At our institution, the strategy for patients with bicuspid aortic valve, aortic valve stenosis (<5 mm), and aortic hypoplasia hypoplastic aortic arch, coarctation of the aorta (CoA), or interrupted ...aortic arch (IAA) with ventricular septal defects (VSDs) as well as normal left ventricular (LV) volume and mitral valve size consists of two parts. The Norwood operation is applied as the first palliation for this group of patients. Second, the decision whether the patients are to undergo the Rastelli operation or a univentricular repair is made depending on the size of the right ventricle after the Norwood operation. This study aimed to examine whether the aforementioned surgical strategy for this group of patients is adequate or not. Seven patients undergoing the Norwood operation as the first palliation for bicuspid aortic valve, aortic valve stenosis (<5 mm), and aortic hypoplasia with VSDs as well as normal LV volume and mitral valve size between February 2005 and March 2010 at Kitasato University Hospital and the Gunma Children’s Medical Center were reviewed. Postoperative serum B-type natriuretic peptide (BNP) and central venous pressure (CVP) were measured in the patients undergoing the staged Norwood–Rastelli operation to assess whether the authors’ right ventricular end-diastolic volume index (RVEDVI) cutoff (80 % of normal) is adequate. At this writing, all seven patients are alive after a mean follow-up period of 58.8 ± 17.8 months. They all had aortic valve stenosis of <5 mm and a bicuspid aortic valve. Four patients had a diagnosis of CoA with VSD, and three patients had IAA with VSD. Six patients underwent biventricular repair, and one patient had univentricular repair due to the small RVEDVI (74 % of normal). The patients with 80–90 % of normal RVEDVI had higher BNP and higher CVP than those with more than 90 % of normal RVEDVI after the Rastelli operation, whereas the patient undergoing the Fontan operation had a low BNP level. In conclusion, the described strategy for patients with severe aortic hypoplasia and aortic stenosis with VSD as well as normal LV and mitral valve size is reasonable.
Objective: Regional cerebral perfusion (RCP) has been shown to provide cerebral circulatory support during Norwood procedure. In our institution, high-flow RCP (HFRCP) from the right innominate ...artery has been induced to keep sufficient cerebral and somatic oxygen delivery via collateral vessels. We studied the effectiveness of HFRCP to regional cerebral and somatic tissue oxygenation in Norwood stage I palliation. Methods: Seventeen patients, who underwent the Norwood procedure, were separated into two groups: group C (n = 6) using low-flow RCP and group H (n = 11) using HFRCP (mean flow: 54 vs 92 ml kg−1 min−1, P ≪ 0.0001). The mean duration of RCP was 64 ± 10 min (range, 49-86 min) under the moderate hypothermia. Chlorpromazine (3.0 mg kg−1) was given to group H patients before and during RCP to increase RCP flow. The mean radial arterial pressure was kept ≪50 mmHg during RCP. To clarify the effectiveness of HFRCP for cerebral and somatic tissue oxygenation, cerebral regional oxygen saturation (rSO2) and systemic venous oxygenation (SvO2) during RCP were compared between the two groups. Changes in the lactate level before and after RCP, and changes in the blood urea nitrogen (BUN), creatinine, lactate dehydrogenase (LDH), and creatinine kinase (CK) levels before and after surgery, were also compared between the groups. Results: Mean rSO2 was 82.9 ± 9.0% in group H and 65.9 ± 10.7% in group C (P ≪ 0.05). Mean SvO2 during RCP was 98.2 ± 4.3% in group H and 85.4 ± 9.7% in group C (P ≪ 0.01). During RCP, lactate concentration significantly increased in group C compared with that in group H (P ≪ 0.001). After surgery, the LDH and CK levels significantly increased in group C compared with that in group H (P ≪ 0.05). Conclusions: Our study revealed that HFRCP preserved sufficient cerebral and somatic tissue oxygenation during the Norwood procedure. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
A 50-year-old male with right lower abdominal pain consulted a nearby general practitioner, and was referred to the emergency room of our hospital with the suspicion of appendicitis. Abdominal CT ...revealed an intussusception, along with a large cecal lipoma that was thought to be the cause of the intussusception. Emergency colonoscopy then uncovered a submucosal tumor (SMT) that appeared to be the lead point of the intussusception, which was reduced endoscopically. Further, to prevent recurrence of intussusception, endoscopic unroofing (EU) was performed. This case suggests that, under the appropriate conditions, one-step EU can be an effective choice for reduction of an intussusception arising from a lipoma. We report its details along with a review of related literature.
The low arterial oxygen saturation (SaO
2
) after bidirectional cavopulmonary shunt (BCPS) predicts poor prognosis. The venous oxygen saturation of inferior vena cava (SivcO
2
), as well as the ...pulmonary blood flow/systemic blood flow ratio (
Q
p
/
Q
s
) affects the SaO
2
. The purpose of this study is to determine whether SivcO
2
or
Q
p
/
Q
s
should be increased to achieve better outcomes after BCPS. Forty-eight patients undergoing BCPS were included. Data of patients’ age and body weight, SivcO
2
,
Q
p
/
Q
s
, pulmonary artery (PA) pressure and resistance, PA area index, morphology of ventricle, atrioventricular valve regurgitation, and history of PA plasty were collected. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the SaO
2
after BCPS. There was a significant correlation between SivcO
2
and SaO
2
(
r
= 0.771,
P
< 0.00001). There was no strong correlation between
Q
p
/
Q
s
and SaO
2
(
r
= 0.358,
P
< 0.05). Stepwise multiple logistic regression analyses revealed that both SivcO
2
(
r
= 0.49, 95 % confidence interval (CI) 0.37–0.62,
P
< 0.0001) and
Q
p
/
Q
s
(
r
= 11.1, 95 % CI 3.3–18.9,
P
= 0.007) most affected SaO
2
after BCPS. Since the SivcO
2
has a stronger correlation than
Q
p
/
Q
s
with SaO
2
, despite the fact that both raising
Q
p
/
Q
s
and raising cardiac output can increase SaO
2
, raising cardiac output should be considered prior to
Q
p
/
Q
s
to raise the SaO
2
after BCPS.
Plasma confinement characteristics of plasma sources, the side walls of which are surrounded by magnetic multipole fields, are analyzed using theoretical equations. Experimental data used are those ...obtained with microwave plasma sources. The plasma flux, the pressure range over which a uniform plasma is produced, the plasma density distribution at a plasma grid and the cusp leak width are discussed. If the leak width is the geometric mean value of the ion and electron Larmor diameters, the results estimated using the theoretical equations are consistent with the experimental ones. It has also been observed from the traces due to the plasma irradiation that the leak width corresponds to the geometric mean value. The validity of the equations has been confirmed. These equations can be used as a basis for the design of a plasma source capable of producing a uniform high-density plasma over a wide area.
The waffle procedure is performed in patients with marked thickening and calcification of the epicardium and no substantial improvement in hemodynamic parameters after pericardiectomy. We ...retrospectively investigated the efficacy of the waffle procedure in 6 of 11 patients who underwent pericardiectomy. These 6 patients showed no improvement in central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, or cardiac index after pericardiectomy. After the waffle procedure, all hemodynamic parameters improved, and there were no significant differences compared to those of the 5 patients who did not require the waffle procedure, despite higher pulmonary capillary wedge pressure and lower cardiac index values preoperatively in the waffle group. The waffle procedure was considered effective in patients with persistent epicardial constriction.
A three-month-old girl weighing 4.2 kg, diagnosed with transposition of the great arteries (TGA) and ventricular septal defect (VSD) was referred to us. She had normal-sized pulmonary annulus and ...moderate pulmonary regurgitation. Because her pulmonary valve was not suitable for systemic circulation due to valvular incompetence, the half-turned truncal switch operation was selected. The postoperative course was uneventful without left or right ventricular outflow obstructions over a year of follow-up. Our report demonstrated that the TGA and VSD with normal pulmonary annulus is not contraindicated for half-turned truncal switch operation.
A 55-year-old man presented to the emergency department with worsening shortness of breath 1 month after a gastrointestinal bleed. He had congestive heart failure, and an electrocardiogram suggested ...ischemic heart disease involvement. Echocardiography revealed a ventricular septal defect complicated by a left ventricular aneurysm in the inferior-posterior wall. Conservative treatment was started, but hemodynamic collapse occurred on the third day of admission and coronary angiography revealed a revascularizing lesion in the right fourth posterior descending coronary artery. Subsequently, his hemodynamic status continued to deteriorate, even with an Impella CP
heart pump, so ventricular septal defect patch closure and left ventricular aneurysm suture were performed. His condition improved and he was discharged on day 23 of admission and was not readmitted within 6 months after the procedure. Hemodynamic management of ventricular septal defects requires devices that reduce afterload, and clinicians should be aware of the risk of myocardial infarction after gastrointestinal bleeding.
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