Junichi Ninomiya

Laser vascular welding in biologic grafts

This study evaluated the possibility and efficacy of laser welding in biologic vascular grafts. Grafts were anastomosed to 21 canine peripheral (femoral and/or carotid) arteries or coronary arteries with a Nd-YAG laser using the contact method. The laser welds were fashioned using 1-1.5 W power for 1-3 sec. The grafts used were heparinized canine carotid artery cross-linked with polyepoxy compounds. The welding was a success in 92% (22/24) of the peripheral artery and 83% (5/6) of the coronary artery procedures. The early patency rate was 100%. The anastomotic sites were strong enough to withstand high pressure (more than 300 mmHg of arterial pressure). Histologic examination was performed on days 0 and 3, 1 week, 3 weeks, or more than 1 month postoperatively to compare the progression of healing. The laser welded sites had a smooth external surface and minimal damage of the internal layer, with minimal inflammatory response and no pathologic granulation. The welded sites fused strongly after 1 postoperative week. In conclusion, an Nd-YAG laser, using a contact method, could successfully weld peripheral and coronary arteries to biologic vascular grafts.

Continuous transoesophageal echocardiography monitoring during weaning from cardiopulmonary bypass in children

The purpose of this study was to evaluate the effectiveness of transoesophageal echocardiography monitoring during weaning from cardiopulmonary bypass after intracardiac repair in children. The left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricle wall motion were monitored continuously by transoesophageal echocardiography in controls weaned easily from cardiopulmonary bypass (group A, n = 25), and those weaned with difficulty from cardiopulmonary bypass after mechanically assisted circulation (group B, n = 16). In group A, left ventricular ejection fraction and left ventricle wall motion were within normal range, and did not change significantly during weaning after cardiopulmonary bypass when compared with pre-bypass data. In contrast, left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricle wall motion in group B during the first trial of weaning from bypass were significantly worsened. Hence, assisted circulation was performed until the data obtained via transoesophageal echocardiography improved with regard to maintenance of fluid balance, catecholamine dosage and assisted pump flow. All cases in group B were weaned safely from cardiopulmonary bypass despite their critical condition. In conclusion, continuous transoesophageal echocardiography monitoring may be a useful tool in children with severe heart failure for safe weaning from cardiopulmonary bypass after intracardiac repair.

A case of strut fracture of the new Björk-Shiley mital valve prosthesis

We treated a 61-year-old Japanese man with a strut fracture of the new Björk-Shiley mitral valve. This fracture occurred about two months after mitral valve replacement. Emergency reoperation was performed as soon as the chest X-ray showed the fracture, despite the presence of cardiopulmonary shock. He died on the 3rd postoperative day. Similar reported cases of literature are reviewed.

Recent progress of surgical treatment for congenital heart disease

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