Masahiko Onoe

Modified ultrafiltration removes serum interleukin-8 in adult cardiac surgery

Cardiopulmonary bypass (CPB) causes an increase in serum cytokine levels and systemic inflamatory responses, which may trigger the onset of various types of postoperative organ failure. In the present study, modified ultrafiltration (MUF) was applied in cases of adult cardiac surgery and an attempt was made to determine whether MUF reduces serum interleukin-8 (IL-8) levels. Nine patients who underwent cardiovascular surgery with CPB and MUF between June 1996 and June 1997 were compared with nine control patients who underwent cardiovascular surgery without MUF in the same period. Modified ultrafiltration was performed, based on a method proposed elsewhere. Serum IL-8 was measured by enzyme immunoassay at the start of CPB, immediately after CPB, immediately after MUF and 3 h after MUF. The mean filtrated volume was 1550.0 ± 173.2 ml. In the MUF group, haematocrit increased significantly from 21.2 ± 2.0 to 24.9 ± 3.3% (p = 0.0008), while systolic blood pressure increased from 97.5 ± 16.7 to 116.5 ± 23.9 mmHg (p = 0.0024) after MUF. In contrast, there were no changes in either haematocrit or blood pressure in the control group. In the MUF group, serum IL-8 was reduced from 69.5 ± 33.5 to 58.9 ± 32.4 pg/ml after MUF (p = 0.0029), whereas it was not reduced in the control group. The results of the present study suggest that MUF has beneficial effects on postoperative haemodynamics, and can reduce serum IL-8 levels in adult cardiac surgery.

Modified Ultrafiltration May Improve Postoperative Pulmonary Function in Children with a Ventricular Septal Defect

Abstract To evaluate the effectiveness of modified ultrafiltration (MUF) on ventricular septal defect (VSD) repair in children, we retrospectively examined 10 patients who underwent VSD repair with MUF at the Kinki University School of Medicine hospital between June 1998, and December 1998 (MUF group). These patients were compared with 14 patients who underwent the same procedure without MUF (control group) between January 1997 and June 1998. Systolic blood pressure and hematocrit values increased significantly during MUF. By the time of postoperative transfer to the intensive care unit, PaO2 was higher in the MUF group than in the control group (503.3 ± 112.2 mmHg vs 376.3 ± 149.2 mmHg; P = 0.0491), whereas A-aDO2 was lower in the MUF group than in the control group (171.9 ± 109.2 mmHg vs 301.1 × 150.4 mmHg; P = 0.0449). These findings demonstrate that MUF had a beneficial effect on pulmonary function in children who underwent surgery to repair a VSD.

Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery

Objective Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24–28°C) or deep hypothermia (18–24°C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28–32°C). Design Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. Results Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. Conclusions Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.

Total cavopulmonary connection using a pedicled pericardial conduit for a patient with apicocaval juxtaposition

A 5-year-old boy, with a double inlet solitary ventricle, pulmonary atresia, and apicocaval juxtaposition underwent an extracardiac total cavopulmonary connection. A pedicled pericardial conduit was placed behind the ventricle to make a straight pathway between the inferior vena cava and pulmonary artery. This report presents a solution for managing patients with complicated heart defects with apicocaval juxtaposition during the completion of a total cavopulmonary connection.

Beneficial effects of ω-3 fatty acid treatment on the recovery of cardiac function after cold storage of Hyperlipidemic rats

Cardiac effects of omega-3 polyunsaturated fatty acids (PUFAs) were studied in female Wister rats fed a standard diet (control [C] diet) or a high-cholesterol (HC) diet. Subgroups of rats from these groups were treated with eicosapentaenoic acid-E (EPA) or docosahexaenoic acid-95E (DHA) for 5 weeks. Although plasma total cholesterol (TC) and triglyceride (TG) levels were higher in each group fed the HC diet versus each group fed the C diet, EPA administration with the HC diet (HC + EPA) significantly (P < .05) reduced these levels. An isolated working-heart preparation was used to determine cardiac function. Cardiac output (CO) was lower in rats fed the HC diet and HC + DHA versus any of the groups fed the C diet (P < .05). In addition, left ventricular (LV) maximum differentiation of pressure-time curve (dp/dt) was lower in the rats fed the HC diet versus any of the C diet groups (P < .05). After evaluation of cardiac function in each rat, the heart was stored in a histidine-tryptophan-ketoglutarate solution for 8 hours at 4 degrees C. The heart was then reperfused, and recovery of cardiac function was evaluated. No significant differences were observed for post-preservative cardiac function within the C diet groups. However, within the HC diet groups, HC + EPA significantly (P < .05) improved the recovery of cardiac function. In addition, HC + DHA also significantly (P < .05) improved the recovery of coronary flow (CF) and LV dp/dt. No significant differences were observed for plasma TC and TG concentrations in the C diet groups. EPA administration significantly decreased cardiac levels of palmitic, oleic, and linoleic acids in the HC diet groups. No significant differences were observed for cardiac levels of free fatty acids (FFAs) within the C diet groups. Cardiac EPA and DHA levels were significantly (P < .05) elevated in EPA- or DHA-treated rats compared with the other diet-fed rats. Cardiac EPA levels were also elevated in DHA-treated rats compared with untreated rats (P < .05). These results suggest that EPA attenuates coronary and myocardial preservation injuries through an increase in serum lipids and an accumulation of myocardial FFAs resulting from a HC diet.

Massive mediastinal bleeding due to spontaneous rupture of the vertebral artery in von Recklinghausen disease

In Von Recklinghausen disease, patients rarely demonstrate vascular abnormalities, but several reports have noted massive bleeding from vascular rupture. A 28-year-old man with Von Recklinghausen disease was admitted to our hospital because of swelling on the left neck accompanied by dyspnea. Neck and thoracic CT revealed a high density shadow on the mediastinum and left upper thorax which was suspected to indicate hemomediastinum. Under suspicion of bleeding from the intrathoracic artery, the patient underwent on surgery. Massive hematoma disrupted visual recognition of bleeding point, but under anatomical consideration, we concluded that the bleeding was from the ruptured left vertebral artery (VA) which branched independently from the aorta. The left VA was ligated distally and proximally. Left subclavian artery, injured unexpectedly, was not reconstructed but sutured carefully because of its fragility. Thus massive bleeding was controlled. Histology of the neighboring subclavian artery revealed involvement with neurofibrinomatosis. Although the patients left arm demonstrated a slightly low blood pressure, he was discharged without complaint on the 56th postoperative day.

Intravascular Extraction of Permanent Pacemaker Leads

Abstract.Purpose: Cardiac leads that became infected, fail, or are otherwise problematic present difficulties in the management of patients. In this report, we assess our intravascular countertraction technique. Method: Between February 1990 and January 2001, 13 leads were removed from 11 patients using the intravascular countertraction technique. The reasons for lead extraction were pacemaker infection and lead dysfunction. Results: In two of these patients, the ventricular leads could not be completely removed. The complete success rate was 85% and the overall success rate was 92%. There were no serious complications such as cardiac rupture, vein injury, or death, and there were no clinical signs of pulmonary embolism. In one of the patients whose ventricular leads could not be removed completely, the ventricular lead was stretched from its previous round shape, but tricuspid valve regurgitation did not occur during the 3-year follow-up period. In the other patient, the distal electrode was left in the subclavian vein. However, this residual distal electrode did not migrate, and there were no clinical signs of any recurrence of infection. Conclusions: The present study suggests that to remove leads successfully, the largest locking stylet that can be easily passed to the leads tip through the coil lumen should be chosen in order to avoid valve injury, which can sometimes occur when a ventricular leads locking stylet is left in the coil lumen.

Cardiac operation for a patient with autoimmune hemolytic anemia with warm-reactive antibodies

We present a case of a patient with autoimmune hemolytic anemia with warm-reactive antibodies who underwent successful coronary artery bypass grafting. We discuss some of the important problematic issues related to perioperative management.

Disseminated Cholesterol Embolism After Coronary Artery Bypass Grafting

Blue toe syndrome caused by cholesterol emboli is a relatively benign disease. However, disseminated cholesterol embolism is a life‐threatening condition. We describe here the case of a 71‐year‐old female admitted because of anterior chest pain and intermittent claudication. Following cardiac catheterization, warfarin potassium was administered. However, the patients toes soon darkened bilaterally, and BUN and creatinine levels increased from the normal value. Skin discoloration and renal failure were improved after stopping warfarin potassium administration. The patient underwent coronary artery bypass grafting and left femoropopliteal bypass. Cerebral infarction and renal failure occurred postoperatively due to disseminated cholesterol embolism. The patient died from renal failure on the 16th postoperative day without regaining consciousness following surgery. For high risk patients, interventional procedures to the ascending aorta must be avoided. When CABG cannot be avoided for coronary revascularization, off‐pump bypass and use of arterial grafts are recommended.

Myxoma of the aortic valve

Myxoma of the aortic valve is exceedingly uncommon. In this article, we report a 58-year-old man with myxoma arising from the aortic valve. Aortic valve replacement was performed, and postoperative histologic examination showed myxoma of aortic valve.