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ABSTRACT: Objective: The enhanced generation of various chemical mediators is regarded as one of the mechanisms by which severe heart failure
progresses to multiple organ failure. Platelet-activating factor is a phospholipid mediator which plays an important role
in inflammatory reactions and circulatory shock. We studied the changes in platelet-activating factor levels in a canine heart
failure model treated with a left ventricular assist device and hemofiltration, and assessed the effect of a protease inhibitor,
nafamostat mesilate.Methods: Twenty dogs underwent multiple coronary ligations, and at 2 hours after the ligations they were maintained on left ventricular
assist device support with continuous hemofiltration. The animals were divided into two groups: a nafamostat group (n = 10)
that received nafamostat mesilate (2 mg/kg/hr), and a control group (n = 10) that received vehicle only.Results: The blood platelet-activating factor level, before coronary ligations, in the control and nafamostat groups was 2.3 ± 0.4
and 2.0 ± 0.7 ng/ml, respectively, and the coronary ligations had little effect on the platelet-activating factor. However,
after the initiation of left ventricular assist device, the platelet-activating factor in the control group (5.6 ± 2.2) was
significantly higher (p < 0.05) than that in the nafamostat group (1.1 ± 0.3). Nafamostat administration was also effective
in controlling the increase in the blood lactate level. Hemofiltration did not change the platelet-activating factor.Conclusions: We concluded that platelet-activating factor may play a critical role in the development of severe heart failure with left
ventricular assistance, and nafamostat administration is likely to be beneficial in such a critical condition by suppressing
the platelet-activating factor level.
Key wordsleft ventricular assist device–platelet-activating factor
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 48(2):106-111.
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ABSTRACT: A 74-year-old man underwent aortic valve replacement due to aortic regurgitation after two months of medication for congestive heart failure. At surgery, the cause of the aortic regurgitation appeared to be dehiscence of an aortic valve commissure. Dehiscence was closed with mattress sutures from outside of the sinus. Dehiscence of an aortic valve commissure is rare and difficult to be diagnosed preoperatively, and we carefully repaired it, and the patient had a good recovery.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 12/2011;
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The Journal of thoracic and cardiovascular surgery 04/2007; 133(3):798-9. · 3.41 Impact Factor
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ABSTRACT: A 46-year-old male had a cardiac stab injury resulting in cardiac tamponade as a result of a suicide attempt using a bodkin, a sharply pointed instrument for making holes. The patient was transferred to our hospital about 12 hours after the injury. Pericardiotomy at the emergency operation revealed the penetration of the right ventricle and the hole was repaired following removal of the bodkin. Postoperative course was uneventful.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 11/2006; 12(5):365-7. · 0.69 Impact Factor
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ABSTRACT: A 64-year-old man underwent aortic valve replacement for aortic regurgitation. The aortic valve was perforated in the noncoronary cusp. Pathological findings showed that the perforation probably occurred due to infective endocarditis. However, the patient had no obvious inflammatory signs preoperatively, to suggest latent infective endocarditis.
The Japanese Journal of Thoracic and Cardiovascular Surgery 03/2006; 54(2):67-9.
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ABSTRACT: Severe circulatory failure after cardiovascular surgery is occasionally difficult to treat and the mortality risk is high. Systemic inflammatory response syndrome (SIRS) is one of the complications resulting in circulatory failure and, continuous hemodiafiltration (CHDF) seems to be a potentially effective treatment to improve the critical condition by removing proinflammatory cytokines. We present two recent cases of SIRS with critical circulatory failure which were successfully treated by CHDF after operation for thoracic aortic dissection.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 09/2005; 11(4):277-80. · 0.69 Impact Factor
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The Annals of thoracic surgery 02/2005; 79(1):355. · 3.74 Impact Factor
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ABSTRACT: Mycotic aneurysm of the descending aorta is usually described as rare. We present two recent cases of mycotic aneurysm of the descending aorta complicated with hemoptysis. Urgent tube graft replacements were successfully performed under cardiopulmonary bypass support. Bacterial causes of the aneurysms were methicillin-resistant Staphylococcus aureus in the first case and Staphylococcus aureus in the second case. Although the first patient died fifteenth months after surgery, the second patient remains well fourteenth months after the operation.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 11/2004; 10(5):314-6. · 0.69 Impact Factor
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ABSTRACT: Mediastinal irradiation has been reported to induce cardiac disease such as pericarditis, valvular dysfunction, conduction abnormalities, accelerated arteriosclerosis of the coronary arteries, and also calcifications of the ascending aorta. We herein describe a case of radiotherapy-induced porcelain aorta and aortic valve disease and their surgical treatment. The patient was diagnosed with myasthenia gravis (MG) in 1965 (Osserman's type II), and mediastinal irradiation was performed in 1970 for treatment of thymic tumor associated with MG. Thirty years after radiation therapy, complete atrioventricular block and aortic valve disease with severe calcification of the ascending aorta and aortic arch (porcelain aorta) were detected on echo cardiogram and cardiac catheterization. A permanent pacemaker was implanted via the left subclavian vein and aortic valve replacement was performed under extracorporeal circulation established by selective cerebral perfusion and balloon occlusion instead of aortic cross-clamping. As no risk factors of arteriosclerosis such as hypercholesterolemia, hyperglycemia and hypertension were apparent, we concluded that the aortic valve disease and porcelain aorta were primarily induced by radiotherapy.
The Japanese Journal of Thoracic and Cardiovascular Surgery 08/2004; 52(7):349-52.
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ABSTRACT: There is a tendency to avoid the bilateral internal thoracic artery (ITA) grafting in diabetics. However, we no longer consider diabetes a reason for excluding the bilateral use of ITAs. We compare the early and long-term results in diabetic cases treated by coronary artery bypass grafting (CABG) using unilateral and bilateral ITA grafts.
A total of 303 consecutive diabetic cases of CABG using ITA grafts between April 1991 and January 2003 were reviewed. Of these, 149 (49%) were being treated with insulin. The cases were divided into two groups: 179 cases in which bilateral ITA grafts had been used and 124 in which a unilateral ITA graft had been used.
The mortality for the bilateral ITA group and unilateral ITA group were 1.7% and 1.6%, respectively. The fact that patients were receiving insulin had no effect on the mortality of CABG. A review of morbidity revealed that no differences were found between the two groups. The survival curves, cardiac-death-free curves, and cardiac-event-free curves showed that there was no difference between the use of one or two ITA grafts in diabetics, while bilateral use of ITA grafts was significantly better than unilateral use in a comparable group of nondiabetics operated during the same time period.
There was no significant difference in operative mortality related to single or double ITA grafting in diabetics. There was also no difference between the use of one or two ITA grafts in diabetics in regard to long-term follow-up.
The Annals of Thoracic Surgery 01/2004; 76(6):2017-22. · 3.74 Impact Factor
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ABSTRACT: Recent surgical progress has had an impact on the mortality of acute type A aortic dissection. Routine aortic arch replacement, irrespective of the location of the intimal tears, may improve not only the outcome of the residual dissection but the operative mortality, because complete resection of intimal tears, including those invisible through the aortotomy in the ascending aorta is achieved.
During the past 7 years, total aortic arch replacement was performed in 50 consecutive patients with acute type A aortic dissection. Cerebral protection was achieved by deep hypothermia associated with pharmacologic cerebroplegia. Computed tomography and aortic angiography were performed to examine 48 patients for the possible presence of residual false channels before discharge.
The duration of circulatory arrest ranged from 30 to 84 minutes. The hospital mortality was 10%, and a cerebral complication was observed in 1 patient. No evidence of a persisting false channel was detected in 27 patients (54%) who were totally thrombosed. During the follow-up period (range: 2 months to 7 years), 2 patients died of hepatoma or pneumonia, respectively, and 2 patients underwent reoperation for recurrence of a dissection at the sinus of Valsalva. The Kaplan-Meier method estimated a 7-year survival of 82%, and a 7-year freedom from reoperation of 93%.
These results suggest that our aggressive use of routine aortic arch grafting can be accomplished with an acceptable risk and that our strategy not only improved the late results but the mortality associated with repairs for acute type A aortic dissection.
The Annals of Thoracic Surgery 01/2004; 76(6):1957-61. · 3.74 Impact Factor
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ABSTRACT: Internal thoracic artery (ITA) grafts provide better early and long-term patency than saphenous vein (SV) grafts. Furthermore, bilateral ITA grafting has recently demonstrated better long-term results than unilateral ITA grafting. However, its use in the elderly is controversial.
From March 1991 through November 2001, 307 consecutive patients aged 65 years or over undergoing isolated coronary artery bypass grafting (CABG) were reviewed, and the influence of bilateral ITA grafting on the early and long-term results was evaluated. All ITA grafts were harvested as a pedicle, and almost all of which were used as in-situ grafts.
Operative mortality in 138 patients undergoing bilateral ITA grafting was 1.4%, and in 108 patients undergoing unilateral ITA grafting, the rate was 0.9%. Pre-discharge angiography conducted in 97% of the subjects showed that the patency rate of all the ITA grafts (98.9%) was superior (p < 0.0001) to that of all the SV grafts (93.6%). In comparisons of survival and freedom from cardiac events at 10 years after CABG, the bilateral use of ITA grafts was proved to be more beneficial than the unilateral use (p < 0.05).
It was demonstrated that bilateral ITA grafting could be performed with acceptable mortality and morbidity. Moreover, it offers better long-term survival and freedom from cardiac events than either unilateral ITA grafting or no ITA grafting. Bilateral ITA grafting thus can serve as a favorable procedure even in elderly patients.
The Japanese Journal of Thoracic and Cardiovascular Surgery 11/2003; 51(10):488-95.
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Shoichi Takahashi,
Shunichi Takaya,
Ikuo Fukuda,
Takemichi Suto,
Kazuyuki Daitoku,
Toshihiko Kuga,
Ikko Ichinoseki, Mamoru Munakata,
Kozo Fukui,
Hiroshi Noda,
Hiraku Yodono
Journal of Thoracic and Cardiovascular Surgery 09/2003; 126(2):600-2. · 3.41 Impact Factor
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ABSTRACT: Protein kinase C (PKC) activation during myocardial ischemia is thought to be cardioprotective. However, the mechanism of ischemia-induced PKC activation remains unclear. We hypothesized that ischemic PKC activation occurs through activation of phosphatidyl-inositol specific phospholipase C (PI-PLC) and protects the heart from ischemic injury.
Isolated rabbit hearts were subjected to 20 minutes of normothermic ischemia and reperfusion. The PI-PLC inhibitor U73122 (0.5 micromol/L), its inactive analogue U73343 (0.5 micromol/L), or the PKC inhibitor chelerythrine (2 micromol/L) were given just before ischemia. Another group received U73122 plus the direct PKC activator phorbol 12-myristate-13-acetate (PMA, 10 pmol/L). Measurements included contractile function, intracellular calcium, PI-PLC activity, and translocation of PKC isoforms.
PI-PLC activity increased during myocardial ischemia and was inhibited by U73122. PI-PLC inhibition prevented the ischemic translocation of PKC-alpha, PKC-epsilon, and PKC-eta, and impaired cardiac recovery and cytosolic calcium regulation without significant changes in energy metabolism. PMA restored both contractile function and PKC translocation pattern in U73122-treated hearts. Direct PKC inhibition with chelerythrine mimicked the effects of U73122.
PI-PLC mediates PKC translocation during myocardial ischemia. Inhibition of PI-PLC or PKC activation, or both, during ischemia significantly impairs postischemic myocardial recovery.
The Annals of Thoracic Surgery 05/2002; 73(4):1236-45. · 3.74 Impact Factor
