Few instruments are currently available to test mitral valve function in an ex vivo state due to the technical difficulties involved. To investigate the native ex vivo mitral valve or prosthetic mitral valve with chordae, we developed a mitral valve adapter with an annulus suturing portion and 2 papillary muscle suturing sites that can be changed in angle, direction, and length of chordae. We used this adapter to test an ex vivo mitral apparatus in beagle dogs and evaluated the morphology and function of the mitral apparatus by endoscopy. Our newly designed mitral valve adapter proved extremely useful for examining the ex vivo mitral valve anatomy and function and for testing stentless mitral prostheses with annular-papillary muscle continuity.

The implementation of coronary artery bypass grafting for angina pectoris with ulcerative colitis has been rarely reported. A 63-year-old man has a past history of acute myocardial infarction in 1984 and ulcerative colitis since 1988. Coronary angiography and cardiac catheterization showed total obstruction of segment 2, 95% stenosis of segment 6, 75% stenosis of segment 7 and total obstruction of segment 12 with LVEF 23%. Coronary artery bypass grafting was performed under IABP support and cardiopulmonary bypass with aprotinin infusion after an inflammatory reaction of ulcerative colitis was adequately suppressed. Ulcerative colitis was controlled by administering 40 mg of predonisolone during perioperative period.

Histopathological examination of a repair of left ventricular free wall rupture associated with acute myocardial infarction using GRF glue was reported. A 63-year-old male with cardiac rupture due to LMT total occlusion was referred to our ward after unsuccessful PTCA with institution of IABP and PCPS. Left ventricular rupture repair by GRF glue and xenograft pericardial patch with concomitant myocardial revascularization (SVG-LAD, CX) was performed under cardiopulmonary bypass. Hemostasis around the ventricular rupture was easily accomplished. Unfortunately, the patient died at 14 POD because of low output syndrome caused by broad myocardial infarction. At autopsy, rupture site was examined histologically and was revealed that GRF glue made a tight adhesion between patch and myocardium. Neither abnormal inflammatory cells nor giant cells were found. We concluded that GRF glue might be a effective histocompatibly in hemostasis for left ventricular rupture associated with acute myocardial infarction.

Lentinan, a (1-3)-beta glucan from Lentinus edodes, is licensed as an immunostimulatory drug. We tested the effect of lentinan in the well-established model system of the murine Listeria monocytogenes infection. Pre-treatment of bone marrow macrophages and dendritic cells with lentinan resulted in increased production of TNF-α and IL-12 after L. monocytogenes infection in vitro. After lentinan treatment bone marrow macrophages showed increased NO-production and enhanced cytotoxic activity against L. monocytogenes. Pre-treatment of mice with lentinan resulted in increased concentrations of TNF-α, IL-12 and IFN-γ and also an increased number of L. monocytogenes specific CD8 T cells in the spleen. The bacterial burden in spleen and liver of mice was significantly reduced during primary and secondary Listeria infection after lentinan pre-treatment of mice. In summary these results show that lentinan enhances the protective CD8 T-cell response against L. monocytogenes probably by a mechanism that involves the IL-12-mediated augmentation of the specific antilisterial CD8 T-cell response.

It is known that lymphocyte function is impaired after cardiopulmonary bypass (CPB). In this study, the lymphocyte stimulation test (LST) with PHA was used before and after CPB in 28 adult patients, and compared with the surgical parameters and serum cytokine (IL-6, IL-8) levels. LST was impaired after CPB in all patients. Although this value usually recovered by the third postoperative day (POD); (normal group, n = 16), some patients showed prolonged duration of the impaired LST (delayed group, n = 12). Therefore, the parameters of surgery, white blood cell (WBC) count, lymphocytes and subsets, and serum cytokine levels were compared between the normal and the delayed groups. There was no significant difference in the number of WBCs or lymphocytes between these two groups. OKT4-positive cells were reduced on the first POD in both groups, and in the normal group, the number of OKT4-positive cells recovered more quickly than in the delayed group. Serum IL-6 and IL-8 levels in the delayed group were elevated after CPB, and were significantly higher in the delayed group than in the normal group. In conclusion, patients who showed prolonged impairment of lymphocyte function may be partly due to prolonged CPB.

A 8-month-old infant with Darling' type Ib of total anomalous pulmonary venous drainage underwent surgical correction. Common pulmonary vein drained into superior vena cava. Pulmonary venous channel was constructed between orifice of common pulmonary vein and atrial septal defect (ASD) with pericardial baffle drainage. Pulmonary venous obstruction occurred at the site of ASD and pericardial baffle was atrophic. ASD was enlarged and new pulmonary venous channel was reconstructed with EPTFE graft. Post-reoperative clinical course was uneventful.

In 24 patients subjected to cardio-pulmonary bypass (CPB) operation, changes in colloid oncotic pressure (COP), cardiac index (CI), respiratory index (RI), and pulmonary capillary wedge pressure (PCWP) were measured within a 48 hour period. The patients were divided into two groups according to dose levels of catecholamine. In 18 patients received small catecholamine doses, a stable hemodynamic and respiratory status were maintained. However, 6 patients received catecholamine doses of more than 15 micrograms/kg/min exhibited low COP, low CI, high RI and high PCWP. In this study we designed a new hemodynamic diagram using COP-PCWP and CI as parameters of the cardiac function. We consider that these parameters are more suitable than Forrester's parameters to evaluate the patient's condition before and after open heart surgery.

A 31-year-old woman had a left atrial myxoma associated with severe pulmonary hypertension and respiratory failure because of incarceration of the tumor to the mitral valve. Emergency surgery was performed, but the patient could not be weaned from cardiopulmonary bypass because of right ventricular failure. A Biomedicus centrifugal pump was used as a right ventricular assist pump. The result was a successful termination of cardiopulmonary bypass. With the support of an intra-aortic balloon pump, the right ventricular assist pump was removed 38 hours after the operation, and the intra-aortic balloon pump was terminated 2 days later. The centrifugal pump is very useful at the majority of centers where the pneumatically activated bi-valved ventricular assist device is unavailable. The Biomedicus centrifugal pump can be easily applied for treatment of perioperative right ventricular failure and is very useful for short-term use without systemic anticoagulants.

A 66-year-old female with a mitral stenosis and a left atrial massive ball thrombus is presented. She was admitted due to a transient right hemiplegia and a speech disturbance. This thrombus had been detected preoperatively by an echocardiogram and a left atriography. A mitral valve replacement using a Björk-Shiley valve 27 mm, accompanied with the removal of the thrombus was performed. The ball thrombus was dark red, 55 x 35 x 32 mm in size and 15 g in weight. After the surgery, the patient progressed well. Because of the high frequency of peripheral embolism and of sudden death, a left atrial ball thrombus should be removed immediately.

A 10 year old girl with diagnosis of Noonan syndrome was admitted to our hospital because of easy fatiguability and cardiac murmur. She had a peculiar face with hypertelorism, saddle nose, webbed neck and kyphosis. Chromosomal analysis demonstrated normal 46 XX pattern. Associated cardiac anomalies in this case were atrial septal defect, ventricular septal defect and pulmonary stenosis caused by pulmonary valvular dysplasia. The cardiac anomalies were corrected successfully and postoperative clinical course was uneventful.

Cu, Zn-SOD levels, free hemoglobin (Hb) and CPK-MB were measured in 18 patients undergoing open heart surgery. In order to evaluate the serum level of Cu, Zn-SOD, the ratio of Cu, Zn-SOD/free Hb was used to eliminate an influx of Cu, Zn-SOD released from erythrocytes during cardiopulmonary bypass. The value of Cu, Zn-SOD/free Hb was decreased significantly 30 minutes after aortic declamping and the minimal value was indicated 1 hour after the termination of cardiopulmonary bypass compared with the preoperative status. We thought that the decrease was due to the consumption of SOD competing against free radical generation. The correlation between the minimal value of Cu, Zn-SOD/free Hb and the ischemic time was apparent but the correlation between the minimal value of Cu, Zn-SOD/free Hb and the value of peak CPK-MB was not determined. It was suggested that the serum free radicals were not only derived from the heart but also from the lung or other parts of the body during open heart surgery.

To clarify the effectiveness of nicardipine, one of the dihydropyridine calcium-channel blockers, for myocardial protection during cold potassium cardioplegic arrest in pediatric cardiac surgery, a clinical trial of nicardipine (0.25 mg/L) added to potassium cardioplegic solution was performed in children undergoing surgical repair of congenital heart diseases. Twenty patients were selected to receive nicardipine cardioplegia and 13 patients received a standard potassium cardioplegia, serving as a control group. Nicardipine cardioplegia provided better cardiac performance in the early postoperative period and reduced release of the MB isozyme of creatine kinase, as determined during a 48-hour postoperative period. These results suggest that nicardipine added to cold potassium cardioplegic solution offers additional protection for the myocardium during ischemia and postischemic reperfusion in pediatric cardiac surgery.

A 66-year-old female was admitted to our hospital with acute heart failure (NYHA III), and diagnosed as an MR + Tr. The cause of MR was torn chordae of the posterior leaflet of the mitral valve. A prolapse part of the posterior leaflet was resected and sutured by McGoon's method. Valvuloplasty was performed by using a Carpentier ring. Postoperative course was uneventful. She recovered well after the operation. Histological examination of the valve showed myxomatous degeneration.

Three patients underwent surgery for postmyocardial infarction ventricular septal perforation (VSP) within 3 to 21 days after onset of infarction. The hemodynamic stabilization was not obtained despite aggressive medical treatment including Intra-aortic Balloon Pumping (IABP) in one patient. The others had sudden hemodynamic deterioration during IABP support. In two of the three cases, the VSP were closed via transinfarct ventriculotomy with double Dacron patch, and ventricular wall reconstruction was performed to sandwich the double septal patch between ventricular free walls with Dacron felt strips. Two of the three patients survived. Our experience suggests that early surgical intervention is essential unless medical therapy results in clinical improvement and the double patch method may provide a successful operative repair and comeout.