We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 l/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.

Bleeding control during aortic surgery is one of the most important issue. The well-known fibrinogen-based hemostat contains the blood product, which means the potential risk of the blood-related infection. Recently, the newly-designed hemostat “Hydrofit”, which is assembled with urethane-based polymer without blood product (Matsudyte : Sanyo-chemical industry, Kyoto, Japan). Hydrofit is applicated for the hemostasis of thoracic aortic surgery. In sealing of the Hydrofit gel to the anastomosis site of aorta, water-contact initiation boosts the chemical change to the forming elastomer and adheres around anastomosis site rapidly. We experienced the extirpation of the Hydrofit which was used over 4 years ago. The patient is 42 year-old female who was operated aortic valve replacement and graft replacement of ascending aorta using a Hydrofit as a hemostat at 4 year 8 months ago due to the aortitis syndrome. Re-sternotomy and re-AVR was performed because of the prosthetic valve dehiscence due to the active aortitis syndrome. Hydrofit left around suture line without infection, and functioned very well as the elastic sealant for the long-term period.

BACKGROUND/AIMS: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.METHODS: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.RESULTS: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.CONCLUSIONS: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.
Adult ; Asian Continental Ancestry Group ; Biological Factors ; Child ; Colectomy ; Colitis ; Colitis, Ulcerative ; Female ; Humans ; Immunologic Factors ; Japan ; Prednisolone ; Remission Induction ; Retrospective Studies ; Tacrolimus ; Ulcer