Arterial revascularization with the right gastroepiploic artery and internal mammary arteries in 300 patients

From September 1989 to September 1992, the right gastroepiploic artery in combination with one or both internal mammary arteries was used as a graft in 300 patients who underwent coronary artery bypass grafting. The gastroepiploic artery was the primary choice in preference to the saphenous vein. The study comprised 263 men and 37 women, ranging in age from 31 to 77 years (median age 59 years). Thirty-nine patients (13%) underwent previous bypass procedures with autologous vein grafts. In 17 patients (5.7%) the gastroepiploic artery was used as a single graft. In 150 patients (50%) the gastroepiploic artery in conjunction with one internal mammary artery was used (in 6 patients combined with a vein graft). In 133 patients (44.3%) the gastroepiploic artery was used with both internal mammary arteries. Revascularization in nine patients (3%) was combined with another cardiac procedure; three aortic valve replacements, two mitral valve repairs, and four resections of a left ventricular aneurysm. Ten patients died in the hospital (3.3%; 70% confidence limits 2.3% to 4.8%); two of these patients had an infarction in the area revascularized by the gastroepiploic artery. At late follow-up, 0.5 to 39 months (mean 14 months) after the operation, we found no mortality. One patient with an occluded gastroepiploic artery graft underwent reoperation with the use of the right internal mammary artery. One patient underwent percutaneous transluminal coronary angioplasty of the right coronary artery after occlusion of the gastroepiploic artery. Elective recatheterization was done in 88 patients 1 to 25 months after operation (mean 10 months). Graft patency in gastroepiploic artery grafts increased steadily from 77% in the first semester of the study to 95% in the fourth semester and then equaled the patency of the internal mammary artery grafts (97%), which was almost constant during the whole period. We conclude that patency of the gastroepiploic artery was initially related to a ''learning curve'' but eventually equaled that of the internal mammary artery grafts. Furthermore, the gastroepiploic artery may well be the graft of choice in conjunction with the internal mammary arteries

Intracardiac anatomical relationships and potential for streaming in double inlet left ventricles.

The aim of this study was to gain better understanding of the variable anatomical features of double inlet left ventricle hearts without cavopulmonary connection that would potentially facilitate favorable streaming. Thirty-nine post-mortem specimens of double inlet left ventricle without cavopulmonary connection were investigated. The focus was on anatomical characteristics that could influence the flow and separation of deoxygenated and oxygenated blood in the ventricles. Elements of interest were the ventriculoarterial connection, the spatial relationship of the ventricles, the position and size of the great arteries, the ventricular septal defect, the presence of relative outflow tract stenosis and the relationship of the inflow and outflow tracts. The most common anatomy was a discordant ventriculoarterial connection with an anatomically left-sided morphologically right ventricle (n = 12, 31%). When looking at the pulmonary trunk/aorta ratio, 21 (72%) hearts showed no pulmonary stenosis relative to the aorta. The ventricular septal defect created a relative subpulmonary or subaortic stenosis in 13 (41%) cases. Sixteen (41%) hearts had a parallel relationship of the inflow and outflow tracts, facilitating separation of deoxygenated and oxygenated blood streams. On the other end of the spectrum were 10 (25%) hearts with a perpendicular relationship, which might lead to maximum mixing of the blood streams. The relationship of the inflow and outflow tracts as well as the presence of (sub-) pulmonary stenosis might play a crucial role in the distribution of blood in double inlet left ventricle hearts. Additional in vivo studies will be necessary to confirm this postulation

Modulating spin transfer torque switching dynamics with two orthogonal spin-polarizers by varying the cell aspect ratio

We study in-plane magnetic tunnel junctions with additional perpendicular polarizer for subnanosecond-current-induced switching memories. The spin-transfer-torque switching dynamics was studied as a function of the cell aspect ratio both experimentally and by numerical simulations using the macrospin model. We show that the anisotropy field plays a significant role in the dynamics, along with the relative amplitude of the two spin-torque contributions. This was confirmed by micromagnetic simulations. Real-time measurements of the reversal were performed with samples of low and high aspect ratio. For low aspect ratios, a precessional motion of the magnetization was observed and the effect of temperature on the precession coherence was studied. For high aspect ratios, we observed magnetization reversals in less than 1 ns for high enough current densities, the final state being controlled by the current direction in the magnetic tunnel junction cell.Comment: 6 pages, 7 figure

New developments in adult congenital heart disease

Contains fulltext : 225482.pdf (Publisher’s version ) (Open Access)Congenital heart disease (CHD) affects 0.8% of live births and over the past decades technical improvements and large-scale repair has led to increased survival into adulthood of over 95% of the new-born. A new group of patients, those who survived their congenital heart defect, has emerged but late complications including heart failure, pulmonary hypertension (PH), arrhythmias, aneurysms and endocarditis appeared numerous, with a huge impact on mortality and morbidity. However, innovations over the past years have changed the landscape of adult CHD dramatically. In the diagnostic process important improvements have been made in the use of MRI, biomarkers, e‑health concepts and 3D visualisation of anatomy. Care is now concentrated in specialised centres, with a continuous emphasis on education and the introduction of weekly multidisciplinary consultations on diagnosis and intervention. Surgery and percutaneous intervention have been refined and new concepts applied, further reducing the burden of the congenital malformations. Research has matured from case series to global networks. Currently, adults with CHD are still facing high risks of early mortality and morbidity. By global collaboration and continuous education and development and innovation of our diagnostic and therapeutic arsenal, we will improve the perspectives of these young patients

Angular dependence of domain wall resistivity in SrRuO3_{{\bf 3}} films

${\rm SrRuO_3}$ is a 4d itinerant ferromagnet (T$_{c}$ $\sim$150 K) with stripe domain structure. Using high-quality thin films of SrRuO$_{3}$ we study the resistivity induced by its very narrow ($\sim 3$ nm) Bloch domain walls, $\rho_{DW}$ (DWR), at temperatures between 2 K and T$_{c}$ as a function of the angle, $\theta$, between the electric current and the ferromagnetic domains walls. We find that $\rho_{DW}(T,\theta)=\sin^2\theta \rho_{DW}(T,90)+B(\theta)\rho_{DW}(T,0)$ which provides the first experimental indication that the angular dependence of spin accumulation contribution to DWR is $\sin^2\theta$. We expect magnetic multilayers to exhibit a similar behavior.Comment: 5 pages, 5 figure

Composite excitation of Josephson phase and spin waves in Josephson junctions with ferromagnetic insulator

Coupling of Josephson-phase and spin-waves is theoretically studied in a superconductor/ferromagnetic insulator/superconductor (S/FI/S) junction. Electromagnetic (EM) field inside the junction and the Josephson current coupled with spin-waves in FI are calculated by combining Maxwell and Landau-Lifshitz-Gilbert equations. In the S/FI/S junction, it is found that the current-voltage (I-V) characteristic shows two resonant peaks. Voltages at the resonant peaks are obtained as a function of the normal modes of EM field, which indicates a composite excitation of the EM field and spin-waves in the S/FI/S junction. We also examine another type of junction, in which a nonmagnetic insulator (I) is located at one of interfaces between S and FI. In such a S/I/FI/S junction, three resonant peaks appear in the I-V curve, since the Josephson-phase couples to the EM field in the I layer.Comment: 16 pages, 5 figure

Electronic transport through domain walls in ferromagnetic nanowires: Co-existence of adiabatic and non-adiabatic spin dynamics

We study the effect of a domain wall on the electronic transport in ferromagnetic quantum wires. Due to the transverse confinement, conduction channels arise. In the presence of a domain wall, spin up and spin down electrons in these channels become coupled. For very short domain walls or at high longitudinal kinetic energy, this coupling is weak, leads to very few spin flips, and a perturbative treatment is possible. For very long domain wall structures, the spin follows adiabatically the local magnetization orientation, suppressing the effect of the domain wall on the total transmission, but reversing the spin of the electrons. In the intermediate regime, we numerically investigate the spin-dependent transport behavior for different shapes of the domain wall. We find that the knowledge of the precise shape of the domain wall is not crucial for determining the qualitative behavior. For parameters appropriate for experiments, electrons with low longitudinal energy are transmitted adiabatically while the electrons at high longitudinal energy are essentially unaffected by the domain wall. Taking this co-existence of different regimes into account is important for the understanding of recent experiments.Comment: 10 pages, 6 figure

Resistance of a domain wall in the quasiclassical approach

Starting from a simple microscopic model, we have derived a kinetic equation for the matrix distribution function. We employed this equation to calculate the conductance $G$ in a mesoscopic F'/F/F' structure with a domain wall (DW). In the limit of a small exchange energy $J$ and an abrupt DW, the conductance of the structure is equal to $G_{2d}=4\sigma_{\uparrow}\sigma_{\downarrow }/(\sigma_{\uparrow}+\sigma_{\downarrow})L$. Assuming that the scattering times for electrons with up and down spins are close to each other we show that the account for a finite width of the DW leads to an increase in this conductance. We have also calculated the spatial distribution of the electric field in the F wire. In the opposite limit of large $J$ (adiabatic variation of the magnetization in the DW) the conductance coincides in the main approximation with the conductance of a single domain structure $G_{1d}=(\sigma_{\uparrow}+\sigma_{\downarrow})/L$. The account for rotation of the magnetization in the DW leads to a negative correction to this conductance. Our results differ from the results in papers published earlier.Comment: 11 pages; replaced with revised versio