The length of the aorta from the subclavian artery to the renal artery based on computed tomographic measurements in Japanese adults.

To estimate the length of the aorta from the subclavian artery to the renal artery in Japanese adults, its length was measured on computed tomographic (CT) images. Data from a total of 110 patients without aortic or aortic valvular diseases (54 men, 56 women) who had undergone 7-mm-slice-interval CT examination of the entire aorta was analyzed in this study. The length of the aorta was found to be 214.1 +/- 20.7 mm and showed a positive correlation with height (r = 0.664). Especially, the length of the aorta in male patients was correlated with body mass, i.e., height, weight, and body surface area. From these results, it appears that the majority of commercially available intra-aortic balloon catheters are too long for use in the Japanese population. It is concluded that a shorter, more suitable catheter should be made available for safe use in Japanese patients.

Scintigraphic assessment of the effects of bone marrow-derived mononuclear cell transplantation combined with off-pump coronary artery bypass surgery in patients with ischemic heart disease.

UNLABELLED: Myocardial SPECT may be useful for assessment of the therapeutic effects and the mechanisms of cardiac regeneration medicine. We aimed to assess first the feasibility and the short-term safety of autologous bone marrow-derived mononuclear cell transplantation (BMCT) into the ischemic myocardium in patients who undergo off-pump coronary artery bypass surgery (OPCAB). In addition, we aimed to assess our hypothesis that the BMCT may help ameliorate myocardial perfusion in patients with ischemic heart disease (IHD) using myocardial perfusion scintigraphy. METHODS: We performed BMCT in 10 patients with IHD during OPCAB. Cells for BMCT were collected by intraoperative bone marrow aspiration or by preoperative cellular apheresis after pretreatment with granulocyte colony-stimulating factor. After OPCAB was performed in all graftable ischemic areas, a total of 3.4 +/- 1.2 x 10(9) mononuclear cells, including 5.2 +/- 1.6 x 10(6) CD34-positive (CD34(+)) cells, were injected into ungraftable ischemic myocardial areas. Dipyridamole-stress and resting (99m)Tc myocardial SPECT was performed before and 1 mo after the procedures. RESULTS: BMCT was performed safely in all patients. Compared with before treatment, myocardial (99m)Tc tracer uptake on the dipyridamole-stress image increased similarly in BMCT- and OPCAB-treated areas, whereas tracer accumulation at rest did not change in all myocardial areas. The improvement of myocardial perfusion was not correlated with the total number of mononuclear cells transplanted. However, it was positively correlated with the number of transplanted CD34(+) cells: (99m)Tc tracer uptake after/before BMCT (ratio) = 1.091 x (CD34(+) cell number [x10(6)])(0.074) (r(2) = 0.48, P < 0.05), although new development of coronary vessels was not documented cineangiographically. Myocardial histopathology in 2 of 3 autopsy cases revealed coronary angiogenesis in the areas corresponding to the sites of BMCT. CONCLUSION: The present study demonstrates the feasibility of BMCT combined with OPCAB. This therapy improves myocardial perfusion possibly via CD34-related development of coronary microvessels.

Changes in platelet aggregation during cardiopulmonary bypass: comparison of poly-2-methoxyethylacrylate and heparin as a circuit coating material.

At present, there are various biomaterials that have high biocompatibility. In particular, there are many types of coated circuits in cardiopulmonary bypass (CPB) systems. However, only a few clinical studies have investigated platelet aggregation caused by these coated circuits. In this study, a CPB system coated with poly-2-methoxyethylacrylate (X coating) was used to ascertain whether platelet aggregation could be suppressed during CPB, and a comparison was made between X coating and ordinary (covalently bonded) heparin coating. The subjects were 19 adult patients who were scheduled to undergo valve replacement or valvuloplasty. They were divided into two groups: group X (X coating) and group H (heparin coating). The platelet aggregation threshold index (PATI, grading curve) and beta-thromboglobulin and plalelet factor IV levels were assessed preoperatively (control), 5 min after heparin administration, 10 and 60 min after the start of CPB, and 0 and 2 h after the end of CPB. The results indicated that platelet aggregation was reduced during CPB and that platelets were activated. The changes in platelet aggregation associated with the X coating were shown to be similar to those associated with heparin coating.

Repair of the aortico-left ventricular tunnel originating from the right aortic sinus with severe aortic valve regurgitation.

A 31-year-old adult with an aortico-left ventricular tunnel (ALVT) arising from the right aortic sinus is reported. Preoperative transesophageal echocardiography demonstrated a ruptured sinus of Valsalva with severe aortic valve regurgitation which originated from the right coronary sinus entering the outlet portion of the left ventricular outflow tract. Operation revealed the aortic entrance of the tunnel was above the right coronary sinus. Direct closure of the orifice of the tunnel using three stitches of 4-0 polypropylene with felt and aortic valve replacement (AVR) was performed. At 10-month follow-up the patient is asymptomatic and receiving no oral medications except anticoagulants. We believe this to be the oldest case of ALVT managed with AVR.

CT features of chronic contained rupture of an abdominal aortic aneurysm.

Four cases among the 149 patients who required repair of an infrarenal abdominal aortic aneurysm (AAA) during the last five years, were chronic contained rupture. The first symptom at onset was back pain and physical examination revealed the patients to be in no acute distress. The sites of rupture were posterior in all cases. They were operated through an extraperitoneal approach. There was no operative mortality and all survived. The CT features, (1) discontinuity of the rim of calcification in the true aneurysm wall, (2) well defined soft tissue density adjacent to the aorta, (3) the concealed psoas muscle and the displaced viscera depending on the size of the lesion, and (4) no appearance of contrast material in the hematoma in some cases, led to the correct diagnosis of contained rupture.