Pediatric coronary artery bypass surgery (PCABS) for congenital heart disease has become increasingly important in infants and children undergoing modern cardiac surgical procedures, because of its ...life-saving potential in unsuccessful coronary transfer operation. This review summarizes the current surgical role of PCABS for treating congenital heart diseases.
Databases, mainly PubMed, were searched for relevant publications about coronary bypass operation in the pediatric population, from 1970 (commencement) to March 2018.
The five main indications were (1) anomalous origin of the left coronary artery from the pulmonary artery, (2) left main coronary trunk atresia, (3) acute and late coronary events in the arterial switch operation for transposition of the great arteries, (4) the Ross operation for congenital aortic stenosis complicated by destructive infective endocarditis, and (5) inadvertent coronary artery injury during heart operation. Direct coronary reimplantation (coronary transfer) in most and surgical angioplastic procedures in selected patients were the first choice; however, PCABS with internal thoracic artery (ITA) grafts can be lifesaving in emergency or severe myocardial hypoperfusion conditions. Because the patency of saphenous vein grafts is poorer than that of ITA grafts, their use should be avoided in growing children. The procedure can be performed safely in neonates, infants, and small children, using high-power magnifying glasses or a surgical microscope.
Long-term results of survival and ITA graft function are excellent in growing children and adults. Congenital heart surgeons should be trained in quick graft takedown and in coping with emergency and late devastating complications in coronary transfer operation.
Prior to the 1970s, pediatric coronary artery bypass surgery (PCABS) was seldomly performed due to the lack of compelling surgical indications. The advent of coronary sequelae secondary to Kawasaki ...disease (KD) and the occurrence of coronary artery complications due to newly developed procedures, such as the arterial switch operation and early repair for intrinsic congenital coronary malformations, necessitated the development of PCABS. Because children grow rapidly and their life expectancy is very long, with increasing exercise capability requirements, the strategy for PCABS should differ from that for bypass surgery in adults. PCABS utilizing unilateral and bilateral internal thoracic arteries (ITA) has become the most reliable surgical method for children because of the distinct structure of ITAs being resistant to KD, growth potential according to the child’s somatic growth and long-term patency without wall degeneration. This operation utilizing ITA grafts is now being performed worldwide and is referred to as the “Kitamura operation” for KD coronary sequelae. Notably, the use of vein grafts should be avoided in children. Likewise, this operation can now be successfully performed in infants using a surgical microscope, for congenital coronary disorders. Currently, PCABS with ITAs has been established as a new arena in cardiac surgery, following our initial attempts.
The internal thoracic artery (ITA) has become the gold standard graft material for modern coronary artery bypass grafting (CABG) because of its excellent long-term patency. The use of ITA grafts has ...also prolonged the postoperative survival of patients when applied to the left anterior descending artery or used bilaterally as 2 grafts for the left coronary system. Moreover, recent large-scale randomized clinical trials comparing the survival rates between CABG and percutaneous coronary intervention (PCI) with stents have shown that CABG is more effective for improving the survival of patients with severe coronary artery disease and/or in those with diabetes mellitus. The fundamental principle underlying these clinical benefits of CABG is the excellent endothelial function of the ITA, which provides physiological and metabolic effects that are beneficial not only for the graft itself, but also for the recipient coronary system. The production of nitric oxide and prostanoids by the ITA endothelium and their beneficial effects on the downstream coronary artery should therefore be taken into consideration when debating the merits of CABG vs. PCI. (Circ J 2011; 75: 766-772)
A panel of radiochemicals has enabled in vivo positron emission tomography (PET) of tau pathologies in Alzheimer’s disease (AD), although sensitive detection of frontotemporal lobar degeneration ...(FTLD) tau inclusions has been unsuccessful. Here, we generated an imaging probe, PM-PBB3, for capturing diverse tau deposits. In vitro assays demonstrated the reactivity of this compound with tau pathologies in AD and FTLD. We could also utilize PM-PBB3 for optical/PET imaging of a living murine tauopathy model. A subsequent clinical PET study revealed increased binding of 18F-PM-PBB3 in diseased patients, reflecting cortical-dominant AD and subcortical-dominant progressive supranuclear palsy (PSP) tau topologies. Notably, the in vivo reactivity of 18F-PM-PBB3 with FTLD tau inclusion was strongly supported by neuropathological examinations of brains derived from Pick’s disease, PSP, and corticobasal degeneration patients who underwent PET scans. Finally, visual inspection of 18F-PM-PBB3-PET images was indicated to facilitate individually based identification of diverse clinical phenotypes of FTLD on a neuropathological basis.
•A new probe, PM-PBB3, captures pathological tau deposits in vivo with high contrast•PM-PBB3 allows an individual-based identification of AD and non-AD tauopathies•Autopsy assays of PET-scanned patients supported the in vivo performance of PM-PBB3
Tagai et al. developed a positron emission tomography probe, 18F-PM-PBB3, for tau deposits in Alzheimer’s and non-Alzheimer’s disease tauopathies. This probe was demonstrated to enable individual- and pathology-based diagnosis, differentiation, and staging of these disorders in addition to translational research and development on tauopathies from mouse models to humans.
As of September 30, 2011, a total of 113 patients with end-stage heart failure underwent heart transplantation in Japan, and the early and late (10 years) survival rates appear better than those ...reported in 2011 by the Registry of the International Society of Heart and Lung Transplantation (ISHLT). Among the risk factors determining survival, use of both left ventricular assist devices (LVADs) during the pretransplant care and marginal donor hearts increased the risk while factors favoring survival included younger adult recipients and fewer patients with ischemic cardiomyopathy; factors noted in Japanese patients in comparison with those registered in the ISHLT report. Although only a few patients have reached 10 years follow-up, so far none has died or required retransplantation due to cardiac allograft vasculopathy (CAV). CAV may develop later in Japanese heart transplant patients than in those of mixed inter-ethnic transplants. Recently, survival rates with newer LVADs have dramatically improved and therefore, selection criteria for the permanent or destination use of an LVAD or for heart transplantation require further evaluation, depending upon the various factors in candidates with profound heart failure.
Depression is one of the common psychiatric disorders in old age. Major depressive disorder (MDD) has been identified as a risk factor or prodrome for neurodegenerative dementias, suggesting ...neuropathological overlaps and a continuum between MDD and neurodegenerative disorders. In this study, we examined tau and amyloid-β (Aβ) accumulations in the brains of MDD and healthy controls using positron emission tomography (PET) to explore pathological substrates of this illness. Twenty MDD and twenty age-matched, healthy controls were examined by PET with a tau radioligand,
CPBB3, and an Aβ radioligand,
CPiB. Radioligand retentions were quantified as a standardized uptake value ratio (SUVR). We also assessed clinical manifestations of the patients using the 17-item Hamilton Depression Scale, the Geriatric Depression Scale, and psychotic symptoms. Mean cortical
CPBB3 SUVRs in MDD patients were significantly higher than those of healthy controls. These values were higher in MDD patients with psychotic symptoms than in those without any. The present findings indicate that tau depositions may underlie MDD, and especially in patients with psychotic symptoms. PET detection of tau accumulations may provide mechanistic insights into neuronal dysfunctions in these cases and could serve as predictions of their clinical consequences.
MSC have self-renewal and multilineage differentiation potential, including differentiation into endothelial cells and vascular smooth muscle cells. Although bone marrow-derived mononuclear cells ...(MNC) have been applied for therapeutic angiogenesis in ischemic tissue, little information is available regarding comparison of the molecular foundation between MNC and their MSC subpopulation, as well as their response to ischemic conditions. Thus, we investigated the gene expression profiles between MSC and MNC of rat bone marrow under normoxia and hypoxia using a microarray containing 31,099 genes. In normoxia, 2,232 (7.2%) and 2,193 genes (7.1%) were preferentially expressed more than threefold in MSC and MNC, respectively, and MSC expressed a number of genes involved in development, morphogenesis, cell adhesion, and proliferation, whereas various genes highly expressed in MNC were involved in inflammatory response and chemotaxis. Under hypoxia, 135 (0.44%) and 49 (0.16%) genes were upregulated (>threefold) in MSC and MNC, respectively, and a large number of those upregulated genes were involved in glycolysis and metabolism. Focusing on genes encoding secretory proteins, the upregulated genes in MSC under hypoxia included several molecules involved in cell proliferation and survival, such as vascular endothelial growth factor-D, placenta growth factor, pre-B-cell colony-enhancing factor 1, heparin-binding epidermal growth factor-like growth factor, and matrix metalloproteinase-9, whereas the upregulated genes in MNC under hypoxia included proinflammatory cytokines such as chemokine (C-X-C motif) ligand 2 and interleukin-1alpha. Our results may provide information on the differential molecular mechanisms regulating the properties of MSC and MNC under ischemic conditions. Disclosure of potential conflicts of interest is found at the end of this article.
Background:Size-mismatched heart transplantation (HTx) is associated with a risk of stenosis of the caval anastomosis site or low cardiac output syndrome. We developed a modified bicaval anastomosis ...technique (mBCAT) that achieved an adjustable caval anastomosis to compensate for size mismatch. This study was performed to validate the rationale of the mBCAT for size-mismatched HTx.Methods and Results:This institutional consecutive series involved 106 patients who underwent HTx with the mBCAT during an 18-year period. The cohort was divided into 3 groups according to the donor-to-recipient body weight ratio: <0.8, undersized group (n=17); 0.8–1.3, size-matched group (n=68); and >1.3, oversized group (n=21); outcomes were compared. The undersized, size-matched, and oversized groups showed no significant differences in the rate of mild or worse echocardiographic tricuspid regurgitation at 1 month 1 (5.8%), 7 (10.2%), and 1 (4.8%), respectively; P=0.87 or the survival rate at 10 years 100%, 93.9%, and 100%, respectively; P=0.25. The right heart catheter study revealed no pressure gradient across the orifices of both cavae in any patient. Additionally, the cardiac index immediately post-HTx was significantly low in the undersized group (P=0.008), but was similar to the other groups at 6 months post-HTx (P=0.16).Conclusions:The mBCAT prevented caval anastomosis-related complications in size-mismatched HTx and achieved excellent hemodynamics regardless of donor size.
Abstract A decellularization method using high-hydrostatic pressure (HHP) technology (>600 MPa) is described. The HHP disrupts the cells inside the tissue. The cell debris can be eliminated with a ...simple washing process, producing clean, decellularized tissue. In this study, porcine aortic blood vessel was decellularized by HHP. The mechanical properties and in vivo performance of the decellularized tissue were evaluated. Mechanical properties of the decellularized tissue were not altered by the HHP treatment. Reduced inflammation of the decellularized tissue was confirmed by xenogenic transplant experimentation. An allogenic transplantation study showed that decellularized blood vessel endured the arterial blood pressure, and there was no clot formation on the luminal surface. In addition, cellular infiltration into the vessel wall was observed 4 weeks after implantation, suggesting that HHP treatments could be applied widely as a high-quality decellularization method.
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