Hisao Manabe

Hemangioma of the liver. Diagnosis with combined use of laparoscopy and hepatic arteriography.

A case of hepatic hemangioma is reported in which preoperative diagnosis, with the combined aid of serial selective hepatic arteriography and laparoscopy, was necessary. The patient underwent right hepatic lobectomy after extensive extrahepatic individual ligations with no severe postoperative complications. The combined use of selective hepatic arteriography and laparoscopy is emphasized as essential for the correct diagnosis of hepatic hemangioma.

Left ventricular function in patients with coronary arteritis due to acute febrile mucocutaneous lymph node syndrome or related diseases

Abstract Reports of a mucocutaneous lymph node syndrome that frequently affects the coronary arteries have been increasing in Japan and other countries including the United States. Twelve patients with a documented history of mucocutaneous lymph node syndrome or a related coronary arteritis were studied with right and left heart catheterization, cardiac output measurements, left cineventriculography and selective coronary arteriography. These patients were separated into two groups on the basis of coronary arteriographic findings. Group 1 comprised six patients with normal coronary arteriograms; group 2 included the remaining six patients with coronary arterial aneurysm or occlusion. Left ventricular function differed in the two groups. It remained essentially normal in group 1 whereas decreased ejection fraction, increased end-diastolic volume, elevated end-diastolic pressure or mitral regurgitation were evident in four of the six patients in group 2. Two ventriculographic abnormalities were identified: (1) regional contraction abnormality secondary to myocardial infarction, and (2) generalized hypokinesia without electrocardiographic evidence of infarction, probably caused by myocarditis resulting from arteritis. Two patients with severe coronary arterial obstruction and myocardial infarction underwent successful aortocoronary bypass grafting. Postoperatively both had patency of all grafts and one had improved left ventricular function. These experiences have first shown the feasibility and significance of surgical management for selected patients with coronary arterial lesions due to coronary arteritis caused by the mucocutaneous lymph node syndrome or related diseases.

Ventricular Septal Defect Associated with Aortic Insufficiency Anatomic Classification and Method of Operation

Thirty-five consecutive patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) who underwent corrective surgery are presented. There were seven operative and three late deaths among the patients operated upon before 1968. No death, however, was encountered among the most recent 18 consecutive patients. The VSD was closed directly in 14 patients and with a Teflon patch in 21. The aortic valve was repaired in 16 patients, replaced in eight, and no interference was indicated in 11.They were classified from the surgical viewpoint according to the location of the VSD, the anatomic type of the right ventricular outflow tract, and the severity of the aortic herniation as follows: type Ia, supracristal VSD and AI without aortic cusp herniation; type lb, supracristal VSD and AI with aortic cusp herniation and conal muscular rim beneath the pulmonic valve; type Ic, supracristal VSD and AI with aortic cusp herniation without conal muscular rim beneath the pulmonic valve; type IIa, infracristal VSD and AI without aortic cusp herniation; type IIb, infracristal VSD and AI with aortic cusp herniation; type III, infracristal VSD and AI with infundibular pulmonic stenosis (PS); type IV, supracristal VSD and AI with infundibular PS.In type Ia and IIa, VSD was closed directly and the aortic valve was replaced. In most of type Ib, VSD was closed directly and no direct procedure was performed upon the aortic valve. In most of type Ic, VSD was closed with a Teflon patch and the aortic valve was repaired. In type IIb, VSD was closed with a Teflon patch and the procedure upon the aortic valve was not uniform. In type III, VSD was closed with a Teflon patch and the aortic valve was repaired in most of them. In type IV, VSD was closed with a Teflon patch and no direct procedure was performed upon the aortic valve.The basic policy for repair of this association of anomalies is selected according to the above mentioned anatomic classification.

Multi-institutional studies of the national cardiovascular center ventricular assist system: Use in 92 patients

A ventricular assist system (VAS) developed at the National Cardiovascular Center (NCVC) and produced by Toyobo Company has been clinically evaluated at 32 institutes. The system consists of a pneumatic and diaphragm-type pump, and a control-drive unit with an automatic bypass flow (BF) control system. The VAS was used in 85 adults and 7 children with acute, severe heart failure. Forty-eight patients were weaned from VAS, and 21 were long-term survivors. Heparin was not used when BF was above 2.0 L/min in an adult sized pump, and 0.8 in a pediatric one. Thrombus formation was noticed in the groove around the valve in eight cases, and in the pump in eight. Pump-originated serious complications were not seen. Hematologic and biochemical findings revealed that the VAS did not directly affect the major organs. The control-drive unit, including the automatic BF control system, functioned accurately, with less manpower, securing reliable control over the circulation. Two major causes of death were irreversible heart failure, and multiple organ failure, which resulted from delayed application. In conclusion, the NCVC-type VAS has been found effective and reliable, less thrombogenic, and requiring less manpower for its clinical use.

Stenosis of pulmonary veins: Report of a patient corrected surgically.

Abstract A 15-year-old boy is reported who underwent surgical correction for stenosis of the right upper and left pulmonary veins at their junction with the left atrium and associated atrial septal defect, ventricular septal defect, and severe pulmonary hypertension. The literature dealing with stenosis of the pulmonary veins is reviewed and the etiology of the lesion and feasibility of preoperative diagnosis are discussed.

Tree-shaped Pulmonary Veins in Infracardiac Total Anomalous Pulmonary Venous Drainage

Three consecutive patients undergoing corrective operation for the infracardiac type of total anomalous pulmonary venous drainage (TAPVD) were found to have tree-shaped pulmonary veins. Preoperative angiocardiography revealed that in 2 patients the superior and inferior pulmonary veins drained separately, bilaterally, into the vertical vein. In the third patient the right pulmonary veins united to connect with the vertical vein, while the left superior and inferior pulmonary veins drained separately into the vertical vein. At operation inferior pulmonary veins connecting separately with the vertical vein were found to be located posterior to the pericardium. In the previous literature dealing with successful repair of infracardiac TAPVD, there is no mention of the tree-shaped pulmonary veins described in this report. As this particular type of pulmonary vein does not seem to be uncommon, its possible presence should be kept in mind during operation, as it may dictate the selection of surgical procedures.

Pancreatic carcinoma in infancy. An electron microscopic study.

A case of a malignant epithelial tumor of tail of the pancreas in a 3‐year‐old Japanese girl is presented. This is the fourth case reported with ultrastructural study. This type of pancreatic carcinoma of the infant has no endocrine granules or endocrine function. The ultrastructural study suggests that the tumor is derived from a primitive epithelial cell with differentiation toward acinar cell.

Identification of cardiac rejection in heterotopic heart transplantation using 111In-antimyosin.

It is important in heart transplantation to evaluate precisely the extent and location of cardiac rejection. At present, right ventricular endomyocardial biopsy has been used as the gold standard, however, establishment of noninvasive, simple, and easy diagnostic procedure is desired. The canine donor heart, in which atrial septal defect and tricuspid regurgitation had been produced beforehand, was heterotopically transplanted into the recipients chest cavity. In seven dogs, two to three mCi of 111In-antimyosin was injected intravenously upon cardiac rejection before the heart was excised. 111In-antimyosin myocardial imaging was then performed using a gamma camera. In the same slice, a histopathological rejection score was calculated and divided into mild, moderate or severe injection. the uptake of 111In-antimyosin was significantly higher in moderate and severe rejected myocardium, since this agent produced a specific and selective localization and concentration in areas of myocardial damage. Therefore, this new technique allows the evaluation of therapeutic intervention upon cardiac rejection and may replace right ventricular endomyocardial biopsy.

Identification of cardiac rejection with magnetic resonance imaging in heterotopic heart transplantation model

SummaryIt is important to evaluate the severity and extent of cardiac rejection in heart transplantations. Eight heterotopic heart transplantations using mongrel dogs were performed, and gated magnetic resonance imaging (MRI) of the donor hearts was carried out. High signal intensity was obtained in the rejected myocardium at the time of cardiac rejection, especially from the right ventricular wall to the intraventricular septal wall compared with the left ventricular posterolateral wall. In addition, MRI was performed in the excised heart. High signal intensity was also observed in the same region of the excised donor hearts. The histopathological rejection scores were well in agreement with prolonged T1 and T2 relaxation times; severe and mild rejection of the myocardium were distinguished by the T1 and T2 relaxation times. Our results suggest that MRI is able to visualize the transplanted myocardium undergoing rejection and that the right ventricular wall is more sensitive to cardiac rejection than the left. MRI may allow noninvasive evaluation of the severity and extent of cardiac rejection.

Plasma cortisol, luteinizing hormone (LH), and prolactin secretory responses to cardiopulmonary bypass.

Abstract We measured the plasma levels of cortisol, luteinizing hormone (LH), and prolactin before, during, and after open heart surgery using cardiopulmonary bypass in seven male patients. The levels of cortisol and prolactin were high immediately before the beginning of perfusion. During and after perfusion, increased secretion of cortisol and prolactin was observed. The secretion of LH increased 30 min after the skin incision, but it decreased to the control levels immediately before perfusion. These levels did not change during and after perfusion. The secretory responses of these hormones during perfusion were almost identical to those in the state of physiological circulation.