Hemodynamic studies during exercise on a treadmill in the calf with a total cardiac prosthesis.
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Biomedical subjects
Publications and source records attributed to T Washizu.
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A calf with a biolized TAH was maintained in reasonably good physiological condition for a major portion of a 145-day experiment as indicated by near normal growth rate and laboratory data. The mechanism for the high CVP and CBV at the beginning and end of the experiment were correlated with protein metabolism. No evidence of thromboembolism was found at autopsy and only modest congestion with minimal parenchymal damage was observed. The cardiac prosthesis itself was free of thrombus, although slight calcification was found on the valves and diaphragms. The pump performance, however, remained satisfactory. In addition, endothelialization appeared to be starting on a portion on the inside of the pump.
A calf into which a biolized, total artificial heart (TAH) had been implanted survived for 145 days. All measured physiological parameters except central venous pressure (CVP) were back to normal one month after implantation, and thereafter the animal's physiological development was similar to that of a normal calf. The intimal weight, which was 96 kilograms at implantation, reached 190 kilogram at the end of experiment, with a daily gain rate of 0.9 kilogram per day. After the nineteenth postoperative week, signs of congestive heart failure appeared, such as high venous pressure, ascites, and enlarged liver although the calf outwardly appeared well. On postoperative day 146, the animal started foaming at the mouth, and a convulsion occurred; then, the experiment was terminated after 3,494 hours of pumping. At autopsy, there were acute bilateral bronchopneumonia involving mostly both upper lobes, pulmonary edema, slight chronic pneumonitis, and hepatomegaly. There were no serious thrombotic deposits inside the cardiac prosthesis.
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The activities of D-glucose transport (D-GT) and cytosolic enzymes were significantly higher in mammary adenocarcinoma of dogs than in mammary gland from normal dogs. The activities of D-GT in adenocarcinoma were over three-and-a-half times higher than in the controls. The K(m) value of the D-GT activity for glucose in both the adenocarcinoma and normal mammary gland was approximately 0.9 mM. The activities of the key glycolytic enzymes, hexokinase and pyruvate kinase, in the adenocarcinoma were also more than three-and-a-half times higher than in the controls. The increased activities of D-GT are considered to be accompanied by an acceleration of glucose utilisation in the adenocarcinoma of dogs.
In order to prevent thrombo-embolism after prosthetic valve replacement, a high dose therapy with 450 mg/day of Dipyridamole and 3,000 mg/day of Aspirin was carried out for 1 year and 2 months in 91 cases (26 cases with aortic valve replacement, 40 cases with mitral valve replacement and 25 cases with multiple valve replacement). In the treated group, the incidence was 1.9% in cases more than 5 years after valve replacement and 2.9% in cases less than 5 years after valve replacement. In contrast, in the control group of 89 cases (47 cases of aortic valve replacement, 30 cases of mitral valve replacement and 12 cases of multiple valve replacement), the incidence was 9.1% and 14.7%, respectively. Thus, in both time intervals following prosthetic valve replacement the incidence of thrombo-embolism in the treated group was significantly lower than in the control group.
The design of an intrathoracic left ventricular assist device (LVAD) is briefly described. The unique feature of the LVAD is that all blood-contacting surfaces are biolized, having either chemically treated natural tissues or protein coatings. The blood-contacting surface of the housing is glutaraldehyde-treated pericardium and is covered with natural rubber and polyurethane. Tri-leaflet valves fabricated from human dura mater are used at the pump inlet; glutaraldehyde-treated bovine aortic valves are used at the outlet. The pumping diaphragm, made of polyolefin rubber with a textured surface, is coated with gelatin and treated with glutaraldehyde. Anticoagulants are not used with this device. Extensive in vivo and in vitro testing in the development of the pumps led to the current configuration having good performance, long life, and improved blood compatibility.