Intrapulmonary venous anastomosis after PV obstraction

Pulmonary venous (PV) obstruction is associated with a poor prognosis, as well as a high risk of recurrence, following surgical treatment. It can also interfere with the successful completion of Fontan circulation in patients with complex congenital heart disease. A case of a patient who had right isomerism (also known as asplenia syndrome), total anomalous pulmonary venous connection (TAPVC), and a single right ventricle is presented. Although bilateral total occlusion of the inferior PVs was identified postoperatively, the formation of the anastomosis and collateral vessels into the superior and middle PVs enabled successful completion of Fontan circulation. Anastomoses and collateral flow of the PVs were found largely in the interlobar pleura and not in the lung parenchyma

シュヨウナ フクブ ゾウキ ケツリュウ オ meandering mesenteric artery カラ キョウキュウ サレタ フクブ ダイドウミャクリュウ ノ 1 シュジュツレイ

A 64 year old man underwent hemodialysis one year ago was detected an infra renal abdominal aortic aneurysm with the occluded lesion of the superior mesenteric（SMA）and the celiac arteries. Abdominal angiogrphy revealed that the branches of the SMA filled reversely from the inferior mesenteric artery through the large meandering mesenteric artery（MMA）. Therefore it was thought that a prolonged clamping time during the aortic reconstruction would possibly result in visceral ischemic injury, the MMA was perfused by an extracorporeal circulation system during the aortic cross-clamping. The postoperative course was uneventful, without visceral ischemic complication. Consequently ischemic enterocolitis is a serious complication and a factor of poor prognosis in an operation of abdominal aortic aneurysm, it is important that understood the state of the visceral circulation and decided the strategy of the operation with or without the branches repaired for preventing ischemia

シンカ スル ウシン バイパス ジュンカン

Since Fontan’s exploit over 30 years ago, a number of important advances relevant tothe Fontan strategy could be achieved as being variations in the technique of anatomical connectionof the systemic venous circulation to the pulmonary arteries and variations instaging of the Fontan procedure. Innovative Norwood procedure and its concept as a firststage of palliation to Fontan circulation have been equivalent to Fontan’s exploit, and haveproduced the “current” philosophy of pushing patients into Fontan physiology early in lifewith hemi-Fontan procedure or bidirectional Glenn shunt.The aim of the first half of our present study is to determine the optimal size and techniquefor construction of the systemic-to-pulmonary arterial shunt which will provide suitablepulmonary blood flow in first-stage Norwood palliation for hypoplastic left heart syndromein neonates. A prosthesis of 3.0 or 3.5 mm in diameter arising from the brachiocephalicartery would be acceptable and can be recommended for first-stage Norwood palliation insmall infants. Although many complicated factors are concerned in the regulation of pulmonaryblood flow, the fundamental strategy is to create a necessary and minimal systemicto-pulmonary arterial shunt in the first-stage Norwood palliation, and then to proceed swiftlywith a second-stage hemi-Fontan procedure.It remains to be determined whether all children should undergo an intermediate hemi-Fontan procedure or bidirectional Glenn shunt prior to their Fontan completion. In my personalopinion, the several advantages of the hemi-Fontan procedure seem to be weighed againstits disadvantages. It is our current practice to perform an intermediate hemi-Fontanprocedure in staging of the Fontan strategy of the patients with some risk factors. Althoughwe generally have waited 6-8 months after a hemi-Fontan operation for a Fontancompletion, we would like to perform an early Fontan completion a few months after hemi-Fontan procedure to shorten the period of partial Fontan circulation and get nearly normaloxygen saturation. Careful follow-up and further investigation will be necessary to determinethe most optimal management guidelines for the Fontan circulation

A successful transatrial repair in redo surgery of postinfarction inferoposterior ventricular septal rupture

A successful transatrial repair in redo surgery of postinfarction posterior ventricular septal rupture (VSR) was performed after an infarct exclusion technique through left ventriculotomy incision of the infarcted area. For the infarct lesion, this approach provides excellent results with sufficient closure of the VSR and prevention of the ventricular remodeling for five years. A right atrial approach for postinfarction posterior VSR is very useful for avoiding any further ventriculotomy in an already impaired ventricle, securing a stable suture, and preserving the left ventricular geometry and function

Human cord blood-MNC transplantation improves PH

Objectives : To investigate the effects of human umbilical cord blood-derived mononuclear cell (hUCB-MNC) transplantation on pulmonary hypertension (PH) induced by monocrotaline (MCT) in immunodeficient mice and their distribution. Methods :MCT was administered to BALB/c Slc-nu/nu mice, and PH was induced in mice 4 weeks later. Fresh hUCB-MNCs harvested from a human donor after her delivery were injected intravenously into those PH mice. The medial thickness of pulmonary arterioles, ratio of right ventricular to septum plus left ventricular weight (RV/S+LV), and ratio of acceleration time to ejection time of pulmonary blood flow waveform (AT/ET) were determined 4 weeks after hUCB-MNC transplantation. To reveal the incorporation into the lung, CMTMR-labeled hUCB-MNCs were observed in the lung by fluorescent microscopy. DiR-labeled hUCB-MNCs were detected in the lung and other organs by bioluminescence images. Results : Medial thickness, RV/S+ LV and AT/ET were significantly improved 4 weeks after hUCB-MNC transplantation compared with those in mice without hUCB-MNC transplantation. CMTMR-positive hUCB-MNCs were observed in the lung 3 hours after transplantation. Bioluminescence signals were detected more strongly in the lung than in other organs for 24 hours after transplantation. Conclusions : The results indicate that hUCB-MNCs are incorporated into the lung early after hUCB-MNC transplantation and improve MCT-induced PH

Systemic Activation of Biomarkers by Varix

Objective: To evaluate the relationship between systemic inflammatory biomarkers and efficacy of surgical treatment of primary varicose veins of the lower extremities. Methods: Total 12 patients who underwent endovenous laser ablation or stripping of varicose veins and six healthy subjects were enrolled. Structural and molecular changes of varices were assessed by immunohistochemical staining with anti-monocyte chemotactic protein-1 (MCP-1). MCP-1 and interleukin-6 (IL-6) levels in systemic antecubital blood were measured before and at 12 weeks after treatment. Results: Immunohistochemical staining revealed prominent manifestation of MCP-1-positive endothelial cells in the walls of varices. Preoperative serum MCP-1 and IL-6 levels in the patients were significantly higher than those in the control (166±12 pg/mL vs 99±10 pg/mL, p=0.003; 5.1±0.95 pg/mL vs 0.0±0.0 pg/mL, p=0.001, respectively). The values were significantly correlated with the severity of chronic venous insufficiency (CVI). Postoperative serum MCP-1 level significantly decreased compared with the preoperative level (152±10 pg/mL vs 166±12 pg/mL, p=0.048). The values after endovenous laser ablation did not significantly decrease compared with those after stripping. Conclusion: Varicose veins with CVI increase inflammatory biomarker levels in the local tissue and systemic blood. Appropriate treatment of symptomatic varicose veins decreases inflammatory biomarker levels

Efficacy and Optimal Timing of TEVAR for Type B-AD

Objectives: To determine the efficacy and the optimal timing of thoracic endovascular aortic repair (TEVAR) for closing the primary entry in uncomplicated patients with chronic type B aortic dissection and a patent false lumen (FL). Methods: Thirteen patients underwent TEVAR for aortic dissection between 2008 and 2012. These patients had chronic dissection with a patent FL and expansion of the aorta. Early TEVAR was performed for five patients within 1–7 months from the index dissection (TEVAR-EC group) and delayed TEVAR was performed for eight patients within 1–16 years (TEVAR-DC group). Changes in the diameters and volumes of the true lumen (TL) and FL and the aortic remodeling were assessed by multidetector computed tomography for 3 years after TEVAR. Results: The reduction rate of FL in the thoracic aorta was notably higher in the TEVAR-EC group than in the TEVAR-DC group regardless of the presence or absence of distal retrograde flow. There was a significant TL expansion despite different timings of TEVAR. Conclusions: Early TEVAR resulted in good prognosis and preferable aortic remodeling in uncomplicated patients with chronic type B aortic dissection and a patent FL, and we recommend early TEVAR within seven months after the index dissection

Evaluation of complex physical therapy for lymphedema of the unilateral lower limbs

We evaluated the effectiveness of the complex physical therapy (CPT) for lymphedema of the unilateral lower limbs of eleven patients who had been admitted to Tokushima Rehabilitation Hospital. Ten patients were of secondary lymphedema, nine of which were after treatment of uterine cancer and one was of primary lymphedema. Our CPT consited of skin care, manual lymph drainage (MLD), compression therapy with elastic bandages or elastic stockings, and exercise therapy under compression. MLD functionally operates to enhance the lymph drainage more proximally in both contralateral and ipsilateral truncal quadrants of the torso, then in the proximal limb, and only thereafter from the distal to proximal portion of the edematous extremity. Swelling ratio of all patients on admission was 26.9± 11.8% and that at discharge was 16.8±9.4%. Edema reduction ratio (ERR) of the entire patients was 41.5± 16.5%, and 81.8% of cases were recognized as effective, in which ERR showed more than 30% at discharge. In a consensus document about the diagnosis and treatment of peripheral lymphedema in 1995, the International Society of Lymphology Executive Committee reported that most operations designed to alleviate peripheral lymphedema have not as yet been perfected or usually are still inferior to combined physiotherapy. At present lymphedema should be accurately diagnosed in the early stage and be treated with CPT correctly by clinicians who understand lymphedema thoroughly and are well trained

フエツズケル ダイドウミャクリュウ チリョウ : カイキョウ カイフク シュジュツカ ステント グラフト チリョウカ

The treatment of Aortic aneurythm is shifting stent graft treatment from open Surgery. Stent graft treatment is useful for the treatment of thoracic aortic aneurythm if the form is adaptable for the stent graft treatment. Open surgery is useful for the treatment of abdominal aortic aneurythm if the patient have no complication and high operative lisk but if the patint have complication and high operative lisk, Stent graft treatment is very useful because of the quality of life is kep