Kazumi Taguchi

Surgical correction of aneurysm of the sinus of Valsalva: A Report of forty-five consecutive patients including eight with total replacement of the aortic valve

Abstract Pathologic, diagnostic and therapeutic aspects of 45 patients with an aneurysm of the sinus of Valsalva are discussed. The surgical procedure must be individualized for a patient according to the pathologic situations when fibrotic or prolapsing aortic cusps are encountered. Three choices are available in the surgical correction of this lesion: simple circumferential Teflon patch, circumferential sandwiched Ivalon-Teflon patch and, finally, prosthetic replacement of the aortic valve after a patch. The presence of fibrotic prolapsing aortic cusps will dictate the choice of valve replacement, while the prolapse alone may be corrected by means of sandwiched patch technic.

Changes in Blood Cortisol and Aldosterone Levels and Ultrastructure of the Adrenal Cortex During Hemorrhagic Shock

Changes of secretory activity and structure of the adrenal cortex were observed in dogs subjected to hemorrhagic shock. Blood cortisol and aldosterone levels were rapidly increased after hemorrhage. The cortisol level reached a maximum value about 5 times that of normal 1 h after hemorrhage, while aldosterone levels attained maximum levels showing a 10-fold increase over normal, considerably later (at the end of the impending stage) than the cortisol. Cortisol secretion was quickly depleted at the end of critical stage and terminal stage of normovolemic shock, while the aldosterone secretion remained relatively high. Morphologically, sticking of leukocytes to the sinusoidal wall and accumulation of SER around lipid droplets in the fasciculata and reticularis cells became conspicuous 1 h after hemorrhage. At the end of the impending stage, infiltration of leukocytes occurred in the zona fasciculata and reticularis. Irregular masses of fibrin strands appeared in the sinusoidal space and at large gaps of the sinusoidal wall. Degenerative changes such as aggregation of SER, dilatation of endoplasmic reticulum and edema were observed in the cells of zona fasciculata and reticularis, especially of inner half of the former. At the end of the critical stage, small necrotic foci and hemorrhage with inflammatory infiltration were scattered in the inner half of the zona fasciculata. Degeneration of the cells of zona fasciculata and reticularis became more severe in this period, while the cells of zona glomerulosa remained unchanged. At the terminal stage of normovolemic shock after reinfusion, degeneration and necrosis were remarkable in the cells of zona fasciculata and reticularis, especially of the inner half of the zona fasciculata. Moreover, destruction of cordal structure, hemorrhage and inflammatory infiltration were distinct in the zona fasciculata and reticularis, while the zona glomerulosa was relatively well preserved.

Intracytoplasmic Inclusion Bodies in Hepatocytes During Prolonged Extracorporeal Circulation

Hyaline inclusion bodies appeared in hepatocytes of acutely congested livers produced by prolonged extracorporeal circulation. The inclusions were positive by PAS, PTAH and Ziehl-Neelsen staining and were colored light green to green by Massons trichrome staining. In methylene blue-stained sections, they were divided into two groups, pale to light blue (Type I) and dark blue (Type II). By electron microscopy, small vacuolar structures which contained small amounts of flocculent material appeared near the vascular pole of hepatocytes at early stages of the experiment. With lapse of time, they became larger and had compact amorphous material. These inclusions corresponded to the Type I inclusions seen by light microscopy. By electron microscopic cytochemistry, these inclusions were usually positive to the acid phosphatase reaction and negative to the DAB reaction. With an increase in serum free hemoglobin, electron-dense inclusions corresponding to the Type II inclusions appeared in the hepatocytes. They were strongly positive to the DAB reaction. Large ones were usually positive to the acid phosphatase reaction in the peripheral narrow rim. Large invaginations of cytoplasmic membranes and large hydropic vacuoles were observed at the late stage of the experiment. They contained frequently fibrin strands or a few erythrocytes. Autophagic vacuoles and myelin figures were also increased in the hepatocytes at the late stage of the bypass circulation.

ELECTRON MICROSCOPIC OBSERVATION OF HUMAN HYPERTROPHIED MYOCARDIUM

Hypertrophied muscle cells of the right ventricles obtained from 12 patients with congential malformation of the heart (VSD, TF, A‐V canal and AASV) have been studied by electron microscope.

Deterioration of ebstein disease after closure of atrial septal defect

We treated a 7-year-old girl in whom the clinical evidence of Ebstein disease was manifest after a surgical closure of an atrial septal defect. This manifestation, which was not evident either in the preoperative catheterization studies or during operative investigation of closure of the atrial septal defect, required further hemodynamic and angiographic evaluation. Tricuspid valve replacement with Hall-Kaster prostheses was carried out.

ULTRASTRUCTURAL CHANGES OF THE DOG MYOCARDIUM IN EXTRACORPOREAL CIRCULATION

The effects of the cardiopulmonary bypass circulation on the cardiac muscle cells were studied electron microscopically. Subendocardial hemorrhage was commonly recognized in both ventricles. However, it appeared earlier and more severely in the right ventricle than In the left ventricle. Clear flocculent areas containing numerous filamentoue structures were originated from degradation of myofibrils. Degradation of myofibrils occurred within 1 hour after bypass circulation. Degenerative changes of myocardial cells such as zonal lesions, contraction bands and swelling or condensation of mitochondria appeared in both ventricles. Damages of myocardial cells In right ventricular wall were more severer as compared with those in the left throughout the period of observation. ACTA PATH. JAP. 27: 435–445, 1977.

Aortic cannulation for cardiopulmonary bypass.

The surgical technique and complications of aortic cannulation for arterial return in total body perfusion utilizing oxygenator were presented based on our experience of 400 patients. Major complications encountered were laceration and bleeding (1 case), hematoma formation and bleeding (2 cases), and malpositioning of the catheter resulting in mild brain damage (1 case). All underwent re-operation with 4 survivals. Aortic cannulation is simple to perform, easy to maintain stability in cardiopulmonary bypass and with much less risk of retrograde dissection in all ages.

Pre- and Postoperative Left Ventricular Bypass Support in Patients With Myocardial Infarction

Pre- and postoperative circulatory support employing ventricular bypass with local heparinization and blood filtration for 5 to 72 hours was conducted in 5 patients with myo cardial infarction. All of these patients had critical cardiac conditions due to cardiogenic shock. Postoperative introduction of ven tricular bypass support was not effective in 2 patients because of bleeding due to removal of hemorrhagic infarcted myocardium, or because of failure to gain sufficient blood re turn from the ventricle. However, the pre operative use of ventricular bypass was ef fective in promoting the ultimate survival of 2 of the 3 patients who underwent surgery.

Surgical Treatment of Congenital Heart Disease with Special Reference to the Application of Hypothermia

This report presents the results of operation for congenital heart disease using two different methods of hypothermia: (1) Immersion hypothermia alone. Of the 782 patients who underwent open-heart operations using this method the results were good in patients whose intracardiac surgical repair took less than one hour (average mortality rate, 5.6%). (2) Rapid extracorporeal cooling. Of the 269 patients with congenital heart diseases such as ventricular septal defect, tetralogy of Fallot, or atrioventricular canal with low cardiac reserve who underwent operation with mild to moderate hypothermia utilizing rapid extracorporeal cooling, the mortality was 11.2%. In the 151 patients with more serious defects, including the extreme form of tetralogy of Fallot, single ventricle, and truncus arteriosus, who underwent open-heart operations with deep hypothermia utilizing extracorporeal cooling, the mortality rate was 15.2%.