IntroductionSarcoplasmic-endoplasmic reticulum Ca2+ ATPase (SERCA) inhibitor, cyclopiazonic acid(CPA) makes store empty of Ca2+ in sarcoplasmic reticulum(SR) which activates Ca2+ influx through store-operated Ca2+ channels(SOCCs) to lead store-operated calcium entry(SOCE). The molecular biological structure of SOCCs recently known to contribute to the above is calcium releasing activated calcium channel protein 1(Orai1). The overall goal of this ex-vivo study is to investigate the effects of intravenous anaesthetics on SOCE which is induced by CPA in isolated thoracic aorta of rat. The effect of SERCA inhibitor, CPA in endothelium-denuded rings is different to that of endothelium-intact rings in the isometric tension study. And the inhibitory effects of intravenous anaesthetics on CPA-induced contractions in endothelium-denuded rat aorta and these anaesthetics attenuated the expression of Orai1 protein activated by CPA.MethodResearch has shown that isometric tension experiments with the isolated aorta of Male Sprague Dawley rats(n=49) cofirm that CPA is able to make SOCE. Further more, the contractile responses in endothelium-denuded rat aortic rings showed that intravenous anaesthetics inhibits SOCE caused by CPA. Finally, Western blotting showed these intravenous anaesthetics inhibit the expression of Orai1.ResultsContractile response to CPA appeared hardly or a little in the endothelium-intact rings but markedly and sustained in endothelium-denuded rings. Application of Nω -nitro-L-arginine methyl ester (L-NAME) as a inhibitor to nitric oxide synthase and indomethacin as a inhibitor to cycolooxygenase in endothelium-intact rings before 30 minutes of CPA produced the similar contractile responses with those of endothelium-denuded rings. These contractile responses were inhibited by 2-aminoethyl diphenyl borinate (2APB), SOCE inhibitor(P < 0.05).The inhibition of contractile responses appeared in 30 μM and 100 μM of propofol, 100 μM of thiopental, 10 μM of midazolam and 100 μM of ketamine(P < 0.05). However, dexmedetomidine showed no effects to contractile responses of CPA. The expression of Orai1 decreased significantly in the group of 100 μM of thiopental and 10 μM of midazolam in comparison with the control(P<0.05).DiscussionReferences1. Yang B, Gwozdz T, Dutko-Gwozdz J, Bolotina VM. Orai1 and Ca2+-independent phospholipase A2 are required for store-operated Icat-SOC current, Ca2+ entry, and proliferation of primary vascular smooth muscle cells. Am J Physiol Cell Physiol 2012; 302(5): C748-56. IntroductionSarcoplasmic-endoplasmic reticulum Ca2+ ATPase (SERCA) inhibitor, cyclopiazonic acid(CPA) makes store empty of Ca2+ in sarcoplasmic reticulum(SR) which activates Ca2+ influx through store-operated Ca2+ channels(SOCCs) to lead store-operated calcium entry(SOCE). The molecular biological structure of SOCCs recently known to contribute to the above is calcium releasing activated calcium channel protein 1(Orai1). The overall goal of this ex-vivo study is to investigate the effects of intravenous anaesthetics on SOCE which is induced by CPA in isolated thoracic aorta of rat. The effect of SERCA inhibitor, CPA in endothelium-denuded rings is different to that of endothelium-intact rings in the isometric tension study. And the inhibitory effects of intravenous anaesthetics on CPA-induced contractions in endothelium-denuded rat aorta and these anaesthetics attenuated the expression of Orai1 protein activated by CPA.

Although thrombotic thrombocytopenic purpura (TTP) is a rare disease, when it develops in a post-cardiac surgery patient, it may have a fatal outcome. Since the frequency of early-onset thrombocytopenia in post-cardiac surgery patients is high, platelet concentrates are commonly transfused during postoperative management. However, when TTP is the likely diagnosis, platelet transfusion is not recommended. We experienced a postoperative TTP in a cardiac surgery patient and discovered the importance of identifying the etiology of postoperative thrombocytopenia. Here, we report the case with a brief review of the literature.

Thrombolytic effects of fucoidans were investigated in the FeCl3-induced arterial thrombus mouse model and compared with heparin and tissue plasminogen activator (t-PA). Thrombosis model was made by applying 5% FeCl3 on the carotid artery of a Balb/c mouse. Twenty minutes after complete occlusion, a couple of test agents including fucoidan were infused into each mouse group with various doses intravenously, before measuring the time to reperfusion. The occluded arteries were reperfused 37.5 +/- 12.4 min after administration of unfractionated fucoidan from Undaria pinnatifida sporophylls (UPS-UF) with a dose of 100 mg/kg. In the mice given either a low-molecular-weight UPS fucoidan or fucoidan source from Fucus vesiculosus (FV-UF), reperfusion was delayed at 55.0 +/- 8.0 min with a higher reperfusion effective dose (RED) of 1 g/kg or at 63.3 +/- 7.2 at RED of 200 mg/kg, respectively. In the control mice given t-PA of 15 mg/kg, reperfusion occurred at 24.8 +/- 6.5 min after administration. In contrast, reperfusion was not observed in the occluded mice given heparin (P<0.001) in the range of 60-1000 mg/kg. Minimal injection of fucoidan in addition to a given t-PA-enabled restoration of blood flow in the blocked artery without reocclusion at 17.2 +/- 2.3 min postinjection (P<0.002). In conclusion, algal fucoidan has both thrombolytic activity and a stimulatory effect on the thrombolytic activity of t-PA in a dose-dependent manner at an arterial thrombosis model. Blood Coagul Fibrinolysis 23:359-366 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

The proximity of thoracic aortic aneurysm to the left subclavian artery (LSA) has made the coverage of LSA during thoracic endovascular aortic repair (TEVAR) be essential. Despite controversy concerning the safety of LSA coverage and the indications for LSA revascularizations, the cerebral hemodynamic change after LSA coverage has not been demonstrated. We prospectively examined two patients who would undergo TEVAR with LSA coverage by using 2D cine phase contrast MR imaging. After LSA coverage, the left subclavian steal was properly compensated by the increased flow volumes of both carotid arteries and right vertebral artery, which is the major collateral supply. The total brain supply after TEVAR did not lessen, which showed good correlation with uneventful clinical outcome. Therefore, 2D phase contrast MR imaging can be recommended as a useful technique to evaluate the hemodynamic change of the LSA coverage during TEVAR and to triage the candidate for LSA revascularization.

A 29-year-old man was admitted for abrupt dyspnea and hemoptysis. An echocardiogram revealed severe mitral regurgitation due to papillary muscle rupture for which an emergency mitral valve replacement operation was performed 4 days after admission. Herein, we report our experience with this case along with a review of the literature.

BACKGROUND:Conventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option.MATERIALS AND METHODS:From August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared.RESULTS:Although not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed.CONCLUSION:Compared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

Chiari's networks are present in 1.5% to 4% of the population. They are a congenital disease characterized by a remnant of the right valve of sinus venosus and rarely have clinical significance. Chiari's network, as the name implies, has network-like shape, but there are other forms of appearance. We have experienced a case of a 60-year-old woman who had a cystic mass on the right atrium. Surgical treatment was performed forthe mass removal and differential diagnosis of the mass. There was no evidence of other tumor, but Chiari's network. As cystic form of Chiari's network have not been reported before, it is the first report of cystic form of Chiari's network.

Aortic thrombi are important because it can cause the central and peripheral embolizations. Aortic thrombi can occur anywhere in the aorta but extremely rare in ascending aorta without atherosclerosis, aneurysm, cardiosurgical or traumatic state. Systemic sclerosis (SSc) is an autoimmune disorder of connective tissue and it can involve multisystem. Enhanced coagulation pathways, decreased fibrinolysis, and endothelial dysfunction probably contribute to vascular events in SSc. We report a case of a highly mobile thrombus in the ascending aorta, presented as an acute embolic stroke in the patient with systemic sclerosis. Surgical removal was performed to prevent recurrent embolic events.

Right sided aortic arch is an uncommon congenital anomaly. It can be classified into three types, depending on the left aortic arch's degenerating pattern and the branching pattern of the great vessels. It can be associated with major congenital heart disease, depending on the type of right sided aortic arch. We report a case of an 18-years-old female who has right sided aortic arch with atrial septal defect (ASD). In our case, the patient had a right sided aortic arch and aberrant left subclavian artery, also she had ASD (ostium secundum) and moderate tricuspid regurgitation with pulmonary hypertension. The patient was successfully performed patch closure of ASD and tricuspid valve annuloplasty via midline sternotomy. The patient had uneventful postoperative course.

The antithrombotic activities and bleeding effects of selected fucoidans (source from either Undaria pinnatifida sporophylls or from Fucus vesiculosus) have been compared with heparin in the ferric chloride‐induced arterial thrombus mouse model. Thrombosis was induced by applying 5% ferric chloride for 3 min on the carotid artery region of Balb/c mouse. Five minutes prior to thrombus induction, mice were infused through the tail vein with either saline (control) or polysaccharides. Either fucoidan or heparin was dosed at 0.1, 1.25, 2.5, 5.0, 10, 25, or 50 mg/kg intravenously (i.v.) The carotid blood flow was monitored until more than 60 min post‐thrombus induction. Mouse tail transection bleeding time was measured up to 60 min after making a cut in the mouse tail. Both antithrombotic and bleeding effects were observed in a dose‐dependent manner for both fucoidans and heparin. Thrombus formation was totally (reflected by Doppler flow meter) inhibited at either 5 or 50 mg/kg of unfractionated Undaria fucoidan or a low‐molecular‐weight Undaria fucoidan fraction, respectively, without prolonging the time‐to‐stop bleeding compared with the control (p < 0.01). The total inhibition of thrombus formation was observed for unfractionated Fucus fucoidan at 25 mg/kg where the time‐to‐stop bleeding was still significantly prolonged, by as much as 8 ± 1.7 min (p < 0.02). In contrast the heparin‐treated group showed total inhibition of thrombus formation even at a small dose of 0.8 mg/kg (400 IU) at which bleeding continued until 60 min. In conclusion algal fucoidans are highly antithrombotic without potential haemorrhagic effects compared with heparin in the arterial thrombus model, but this property differs from algal species to species, and from the molecular structure of fucoidans. Copyright © 2011 John Wiley & Sons, Ltd.

A right-sided aortic arch (RAA) is a rare congenital anomaly, and Stanford type B dissection aneurysms involving this anomaly is also uncommon. Surgical approaches to dealing with an RAA are complicated by the unusual anatomical features of the condition. Here we report the case of a 47-year-old male who had a type B dissecting aneurysm involving an RAA with Kommerell's diverticulum. Graft replacement was successfully performed with an uneventful postoperative course.

Atherosclerosis is a chronic inflammatory process occurring in the walls of arteries, in large part due to the accumulation of inflammatory cells. This study was conducted to determine the effect of nuclear factor (NF)-κB decoy oligodeoxynucleotide (ODN) in an atherosclerosis animal model. The mice received i.p. injections of lipopolysaccharide (LPS, 2 mg/kg) three times a week to induce atherosclerotic change, and fed an atherogenic diet for 12 weeks. NF-κB decoy ODN (0.4 mg/kg) was injected into the tail vein. Treatment with NF-κB decoy ODN decreased pro-inflammatory cytokines, tumour necrosis factor (TNF)-α and interleukin (IL)-1β and inflammatory markers, vascular adhesion molecule (VCAM)-1 and intercellular adhesion molecule (ICAM)-1, in the LPS/Fat-induced mice. In addition, the expression of proteins related to fibrosis, transforming growth factor (TGF)-β1 and fibronectin were markedly decreased in the mice treated with NF-κB decoy ODN compared with the LPS/Fat-induced mice without decoy ODN treatment. These data suggest that NF-κB decoy ODN may exert an inhibitory effect on the expression levels of pro-inflammatory cytokines and cell adhesion molecules in atherosclerotic mice.

Seok Kim, M.D.*, Oh-Choon Kwon, M.D.*, Sub Lee, M.D.*, Jun Woo Cho, M.D.*, Chi-Hoon Bae, M.D.*, Ki-Sung Park, M.D.*. Korean J Thorac Cardiovasc Surg 2010;43:529-33. https://doi.org/10.5090/kjtcs.2010.43.5.529

Conventional surgery for aortic arch aneurysms have many postoperative complications and a high mortality rate due to prolonged cardiopulmonary bypass time, especially in high risk patients. In this report, we present two cases of a hybrid procedure that involves open brachiocephalic bypass with concomitant endovascular arch stent grafting in high risk patients with distal aortic arch aneurysm.

Moyamoya disease (MMD) is a progressive cerebrovascular occlusive disease of the internal carotid arteries and anterior and middle cerebral arteries.Non-neurological surgery in patients with MMD is often complicated by cerebral ischemia or infarction.The goals of perioperative management are to maintain normotension, normocarpnia, normovolemia and normothermia.Here we report a case of a patient with MMD who underwent patch closure of an atrial septal defect and pulmonary valvotomy by use of a normothermic and non-hemodiluted cardiopulmonary bypass.To prevent intraoperative neurological complications we performed total intravenous anesthesia with propofol, made burst suppression in EEG and monitored the jugular bulb oxygen saturation (SjvO2) for cerebral desaturation.(

Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. The hemostatic aspects of antiphospholipid syndrome (APS) in patients requiring thrombectomy along with cardiopulmonary bypass present unique challenges to anesthesiologists.We present the case of a 36-year-old woman with thrombosis of the inferior vena cava as a result of APS with particular reference to the precautions that are necessary during the perioperative care.The particularly important things are the prevention of thrombotic or hemorrhagic complications, management of the associated thrombocytopenia and the laboratory methods of monitoring the perioperative anticoagulation in the setting of a prolonged clotting time.

Chylothorax is a rare complication following cardiac surgery for congenital heart diseases. Although conservative management is successful in the majority of cases, surgical intervention is required in a refractory one. Recently, subcutaneous or intravenous infusion of octreotide has been used as a safe treatment that helps avoiding surgical intervention. Herein, we report two cases of postoperative chylothorax treated with parenteral octreotide and conservative therapy.

Purpose : The efficacy of magnetic resonance imaging for evaluating coronary artery disease has been reported. In this study, we evaluated the usefulness of breath-hold segmented K-space cine MR imaging for evaluating the patency of coronary artery bypass grafts (CABG). Materials and Method s : Thirty eight patients with a total of 92 CABGs (36 internal thoracic arteries and 56 saphenous vein grafts) were evaluated using segmented K-space cardiac-gated fast gradient echo sequence (2D-FASTCARD) MR imaging. MR magnitude images were evaluated from the hard copies by two independent observers. A graft was defined as patent if it was seen as a bright small round area on at least two consecutive images throughout the cardiac cycle at a position consistent with the expected location for that graft. Results : MR images were obtained successfully for 23 patients (61%). The sagittal planes were most helpful in visualizing the cross-section of sapheneous vein bypass graft to left circumflex artery branch, whereas the transverse planes were used for identification of internal mammary artery grafts to left anterior descending coronary artery or its branch and identification of saphenous vein grafts to right coronary artery. Forty five grafts were visible using this MR technique, while the grafts were not visible on seven saphenous vein grafts and two internal mammary artery grafts. In two patients showing symptoms of myocardial ischemia, one or two bypass grafts were not visible. Imaging, perpendicular plane to a CABG was important to visualize the flow inside the CABG with maximum sensitivity. Conclusion : Evaluation of patency of the bypass graft was clinically feasible by 2D-FASTCARD MR imaging, whereas any invisible bypass grafts should be further studied by contrast-enhanced MR angiography or by conventional angiography for confirmation of abnormalities.