Biomedical subjects
Publications and source records attributed to K Haneda.
Five cases of vascular ring are presented. Three cases have double aortic arch and two cases have right aortic arch with aberrant left subclavian artery. Other congenital heart diseases are complicated in four cases. MRI was useful for the evaluation of tracheal and esophageal compression.
From 1971 to 1993, four patients, 7 to 13 years of age, underwent intracardiac operation for infective endocarditis. Two patients underwent mitral valve replacements, one was tricuspid replacement and one received tricuspid valvulectomy. There was no operative death but one late death occurred (correction of occurred) due to cerebral bleeding. Surgical treatment of infective endocarditis in childhood could be performed safely by adequate selection of operative methods.
For the systemic-pulmonary artery shunt operation, the modified Blalock-Taussig shunt was the first choice for procedure in our institution. Since 1990, Golaski knitted Dacron graft (4 or 5 mm in diameter) was used for the prosthesis. Ex-vivo flow calibration of the electromagnetic flow meter (Nihon Koden, MFV-3100) to Golaski graft showed good correlation between the real flow and value measured by the electromagnetic flow meter. Shunt flow was measured in the consecutive clinical fifteen cases. The shunt flow per body surface area of the patient who required additional shunt operation was 721 ml/min/m2 and one patient in whom the congestive heart failure developed after the shunt operation, had the shunt flow of 3,022 ml/min/m2. The adequate shunt flow in these cases was ranged from 745 to 2,820 ml/min/m2 (mean +/- 1 SD, 1,490 +/- 587.8). Therefore we performed the systemic-pulmonary artery shunt operation using Golaski graft to get the shunt flow of 1,000 ml/min/m2 (approximately a third of cardiac index) for the guide of good results.
Pulmonary arterial changes were histometrically analyzed in four cases of postoperative death following a modified Fontan procedure in which pulmonary artery banding had previously been performed because of pulmonary hypertension. Case 1 was a 3-year-old girl with corrected transposition of the great arteries (TGA), ventricular septal defect, and double-inlet left ventricle; case 2 was a 6-year-old girl with single ventricle (SV) and complete TGA; case 3 was a 25-month-old boy with SV and double-outlet right ventricle; and case 4 was a 21-year-old man with tricuspid atresia. The cause of death in cases 1, 2, and 3 was pulmonary hypertensive crisis due to postoperative vasoconstriction of the small pulmonary arteries. Medical hypertrophy remained in half of the preacinar small pulmonary arteries although it was not observed in all the intraacinar arteries in cases 1 and 2, even after banding. The postoperative course of case 4 was uneventful despite multiple thromboembolism in the small pulmonary arteries. However, the patient died due to a thrombosed artificial valve. The results suggest that residual medial hypertrophy of the small pulmonary arteries was a major risk factor in these cases. Lung biopsy is recommended to determine the indications for the Fontan procedure in these hemodynamically critical cases.
Fifty-eight patients with ventricular septal defect (VSD) associated with severe pulmonary hypertension (Pp/Ps > or = 0.90) were repaired between 1971 and 1992. Their preoperative Pp/Ps, Rp/Rs and Rp were 0.98 +/- 0.06, 2.37 +/- 1.20 and 4.81 +/- 3.06 units.m2, respectively. Late results were analyzed in 56 operative survivors. The age at the time of operation ranged from 2 months to 32 years (average 4.1 years) and the postoperative follow-up period ranged from 1 month to 20 years (average 5.5 years). Eighty-two percent of the patients were in New York Heart Association functional class I, 15% were in class II and 3% in class III. The postoperative Pp/Ps and Rp/Rs significantly decreased to 0.41 +/- 0.13 (p < 0.001) and 0.25 +/- 0.16 (p < 0.001), respectively. There were significant differences in Rp/Rs and Rp between the patients operated on before (Group 1) and after 2 years of age (Group 2). Rp/Rs and Rp in Group 1 were 0.17 +/- 0.06 and 2.52 +/- 0.65 units.m2, whereas 0.31 +/- 0.19 (p < 0.05) and 4.26 +/- 1.88 units.m2 (p < 0.05) in Group 2, respectively. One patient died 14 months after VSD closure due to respiratory failure. It is concluded that a patient with VSD associated with severe but reversible pulmonary hypertension should be surgically corrected before 2 years of age.
Penicillium sp. FO-2295, a water isolate, was found to produce a series of new anticoccidial compounds. Two active compounds, designated arohynapenes A and B, were isolated from the fermentation broth of the producing strain by solvent extration and preparative HPLC. Arohynapene A was deduced to be (2E,4E)-5-(5-hydroxy-2,6,8-trimethyl-5,6,7,8-tetrahydronaphtale ne)-2,4- pentadienoic acid, and arohynapene B was (2E,4E)-5-(2-hydroxymethyl-6,8-dimethyl-5,6,7,8-tetrahydronapht alene)-2,4- pentadienoic acid. Arohynapenes inhibited the growth of Eimeria tenella in an in vitro assay using BHK-21 cells as a host. No schizont in the cells was observed at concentrations ranging above 35.0 microM and 7.0 microM for arohynapenes A and B, respectively.
Streptomyces amakusaensis KO-8119, a soil isolate, was found to produce a series of new anticoccidial compounds. Four active compounds, designated as cytosaminomycins A, B, C and D, were isolated from the fermentation broth of the producing strain by solvent extraction, silica gel column chromatography and preparative HPLC. Cytosaminomycins inhibited the growth of Eimeria tenella in an in vitro assay system using primary chicken embryonic cells as a host. No schizont in the cells was observed at concentrations ranging from 0.3 to 0.6 microgram/ml for cytosaminomycins A, B and C, and at 2.5 micrograms/ml for cytosaminomycin D.
Structures of novel anticoccidial antibiotics, cytosaminomycins A, B, C and D, were elucidated by NMR studies. Cytosaminomycins were shown to be nucleoside antibiotics related to oxyplicacetin. Their carboxylic acid moieties bonded to the cytosine residue were different from that of oxyplicacetin. The carboxylic acids contained in cytosaminomycins A, B, C and D were (E)-3-(methylthio)acrylic acid, 4-methylaminobenzoic acid, 3-methylcrotonic acid, and tiglic acid, respectively.
A case of a 14-year-old boy who underwent a prosthetic tricuspid valve insertion two years after the tricuspid valvulectomy due to intractable right-sided active endocarditis is presented. At the initial operation, the tricuspid valve was thoroughly resected because of marked destruction and attachment of vegetations, and a concomitant ventricular septal defect was directly closed. When a prosthetic valve was placed in the tricuspid portion, a semicircular Dacron patch was attached to the right side of the interventricular septum in a fashion of up-chord and down-arc to cover the bundle of His. The straight edge of the patch was located near the AV node and was not sutured to the tricuspid valve annulus. A 31 mm of CarboMedics prosthetic valve was sutured to the tricuspid valve annulus and to the free edge of the patch at the position near the AV node to prevent AV block. Postoperative course was uneventful and ECG showed regular sinus rhythm.
Complement activation and it's influence on lung injury were studied in 20 patients undergoing cardiopulmonary bypass (CPB). Anaphylatoxins increased remarkably to 3130 +/- 1770 ng/ml in C3a, 2480 +/- 2530 ng/ml in C4a and granulocytes were significantly fewer in left atrium (LA) than right atrium (RA) during CPB. Granulocyte elastase (GEL) was significantly higher in LA than RA at the time of reperfusion. Postoperative respiratory index was well correlated with C3a and GEL. We concluded that lung injury after CBP was caused by anaphylatoxin which aggregated granulocyte in pulmonary vasculature and released GEL during CPB, and anaphylatoxin was produced not only by using CBP but in patient's lung.
The case of a 13-year-old boy with a tricuspid valve myxoma and coronary artery occlusion and aneurysms suspected to be caused by Kawasaki's disease is presented. Simultaneous extirpation of the myxoma and coronary artery bypass grafting to the left anterior descending artery using the left internal mammary artery was performed. His postoperative course was satisfactory. Coronary artery bypass grafting in a child is also discussed.
Late hemodynamics following corrective surgery for congenital heart diseases were evaluated in 65 patients. The patients were divided into 4 groups due to the operative procedures including closure of ventricular septal defect (VSD group = 15 patients), repair of tetralogy of Fallot (TOF group = 20), Mustard operation (Mustard group = 19) and Fontan operation (Fontan group = 11). The postoperative period was 3.8 +/- 3.8, 1.0 +/- 0.1, 5.7 +/- 4.3 and 3.2 +/- 4.9 years in VSD, TOF, Mustard and Fontan groups, respectively. Postoperative pulmonary to systemic arterial pressure ratio in VSD group significantly decreased to 0.38 +/- 0.13 from the preoperative value of 0.97 +/- 0.04. Pulmonary vascular resistance (Rp) in VSD group significantly decreased from 4.88 +/- 2.40 to 2.56 +/- 0.75 U.m2 and Rp in Fontan group significantly increased from 1.63 +/- 0.70 to 3.66 +/- 0.47 U.m2 postoperatively. Postoperative cardiac indices in VSD, TOF, Mustard and Fontan groups were 4.30 +/- 1.34, 4.28 +/- 0.72, 3.83 +/- 1.38 and 3.48 +/- 1.38 l/min/m2, respectively, without significant differences. Ejection fraction (EF) of the systemic ventricle (left ventricle) in VSD, TOF and Fontan groups were 0.66 +/- 0.06, 0.65 +/- 0.07 and 0.63 +/- 0.08, respectively. In Mustard group, EF of the systemic ventricle (right ventricle) was 0.56 +/- 0.12 and significantly less than left ventricular EF in the other 3 groups. The hemodynamic characteristics after these operative procedures should be considered for patient management.
Twenty-four adult mongrel dogs were divided into four equal groups according to the following method of cardiopulmonary bypass: normothermic continuous (so-called nonpulsatile) perfusion, normothermic pulsatile perfusion, hypothermic continuous perfusion, and hypothermic pulsatile perfusion. Cerebral blood flow was determined by measuring the volume of sagittal sinus venous blood outflow with a transit-time ultrasonic flowmeter. Cardiopulmonary bypass was initiated at a flow rate of 80 ml/kg per minute. Cerebral temperature was maintained at 37 degrees C in the normothermic groups and at 25 degrees C in the hypothermic groups. Arterial pH and carbon dioxide were maintained within the physiologic range by alpha-stat acid-base regulation. Mean cerebral perfusion pressure and blood flow were not affected during 90 minutes of the bypass. The respective values were 67.1 mm Hg and 37.1 ml/100 gm brain per minute with normothermic continuous perfusion, 72.8 mm Hg and 39.0 ml/100 gm per minute with nonpulsatile perfusion, 98.0 mm Hg and 23.0 ml/gm per minute with hypothermic continuous perfusion, and 86.8 mm Hg and 22.3 ml/100 gm per minute with hypothermic pulsatile perfusion. Pump flow rates were altered from 10 to 120 ml/kg per minute in a stepwise fashion to obtain graded changes of perfusion pressure. Cerebral blood flow, however, was not changed significantly by cerebral perfusion pressure so long as perfusion pressure was greater than 50 mm Hg. Conversely, cerebral blood flow changed proportionally with cerebral perfusion pressure at a pressure less than 50 mm Hg. The correlation between cerebral blood flow and perfusion pressure was described as two separate lines determined by linear regression. The slope of the regression line relating cerebral blood flow to perfusion pressure was 0.16 +/- 0.08 for a cerebral perfusion pressure above 50 mm Hg and 0.68 +/- 0.11 below 50 mm Hg in the normothermic continuous perfusion group; 0.14 +/- 0.09 and 0.32 +/- 0.09 with normothermic pulsatile perfusion; 0.10 +/- 0.04 and 0.62 +/- 0.18 with hypothermic continuous perfusion; 0.09 +/- 0.08 and 0.39 +/- 0.04 in the hypothermic pulsatile perfusion group. The slope above 50 mm Hg was significantly smaller and closer to zero in all groups than it was at a perfusion pressure below 50 mm Hg (p < 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)
Autologous or glutaraldehyde treated bovine pericardial valved patch was utilized for widening of the right ventricular outflow tract in 20 patients with tetralogy of Fallot (autologous pericardium group in 10 patients and bovine pericardium group in 10). Pericardial valve function of the both materials was evaluated by postoperative cardiac catheterization performed 1 year after the operation. There were no significant differences in pulmonary arterial and right ventricular pressures, and right ventricular ejection fraction and end-diastolic volume between the 2 groups. Pulmonary angiogram in the autologous pericardium group patients demonstrated the pulmonary regurgitation (PR) of grade 1 in 5 patients, grade 2 in 4 and grade 3 in 1. On the other hand, 1, 3 and 6 patients in the bovine pericardium group demonstrated no-PR, grade 1 PR and grade 2 PR, respectively. It was concluded that there were no significant differences between autologous and glutaraldehyde treated bovine pericardium as a material of valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot.
The adequacy of the circuits for brain perfusion has been explored by hemodynamic assessment using the ability of the brain to autoregulate blood flow as an indicator, and by morphologic observation using carbon black or Evans blue infusion into the brain perfused antegradely or retrogradely. It is concluded that the safe pressure of cerebral perfusion needed to maintain cerebral integrity is between 40 and 50 mm Hg in both normothermic and hypothermic perfusions, a pressure that can be generated by nonpulsatile pump flows through the pump greater than 40 mL.kg-1 x min-1. Morphologic studies revealed development of focal infarctions in the brain and destruction of the blood-brain barrier by retrograde cerebral perfusion. The retrograde approach, therefore, is definitely inferior to the antegrade method. Antegrade perfusion for 90 minutes, however, produced minimal cerebral edema, suggesting the need for further improvement even in techniques of antegrade perfusion.
Seven adult mongrel dogs with an average body weight of 11.3 kg were subjected to experimental Fontan operation in order to evaluate acute hemodynamic changes at the Fontan circulation. The Fontan circulation was established by occlusion of the tricuspid valve with tightening a purse-string suture which was placed around the valve under inflow occlusion and was passed through the anterior right atrial wall, and by connection with a 10 mm Gore-Tex graft between right atrium and pulmonary artery. When the Fontan circulation was established, aortic pressure and cardiac output (CO) decreased from 94.9 +/- 22.0 mmHg to 41.9 +/- 6.0 mmHg and 0.907 +/- 0.179 liter/min to 0.259 +/- 0.072 liter/min, respectively. There were no significant changes in heart rate and systemic vascular resistance between normal and the Fontan circulations. On the other hand, pulmonary vascular resistance (PVR) increased from 11.6 +/- 7.3 units in the normal circulation to 21.8 +/- 13.0 units in the Fontan circulation. From this study it was concluded that main changes in hemodynamic parameters immediately after establishing the Fontan circulation were marked decrease in systemic arterial pressure and CO, and an increase in PVR. Therefore, one should consider a possibility of an increase in the PVR to the critical level when the Fontan operation was applied to patients with pulmonary hypertension.
In order to obtain a better understanding of the pathogenesis of the postoperative low cardiac output syndrome (LOS), a multivariate regression analysis was performed, evaluating predictive risk factors quantitatively as a function of plural preoperative variables. A total of 145 cases including 76 MVR (MS 36 MR 40), 42 AVR and 27 DVR were analyzed in this study. Ten historical, 10 hemodynamic and 4 operative risk factors were collected to compose the data file with corresponding status of postoperative cardiac function which was classified as follows. Patients who were not associated with postoperative LOS (Score 1), associated with the LOS which required and responded to ordinal dosage of a catecholamine (Score 2) associated with the LOS which required and responded to maximal dosage of the catecholamine and/or mechanical circulatory support (Score 3), and died of LOS (Score 4). Variables with significant relationships to postoperative LOS, regression equation to LOS score and their multiple correlation coefficients (R) of each group were as follows. MVR group: technical trouble (TT), extracorporeal circulation time (ECCT), change of myocardial preservation methods, delta LVSWI/delta LVEDP, diseased duration, aortic cross clamping time, CTR, Y = -1.16 + 1.01 (TT) + 0.05(ECCT) + 0.16(delta LVSWI/delta LVEDP) + 0.02(CTR), R = 0.76. AVR group: LVMMI, ECCT, cardiac failure, NYHA, Y = -0.71 + 0.03(LVMMI) + 0.004 (ECCT) + 0.22(NYHA), R = 0.78. DVR group: delta LVWI/delta LVEDP, LVMMI, NYHA, LV diastolic eccentricity ratio, ECCT, Y = -0.50 + 0.60 (delta LVWI/delta LVEDP) + 0.003(LVMMI) + 1.18(NYHA) + 0.38(delta LVSWI/delta LVEDP) + 0.003(ECCT), R = 0.87. It was demonstrated that preoperative ergometer exercise study during cardiac catheterization was useful in prediction of postoperative outcomes, especially in the MVR (MS) group.
Penicillium sp. FO-1611, a soil isolate, was found to produce a series of new anticoccidial compounds. Three active compounds, designated hynapenes A, B and C, were isolated from the fermentation broth of the producing strain by solvent extraction, silica gel column chromatography, gel filtration on Sephadex LH-20 and preparative HPLC. Hynapenes inhibited the growth of Eimeria tenella in an in vitro assay using BHK-21 cells as a host. No schizont in the cells was observed at concentrations ranging above 123 microM, 34.7 microM and 34.7 microM for hynapenes A, B and C, respectively.