Biventricular Repair Conversion After Temporary One and a Half Ventricular Repair for Hypoplastic Right Ventricle.

This case was an infant with critical pulmonary stenosis at birth. A temporary one and a half ventricular repair was performed to increase right ventricular end-diastolic volume and the size of the tricuspid valve annulus before biventricular repair conversion. The one and a half ventricular repair was performed using a unidirectional bicaval Glenn anastomosis. The right ventricular end-diastolic volume at 3 years was 73.2% of normal value but with a 64/36 right/left lung perfusion ratio. An anatomic biventricular correction included removal of the bicaval Glenn shunt and reconstruction of the continuity between the right and main pulmonary arteries. The one and a half ventricular repair made the reconstruction feasible.

A Successful Case of External Stenting for Bronchomalacia Lasting Over 20 Years.

We report on a patient with perimembranous ventricular septal defect and pulmonary hypertension. He underwent pulmonary artery banding followed by external stenting of the left bronchus because of secondary bronchomalacia. The external stent applied was a ringed expanded polytetrafluoroethylene graft, 10 mm in diameter and fixed at 8 points. Intracardiac repair was performed at the age of 2 years and the external stent was left in place. Since then, the patient has been healthy and computed tomography reveals that the external stent graft has retained function for over 20 years.

[Caseous Calcification of Mitral Valve Annulus;Report of a Case].

We report a case of an 80-year-old female presenting with a mitral valve tumor. Postoperatively, pathologic diagnosis was caseous calcification of the mitral annulus. In surgery, she successfully underwent a mitral valve replacement with a 20 mm mechanical valve. The importance of correctly making a preoperative diagnosis cannot be over-emphasized. Technical discussion on possibility of mitral valve repair and patient-prosthesis mismatch after mitral valve replacement is also made.

[Surgical repair of pseudoaneurysms with complete atrioventricular block after aortic valve replacement; report of a case].

Aortic pseudoaneurysm is a late complication after cardiac surgery. The patient was a 63-year-old female who had undergone aortic valve replacement 3 years before. She complained of syncope and underwent pacemaker implantation for complete atrioventricular block. Aortic root pseudoaneurysms were accidentally detected by computed tomography, and 1 of them was 50 mm in size. She underwent aortic root replacement with a modified Bentall technique. Although there was no definite infection or inflammation, careful follow-up was considered to be mandatory.

[Long-term outcome of the surgical treatment for acute aortic dissection with a ringed intraluminal graft; report of a case].

A 61-year-old female, who had undergone the surgical treatment of acute type A aortic dissection with a ringed intraluminal graft 26 years before, presented with breathlessness. Computed tomography (CT) showed peri-prosthetic leakage and enlargement (45×50 mm in diameter), enlargement of the aortic root (42 mm in diameter), and aneurysm of the ascending aorta and the aortic arch (55 mm in diameter) with chronic type A aortic dissection. Echocardiography showed severe aortic regurgitation. She successfully underwent aortic root replacement( Bentall procedure) and total arch replacement.

[Surgical treatment of traumatic pseudoaneurysm of the brachiocephalic artery; report of a case].

Traumatic injury to the great vessels may be one of the highly lethal states. In many of these cases, the lesion was confirmed at the aortic isthmus. We report a case of successful surgical treatment of the traumatic pseudoaneurysm of the brachiocephalic artery. Pre-operative 3-dimension computed tomography (CT) showed an aneurysm at the left dorsal of the artery. At surgery, the proximal portion of the brachiocephalic artery, the right common cartid artery and the right subclavian artery were clamped with the simple extracorporeal shunting between the aortic arch and the distal of the right common cartid artery for maintaining the blood flow to the brain. A longitudinal dissection was found at the left dorsal position when the aneurysm was opened. The aneurysm was removed and interposed using an artificial vessel. After surgery, no neurologic complication or aftereffects were revealed, and the cerebral infarction due to the procedure was not detected by the brain CT.

[Surgically treated tracheo-innominate artery fistula].

Tracheo-innominate artery fistula (TIF) is one of the highly lethal complications after the tracheostomy. We report a case of successful surgical treatment of TIF 4-year after the tracheostomy due to subacute sclerosing panencephalitis. Once the bleeding was controlled by the position and the high pressure of the tracheostomy tube cuff, but was not able to be controlled 24-hour after the hospitalization. At surgery, innominate artery was clamped simply at its origin under a median sternotomy. The each side orifice of the fistula was closed directly. The thymus was interposed between the innominate artery and the trachea to prevent the infection and the re-adhesion. After surgery, the cerebral infarction due to the procedure was not detected by the brain computed tomography (CT) and also the stenosis of the innominate artery was not detected by the chest enhanced CT.

[A case of liver metastasis from anorectal malignant melanoma on hemodialysis treated by chemotherapy].

We report a case on hemodialysis with liver metastases from anorectal malignant melanoma treated by dacarbazine (DTIC). A 61-year-old man presented with anal bleeding. An elastic soft mass was palpated in the anal canal, and a biopsy specimen was diagnosed as anorectal malignant melanoma histologically. After introducing hemodialysis for the chronic renal failure, abdominoperineal resection was performed. Two and a half years after surgery, computed tomography showed multiple liver metastases. We chose chemotherapy consisting of DTIC 100 mg for five consecutive days every 4 weeks in addition to hemodialysis (3 times a week). After three cycles of chemotherapy, liver metastases were stable, but new lung metastases were found. After 12 cycles of chemotherapy, liver metastases became stable, but lung metastases were progressive. Subsequently, the patient died of respiratory failure 4 years after surgery, 1 year and 7 months after the diagnosis of multiple liver metastases. No severe toxicity was observed during this period. We conclude that administration of DTIC undergoing hemodialysis for malignant melanoma with renal failure seems to be useful without severe adverse events.

[Clinical study of S-1 for advanced gastric cancer after reduction surgery].

We investigated the clinical efficacy and safety of S-1 retrospectively for the treatment of 32 patients with advanced gastric cancer after reduction surgery (gastrectomy). S-1 was administered orally twice daily, at a standard dose of 80 mg/m(2) per day for 28 days, followed by a 14-day rest. There were 21 patients having only a single residual metastatic site and 11 with two or more metastatic sites. Major residual metastatic sites were peritoneum in 25 patients, lymph nodes in 7, liver in 4 and lung in 2. The response rate by target organ was 28.6% for lymph node metastasis, and 0% for liver and lung metastasis. Peritoneal metastasis was not considered measurable site. The median survival time (MST) after S-1 administration was 573 days (95% confidence interval, 439 to 707 days). The 1-, 2- and 3-year survival rates were 62.3%, 40.3% and 28.2%, respectively. Of the 32 patients, 14 received S-1 for more than a year, and the MST in these patients was 897 days (95% confidence interval, 255 to 1,539 days). The incidence of adverse events was 90.6%, but the incidence of grade 3 or 4 was 12.5%. Long-term administration of S-1 may serve to prolong the survival period of patients with gastric cancer after reduction surgery, particularly in peritoneal metastasis.

Attenuation of graft injury in porcine liver transplantation from non-heart beating donor by FR167653.

BACKGROUND/AIMS: Orthotopic liver transplantation (OLTx) from non-heart beating donor (NHBD) often involves hepatic warm ischemia and reperfusion injury which is triggered by the inflammatory cytokines. This study was carried out to investigate whether a newly synthesized cytokine suppressive anti-inflammatory agent, FR167653, attenuates graft injury in OLTx from NHBD. METHODOLOGY: Porcine OLTx from NHBD was performed. No-heart beating time was scheduled to be 60 minutes. Animals were divided into two groups: no treatment control (CT) group (n=5), and FR167653 treated (FR) group (n=5), in which FR167653 was administered intravenously before the aortic cross clamp in the donor, and before and after the hepatic allograft reperfusion in the recipient continuously. RESULTS: Four out of five pigs died within 24 hours and one on postoperative day 1 from graft liver failure in the CT group, while two pigs died on day 3, and three survived more than 7 days in the FR group (p<0.05). Microcirculatory disturbance was attenuated, liver injury was lessened, and ATP resynthesis was enhanced in the FR group. Additionally, FR167653 inhibited neutrophils infiltration in the liver tissue, and suppressed release of inflammatory cytokines after OLTx from NHBD. CONCLUSIONS: The treatments with FR167653 successfully prevented graft injury after OLTx from NHBD by means of improvement of liver microcirculation, and attenuation of neutrophils activation. The inhibitory effect of FR167653 on the release of inflammatory cytokines played an important role in the liver graft protection.

Autopericardial patch tracheoplasty for tracheal stenosis after arterial switch operation.

Though congenital tracheal stenosis in infants with congenital heart disease is uncommon, congestive heart failure is often deteriorated by respiratory symptoms. We report an infant having a diagnosis of congenital tracheal stenosis complicated with congenital heart disease who underwent pericardial patch tracheoplasty after the arterial switch operation for the transposition of the great arteries. External appearance of the trachea showed no stenosis and tracheal rings were well formed. Intraoperative bronchofiberscopy transilluminated the upper border of stenosis. The trachea was opened longitudinally to the extent of 30 mm to the point from 10 mm point proximal to the bifurcation. The incision was enlarged with the autologous pericardial patch using running absorbable suture. Then pericardial patch was anchored at several points to the posterior surface of the ascending aorta, innominate artery, and to the strap muscles of the neck. He is doing well now without any respiratory symptom.

[Sandwich technique for closing of the large muscular Swiss-cheese type ventricular septal defects].

A 9-year-old girl, who has had a diagnosis as a Taussig-Bing anomary, underwent an original Jatene procedure (o-J) 2 months after birth. This time, she had a diagnosis of the muscular multiple ventricular septal defects (mVSD) and pulmonary stenosis after o-J. The mVSD was Swiss-cheese type and was large from the proximal of the infundibular septum to the apex and posterior of the septum. It was closed by the sandwich technique using a pair of felt patches, which of one was placed at right ventricular side and the other was at left ventricular side, slightly larger than the whole area of the mVSD. The patch fixation was placed with 1 stitch at the center between the patches and a few stitches around the right ventricular side patch to the ventricular septum. Postoperative cardiac function was uneventful regardless of the very large patches placed at the ventricular septum and the cardiac catheterization after 1 year postoperatively showed the pulmonary/systemic blood flow ratio was 1.0. This technique for the closure of the large Swiss-cheese type mVSD can be considered to be very effective.

[Valvuloplasty for mitral regurgitation immediately following Kawasaki disease without abnormal coronary arteries lesion; report of a case].

It is not uncommon that valve disease is complicated with Kawasaki disease (KD). However, it is rare to show normal coronary arteries simultaneously. We experienced a case of valvuloplasty towards the mitral regurgitation (MR) followed immediately after KD showing normal coronary arteries. A 3 year-old-female, with a diagnosis of KD at 4 months after birth, was referred to our hospital 5 months after birth. The echocardiography detected a moderate MR. The preoperative catheterization at 2.5 years old showed grade III MR, enlargement of left atrium and left ventricle, pulmonary capillary wedge pressure (PCWP) = 12 mmHg, left ventricular ejection fraction (LVEF) = 675, and normal coronary arteries. Pulmonary hypertention was not revealed. The operative findings showed mitral valve prolapse due to the elongation of the chordae of the anterior leaflet. She underwent artificial chordal reconstruction using expanded polytetrafluoroethylene sutures and mitral annuloplasty by Kay-Reed method. The postoperative course was uneventful, and she was discharged on postoperative day 19.

Attenuation of microcirculatory disturbance after liver ischemia by newly synthesized inflammatory cytokine suppressor, FR167653.

BACKGROUND/AIMS: Inflammatory cytokines, such as interleukin-1 beta and tumor necrosis factor-alpha, which activate neutrophils, contribute to hepatic warm ischemia-reperfusion injury. However, the role of the cytokines in hepatic microcirculation immediately after reperfusion is still unclear. This study was carried out to investigate whether FR167653, a dual inhibitor of interleukin-1 beta and tumor necrosis factor-alpha, attenuates hepatic microcirculatory disturbance at the initial phase of reperfusion following liver ischemia. METHODOLOGY: Adult mongrel dogs were subjected to 90 minutes of liver ischemia by a Pringle's maneuver under portosystemic bypass. The animals were divided into two groups: a control group (n = 10), subjected to hepatic warm ischemia only, and a FR167653 administered group (n = 5), which received 1 mg/kg/h FR167653 for 4 hours since 30 minutes before the ischemia to 2 hours after the reperfusion continuously. Seven days animal survival, hepatic tissue blood flow, liver function test, hepatic venous blood concentration of endothelin-1 and plasminogen activator inhibitor-1, liver tissue biochemistry, and histopathology were analyzed. RESULTS: The treatment with FR167653 attenuated microcirculatory disturbance, lessened liver injury, enhanced adenine nucleotides resynthesis, and improved animal survival after liver ischemia. In addition, FR167653 significantly inhibited release of both endothelin-1 and plasminogen activator inhibitor-1 from the liver cells. CONCLUSIONS: These results suggest that the inflammatory cytokines induce microcirculatory disturbance in the initial phase of reperfusion following liver ischemia.