Out of 104 patients with perimembranous or infundibular-isolated ventricular septal defect (VSD), causative factors of Prol and AR, and the operative indication were studied in 17 with prolapse of the aortic cusp (Prol) and 10 with aortic valve regurgitation (AR). The left to right shunt ratio and the size of VSD were smaller in patients with Prol or AR than in those with the normal aortic cusp, suggesting that hemodynamics might take part in the cause of Prol or AR. Twenty-two patients underwent VSD closure only, four valvuloplasty and one aortic valve replacement. Residual AR was occurred in three out of ten patients. After surgery, AR was disappeared in six out of seven patients with the first grade preoperative AR, but AR remained in all two patients with the second grade preoperative AR. Careful preoperative observation and early operation before the appearance of AR are the important factors for avoiding residual regurgitation after aortic valvuloplasty.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

Surgical interventions for aorto-iliac obstructive diseases were studied through the operative results. Eighteen patients underwent aorto-femeral bypass (AOF) and 23 who were over 70 years of age or who had serious preoperative complications had axillofemoral bypass (AXF). No perioperative death occurred in AOF patients, while the mortality rate of AXF patients was 8%. Postoperative ankle pressure indexes were significantly higher in AOF patients than in AXF patients. Follow-up graft patency rate was 100% in AOF patients at 54 months (mean), and 85% in AXF patients at 44 months respectively. AOF should be the first choice for patients with aorto-iliac obstructive disease, and AXF is suitable only for high-risk patients.

In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.

Blood oxygen saturation, keton boby ratio and endotoxin concentration of arterial and hepatic venous blood were measured in 12 adult patients before, during and after extracorporeal circulation (ECC). When rectal temperature returned to 32°C during ECC, the levels of hepatic venous blood oxygen saturation (ShvO₂) and arterial keton body ratio, hepatic venous keton body ratio decreased. The serum level of endotoxin concentration was within normal limits on the operative day and increased at the first and second day after surgery. In three patients in whom the level of ShvO₂ was under 50% at 60 minutes after ECC, postoperative liver dysfunction occurred frequently. Endotoxin changes on the first day after surgery is probably due to recovery differences between hepatic and gastrointestinal circulations.

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

A follow-up study of 98 patients undergoing abdominal aortic aneurysm (AAA) repair for 44 months, ranging 2 to 113 months, revealed no difference in 5-year actuarial survival between patients aged 75 or older and patients aged less than 75. The 5-year actuarial survival of ruptured and nonruptured AAA cases was 469% and 71.2%, respectively (p<0.01). Late deaths after the repair of ruptured AAA were all due to atherosclerotic diseases. During a follow-up period after AAA repair, 9 patients were diagnosed as having malignant diseases with a fatal outcome in 6. Careful attention to atherosclerotic and malignant diseases is indispensable for follow-up management after AAA repair.

A 61-year-old man was found to have an abdominal aortic aneurysm (AAA) during follow-up for ischemic heart disease. On admission, ultrasonograms and computed tomograms revealed a thickened aortic wall surrounded by a soft tissue (so-called mantle). The obstructive right anterior brain artery and stenotic right internal carotid artery were also detected by angiography. Coronary angiography demonstrated multiple stenotic lesions of the coronary arteries. The excised AAA was replaced with an prosthetic graft. The mobilization of the adjacent viscera was kept as little as possible in order to prevent injury to them. We reported a case of “inflammatory” abdominal aneurysm associated with various atherosclerotic lesions.

OBJECTIVES: To examine the effects of whole body vibration (WBV) on bone properties in growing rats, and to explore the optimal conditions for enhancing bone properties. METHODS: Thirty-six 4-week-old male rats were divided into 1 control and 5 experimental groups. Each experimental group underwent WBV at 15, 30, 45, 60, and 90 Hz (0.5 g, 15 min/d, 5 d/wk) for 8 weeks.We measured bone size, muscle weight and bone mechanical strength of the right tibia. Trabecular bone mass and trabecular bone microstructure (TBMS) of the left tibia were analyzed by micro-computed tomography. Serum levels of bone formation/resorption markers were also measured. RESULTS: WBV at 45 Hz and 60 Hz tended to enhance trabecular bone mass and TBMS parameters. However, there was no difference in maximum load of tibias among all groups. Serum levels of bone resorption marker were significantly higher in the 45-Hz WBV group than in the control group. CONCLUSIONS: WBV at 45–60 Hz may offer a potent modality for increasing bone mass during the period of rapid growth. Further studies are needed to explore the optimal WBV conditions for increasing peak bone mass and TBMS parameters. WBV modality may be a potent strategy for primary prevention against osteoporosis.
Animals ; Bone Resorption ; Humans ; Male ; Osteoporosis ; Primary Prevention ; Rats ; Tibia ; Vibration