[Introduction] The ideal mechanical prosthesis to replace the aortic valve in patients with a small aortic annulus remains controversial. The purpose of this study is to compare hemodynamic performance and clinical results of the SJM-HP with those of standard valves(Bjork-Shiley(B-S) and standard SJM) in patients with a small aortic annulus who received a patch enlargement. [Materials and Methods] Between 1975 and 1998, 33 patients received a 21mm SJM-HP (16 patients), a 21mm standard SJM(5 patients), or a 23mm B-S(12 patients) aortic prosthesis. For all patients who had one of the standard valves implanted the patch enlargement was performed using Nicks' method. Either doppler echocardiography or catheterization were performed both before and after the operation, and readings of flow velocity, and the pressure gradient across the valve were measured. [Results] There were no differences in flow velocity or pressure gradient between the groups. Moreover, we experienced no operative mortalities or significant perioperative complications. Peak and mean pressure gradients, along with flow velocity, in the 21mm SJM-HP group were significantly lower than the 21mm SJM group, in early postoperative and later follow-up periods. However, there were no statistical differences in these indices between the 21mm SJM-HP group and the 23mm B-S group seen at follow-up. [Conclusion] Based on our results, we believe that the 21mm SJM-HP should be selected for AVR when the preoperative aortic annulus diameter is approximately 22mm and for patch enlargement for a small aortic annulus when the preoperative aortic annulus diameter is below 20mm.
JTE-607, a novel inhibitor for multiple inflammatory cytokine, attenuates cardiopulmonary bypass induced inflammatory reactions. [Background] However cardiovascular surgery is more safety and less invasive due to the improvement of cardiopulmonary bypass (CPB), it is still insufficient and improvable. JTE-607 is a novel N-benzoyl-L-phenylalanine derivative compound, and is reported as a multiple cytokine inhibitor. So we evaluated the effect of JTE-607 on the attenuation of CPB induced inflammatory reactions. [Methods and results] CPB circuit consisting of a miniature oxygenerator and a roller pump was connected to a SD-rat (,BW 400±450g) with cannulae in the right atrium from the right jugular vein for venous drainage and the right femoral artery for arterial return. After 60minutes of CPB (perfusion flow 50±60ml/kg/min.), all rats weaned from CPB. Ten rats were divided into a control group (n=5) and a JTE-607 group (n=5). JTE-607 (50mg/kg/h) was continuously given during CPB in the JTE-607 group. As compared with the control group, the JTE-607 group showed a significantly higher blood pressure after CPB (74 33 vs. 129 16 mmHg, p=0.01) and lower levels of IL-6 (385 271 vs. 62 21 pg/ml, p=0.1) and IL-8 (400 45 vs. 264 11 pg/ml, p=0.0004). [Conclusion] These results suggested that JTE-607 given during CPB attenuate CPB induced inflammatory reactions and improve the hemodynamic status after CPB.
Minimally invasive cardiac surgery is now becoming standard in the correction of simple congenital cardiac malfbrmations. We introduced a clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery, and assessed the function of the pathway in children with atrial or ventricular septal defects, comparing minimally invasive surgery to repair through a conventional full sternotomy.We studied 15 children of school age who underwent repair of an atrial or ventricular septal defect through a lower midline sternotomy, and 10 children undergoing repair through a full sternotomy. The clinical pathway was for extubation to take place in the operating room, echocardiographic evaluation on the 5th postoperative day, and discharge home on the 7th postoperative day, with return to school within 2 weeks, and resumption of all gymnastic activity within 6 weeks of the minimally invasive surgery.In those having a lower midline sternotomy, postoperative hospital stay was 7.4 +/- 0.8 days, with return to school 8.0 +/- 2.4 days after discharge. They resumed gymnastics 41 +/- 11 days after the minimally invasive surgery. In those having a full sternotomy, in contrast, these parameters were 13.5 +/- 2.7, 23.1 +/- 8.4, and 95 +/- 43 days, respectively. Of the 15 children undergoing a minimally invasive approach, 12 (80%) fulfilled the criterions of our clinical pathway.We conclude that minimally invasive cardiac surgery can safely be performed in children. In addition to its cosmetic role, the technique has added value in promoting early return to normal school life, including gymnastics.
Mitral regurgitation is a significant complication of end-stage cardiomyopathy, and its existence predicts poor survival. In general, it is thought that mitral valve replacement (MVR) alone is ineffective; however, there are few detailed reports of the clinical course of patients who have undergone MVR. Five patients with mitral regurgitation whose preoperative left ventricular end-systolic volume index was more than 100ml/m2 were studied. Although their prognosis late after MVR became poor, none of them died within 30 days of the operation. Postoperative cardiac catheterization was performed 6.3±1.1 months after surgery; the end-diastolic volume had reduced (before: 193±26ml/m2; after: 166±34ml/m2, p<0.05), but the end-systolic volume had not (before: 110±7ml/m2; after: 112±32ml/m2). The end-systolic wall stress was substantially elevated preoperatively (238±29kdyne/cm2) and tended to increase after surgery (295±96kdyne/cm2). All the patients were able to return to work at some stage postoperatively (their New York Heart Association functional class improved to I or II), but 3 of the 5 patients died suddenly of heart failure at 3.3±1.6 years after surgery and the New York Heart Association functional class of the others worsened to III again. Mitral valve surgery, including MVR, can manage severe end-stage heart disease with mitral regurgitation.
