Jiro Hirai

Venous reconstruction using hybrid vascular tissue composed of vascular cells and collagen: tissue regeneration process.

In this study, a tubular hybrid vascular tissue composed of vascular cells and collagen was implanted as a venous substitute, and its remodeling process was histologically investigated. First, a hybrid medial tissue was prepared by pouring a cold mixed solution of canine jugular smooth muscle cells (SMCs) and Type I collagen into a tubular glass mold and subsequent incubation at 37 degrees C. Culture in medium for 10 days produced a dense tubular tissue. Seeding of jugular endothelial cells (ECs) onto the luminal surface of the tissue produced a hybrid vascular tissue with a hierarchical structure. These vascular tissues (inner diameter, 7 mm; length, 3 cm; wall thickness, 1 mm; n = 14) were implanted autologously in the canine posterior vena cava wrapped in Dacron mesh for up to 24 wk. Nine of 14 grafts were patent throughout implantation. In patent grafts, monolayered ECs were oriented in the direction of blood flow at 1 wk. Circumferentially oriented SMCs accumulated at the subendothelial layer and ingrown fibroblasts were sparsely distributed throughout the wall at 12 wk. Contractile phenotype of SMCs was evident at 24 wk. Collagen fibrils, which were sparsely distributed at an early period of implantation, gradually assembled to form fibrous meshes at 24 wk. Sheet-like elastic lamellae were also observed at this time. Marked wall thinning was observed at 12 and 24 wk. The resultant tissues became highly dense. The specific gravity of tissues increased with time, and reached those of natural vessels at 24 wk. Tissue remodeling progressed in a time-dependent manner and appeared to be almost complete within 6 mo of implantation.

Self-organized, tubular hybrid vascular tissue composed of vascular cells and collagen for low-pressure-loaded venous system

A tubular, hierarchically structured hybrid vascular tissue composed of vascular cells and collagen was prepared. First, a cold mixed solution of bovine aortic smooth muscle cells (SMCs) and Type I collagen was poured into a tubular glass mold composed of a mandrel and a sheath (example of dimensions: inner diameter, 1.5 mm; outer diameter, 7 mm; length, 7 cm). Upon incubation at 37 degrees C, an SMC-incorporated collagenous gel was formed. After the sheath was removed, the resulting fragile tissue, when cultured in medium, thinned in a time-dependent manner to form an opaque, dense tissue. Higher SMC seeding density and lower initial collagen concentration induced more rapid and prominent shrinkage of the tissue. Morphologic investigation showed that over time, bipolarly elongated SMCs and collagen fiber bundles became positioned around the mandrel. Both components became circumferentially oriented. When the mandrel was removed, a tubular hybrid medial tissue was formed. A hybrid vascular tissue with a hierarchical structure was constructed by seeding endothelial cells onto the inner surface of the hybrid medial tissue. Prepared tissues tolerated luminal pressures as great as 100 mmHg and mechanical stress applied during an anastomotic procedure. This method allowed us to prepare a tubular hybrid medial tissue of predetermined size (inner diameter, wall thickness, and length) by selecting appropriate mold design, initial collagen concentration, and SMC seeding density. Such hybrid vascular tissues may provide physiological functions when implanted into the venous system.

Highly oriented, tubular hybrid vascular tissue for a low pressure circulatory system.

A hierarchically structured hybrid vascular tissue was prepared from vascular cells and collagen. First a hybrid medial tissue was prepared by pouring a cold mixed solution of bovine aortic smooth muscle cells (SMCs) and Type I collagen into a tubular glass mold composed of a mandrel and a sheath (inner diameter, 1.5 mm; outer diameter, 7 mm; length, 7 cm). An SMC incorporating collagenous gel was formed with incubation at 37 degrees C. After the sheath of the mold was removed, the resulting fragile tissue cultured in the medium shrank in a time dependent manner to form an opaque, dense tissue. Seeding at a higher cell density and a lower concentration of collagen resulted in rapid and prominent shrinkage. Morphologic investigation showed that with time, bipolarly elongated SMCs and collagen fiber bundles became positioned around the mandrel. When the mandrel was removed, a tubular hybrid medial tissue was formed. A hybrid vascular tissue with a hierarchical structure was constructed by seeding endothelial cells onto the inner surface of the hybrid medial tissue. Prepared tissues tolerated luminal pressures as great as 100 mmHg and mechanical stress applied during the anastomotic procedure. This method allowed the authors to prepare hybrid medial tissues of predetermined size (specifically inner diameter, wall thickness, and length) and mechanical property, which all depend on the mold design, SMC seeding density, initial collagen concentration, and incubation period. Hybrid vascular tissues may provide physiologic functions such as antithrombogenicity and regulation of vasomotor tone when implanted into a venous system.

A new double lumen balloon catheter for retrograde cerebral perfusion via jugular vein cannulation.

A new catheter for retrograde cerebral perfusion (RCP) was developed that can be used to deliver blood directly into the internal jugular vein (IJV) beyond the venous valves at the jugular-subclavian junction and prevent blood from draining into the lower half of the body. This catheter can be inserted into the IJV via a standard puncture technique by use of a 14 Fr sheath. The catheter shaft has two channels for balloon inflation and blood perfusion, respectively. A balloon for occlusion of drainage veins (superior vena cava and azygos vein) is installed at the catheter tip. Side holes, through which oxygenated cold blood is delivered into the IJV, are located 95 mm from the catheter tip. In a mock circulatory study, the pressure at the perfusion line (16–118 mmHg) increased with the increasing flow rate (0–400 ml/min). In clinical application, under circulatory arrest with profound hypothermia, inflation of the balloon effectively reduced blood drainage into the lower half of the body and, consequently, RCP was successfully performed (flow rate, 300–350 ml/min; pressure at the IJV, 15 mmHg). Because all of these procedures were controlled from outside the operative field, RCP by use of this catheter could be useful in distal arch replacement via left lateral thoracotomy. ASAIO Journal 1997; 43:M731-M735.

A case of Successfully Operated Pelvic Arteriovenous Malformation.

動静脈奇形 (AVM) は四肢や脳, 肺などに発症することが多 く骨盤内のものは少ない. 今回われわれ は, そのような骨盤内AVMの 一例に対 して根治せしめたので報告する. 症例は59歳 女性で, 主訴は 右下腹部腫瘤である. 骨盤部CTと 血管造影で異常血管瘤を伴うAVMと 診断した. 手術は術前より 診断しえた feeding artery である右内腸骨動脈と右腰動脈および右尿管動脈を結紮し, 右腎動脈から のAVMと 瘤を摘出した. 術後の血管造影では, 右内腸骨動脈末梢の正常血管は左側からの側副血行 路により造影されたが, AVMは 完全に消失していた. 近年AVMに 対する治療法としてカテーテル による塞栓術が頻用されているが, 本症例のように流出系に異常血管瘤を伴う場合には, 塞栓術は危 険を伴い, 不確実である. このような症例には feeding artery を結紮し瘤を切除することが, より確 実で安全であり, 今回のような外科的摘出術が第一選択になると思われる. 日心外会誌23巻2号: 125-128 (1994)

Development of a vascular prosthesis for a growing child: a graft expandable in vivo

Specially designed vascular prostheses that can be dilated after implantation using a percutaneous transluminal angioplasty (PTA) balloon catheter have been developed. The grafts are made of woven polyester fiber fabrics, the circumferential yarns of which consist of two different types of polyester fiber bundles: One is a straight weak bundle, the other is a strong bundle wound around the former. The graft with an initial diameter of 6 mm could be dilated to 9 mm by luminal inflation of the balloon four to five times at 10 atmospheres (atm) in vitro. After disrupting the weak bundle by the dilatation procedure, the strong bundles were straightened, which maintained the enlarged diameter of the new caliber. Grafts of 6 mm in initial diameter implanted into the thoracic aortas of mongrel dogs for 3 months also could be dilated in vivo by inflating the PTA four to five times at 15 atm, as found in the vitro study. Macroscopic observation revealed that, around the dilated grafts, only a tiny hematoma was formed and nominal subsequent bleeding was observed, which indicated that the dilatation procedure was performed safely. The graft, which enables adaptation of the hydrodynamic property of the graft to the increased blood flow by PTA after implantation, is applicable in a growing child.