients with diabetes mellitus (DM) than in patients without DM (non-DM), without changes in the levels of the membrane-bound 5-HT2A receptor of their smooth muscle cells. Although the internal thoracic artery (ITA) is the key graft conduit for CABG, the effect of DM on the ITA graft spasm is still unclear. Therefore, in this study, we investigated the effect of DM on 5-HT-induced vasoconstriction and the level of membrane-bound 5-HT2A receptor in ITA grafts. 5-HT-induced constriction of the isolated human endothelial-denuded ITA was significantly higher in patients with DM than in patients without DM. In addition, the level of the 5-HT2A receptor in the membrane fraction of human ITA smooth muscle cells was significantly higher in patients with DM than in those without DM. These results demonstrate that DM is a risk factor for CABG in both venous and arterial conduits, and that it differentially affects the level of the membrane-bound 5-HT2A receptor in the venous and arterial smooth muscle cells.

Angiotensin II, as well as 5-hydroxytriptamine, is a potent vasospasm inducer of saphenous vein graft for coronary artery bypass grafting in patients with diabetes mellitus.

Diabetes mellitus (DM) is an important risk factor for adverse outcomes of coronary artery bypass grafting. The bypass grafts harvested from patients with DM tend to go into spasm after their implantation into the coronary circulation. To clarify the contribution of 5-hydroxytriptamine (5-HT) and angiotensin II (AngII) in the bypass graft spasm, we examined the contractile reactivity to 5-HT or AngII of isolated human endothelium-denuded saphenous vein (SV) harvested from DM and non-DM patients. The 5-HT-induced constriction of the SV was significantly augmented in the DM group than in the non-DM group, which is similar to our previous report. AngII-induced constriction of the SV was also significantly augmented in the DM group than the non-DM group. Especially in the non-DM group, the AngII-induced maximal vasoconstriction was markedly lower than the 5-HT-induced one. Meanwhile, the increasing rates of AngII-induced vasoconstriction in the DM group to the non-DM group were significantly greater than those of 5-HT-induced vasoconstriction. These results indicate that 5-HT is a potent inducer of SV graft spasm in both DM and non-DM patients, while AngII is a potent inducer of SV graft spasm only in patients with DM. Furthermore, the protein level of AngII AT1 receptor (AT1R), but not the protein level of 5-HT2A receptor, in the membrane fraction of the SV smooth muscle cells of DM patients was significantly increased as compared with that of the non-DM patients. These results suggest that the mechanism for hyperreactivity to AngII in the SV from DM patients is due to, at least in part, the increase in the amount of AT1R on membrane of the SV smooth muscle cells.

[Aortic Root Reimplantation for Extra-cardiac Unruptured Sinus of Valsalva Aneurysm].

Aneurysms of the sinus of Valsalva are rare. We report a case of extra-cardiac unruptured aneurysm of the sinus of Valsalva with moderate aortic regurgitation (AR). A 57-year-old woman was referred to our institution because of AR. Echocardiography showed moderate AR and computed tomographic scanning demonstrated an extra-cardiac aneurysm of the unruptured sinus of Valsalva, which extended from the right sinus of Valsalva to the non-coronary sinus of Valsalva. She underwent aortic root reimplantation procedure with a Valsalva graft. Although mild AR was observed postoperatively, her postoperative course was uneventful.

Water-soluble jack-knife prawn extract inhibits 5-hydroxytryptamine-induced vasoconstriction and platelet aggregation in humans.

Coronary artery spasm plays an important role in the pathogenesis of various ischemic heart diseases or serious arrhythmia. The aim of this study is to look for functional foods which have physiologically active substances preventing 5-hydroxytryptamine (5-HT)-related vasospastic diseases including peri- and postoperative ischemic complications of coronary artery bypass grafting (CABG) from ocean resources in Japanese coastal waters. First, we evaluated the effect of water-soluble ocean resource extracts on the response to 5-HT in HEK293 cells which have forcibly expressed cyan fluorescent protein-fused 5-HT2A receptors (5-HT2A-CFP). Among 5 different water-soluble extracts of ocean resources, the crude water-soluble jack-knife prawn extract (WJPE) significantly reduced maximal Ca(2+) influx induced by 0.1 µM 5-HT in a concentration-dependent manner. The Crude WJPE significantly inhibited, in a concentration-dependent manner, 5-HT-induced constriction of human saphenous vein. 5-HT released from activated platelets plays a crucial roles in the constriction of coronary artery. Next the WJPE was purified for applying the experiment of 5-HT-induced human platelet aggregation. The purified WJPE significantly inhibited 5-HT-induced human platelet aggregation also in a concentration-dependent manner. Based on our findings, jack-knife prawn could be one of a functional food with health-promoting benefits for most people with vasospastic diseases including patients who have gone CABG.

Predictors of early and late outcome after total arch replacement for atherosclerotic aortic arch aneurysm.

OBJECTIVES: This study aimed to identify predictors of early and late outcome after total arch replacement (TAR) for atherosclerotic aortic arch aneurysm. METHODS: TAR with separate arch vessel grafting and selective cerebral perfusion was performed in 130 patients. The median age at operation was 72.9 ± 6.1 years (57-86 years). Emergency operation was performed in 9 patients (6.9 %) and the frozen elephant trunk technique was used in 51 patients (39.2 %). RESULTS: The in-hospital mortality rate was 3.8 %. Chronic renal failure (CRF) was identified as an independent predictor of in-hospital mortality (p = 0.0001). Permanent neurological dysfunction occurred in nine patients (6.9 %). Clot or atheroma in the aneurysm (p = 0.01) and the duration of selective cerebral perfusion (p = 0.011) were identified as independent predictors of permanent neurological dysfunction. Long-term survival rates were 82.0 % at 3 years, 70.0 % at 5 years, and 52.4 % at 8 years postoperatively. CRF (p = 0.0190), age (p = 0.0147), and permanent neurological dysfunction (p = 0.0048) were identified as independent predictors of long-term mortality. CONCLUSIONS: Prevention of permanent neurological dysfunction is crucial for long-term survival after TAR. Older patients with renal dysfunction may have reduced long-term survival after TAR.

Long-term results of endovascular repair for distal arch and descending thoracic aortic aneurysms treated by custom-made endografts: usefulness of fenestrated endografts.

OBJECTIVE: We evaluated early and long-term results of atherosclerotic aneurysm repair with custom-made endografts. MATERIALS AND METHODS: Eighty-one consecutive patients underwent thoracic endovascular aortic repair with custom-made endografts. Fenestrated grafts were used in 37 patients (45.7%) to maintain blood flow of the neck and a landing zone for as long as possible for distal arch or proximal descending aneurysms. The rates of perioperative mortality, stroke, paraplegia, and primary endoleaks were assessed to evaluate in-hospital safety. The rates of endoleak development, survival, and freedom from aortic-related death were assessed to evaluate long-term efficiency. RESULTS: Twenty-four patients (29.6%) underwent urgent operations, and 38 (46.9%) underwent distal arch or proximal descending aortic aneurysm repair. There was one case (1.2%) of in-hospital mortality and no cases of stroke. Permanent spinal injury occurred in one patient (1.2%). Early and late endoleaks occurred in one and 16 patients, respectively. The actuarial survival rates were 88.9%, 64.9%, and 51.7% at 1, 5, and 10 years, respectively. The actuarial rates of freedom from endoleaks were 90.1%, 81.3%, and 68.6% at 1, 5, and 10 years, respectively. CONCLUSION: Early results of custom-made endografts were excellent, and fenestrated endografts were safe for distal arch and proximal descending aortic aneurysms.

Inflammatory abdominal aortic aneurysm: report of seven cases.

We reviewed 575 cases of abdominal aortic aneurysm (AAA) repair performed in our institution from 1979 to 2010. In this group, 7 (1.2%) patients (mean age, 72.6 years) had evidence of inflammatory AAA (IAAA). Mean aneurysmal diameter was 70.4 mm as measured on CT, and the mantle sign was present in all cases. They were male smokers. Two patients had hydronephrosis, and required a ureteral stent before surgery. All patients underwent laparotomy, and no perioperative deaths occured. We suggest that operative technique should be modified to avoid excessive dissection on both the proximal and distal sides of the IAAA.

Circumferential dissection of the ascending aorta "intimo-intimal intussusception".

We describe a rare case of acute Stanford type A dissection with "intimo-intimal intussusception." A 38-year-old male with sudden back pain and unconsciousness was admitted to the hospital. A computed tomography (CT) scan revealed the presence of an intimal flap in the aortic root and the aortic arch, absence of an intimal flap in the ascending aorta along with dilatation and occlusion of the brachiocephalic artery. Surgical treatment consisted of ascending aorta replacement under circulatory arrest. During the operation, complete circumferential detachment of the intima at the level of the sinotubular junction with an inverted flap intruding into the brachiocephalic artery was visualized. The surgery was successful with an uneventful postoperative recovery.

[Acute massive pulmonary thromboembolism treated with percutaneous cardiopulmonary support perioperatively].

A 57-year-old female was transferred to our hospital because of sudden dyspnea. She was hypotensive and hypoxic. Acute massive pulmonary thromboembolism was detected by echocardiography and computed tomography (CT). Before the operation, she fell into severe shock and needed cardiopulmonary resuscitation. We applied percutaneous cardiopulmonary support (PCPS), and performed emergency open embolectomy under total cardiopulmonary bypass. Because of the right ventricular failure, she could not be weaned from total cardiopulmonary bypass. PCPS was required again and used continuously during postoperative management. Her cardiopulmonary state improved gradually. PCPS was stopped at 6 days after surgery, and she was extubated at 14 days after surgery. PCPS was very useful for resuscitation and stabilization of the cardiopulmonary function for acute massive pulmonary thromboembolism perioperatively.

Effects of a worker participatory program for improving work environments on job stressors and mental health among workers: a controlled trial.

The Mental Health Action Checklist for a Better Workplace Environment (MHACL) is a tool for a worker participatory approach to improve work environments for worker mental health. The present study investigated the effects of an organizational intervention using the MHACL on reducing job stressors and the psychological distress of workers of a manufacturing enterprise in Japan with a controlled study design. Nine of 45 departments participated in a work environment improvement program, including planning workshops, implementation and monitoring, between July and December 2005 (intervention group, n=321). The remaining 36 departments served as the control group (n=750). Outcomes (job stressors, worksite support, psychological distress, etc.), measured using the Brief Job Stress Questionnaire, as well as sick leave days taken from the company record, were recorded before and six months after the program for both groups. Among women, skill underutilization, supervisor and coworker support, psychological distress, and job satisfaction changed more favorably in the intervention group than in the control group (p<0.05). No significant favorable effect of the program was observed among men. Improvements in the outcomes were more prominent among departments with a 50% or higher rate of worker participation in the planning workshops and among departments with a 50% or higher rate of implemented vs. planned actions. A worker participatory organizational intervention using the MHACL seems effective for promoting mental health among Japanese white-collar women.