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We describe the case of a 1-year and 7-month-old girl who was born at 36 weeks and 6 days of pregnancy weighing 1,351 g. In addition to the diagnosis of Cornelia de Lange syndrome and Tetralogy of Fallot, we confirmed shunt blood flow from the lesser curvature of the aortic arch to the main pulmonary artery. Thus, we additionally diagnosed ectopic patent ductus arteriosus (PDA). Ultrasonography showed interruption and retrograde flow of the diastolic blood flow in the anterior cerebral artery. Therefore, we made a diagnosis of blood stealing due to an ectopic PDA, and we performed surgical intervention via a median sternotomy at 25 days. When we ligated the shunt blood vessel, the percutaneous oxygen saturation decreased from the high 90% range to the low 70% range, thus we temporarily released the ligation. We narrowed the ectopic PDA so that the percutaneous oxygen saturation could be maintained the high 80% range. Postoperative ultrasonography showed improvement of the pressure waveform in the anterior cerebral artery. After discharge, oxygen demand increased gradually with weight gain, and we performed intracardiac repair using a monocusp valve patch at 1 year and 7 months. We report a rare case of Cornelia de Lange syndrome wherein we achieved intracardiac repair of Tetralogy of Fallot after ectopic PDA banding in the neonatal period.
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We report a case of a 64-year-old woman who presented with symptoms for the common cold, for a medical examination. The chest X-ray showed enlargement of the heart, and echocardiography detected a mobile mass suggestive of a tumor 21×14 mm in the left ventricle. Because there was a risk of embolism, we decided to perform an operation. The tumor was elastic and soft and had a stalk arising from the wall of the left ventricle. We considered that it would be difficult to observe and expose the left ventricular tumor by direct vision. Therefore, we chose to perform a complete endoscopic resection. The tumor was determined histopathologically to be a papillary fibroelastoma. Here, we report the relatively rare benign tumor, a papillary fibroelastoma, and include a discussion of the literature.
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<b>Introduction:</b> The regional palliative care support center (PCSC) has set the following palliative care goals for correction of misunderstanding and prejudice of the general community against palliative care, home care and home death of cancer patients: practice palliative care early after diagnosis, educate the community to understand palliative care and build a regional palliative care cooperation system.<b> Method:</b> This study reviewed four years (2009-2012) of data from the PCSC. Outcome data of the patients were collected during outpatient care, inpatient care, and in-home care that were supported by the PCSC. The PCSC managed palliative care based on patient conditions and symptoms in the early stage after diagnosis. The PCSC worked to spread the idea and importance of palliative care to the general community and health care professionals of the region, and also worked to promote the regional palliative care cooperation. <b>Result:</b> These efforts led to an increase in the number of first center visit of patients, especially introduction patients, and an extension of the period of treatments of both tumor department and palliative care department. These outcomes resulted in an increase in the rate of in-home care transitions, the length of in-home care and the number of deaths at home. These results suggest that the place of appropriate medical and caregiving treatments and the place of death are converting into home gradually from hospital.
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The evaluation of coronary arteries has become easier, with regard to postoperative coronary artery bypass grafting (CABG) evaluation through the development of multidetector computed tomography (MDCT). In this study, MDCT and coronary angiography (CAG) were performed for graft assessment after CABG, and the usefulness and assessment capability of MDCT were examined. We examined the morphology of graft stenosis and obstruction in 63 cases (51 men, 12 women, mean age 66 years old) in whom comparison by MDCT and CAG was possible. We used 49 grafts for LITA and 65 grafts for SVG (mean number of anastomoses 2.8). The graft evaluation was possible in all cases in CAG, but it was difficult to evaluate due to artifacts in 5 cases in MDCT. MDCT is less invasive than CAG and is useful for early postoperative assessment of CABG. Also, MDCT allows evaluation of the anastomotic region which can be difficult to evaluate from many directions in CAG, by building an image by the VR, MIP and MPR method. It was particularly useful for evaluation of the form of the whole graft and anastomotic region form by the curved MPR method. Further advance in the evaluation of coronary and bypass graft will depend on future developments in scaning methods and instrument improvements.
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We experienced the coronary artery bypass grafting (CABG) with essential thrombocythemia (ET). A case is a man of 73 years old. As for him, 3 vessel disease including left main trunk was recognized on coronary angiography, and it was planned CABG. However, we recognized blood cell aberration in blood examination, and it was diagnosed as ET. ET is classed as a chronic myeloproliferative disorder. It has two opposite tendencies, a bleeding tendency and thrombus tendency. Ischemic heart disease to merge ET is acute myocardial infarction by thrombus in case of most, and there are a few cases to need blood circulation reconstruction of coronary artery for angina pectoris. Perioperative hemorrhage and postoperative graft closure become a problem in CABG with ET. With the hydroxycarbamide which is DNA synthesis inhibitor of a platelet count, a function controlled it, and enforced CABG. He doesn't have any cardiac events and complications due to ET for 7 years post CABG. We report this case with a review of the literature.
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Preservation is essential for successful cell transplantation. 1) Control group (<i>n</i>=13); Cells isolated from human right atrial tissues were cultured for 15 days. 2) Cell-cryopreservation (C. P.) group (<i>n</i>=23), Tissue-C. P. group (<i>n</i>=29); Human heart cells and minced tissues were cryopreserved in freezing medium containing 70% IMDM, 20% FBS, and 10% DMSO at a rate of 1°C/min. to -80°C by a programmed freezer and stored in liquid nitrogen (-196°C) for 1 week. After cryapreservation, the tissues and cells were thawed rapidly at 37°C. The cells, cryopreserved cells and cells isolated from cryopreserved tissues were cultured as passage 1, 2, and 3 for 15 days each. Cell proliferation was compared with a control group by determining growth curves, and 2-day proliferation rates. A growth factor, biochemical features and cell cycle were measured pre and post-cryopreservation. The cryopreserved group proliferated much more than the control group within 15 days at passage 1, 2, and 3 (1.7, 2.1, and 3.1 times, <i>p</i><0.0001) respectively. The 2-day proliferation rates of cryopreservation group were higher than the control group in 15 days (<i>p</i><0.05). The bFGF release after cryopreservation was on average 46.8 and 6.8 times greater than before cryopreservation for the Cell-C. P. and Tissue-C. P. groups, respectively. The TGF-β1 release was also accelerated by cryopreservation (Cell-C.P. group: 1.78 times, Tissue-C. P. group: 1.45 times in average) after cryopreservation. The cell cycle of human heart cells shifted to G2+M from the G1+G0 period by cryopreservation. Human atrial tissues and cells can be cultured and cryopreserved. The cryopreserved cells and cells isolated from cryopreserved tissue proliferate much more than non-cryopreserved cells at all cell ages. Cryopreservation enables human tissues and cells to proliferate more because of the greater release of growth factors and changing cell cycle.
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A 67-year-old man presented complaining of unstable angina. Coronary angiography revealed 50% stenosis of the left main trunk of the left coronary artery and a coronary artery aneurysm in the left anterior descending artery (LAD) #6. Furthermore, significant stenosis was noted in the peripheral LAD #7 and #9. The patient had hepatitis C, probably due to an earlier transfusion, and was suffering from liver cirrhosis (Child-Pugh classification grade A) and advanced thrombocytopenia. We anastomosed the saphenous vein graft (SVG) to the LAD and diagonal branch by off-pump coronary artery bypass grafting; we did not treat the aneurysm. There were no postoperative complications and the patient's progress was good. On postoperative coronary angiography, the aneurysm was occluded and the patency of the SVG was satisfactory.
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A 2-month-old girl had been urgently seen on postnatal day 10 due to poor weight gain and tachypnea. Echocardiography showed congenital valvular aortic stenosis (AS), ventricular septal defect (VSD), atrial septal defect (ASD), and aortic valve dysplasia, but no cyst image was seen at the aortic valve level. Aortography revealed a dysplastic aortic valve along with coarctation of aorta (CoA) and patent ductus arterious (PDA). Balloon aortic valvotomy (BAV) was performed on day 53. Ballooning was satisfactory, but there was no change in gradient. Operation was performed on day 70 under a diagnosis of congenital AS and CoA complex. After cardiopulmonary bypass was established, the ascending aorta was transected. The blood cyst originated from the center of the anterior leaflet and was resected. The pressure gradient at the aortic valve decreased to 22.5mmHg. The patient was discharged 25 days after surgery.
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Operations were performed 3 times on ventricular septal perforation after acute myocardial infarction which exhibited cardiogenic shock, and the patient's life was saved successfully. The case was a female aged 64. Ventricular septal perforation developed in 6 hours after onset of acute myocardial infarction, and an emergency operation was performed because the patient exhibited cardiogenic shock. Intraventricular re-shunt was observed on the postoperative 5th day, and second operation was performed on the postoperative 7th day because a trend of cardiac insufficiency was intensified. Intraventricular re-shunt was observed again on the 5th day of the second operation, but third operation with a principle that further operation is to be performed awaiting regeneration of the tissue on the perforated margin to occur since the circulatory kinetics were seen to have been stabilized. The postoperative course was favorable, and the patient was discharged on 53 rd day of the third operation with the symptom alleviated. It was considered that our policy is to have to repeat operation when the patient's movement of circulation deteriorate at re-shunt from our experience of this time.