Of 26 patients who underwent both coronary artery bypass grafting and abdominal surgery at our institution between 1977 and 1992, nine had severe coronary artery disease associated with UICC stage I gastric cancer. They were treated by coronary artery bypass grafting followed by a curative operation for gastric cancer; the initial four patients underwent two-staged surgery (group A), and the most recent five patients underwent simultaneous surgery (group B). The cardiac surgery was performed first in all patients, and in group A the interval between the two procedures was 2 to 7 weeks. There were no significant differences between the two groups in terms of preoperative characteristics: sex, age, preoperative complications, NYHA class, prior myocardial infarction, ejection fraction, cardiac index, number of vessels diseased, or number of grafts. There were no significant differences between the two groups in terms of blood loss during the gastric operation (A: 649 +/- 194 ml; B: 842 +/- 326 ml) or the operating time (A: 371 +/- 106 minutes; B: 343 +/- 46 minutes). Two group A patients had postoperative complications (one had arrhythmia, and one died of sepsis caused by sutural insufficiency). On the other hand, four group B patients had complications (three cases of transient hyperbilirubinemia and one case of postoperative bleeding; none died). The postoperative hospital stay after gastrectomy was not prolonged in group B compared with group A (A: 41.7 +/- 22.7 days; B: 46.0 +/- 25.0 days). In conclusion, simultaneous procedure of coronary artery bypass grafting and gastric surgery can be performed safely, although careful management is indispensable.

Aged↗

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Successful surgical repair of a complex congenital anomaly in a patient with chronic benign granulocytopenia.

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Agranulocytosis↗

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Isolation of the third component of complement and its derivative with anaphylatoxin-like activity from the plasma of the newt Cynops pyrrhogaster.

The third component of complement (C3) of a newt, Cynops pyrrhogaster, was purified using a fast protein liquid chromatography technique. The purified newt C3 consists of two polypeptide chains (the molecular masses of the alpha and beta-chains of C3 were 120,000 and 70,000, respectively) linked by disulfide bonds. The alpha-chain retained an internal thiolester bond that was cleaved with methylamine, and the N-terminal amino acid sequence of the alpha-chain was XVQLIDAKAGKAAKF. Digestion of newt C3 with trypsin yielded fragments that induced significant histamine release from newt peritoneal cells. These results indicate that newt C3 retains structural and functional properties shared with mammalian C3.

Amino Acid Sequence↗

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Normothermia has beneficial effects in cardiopulmonary bypass attenuating inflammatory reactions.

"Post perfusion syndrome" after cardiopulmonary bypass (CPB) has been known to be evoked by inflammatory reactions. To elucidate the effect of perfusate temperature during CPB on subsequent inflammatory reactions, serum levels of interleukin (IL)-6, IL-8, tumor necrosis factor-alpha, IL-1 beta, and polymorphonuclear (PMN) elastase were measured before and after (0, 12 hours, and 24 hours after) CPB in adult patients undergoing cardiac operations. Patients were divided into two groups: the normothermic CPB group (NOR, 34 degrees C perfusate temperature, n = 8) and hypothermic CPB group (HYP, 28 degrees C perfusate temperature, n = 8). In both groups, IL-6, IL-8, and PMN elastase levels were elevated during CPB, while the increase of tumor necrosis factor-alpha and IL-1 beta was not detected. The increase in IL-8 and PMN elastase levels at 12 hours after CPB was significantly less in NOR than in HYP (IL-8; NOR versus HYP, 15.1 +/- 12.9 versus 62.5 +/- 30.6 pg/ml, p < 0.05, PMN elastase; 394 +/- 200 versus 1085 +/- 523 micrograms/L, p < 0.05) while neither group showed any difference in IL-8 and PMN elastase at 24 hours after CPB. There was no difference in IL-6 between the two groups, and no significant increase in tumor necrosis factor-alpha and IL-1 beta levels were detected in either group after CPB. These results demonstrate that although CPB activated inflammatory reactions detected by IL-8 and PMN elastase activity, post operative persistence of these reactions were attenuated by warm CPB.

Adult↗

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Clinical experience with long-term use of the Toyobo left ventricular assist system.

The Toyobo-NCVC extracorporeal pneumatic left ventricular assist system (LVAS) was used in four patients with advanced dilated cardiomyopathy. The duration of support ranged from 46 to 390 days (mean, 206 days). In all patients, stable hemodynamics were achieved with 3.5-5.5 L/min flow rates. Two patients survived long term. One was transported to the United States by a chartered jet while on LVAS and successfully underwent heart transplantation after 119 days of support. The other is on LVAS and is doing well for 390 days. The remaining two patients died of multi-organ failure while their hemodynamics were quite stable under LVAS. In these two patients, severe hepatic failure had developed before LVAS implantation. Minor cerebral embolisms occurred in the two survivors, but neither of them experienced permanent neurologic deficits. In only the initial patient were major thrombi noted on the diaphragm of the pump; the thrombi required pump exchange four times during 119 days. In the patient supported for 390 days, a small tear in the diaphragm was observed after 209 days of support, and the pump was safely exchanged. It is suggested that the Toyobo LVAS can provide consistent and reliable performance for long-term use.

Adolescent↗

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Comparison between pulsatile and nonpulsatile circulatory assist for the recovery of shock liver.

In patients with prior shock and liver injury, mechanical circulatory assist still has a high risk of hepatic failure. The purpose of this study was to evaluate the effect of mechanical circulation using pulsatile or nonpulsatile blood pumps on shock organs, particularly shock liver. In 14 dogs, a shock liver model was produced by clamping the descending aorta above the diaphragm. After 60 minutes of ischemia, left atrial-femoral artery bypass (LHB) was started while the clamp remained in place. A pneumatic pulsatile pump (Toyobo; Tokyo, Japan) was used in seven dogs (Gr-PP) and a centrifugal pump (Biomedicus; Minneapolis, MN) in seven (Gr-NPP). In both groups the mean arterial pressure was maintained at 80 mmHg. The mean bypass flow was 96 +/- 14 ml/kg/min for Gr-PP, and 95 +/- 35 ml/kg/min for Gr-NPP. In both groups the bile flow and arterial ketone body ratio decreased significantly after ischemia, and recovered to normal after 120 min of LHB. There was no significant difference between the two groups in this model. The other parameters (glutamic oxaloacetic transaminase [GOT], glutamic pyruvic transaminase, lactate dehydrogenase, mitochondrial GOT) were independent of the period of ischemia and reperfusion, and there was no difference between the two groups. In conclusion, these results suggest that nonpulsatile circulatory assist may not be disadvantageous for the circulatory support and recovery of liver function in the setting of shock liver.

Animals↗

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Application of ultra short acting beta blockade (esmolol) in pediatric open heart surgery: a trial in total anomalous pulmonary venous return.

BACKGROUND: In the repair of total anomalous pulmonary venous return (TAPVR) under cardiopulmonary bypass, esmolol, ultra short acting beta blocker, was applied to obtain low heart rate and weak ventricular contraction under mild hypothermic cardiopulmonary bypass. METHODS: Five infants aged from 14 to 158 days with an average of 70 days, underwent a primary or palliative repair of TAPVR. The type of anomalous return was supracardiac type (2), infracardiac (2), and intracardiac (1). A primary repair was done in three for isolated TAPVR with bypass time of 65 to 76 minutes, and a palliative repair for two with complex anomalies with bypass time of 64 and 87 minutes. RESULTS: There was one operative death from cerebral bleeding in an infant with complex TAPVR who underwent simultaneous pulmonary banding. CONCLUSION: This strategy seems to be applicable in pediatric cardiac surgery when aortic cross-clamping is better to be avoided and the surgery is mainly limited to the atrial level.

Adrenergic beta-Antagonists↗

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Bentall operation for a child with Marfan syndrome: a case report.

Children with Marfan syndrome rarely undergo surgery for annuloaortic ectasia and aortic regurgitation in the first decade. A 7-year-old girl presented with congestive heart failure due to severe aortic regurgitation associated with annuloaortic ectasia (6 cm). She also had funnel chest. She underwent a Bentall operation and sternal turn-over with a satisfactory result. Since the aortic valve cusps had rolled edges, the aortic valve was not spared. Histology of the aortic valve cusps showed myxoid degeneration and fragmentation of elastic fibers.

Aorta↗

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Common pulmonary vein atresia: a successfully corrected case.

Common pulmonary vein atresia is a rare congenital cardiac anomaly in which there is no communication between the confluence of the pulmonary veins and the heart or the major systemic venous system. We successfully treated this disease in a 5-day-old boy by performing an anastomosis of the left atrium to the common pulmonary vein. Only one patient with this lesion who survived this procedure has been reported in the literature. Early recognition of this lesion and immediate surgical intervention are the only way to save the patient's life.

Echocardiography↗

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Clinical application of percutaneous left ventricular support with a centrifugal pump.

A percutaneous left ventricular support (PLVS) system can play an important role in the short-term support of patients with severe heart failure, but these devices are not available for clinical use. We devised a new transseptal left atrial (LA) cannula for PLVS without thoracotomy. The cannula is 21 Fr in size (internal diameter: 5.3 mm) and 65 cm in length. This transseptal LA cannula can be inserted easily into the left atrium under fluoroscopy, by the usual transseptal technique, using a conventional Brockenbrough's needle. PLVS was used in two patients who developed cardiogenic shock following acute myocardial infarction and underwent resuscitation using percutaneous cardiopulmonary support (PCPS). The patients could not be weaned from PCPS even after successful percutaneous transluminal coronary angioplasty (PTCA), and PLVS provided 3.0 L/min of assist flow. The duration of PLVS was 114 and 92 hr. Both patients were weaned from PLVS, and one survived. There were no complications related to the PLVS. PLVS with a new transseptal LA cannula may be effective and useful for patients with severe heart failure.

Heart Failure↗