Absent pulmonary valve (APV) syndrome is a rare anomaly that is usually associated with tetralogy of Fallot (TOF) and causes severe respiratory distress by compression of the trachea. Mortality following surgical repair in these patients is increased, especially in infants presenting with severe respiratory compromise. Preoperative ventilator dependency and age at operation are risk factors for mortality after surgical repair. Between 1995 and 1999, 5 patients underwent surgical treatment for TOF with APV. The mean age at operation was 9 months (range: 1 to 29 months), and the mean weight at operation was 5.2kg (3.6-9.1kg). Among these patients, 3 patients presented with severe respiratory distress caused by dilatation of aneurysmal pulmonary artery (pulmonary artery index>2,000) and 2 of these patients were dependent on a respirator prior to surgical treatment. Reduction of dilated pulmonary artery, including anterior wall resection and posterior placation, was performed in all patients. In the patients with severe preoperative respiratory compromise, the right ventricular outflow tract was reconstructed with an extracardiac conduit with autologous pericardial valve leaflets to avoid pulmonary valve regurgitation after the operation and a transannular patch with a PTFE valve was used in 2 patients without respiratory compromise. One patient died suddenly 7 months after surgical intervention. Three of the surviving patients underwent a second right ventricular outflow tract reconstruction because of progressive right ventricular outflow tract stenosis. In two of these patients the right ventricular outflow tract was reconstructed with an extracardiac conduit with autologous pericardial valve leaflets at first operation. All surviving patients are well without any physical limitations and have been placed in NYHA class I. Despite the need for reoperation for right ventricular outflow tract stenosis, aggressive surgical treatment for TOF with APV has produced a satisfactory mid-term outcome.

We performed a double switch operation for the patients with corrected congenital transposition of the great arteries concomitant with intra-cardiac abnormalities including dextrocardia, non-confluent pulmonary artery and Ebstein's malformation between April 2003 and August 2006. The mean age and weight at the time of surgery were 38 months (range 2-89 months) and 10.7kg (range 4.6-16.1kg), respectively. Before the double switch operation, one patient had received a right modified BT shunt as a neonate and another had received bilateral modified BT shunts at the age of one month and 2 months respectively, followed by a central pulmonary artery angioplasty with installation of a right ventricle to a pulmonary artery shunt at the age of 5 years. For definitive repair, the Senning+Rastelli procedure was performed in two patients and Senning+Jatene procedure was performed in one patient. Mitral valve-and tricuspid valve plasties were performed, the atrialized right ventricle was plicated in the patient with Ebstein's malformation during the double switch operation. A Senning procedure was performed in patients with apicocaval juxtapositions. We reconstructed the systemic venous chamber with a dog-ear-like structure made from suture line pouches at the site of upper and lower portions of the atrial free wall, and the pulmonary venous chamber was completed, without augmentation with additional material. The mean surgery, cardiopulmonary bypass-and aortic cross clamp times were 606, 318 and 151 min, respectively. Postoperative CT scans showed smooth systemic venous returns and no pulmonary vein obstruction. No arrhythmias of any kind were detected after the double switch operation. These results suggest the suture line pouch technique in the atrial switch operation is useful in the double switch operation.

In particular, pseudoaneurysms formed at suture lines often are injured during resternotomy. Between 1993 and 1997, 5 patients with large ascending aortic aneurysms eroding the sternum underwent graft replacement using profound hypothermic circulatory arrest. A VA bypass was established through the femoral artery and vein and the patients were cooled to achieve profound hypothermia. After total disappearance of EEG activity was confirmed, circulatory arrest was established and resternotomy was conducted. In 4 patients who had pseudoaneurysms at proximal suture lines, the aneurysms were injured during resternotomy, however the grafts above the aneurysms were clamped 5 to 10min after resternotomy and cardiopulmonary bypass resumed. Infected grafts were removed and replaced with new grafts in 4 cases and hemiarch repair was conducted in 1 case. There was 1 hospital death due to multiple organ failure. Four patients survived operations and were discharged without any deficit. The hypothermic circulatory arrest technique makes it easier to obtain a good operative field and to manage any rupture immediately than by the selective cerebral perfusion technique.

[Aim] Diffuse pan-bronchiolitis (DPB) causes severe respiratory dysfunction and severely limits a patient's daily activities. Case: This paper reports a case of a DPB patient whose respiratory symptoms were successfully improved by acupuncture. In a case report in January 2002, a 62-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of cough, pumlent sputum and dyspnea on exercise. His general condition had worsened despite ordinary medical treatment. Thus acupuncture was added to the treatment in August, 2001. Intervention: The patient received acupuncture treatments once a week for 50 weeks. The acupuncture treatment was based on the Chinese medicine theory. Measurements: Outcome measures were respiratory symptoms using the Fletcher-Hugh-Jones (F-H-J) classification, 6-minute walking distance (6 MWD), blood test, arterial blood gas and pulmonary function tests. Computed tomography (CT) was assessed. Each evaluation was done after 15 weeks and 50 weeks later.
[Results] After 15 weeks of acupuncture treatment, cough, pumlent sputum, walking distance, the Borg scale and respiratory function were significantly improved compared with the baseline. Moreover, the effect of the acupuncture treatment continued for 50 weeks.
[Conclusion] This suggests that acupuncture treatment was effective in treating the advanced case of DPB.

[Objective] Physical exercises raise more or less body temperature. A body temperature is regulated constantly generally by homeostasis mechanism. Perspiration is only heat radiation mechanism under high temperature environments. And sudoriferous water is supplied from blood. Blood flow is determined by blood fluidity, blood volume and the cardiovascular system. It was reported that strong stress decreased blood fluidity.In this experiment, we investigated the relation between blood fluidity and water supply in rats loaded with forced exercise in high temperature environment.[Methods] SPF male Wistar rats weighing 150 g were used. All animals were put in high temperature environment (Wet Bulb Globe Temperature; WBGT: 28°C) through whole experimental period. In a group of water supply, distilled water was served before and later exercise by sonde forcibly. The rats were divided into five groups randomly; Rest-Non water intake (RN), Rest-Water intake (RW), Exercise-Non water intake (EN), Exercise-Water intake (EW) and Baseline (B). The blood was collected before or later of exercise and blood fluidity or platelet aggregation was measured.[Results] In the EN, platelet aggregation, lactic acid and corticosterone increased while blood fluidity were decreased significantly compared with the RN, RW and EW. In addition, the hematocrit did not increase even if water equivalent to 8 % of body weight lost it.[Conclusion] We speculate that exercise in high temperature environment decreases blood fluidity. However, the water supply that does not completely make up for quantity of depletion in exercise may improve blood fluidity.

Emphysema with bronchial asthma (BA) in chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits a patient's daily activities. This paper reports the case of a COPD patient whose respiratory symptoms were successfully improved with acupuncture. In July 1998, a 69-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of dyspnea on exercise, and asthma attacks. His general condition had worsened despite strictly controlled medication and home oxygen therapy (HOT). Acupuncture was thus added to these treatments from ******. Before initiating the acupuncture treatment, the severity of dyspnea in the patient was diagnosed as level III (Severe), according to the GOLD classification. Spirometry showed severely disturbed respiratory function (%VC: 90.7%, FEV₁%: 35.1%, %FEV₁: 38.2%, V 25: 0.20 L/S). The basic combination of meridian points used in this case included LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV 4 (Guanyuan), CV 12 (Zhongwan), CV 22 (Tiantu), ST 40 (Fenglong), BL 13 (Feishu), BL 23 (Shenshu) and KI 3 (Fuliu). The patient received acupuncture treatments once a week for 10 weeks. Respiratory function and symptoms were measured. After 10 weeks of acupuncture treatment, asthma attacks, walking distance, the Borg scale and respiratory functions were significantly improved compared with the baseline. This suggests that acupuncture treatment was effective in treating advanced cases of both asthma and COPD.

Many acute and subacute complications of coronavirus disease 2019 (COVID-19) have been reported. However, the recovery process in severely ill patients is not clear. Here, we report three patients with favorable physical function after severe COVID-19. All three patients were older than 65 years and had comorbidities such as diabetes mellitus, hypertension, and smoking habits. During respiratory failure, they received mechanical ventilation support for more than 4 days. Two patients had undergone tracheostomy, and one had undergone extracorporeal membrane oxygenation (ECMO). At the time of transfer to our hospital, they had lower-limb muscle weakness, respiratory distress on exertion, exercise-induced hypoxemia (EIH), and complications from immobility, such as peroneal nerve palsy. During rehabilitation, we monitored peripheral blood oxygen saturation, adjusted the workload, and administered temporary orthotic therapy. The patients improved within 150 days after the onset of the disease, and they were discharged home and were able to walk as a practical means of transportation. Even after severe COVID-19, the patients achieved good physical function. Interventions for EIH and complications due to immobility were additionally necessary. In the future, we must examine the relationship between improvements in physical function and rehabilitation.