The significant immunosuppressive effect of ganglioside GM3 in heart transplantation.
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Animals↗
Biomedical subjects
M Hachida
Publications and source records attributed to M Hachida.
Percutaneous cardiopulmonary support as the second generation of venoarterial bypass: current status and future direction.
We have developed a new percutaneous cardiopulmonary support (PCPS) system in cooperation with Terumo Corporation, called the Emergency Bypass System (EBS). This preassembled system is unique in terms of its small priming volume (470 cc), fully automatic priming function, originally developed membrane oxygenator, and Capiox straight path centrifugal pump. The priming process takes only 5 min. We have used this system in 4 patients (all were male; mean age 56 years, range 35-73 years). The duration of assist ranged from 15 min to 210 h. Maximum bypass flow ranged from 2.2 to 3.6 L/min, systemic circulation was very well maintained, and urinary output was acceptable. Although the centrifugal pump was in good working condition, we had to change the oxygenator because of serum leakage 36 to 48 h after initiation of the assist. One patient was weaned from the PCPS, but died of brain death. The other patients could not be weaned from the PCPS. The cause of death in these patients was irreversible myocardial damage. Disseminated intravascular coagulopathy triggered by surgical trauma related to various procedures developed in 2 patients during assist and was the cause of cessation of the assist. Problems to be ratified and future directions in the EBS and PCPS were earlier introduction through the establishment of clear indications and endpoint, heparin coating, improvement in durability of the oxygenator, and cost.
Adult↗
[The strategy how to restart heart transplantation in Japan from the viewpoint of cardiovascular surgeons].
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Adult↗
[The strategy how to restart heart transplantation in Japan from the viewpoint of cardiovascular surgeons].
Japan is still in the midst of confusion the ethical, social and legal standpoints of organ transplantation. We have paid attention and effort to negotiate and reorganize the heart transplantation environment. This paper discusses several problems concerning the criteria, standardization, assessment, evaluation committee and authorization of medical centers to initiate heart transplantation in this country.
Heart Transplantation↗
[A report of two cases of coronary bypass surgery after renal transplantation].
Coronary artery bypass surgery was performed in two patients who had had renal transplantation. They had been taking immunosuppressive therapy. There were some problems in the management of these patients including prevention of postoperative infection, renal damage due to cyclosporin, and rejection of the transplanted kidney. Immunosuppressive therapy was continued under the meticulous monitoring of blood cyclosporin levels, blood T-cell subsets, markers of infection such as antiviral titers. The anticipated problems were not encountered in both cases. This is the first report in Japan which describes successful coronary artery bypass surgery for kidney transplant recipients.
Coronary Artery Bypass↗
Optimal shape of prosthesis for tricuspid valve replacement.
To develop an optimal prosthesis for use in the tricuspid valve, we determined the change in cardiac performance associated with the change in shape of the anulus of the tricuspid valve using a metal ring of variable flat ratio (defined as the long/short axis). In experiment I in an isolated autoperfusion model with six dogs, the left ventricular stroke work under a constant left atrial pressure of 7 mm Hg were, in grams per beat per minute, 11.88 +/- 0.52 with a flat ratio of 1.0, 11.88 +/- 0.70 with a flat ratio of 1.3, 16.23 +/- 0.61 with a flat ratio of 1.6, and 11.22 +/- 0.38 with a flat ratio of 2.3 (mean +/- standard error of the mean). The volume was significantly higher with a flat ratio of 1.6 than with the other ratios (p < 0.05). In experiment II with six dogs in vivo, the blood flow of the pulmonary trunk artery was 0.57 +/- 0.03 L/min with a flat ratio of 1.0, 0.66 +/- 0.03 L/min with a flat ratio of 1.6, and 0.58 +/- 0.03 L/min with a flat ratio of 2.3; the flow was significantly larger with a ratio of 1.6 than with the other ratios (p < 0.05). Right ventriculography was performed in five dogs. The percentage of radial shortening of the apex close to the acute margin was 19.4% +/- 3.1% with a flat ratio of 1.0 and 49.2% +/- 5.1% with a flat ratio of 1.6 (p < 0.05). In conclusion, the best hemodynamic results were obtained with a flat ratio of 1.6, which showed more advantageous hemodynamics than do the ratios of conventional circular prostheses.
Animals↗
[Pathological assessments of allografts after heart transplantation using a dog model--allograft vasculopathy].
The pathological findings of allografts after heart transplantation were assessed in long-term period using a dog model. Eight orthotopic heart transplantations were performed with cross-circulation method using a dog. Two dogs survived over 1 year after heart transplantation. One dog died due to cardiac rejection, and the another dog died due to infection at 14 months and 16 months after the transplantation, respectively. The coronary artery morphologic features were assessed in the allografts. The pathological findings showed fibrous intimal thickening with infiltration of lymphocytes and macrophages. And it was diffusely distributed to each area of transplanted heart. The stenosis of coronary lumen was significantly seen in middle size of coronary arteries which was from 100 microns to 50 microns. The characteristics of these findings in comparison with arteriosclerosis change were 1) rapid progression, 2) diffuse fibrous intimal thickening, 3) preserved internal elastic lamia. These findings might be important for treating this complication.
Animals↗
[Efficacy of myocardial preservation using GIK solution for prolonged ischemic heart].
The efficacy of myocardial preservation using GIK solution combined with continuous cold blood perfusion was assessed in patients with prolonged ischemia. Fifteen patients receiving more than 4 hours' ischemia were divided into two groups. In Group A, seven patients were associated with severe aortic regurgitation and showed increased left ventricular volume of more than 60 mm in LVDd and 45 mm in LVDs. In Group B, eight patients had a normal left ventricular volume of less than 60 mm in LVDd and 45 mm in LVDs echocardiographically. There was no significant difference in ischemic time, or preoperative hemodynamic parameters between the two groups. The postoperative cardiac index was 2.93 +/- 0.87 in Group A and 4.3 +/- 0.8 in Group B (p < 0.01). The postoperative shortening fraction was 0.17 +/- 0.01 in Group A, 0.43 +/- 0.12 in Group B (p < 0.01). These parameters significantly deteriorated in Group A compared to Group B. Released enzymes (GOT, CK-MB) were significantly increased in Group A with prolonged ischemic time. In conclusion, postoperative cardiac function after 4 hours' ischemia using GIK solution deteriorated in the patients with a dilated heart due to aortic regurgitation.
Aortic Valve Insufficiency↗
[Functional evaluation of skeletal muscle ventricles for circulatory assist].
Skeletal muscle has a potential power for cardiac assist. Two approaches have been used to harvest this power: dynamic cardiomyoplasty, which involves the application of muscle directly to the heart to support cardiac contractile function; and the construction of skeletal muscle pouches or ventricles, which are used as separate pumps working either in parallel or in series with the heart. In this study, we evaluated the function of the skeletal muscle ventricles (SMVs) for circulatory assist. In six dogs (18.5 +/- 2.3 kg, mean +/- S.E.M.), SMVs were constructed from the right latissimus dorsi muscle, and placed in the right hemithorax. After a 3-week vascular delay period, the SMVs were preconditioned electrically by 2 Hz continuous stimulation for six weeks. Nine weeks later, SMVs were connected to a mock circulation device for functional evaluation. As right-sided pumps, at a preload of 10 mmHg, SMVs generated stroke work of 0.63 +/- 0.04 x 10(6) ergs with 25 Hz and 0.80 +/- 0.06 x 10(6) ergs with 85 Hz, which exceeded that of the native right ventricle. As left sided pumps, also at a preload of 10 mmHg, SMV stroke work was 0.49 +/- 0.13 x 10(6) with 25 Hz 0.90 +/- 0.09 x 10(6) ergs, which was roughly half that of the left ventricle. These results demonstrate that SMVs have the potential to function as left or right heart assist devices.
Animals↗
[Efficacy of myocardial preservation using HTK solution in continuous 120 min cross-clamping method--a comparative study with GIK method].
The aim of this study is to investigate the efficacy of HTK solution in the 120 minutes cross-clamping method in comparison with conventional intermittent cardioplegia using GIK solution. Fifty-four open heart surgery were performed with cardioplegic solution using either HTK solution (HTK) or GIK solution (GIK). In the HTK, HTK (3L) was infused for the initial dose and 1L was added every 60 min after 120 min of cross-clamping. In GIK, 1L of GIK solution was intermittently infused initially and then every 30 min together with continuous cold blood perfusion. The effect of two cardioplegic solution was evaluated by postoperative cardiac function (CI, %SF), released enzymes (CPK), histology and dosage of catecholamine. Postoperative CI was 3.67 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). % SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). %SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 9.2 in GIK (NS). The CK-MB (IU/dl) level after reperfusion was significantly decreased in HTK at 60 and 180 min after reperfusion. Histology at 60 min of ischemia revealed a significant increase of edema of mitochondria in GIK. Postoperative catecholamine dose was 2.65 +/- 1.3 in HTK and 10.3 +/- 3.4 in GIK (p < -0.01). PH of myocardium was well maintained around 7.4 during cross-clamping in HTK, however, it was decreased in GIK. In conclusion, The HTK method offers a reliable cardiac protection due to effective buffering using Histidine in comparison with GIK.
Cardioplegic Solutions↗
Heart and lung preservation using a new solution; UCLA Formula.
Heart and lung preservation is a significant barrier in clinical heart and lung transplantation. In a previous study, we have shown that UCLA Formula, modified from cardioplegic solution, has a favorable effect on lung preservation. In this study, we evaluated the effect of the simultaneous flushing method using UCLA Formula alone on both heart and lung preservation. We conducted six experiments using 18 mongrel dogs, weighing 20-28 kg. In the donor animals, the heart and lungs were each flushed with 500 ml of cold UCLA Formula, using two catheters, one inserted into the ascending aorta and the other into the main pulmonary artery. After the heart and lung block was trimmed, orthotopic cardiac transplantation and single left lung transplantation were independently performed on different recipients following preservation for 4.3 h in the case of the heart and 7.5 h in the case of the lung. Thus, the function of the preserved organs was independently assessed using cardiac output and left ventricular end-diastolic pressure (LVEDP) with constant central venous pressure (CVP) in heart transplantation, and arterial gas analysis and the relationship between inspiratory pressure and expiratory tidal volume in lung transplantation. These measurements were performed before harvesting and 1 h and 4 h after transplantation. After heart transplantation cardiac output showed no significant deterioration. No significant differences in gas analysis and the pressure-volume curve were seen after lung transplantation. In conclusion, the simultaneous flushing method using the UCLA Formula may offer reliable preservation for both heart and lung in preparation for transplantation.
Animals↗
[A case report on the sliding commissuroplasty for mitral regurgitation due to posterior commissural chordal rupture].
We have performed a mitral valve reconstruction on a 31-year-old man who suffered from infective endocarditis four years ago. Severe mitral regurgitation and posterior commissural chordal rupture were noted. The mitral valve was repaired by Carpentier's sliding commissuroplasty and ring annuloplasty. The postoperative course was uneventful, and mitral regurgitation completely disappeared. It appears that Carpentier's sliding commissuroplasty is a superior new reconstructive technique for mitral regurgitation due to commissural chordal rupture.
Adult↗
[A clinical assessment of efficacy in continuous retrograde cerebral perfusion method].
From November 1990 to June 1991, 8 patients underwent surgical repair using continuous retrograde cerebral perfusion (CRCP). We evaluated the effect of CRCP from these 8 cases. As a method of CRCP, we perfused with oxygenated blood from SVC canulae with a internal jugular vein pressure of 30-40 cmH2O. Simultaneously systemic perfusion from femoral arterial canulae was performed. At nasopharyngeal temperature of 15-21 degrees C, CRCP time was 46-115 minute. SVC perfusion flow was 280-900 ml/min, and femoral arterial perfusion flow was 450-1,200 ml/min. At 30 minute after starting CRCP, oxygen tension of the blood which was returned to aortic arch was 11-23 mmHg, whereas oxygen tension of the SVC perfusion blood was 210-398 mmHg. In only one patient, transient involuntary movement was seen after operation, but prolonged emergence from anesthesia was not seen. In conclusion, CRCP is considered as an useful method in the operation of the aortic arch.
Aorta, Thoracic↗
[A case report: an elderly patient surviving conservative surgical repair of ventricular septal perforation (VSP) with using Swan-Ganz catheter in order to close VSP temporarily].
A 81-year-old female was referred to our hospital for VSP. Preoperative catheterization showed that pulmonary arterial pressure (PAP) was 50 mmHg over in systole, and L-R shunt rate was 63.4%. In spite of any medications under intraaortic balloon pumping, hemodynamics was gradually worsened. And so Swan-Ganz catheter was inserted into right ventricle via VSP retrogradely in order to close VSP with the balloon of the catheter. PAP decreased to about 40 mmHg in systole and L-R shunt rate became to 49.7% by this method. This treatment could conserve the surgical repair for 5 days and the operation was performed on 22 days after the onset of VSP. It is very important to be able to conserve VSP operation by using Swan-Ganz catheter to close VSP temporarily.
Aged↗
[Surgical repair of distal aortic arch aneurysm using "elephant trunk" technique].
We present a surgical case of 61-year-old man with distal aortic arch aneurysm. Under selective cerebral perfusion in deep hypothermia, we approached to the aneurysm through median sternotomy. Dilated distal aortic arch and proximal descending aorta with mural thrombus in the aneurysmal lumen were found. The aortic occlusion balloon catheter was inserted into the descending aorta. A Cooley woven Dacron graft (26 mm in diameter) was anastomosed at 5 cm above its distal end loosely to the descending aorta with five interrupted mattress sutures, and the distal portion of the graft was pushed down into the distal aorta ("elephant trunk" technique). Postoperative course was uneventful and the dead space around the graft in aneurysm was filled with thrombus. Six months later, however, emergent operation was performed because of compression of the bronchus and the esophagus by enlargement of the aneurysm due to leakage. The second operation was approached through 5th left intercostal thoracotomy and median sternotomy. The aneurysm was opened, and the thrombus was amounted to 500 g. The distal end of the graft was anastomosed end-to-end to the mid-portion of the descending thoracic aorta. Postoperative course was uneventful and the patient was discharged. It is concluded that Elephant trunk technique is effective and the postoperative control of hypertension is very important.
Aorta, Thoracic↗
[Classification of congenitally bicuspid aortic valve and its angiographic and surgical significance].
From January, 1978 to December, 1990, 85 patients with congenital bicuspid aortic valve underwent aortic valve replacements (AVR) with St. Jude Medical valve prosthesis. We classified congenital bicuspid aortic valve into four types. Type I (44.7%): Two cusps are situated right and left, a coronary artery arises from each related sinus of valsalva. Type II (22.4%): Type I + raphe in the right cusp. Type III (3.5%): one cusp is located anteriorly, the other posteriorly and both coronary arteries arise from anterior cusp. Type IV (29.4%): Type III + raphe in the anterior cusp. Regarding to preoperative diagnosis, aortic stenosis dominated in Type I (78.8%) and aortic regurgitation dominated in Type IV (72.0%). Implanted valve sizes were 22.2 +/- 1.8 (Type I), 23.4 +/- 1.6 (Type II) and 24.0 +/- 2.2 (Type IV). There was a significant difference between Type I and Type II, same as Type I and Type IV. Babb's method and outflow measurement method were utilized to predict the aortic annular size. However, both of them were not reliable for estimating the size of the aortic annulus in cases of aortic stenosis undergoing AVR with a 21 mm prosthesis.
Adolescent↗
Percutaneous transaortic closure of postinfarctional ventricular septal rupture.
We report a case of successful closure of a postinfarctional ventricular septal defect by means of the transaortic approach with a balloon catheter. This method brought about substantial improvement in cardiopulmonary function before an elective operation and made it possible to successfully perform the operation on the patient, an 81-year-old woman, on the 22nd day of admission.
Aged↗
[Recanalization of saphenous vein graft occlusion after CABG using a newly designed coronary wire].
A 57-year-old male underwent coronary bypass grafting, consisting of sequentially grafting of saphenous vein grafts to the diagonal and left descending arteries and the right coronary artery. On the 12th postoperative day, he had chest pain and ECG showed significant ST elevation on the V1-5 leads. Subsequently, PTCR was performed, however, the occlusion of the graft between the diagonal artery and the left descending artery remained. Then, a coronary boring wire we designed was inserted into the left descending artery and coronary recanalization was successfully achieved.
Angioplasty, Balloon↗