Calcium dependence of the priming, activation and inactivation of ryanodine receptors in frog motor nerve terminals.

We studied the effects of varying extracellular Ca(2+) ([Ca(2+) ](o) ) and Ca(2+) channel density and intracellular loading of Ca(2+) chelators on stimulation-induced rises in intracellular Ca(2+) ([Ca(2+) ](i) ) in frog motor nerve terminals with Ca(2+) imaging. The slowly waxing and waning components of rises in [Ca(2+) ](i) induced by repetitive tetani were suppressed by blockers of Ca(2+) pumps of the endoplasmic reticulum (thapsigargin and cyclopiazonic acid) and a blocker of ryanodine receptors [8-(N,N-diethylamino)octyl 3,4,5-trimethoxybenzoate hydrochloride] without affecting the initial quickly-rising component, thus reflecting the priming (and then subsequent rapid activation) and inactivation phases of Ca(2+) -induced Ca(2+) release (CICR) from the endoplasmic reticulum. A short tetanus-induced rise in [Ca(2+) ](i) was proportional to [Ca(2+) ](o) , whereas the component of CICR was non-linearly related to [Ca(2+) ](o) with saturation at 0.9 mm. The progressive blockade of Ca(2+) channels by ω-conotoxin GVIA caused proportional decreases in CICR and short tetanus-induced [Ca(2+) ](i) rises. Intracellular loading of BAPTA and EGTA reduced the magnitude of CICR as well as short tetanus-induced rises in [Ca(2+) ](i) with a greater effect of BAPTA than EGTA on CICR. The time to peak and the half decay time of CICR were prolonged by a low [Ca(2+) ](o) or Ca(2+) channel blocker or [Ca(2+) ](i) chelators. These results suggest that ryanodine receptors sense the high [Ca(2+) ](i) transient following single action potentials for triggering CICR, whereas the priming and inactivation processes of CICR sense a slower, persisting rise in [Ca(2+) ](i) during and after action potential trains. A model is presented that includes CICR activation in elementary units.

Anatomical tricuspid valve replacement in a patient with corrected transposition of the great arteries and situs inversus with 90° clockwise rotation of the heart through right thoracotomy.

The patient was a 34-year-old man with corrected transposition of the great arteries and situs inversus who was admitted with dyspnea. He had undergone ventricular septal defect closure and pulmonary valve commissurotomy at the age of 15. Preoperative examinations revealed severe tricuspid (systemic atrioventricular valve) insufficiency associated with dysfunction of the systemic (anatomical right) ventricle. The tricuspid valve orifice was shown to open dorsally by computed tomography. Because of 90° clockwise rotation of the heart, surgery was performed through right side thoracotomy. Tricuspid valve replacement with preservation of all leaflets and chordae tendineae was performed successfully, and the patient had an uneventful recovery after surgery.