So-called mesothelial/monocytic incidental cardiac excrescences obtained during valve replacement surgery: report of three cases and literature review.

We present three cases of so-called mesothelial/monocytic incidental cardiac excrescences (MICE) of the heart and a brief review of related literature. Case 1 was a 51-year-old woman who underwent mitral- and aortic-valve replacement. A tissue sample was submitted as a thrombus attached to the left atrial endocardium. Case 2 was a 69-year-old woman who underwent mitral-valve replacement. The sample was incidentally obtained as whitish clot-like fragments, but its exact origin was not known. Case 3 was a 68-year-old woman who underwent mitral-valve replacement for suspected infective endocarditis. The sample adherent to the pericardium was removed after valvular surgery. Histologically, these lesions were composed of a mixture of plump histiocytoid cells, a papillary arrangement of cuboidal cells, various sized vacuoles, and fibrin. The nests of cuboidal cells resembled cancer cells but showed features of mesothelial cells and no proliferative activity, immunohistochemically or ultrastructurally. In all cases, a suction tube placed in the left atrium was occasionally used to remove overflowing intrapericardial fluid during the surgery. The tip of the suction tube was covered with spiral wire, which is likely to transfer the stripped pericardial mesothelial cells to the left atrium. The significance of MICE is their possibility of being misdiagnosed as metastatic carcinoma by pathologists and a risk of arterial embolization by mesothelial debris clinically.

The GroEL-like protein from Campylobacter rectus: immunological characterization and interleukin-6 and -8 induction in human gingival fibroblast.

The native GroEL-like protein was purified from Campylobacter rectus, a putative periodontal pathogen, by affinity chromatography on ATP-agarose followed by high performance liquid chromatography on Superose 6. The purified 64-kDa protein (denatured form of GroEL-like protein) was immunoreactive by SDS-PAGE and Western immunoblotting with the monoclonal antibody directed against heat shock protein 60 of human origin. The native GroEL-like protein stimulated both interleukin-6 (IL-6) and IL-8 secretion by a confluent monolayer of human gingival fibroblast in their culture supernatant. During the 22-h incubation, the amounts of IL-6 and IL-8 were increased by 5.4- and 3.5-fold, respectively. These data suggested that the GroEL-like protein might be considered to be a virulence factor of C. rectus in periodontal disease.

[A case of pseudoaneurysm of the thoracic aorta with Behçet's disease].

A 54-year-old female with incomplete type of Behçet's disease was operated on because of impending rupture of the thoracic aneurysm. There was a saccular pseudoaneurysm below the left subclavian artery, and a punched out lesion of the aorta was recognized. The defect of the aortic wall was closed with a PTFE patch. Before and after the operation, we have given prednisolone. The postoperative course was uneventful. Two years later, there was no recurrence of pseudoaneurysm near the PTFE patch. In many reports, aneurysms of Behçet's disease are saccular pseudoaneurysms, and have high incidence of complications about anastomosis postoperatively. We need a further follow-up about this patient.

Changes in plasma dopamine-beta-hydroxylase activity during the perioperative period of cardiac surgery: an index of sympathetic nerve activity.

To evaluate the usefulness of plasma dopamine-beta-hydroxylase (DBH) activity as an index of sympathetic nerve activity during cardiac operations, we examined the serial changes in plasma DBH activity, in relation to the plasma noradrenaline (NA) level and hemodynamic parameters, in patients who underwent cardiac surgery. The plasma DBH activity decreased significantly after cardiopulmonary bypass, and remained low during dopamine (DA) infusion until 72 h after the operation. However, recovery of the hemodynamic parameters, being the mean arterial pressure, heart rate and cardiac index, was seen as early as 1-3 h postoperatively. It was therefore assumed that the plasma DBH activity takes a long time to recover after an operation. The time-course changes in the plasma NA level were quite different from the changes in DBH activity, with an apparent negative correlation being observed between them. Thus, there is a possibility that exogenously administered DA, as well as increased plasma NA, might inhibit DBH activity during cardiac surgery. Moreover, since catecholamines are often administered upon completion of cardiac surgery, measurement of the plasma catecholamine level would be inappropriate for evaluating real sympathetic nerve activity. From the results of this study, it is surmised that measurement of the plasma DBH activity could be useful for estimating the intrinsic sympathetic nerve activity of patients who have undergone cardiac surgery.

[A case report of Lucas-Schmidt IIA type Cor triatriatum in neonate].

Lucas-Schmidt IIA type of Cor triatriatum has been rarely reported. Since it shows the same hemodynamics as Darling IIb type TAPVC, it is important as a emergent surgical case in early infancy. We reported a male neonate with IIA type Cor triatriatum. He was admitted to our hospital because of cyanosis and dyspnea since birth. The echocardiographic examinations revealed the accessory chamber behind the left atrium and atrial septal defect. The view from the right atrium revealed that there was no direct connection between the accessory chamber and the true left atrium, and we diagnosed it Lucas IIA type Cor triatriatum. The abnormal diaphragma was resected, and the atrial septum was corrected with a Xenomedica patch. The patient had an uneventful postoperative course, and was discharged on the 25th postoperative day.

Clinical significance of late potentials in patients after intracardiac operation for congenital heart disease.

The aim of this study was to evaluate the late potentials (LPs) in postoperative patients with congenital heart disease (CHD) and to study the association with the clinical characteristics in the postoperative patients with LPs. Signal averaged electrocardiogram (SA-ECG) was recorded in 119 postoperative patients aged 4 to 23 years and compared with those in age matched 49 healthy volunteers with and without right bundle branch block. Based on control data, criterias of LP were defined and altered in the presence of bundle branch block. Abnormal SA-ECGs were not detected in the patients with non-cyanotic CHD. However, abnormal and borderline SA-ECGs were recognized in 5 (12%) of 42 patients after intracardiac operation for tetralogy of Fallot and 3 (30%) of 9 patients after Rastelli's operation. The patients with abnormal and borderline SA-ECGs were significantly older at the time of operation, and had more frequent ventricular arrhythmias (7/8: 3/111, p less than 0.01) and depression of the ST-T segment on ECG (7/8: 11/111, p less than 0.01), compared with the normal SA-ECG group. Abnormal SA-ECGs including those of borderline patients were 50% sensitive and 96% specific for documented ventricular arrhythmias. However, there was no association between abnormalities of SA-ECGs and cardiomegaly on chest X-ray or left ventricular ejection fraction on echocardiogram. These results indicate that prolonged exposure to hypoxia may be the main cause of the primary role in the development of LPs. And late surgical intervention may result in histological background for the development of LPs.

[Changes in plasma sulfoconjugated catecholamines during perioperative period of cardiac operations--effect of continuous infusion of dopamine].

In order to clarify the physiological significance of sulfate conjugation of catecholamines and the effect of continuous dopamine infusion on the conjugate formation, we measured the plasma levels of free and sulfoconjugated catecholamines during the perioperative period of cardiac operations. The study group consisted of 12 adult patients who underwent cardiac operations. There were 13 study intervals starting from a day before each operation to 72 hours after each operation for the collection of blood specimen. The plasma levels of free and sulfoconjugated catecholamines were measured by radioenzymatic assay. The plasma levels of free dopamine did not show significant change by the induction of anesthesia, but they increased rapidly after the start of dopamine infusion to the level of 7654.9 +/- 731.7 pg/ml. Thereafter, the plasma free dopamine levels remained steady during the 24 hours after operation at 7516.7 pg/ml to 8449.2 pg/ml. On the other hand, the plasma levels of conjugated dopamine increased progressively by dopamine infusion during the 24 hours after operation. The plasma levels of free adrenaline increased significantly to the level of 1049.5 +/- 117.7 pg/ml by dopamine infusion, and lasted with plateau until the 24th hour after operation at the range of 1076.8 pg/ml to 1218.9 pg/ml. Conjugated adrenaline followed a similar pattern to that of conjugated dopamine, with a progressive increase due to the infusion of dopamine. In the case of noradrenaline, free noradrenaline started to increase at the time of cardiopulmonary bypass and showed a further increase by dopamine infusion during the first hour after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[The evaluation of the modified Blalock-Taussig shunt with a prosthesis of microknitted Dacron for tetralogy of Fallot in early infancy].

We evaluated the surgical results of the modified Blalock-Taussig shunt (MBTS), performed with a prosthesis of microknitted Dacron, for the ductus-dependent tetralogy of Fallot (TOF) in early infancy. Nine MBTSs for eight patients, 4 with and 4 without pulmonary atresia, were performed, and one patient died. The mean age was 30 +/- 27 days, and the mean weight was 3460 +/- 770 g at the initial MBTS. In the initial two cases, the patients experienced convulsions due to severe hypoxia on account of the troubles of the preoperative administration of Prostaglandin E1 (PGE1). Thereafter, in order to prevent brain damage, we performed the MBTS following short-term administration of PGE1 (2-13 days). Consequently, we did not experience brain damage in later cases. Half of the patients with the MBTS with a 5 mm diameter prosthesis experienced postoperative congestive heart failure due to excessive pulmonary flow, and one of them died. The patients with the MBTS with a 4 mm diameter prosthesis had good postoperative courses. The suitable shunt flow in these patients was estimated to be 70-90 ml/kg/min. The MBTS with a 4 mm prosthesis obtained the lower level of this suitable shunt flow, but that a 5 mm prosthesis induced excessive shunt flow. Observing the patients' weight gain and the progress of polycythemia until two years of age, there were no differences between the MBTS with a 4 mm prosthesis and that with a 5 mm prosthesis. From these results, we recommend a 4 mm microknitted Dacron prosthesis for the MBTS of the TOF in early infancy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radical correction of paracardiac type IIb of total anomalous pulmonary venous connection using pedicled flaps of right atrium and atrial septum].

Surgical results of total anomalous pulmonary venous connection (TAPVC) has been improved in recent years, however, late development of pulmonary venous obstruction was our concern in its total correction in early infancy. In the cardiac type of TAPVC, in which the pulmonary veins were connected to the right lateral wall, prosthetic patch is conventionally used in diversion of pulmonary venous flow into left atrium. It seemed favorable to repair this subset without using prosthesis. A 3-month-old female with TAPVCIIb according to Darling's classification underwent total correction on September 22th, 1988. Two pedicled flaps were developed using the right atrial wall and the atrial septum to create a pulmonary venous channel to divert arterial blood into left atrium and absorbable sutures were used throughout. Right atrium was entered through a vertical incision in its body and all the pulmonary veins were found in a recess in the lateral wall of the right atrium. Atrial septal defect in the cranial aspect of the fossa ovalis was enlarged by cutting the primum tissue along the right limbus and its caudal margin so as to form a pedicled flap attached to the left limbic tissue. Then the flap was sutured along the limbus to create a roof of the fossa ovalis. The second flap was made in the middle of the lateral atrial wall and was used to create a tunnel from the recess to the atrial septal defect. The defect in the right atrial wall was closed directly and no prosthetic patch was used. Postoperative course was uneventful and echocardiogram showed wide pulmonary venous channel draining into the left atrium.

[A case report of successful surgical removal of a lipoma in the left ventricle].

A 63-year-old man with anterior chest oppression was diagnosed as an acute myocardial infarction. The two-dimensional echocardiogram revealed a mass which bulged into the left ventricular cavity. Subsequently, the computed tomographic findings of the mass lesion demonstrated the attenuation values of -49 Hounsfield units, which corresponded to that of fatty tissues. From these findings the left ventricular lipoma was highly suspected. The tumor existed at the base of the anterior papillary muscle. It was successfully resected and mitral valve replacement was performed concomitantly. The tumor was yellowish and sized by 25 X 20 mm. On histological examination of the specimen, the tumor was composed of mature fatty cells. CT scanning was very useful for the preoperative evaluation of lipoma.