[Evaluation of cerebral oxygenation changes with clamping of the left superior vena cava by near-infrared spectroscopy].

OBJECTIVE: The left superior vena cava (LSVC) is often complicated with congenital heart defect. Although we simply clamp LSVC during cardio-pulmonary bypass (CPB), appropriateness of this technique has not been clarified. We noninvasively evaluate cerebral tissue oxygenation while the clamping of LSVC under CPB by near-infrared spectroscopy (NIRS). METHODS: Six children (3 male and 3 female; aged 1.0 +/- 0.6 year) undergoing open heart surgery were studied. The NIRO 300 was incorporated into an established multimodal monitoring system. Tissue oxygenation index (TOI), oxyhemoglobin (O2Hb), and deoxyhemoglobin (HHb) changes were assessed and compared with LSVC pressure. RESULTS: There were no significant changes in cerebral oxygen delivery after LSVC clamp. LSVC pressure increased from 7.3 +/- 1.8 mmHg to 20.1 +/- 2.6 just after LSVC clamp, but gradually decreased without any maneuver. CONCLUSION: These data demonstrated that LSVC could be safely clamped when LSVC pressure was under 30 mmHg.

[Long-term outcome of aortic valve replacement with annular enlargement].

BACKGROUND: The choice of appropriate treatment in children with aortic valvular lesions remains controversial. The purpose of this study is to assess early and late outcomes of aortic valve replacement with annular enlargement in children. METHODS: A retrospective study was conducted in 16 consecutive patients aged 0.26 to 15.9 years operated on between 1993 and 2008. Thirteen children underwent aortic valve replacement with Konno procedure (mechanical valve: 12, homograft: 1), 2 children underwent Ross procedure, and the last child underwent Nicks procedure with mechanical valve replacement. All patients undergoing mechanical valve replacement were given warfarin with a monthly international normalized ratio (INR) control. RESULTS: Overall early mortality was 12.5% (2 cases). Emergency operation was performed in these cases because of infectious endocarditis and acute cardiac failure. However, cardiopulmonary bypass (CPB) weaning could not be obtained. There was 1 late death 5 months after mechanical valve replacement. The patient developed methicillin-resistant Staphylococcus aureus (MRSA) sepsis after cleft palate repair. Reoperation was needed in 1 case. CONCLUSION: We conclude that mechanical valve replacement with aortic annular enlargement is an acceptable treatment in children. It is associated with acceptable mortality and low incidence of late events, and provides long-term survival.

[Results of Norwood type operation for interrupted aortic arch complex; surgical decision making].

BACKGROUND: Interrupted aortic arch (IAA) is associated with a multitude of lesions ranging from isolated ventricular septal defect to hypoplastic left ventricle or severe subaortic stenosis (SAS). Left ventricular outflow obstruction such as SAS continues to be an important factor for deciding the surgical procedure between univentricular and biventricular repairs. METHODS: A retrospective study was conducted in 8 consecutive infants aged 14 to 117 days and operated on between 2004 and 2009. Seven patients had undergone bilateral pulmonary artery banding for pulmonary high flow regulation. All patients underwent Norwood-type operation (4 with systemic to pulmonary artery shunt, 3 with right ventricle to pulmonary artery shunt, and 1 with bidirectional Glenn shunt). RESULTS: One patient died 2 months after surgery due to respiratory failure. The others were discharged in a good condition. One patient underwent Rastelli-type operation and biventricular circulation was achieved. The other 6 patients were all Fontan candidates. CONCLUSION: Satisfactory initial palliation can be achieved by Norwood-type operation for IAA with severe SAS or hypoplastic left ventricular-aortic complex.

[Acute coronary syndrome due to abnormal fibrous tissue growth after Aubert-Imai modification for transposition of the great arteries].

We report a female infant with acute coronary syndrome after Aubert-Imai modification for transposition of the great arteries. Two months postoperatively, she visited the emergency room because of perspiration and tachypnea. She was diagnosed with acute coronary syndrome by blood chemistry examination. Cardiac catheterization revealed Aubert route stenosis, and emergency operation was performed. The lumen around the aortopulmonary window was almost totally occluded by fibrous tissue extending from the equine pericardial patch. This fibrous tissue was completely resected and the aortopulmonary window was deepened to enlarge the coronary ostium. We recommend a close follow-up including angiography after these procedures.

[Pulmonary valve replacement due to ectopic ossification on expanded polytetrafluoroethylene cusp after tetralogy of Fallot repair; report of a case].

Operative correction of tetralogy of Fallot has been performed for more than 50 years and well established. To date, the literature on reoperation has focused and indications and the long-term outcome have not been well defined. We herein report a case of pulmonary valve replacement due to ectopic ossification on expanded polytetrafluoroethylene (ePTFE) cusp in a female child who had undergone right ventricular outflow tract reconstruction for tetralogy of Fallot with pulmonary atresia. Because of severe right ventricular dilatation with end diastolic volume of 186 ml/m2 on cardiac catheterization, redo operation was planned for functional recovery of the right ventricle. Previous transannlar patch was removed and pulmonary valve replacement was performed using CEP 23 mm. A hard calcification was observed around the cusp of transannular patch. Pathological findings revealed ectopic ossification with osteoblast colonization around the ePTFE cusp. This is the 1st report of ectopic ossification on ePTFE.

Workload of the steering work on a high-speed vessel.

The higher incidence of accidents occurring on board among the high-speed vessels has motivated this study focusing on the actual operating conditions contributing to the incidence. The working activities and workload of the officers and quartermasters were compared between the conventional and high-speed vessels of regular service ferry, by recording video-pictures and heart rate of the crews during actual navigations. An autopilot equipment was installed in the conventional vessel of over 6000 tons, but not in the high-speed vessel of about 1500 tons. Either on the conventional or high-speed vessel, dominant activities of the officers were lookout and watching radar, which were conducted in standing on the conventional vessel and in sitting on the high-speed vessel. Major works of the quartermasters were lookout and radar watch in standing on the conventional vessel and steering operations with a joystick in sitting on the high-speed vessel. Despite these differences in postural conditions, the mean % heart rate increase in both crews was significantly higher on the high-speed than on the conventional vessel. In the quartermaster, the events requiring steering maneuvers on the high-speed vessel were associated with increase in heart rate. The findings as a whole suggest occurrence of substantial mental strains in the crew on the high-speed vessel. These strains, certainly derived from caring for the safety in the absence of autopilot equipment, must have intensified the workload in the crew. In connection with the workload, the necessity for some fail-safe systems, including the autopilot facilities, and educational systems for techniques of steering high-speed vessels was discussed.