Objective : To investigate the efficacy of aortic valve replacement with annular enlargement for congenital aortic valve stenosis. Methods : Eleven patients underwent aortic valve replacement with annular enlargement for congenital aortic valve stenosis in our institute between January 2002 and July 2012. The clinical status of these patients, including preoperative and postoperative echocardiography, was evaluated in this study. Results : The median age of the patients was 15.5 years (range : 9-38 years). The patients had a mean body surface area of 1.48±0.3 m² (range : 1.00-1.92 m²). Mechanical prostheses were used in all patients and the techniques of aortic annular enlargement were the Nick procedure in 4 patients, Manouguian procedure in 3 (modified Manouguian in 2), Yamaguchi procedure in 2, and Konno procedure in 2. The average follow-up period was 32.1 months (range : 1-117 months). There was neither operative death nor late death. The peak/mean pressure gradient of aortic valve improved from 77.9±31.7/46.6±18.0 mmHg preoperatively to 27.9±7.7/14.8±4.7 mmHg postoperatively and to 28.3±11.1/14.1±7.0 mmHg at intermediate-term follow-up. The estimated left ventricular mass also improved from 206.8±93.4 g preoperatively to 179.7±61.1 g postoperatively and to 100.4±76.3 g at intermediate-term follow-up, respectively. Conclusions : Our series shows the efficacy and safety of aortic valve replacement with annular enlargement for congenital aortic valve stenosis.

The diagnosis of ruptured dissecting limited abdominal aortic aneurysm was made in four cases. The sex ratio (M/F) was 1/3, and mean age was 63.5 years (from 53 to 78yr). Only one of these cases die due to intraoperative bleeding. Other three cases were discharged from our hospital. Intraluminal proximal anastomosis after fixed dissected aortic wall due to mattress suture and end to end anastomosis with reinforcement by Teflon felt were good results. The one case who was anastomosed simple intraluminal method has pseudoaneurysm in the proximal portion. It is important to diagnose preoperatively dissection and to make end to end anastomosis with Teflon felt.

Between Nov. 1981 and Dec. 1990, seventy-seven patients underwent surgical repair for abdominal aortic aneurysm (56, non-ruptured and 21, ruptured). There were no operative and hospital deaths in the non-ruptured group and 4 deaths (19%) in the ruptured group. To improve operative results by means of decreasing hemorrhagic blood loss and operative time, we have ameliolated some points of the technical procedures as follows. Dissection of the perianeurysmal tissue was limited to only the neck and anterior peritoneal surface of the aneurysm. Taping to keep the aorta and distal iliac artery was not applied and vascular clamps were placed without dissection of the posterior walls of the aorta and distal arteries. Proximal anastomosis of the Y-vascular prostheses were performed by the inclusion technique. The end-to-side method was used in distal anastomosis to the external iliac arteries routing behind the ureter. Even when aneurysmal dilatation involved the common iliac arteries, the orifices of the common iliac arteries were closed by continuous sutures bilaterally. In ruptured cases too, this standard technique was used without application of special means for proximal cross-clamping. Postoperative arteriography or enhanced computed tomography reveald thrombosis and reduction in size of residual aneurysm of the common iliac artery. By these improved surgical techniques, 25 cases (45%) of the 56 non-ruptured group had surgical correction of the abdominal aortic aneurysm without using homologous blood transfusion. Cumulative 5-year survival rate by Kaplan-Meier method of non-ruptured and ruptured group was 87% and 49% respectively.

A 54-year-old man developed cardiogenic shock after acute myocardial infarction. Urgent coronary angiogram revealed complete occlusion at proximal portion of the right coronary artery and severe stenosis at just proximal site of the left anterior descending branch. Following thrombolytic therapy was not successful and he was sent to the operating room for coronary artery bypass surgery under external cardiac massage after 6hr from the onset. Three aorto-coronary bypasses were made to left anterior descending branch, first diagonal branch and right coronary artery using saphenous vein grafts by aortic cross-clamping of 67min. He fell into severe low cardiac output syndrome and could not be weaned from the cardiopulmonary bypass even by catecholamine infusions and IABP support. Veno-arterial bypass consisted of centrifugal pump and membranous artificial oxygenator was instituted. Venous blood was drained from the right atrium using percutaneous cannula via the right femoral vein and oxygenated blood was returned to the right subclavian artery. Hemodynamics recovered dramatically and after 71hr of this assisted circulation he was weaned from veno-arterial bypass. Activated coagulation time was maintained within 180-200sec. During this period, the centrifugal pump and oxygenator was not necessary to change and no clot was seen in the bypass system. He discharged from our hospital after 2 mo, postoperatively and now he is doing well as NYHA class-II 8 mo. postoperatively.

We experienced a 51-year-old male case of CABG whose graftography one month after CABG revealed a 0.5cm venous bypass graft aneurysm. Anginal pain recurred in the eighth month after CABG. Re-graftography showed enlargement of the aneurysm and stenosis of the graft at the same site. Re-CABG was carried out successfully and his postoperative course was good. Venous graft aneurysm is a comparatively rare complication, and that of the present case was considered to be most ascribable to the fragility of the graft, caused by mediastinitis secondary to the first CABG. Thrombus formation was noted in the aneurysm, with a risk of causing rupture or myocardial infarction. Therefore, such graft aneurysms should be treated by re-CABG as soon as possible after detection.

A 27-year-old female with Marfan's syndrome underwent successful emergency surgery for rupture of an abdominal aortic aneurysm. Annulo-aortic ectasia with a saccular aneurysm of the aortic arch was revealed by angiography after the initial operation. Cabrol's operation with replacement of the aortic arch was performed. Because bleeding from the distal anastomotic portion was uncontrollable, the segment was ligated and an extra-anatomical bypass was performed from the ascending aortic graft to the bilateral femoral arteries. Intra-graft balloon pumping was carried out in the extra-anatomical bypass graft while the patient was in low cardiac output condition after the second operation. This was considered to be an effective circulatory assist procedure.

We present a rare case of mitral stenosis with bilateral pulmonary arteriovenous fistulae (PAVF). A 55-year-old female who complained of dyspnea did not have pulmonary hypertension. She underwent successfully mitral valve replacement with an artificial valve 2 months after transcatheter coil embolization for PAVF. The combination with mitral valve replacement and transcatheter embolization is regarded as a useful procedure for mitral valve disease associated with PAVF.

Between 1984 and 1994, 58 patients underwent operations for type A aortic dissection. A sutureless ringed intraluminal graft was used in 9 of the 58 cases. The patients ranged from 47 to 74 years old (mean, 60.4 years). Six patients were discharged from the hospital and three patients died. The operative mortality rate for the 9 patients was 33.3% and for the other 49 patients it was 20.4%. Post-operative aortograms revealed a remaining false lumen in 5 of the 6 discharged patients. The result of the operation with the sutureless ringed intraluminal graft was not satisfactory. Therefore, we prefer to resect and replace the dissected aorta using the prosthetic graft rather than repair with the sutureless ringed intraluminal graft.

An 81-year-old woman with severe chest pain was admitted to our hospital. Computed tomography showed aortic dilation and a non-enhanced crescentic area in the ascending aortic wall, indicating a DeBakey type-II aortic dissection with thrombus. The ascending aorta was replaced with an impregnated knitted Dacron graft. Fresh clotted hematoma was found in the dissected ascending aortic wall, and the intimal surface was involved with a local atherosclerotic ulcer penetrating the media. Operative findings were compatible with intramural hematoma due to penetrating atherosclerotic ulcer described by Stanson et al. In the literature most penetrating atherosclerotic ulcers are located in the descending aorta, thus this case is rare.

AIMTo analyze the relationship between sperm mitochondrial membrane potential and sperm motility parameters by means of a computer-assisted sperm analyzer (CASA) and in-vitro fertilization rate(%FR).

METHODSSemen samples were obtained from 26 men undergoing in vitro fertilization-embryo transfer (IVF-ET). Informed consent was obtained from all men prior to the study. Samples were prepared using wash and swim-up method in HEPES-HTF medium. The sperm motility (%MOT), progressive motility (%PMOT), average path velocity (VAP) microm/s), straight line velocity (VSL) (micro m/s), curvilinear velocity (VCL) (microm/s) and %hyperactivated sperm (%HA), and the %FR were assessed. The samples were incubated in the presence of 2.0 mciromol/L of 5,5',6,6'-tetra-chloro-1,1',3,3'-tetraethylbenzimidazolyl-carbocyanine iodide (JC-1) for 30 min at 37 degrees C in air and washed in PBS before flow cytometry (FACSCalibur: Becton Dickinson) analysis. The mitochondrial probe JC-1 was used to identify the mitochondrial membrane potential. The sperm was divided into three populations according to the fluorescence pattern as follows: the high mitochondrial membrane potential group (n=8), the moderate group (n=5), and the low group (n=13). Statistical analysis was performed using unpaired t-test.

RESULTSSignificant differences were found between the high and the low groups in %MOT (91.1+/-8.5 vs 63.0+/-32.7, mean+/-SD), VAP (73.0+/-14.2 vs 52.1+/-12.5), VCL (127.0+/-28.1 vs 87.0+/-22.6), %HA (27.3+/-23.6 vs 7.2+/-9.0) and %FR [73.2 (48/56) vs 59.0 (69/117)]. No significant differences were found in other CASA parameters.

CONCLUSIONWhen the sperm mitochondrial membrane potential increases, sperm motility parameters and fertility potential will also increase. The JC-1 dye method is useful to predict sperm fertility potential.

Embryo Transfer ; Female ; Fertility ; physiology ; Fertilization in Vitro ; Flow Cytometry ; Humans ; Intracellular Membranes ; physiology ; Male ; Membrane Potentials ; physiology ; Mitochondria ; physiology ; ultrastructure ; Semen ; physiology ; Sperm Motility ; Spermatozoa ; physiology