Development of a magnetically suspended centrifugal pump as a cardiac assist device for long-term application

To overcome problems with the shaft seal in conventional centrifugal pumps, the authors have been developing a magnetically suspended centrifugal pump (MSCP) that operates as a valveless, sealless, and bearingless pump. The prototype of the MSCP was modified with respect to size of the volute diffuser and impeller blade profiles. A hemolysis test in vitro using a new version of the MSCP was performed in comparison with a commercially available centrifugal pump. The test circuit for the hemolysis test comprised a blood reservoir, a pump, and polyvinyl tubes, and was filled with fresh heparinized bovine blood. The pumping conditions were a flow rate of 5 L/min and a pump head afterload of 100 mmHg. The index of hemolysis in the MSCP was significantly lower than that in the Biomedicus pump (0.0035 +/- 0.0025 versus 0.0097 +/- 0.0056 g/100 L, p < 0.05). Reduction in the platelet count during pumping also was lower in the MSCP compared with the Biomedicus pump at both 6 hrs and 12 hrs of pumping (p < 0.01). This MSCP may be advantageous for extended use of assist devices, not only from the theoretical point of view, but in a practical sense after the results of the current hemolysis test.

Influence of hepatic mitochondrial redox state on complement biosynthesis and activation during and after cardiopulmonary bypass operations

We have proposed the hazardous phenomena associated with cardiopulmonary bypass (CPB) are due to metabolic derangement by hepatic mitochondrial dysfunction during and after CPB. On the contrary, complement activation and consumption during CPB is reported to be related to the morbidity associated with cardiac surgery. To determine the significance of the hepatic mitochondrial function on the morbidity of cardiac surgery, we measured the serum levels of complements (C3 and C4), activated complements (C3a and C4a), and the arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, in 30 patients undergoing CPB. The AKBR, which was at a normal level preoperatively, dropped to a critical level after the initiation of CPB and remained at a low level during the CPB, returning to the preoperative level on the second postoperative morning in a time dependent fashion. The patients group were assigned to two groups according to their AKBR on the first postoperative morning. Group I consisted of patients whose AKBR had recovered to above 0.7 on the first postoperative morning (n = 16). Group II consisted of the rest of the patients (n = 14). The serum complement concentration had considerably decreased by the end of bypass, but recovered in a time-dependent fashion after CPB. The group I patients (C3: 71% of its preoperative value, C4: 85% of its preoperative value) recovered their complements more quickly than the group II patients (C3: 56% of its preoperative value, C4: 54% of its preoperative value). However, the serum C3a and C4a concentrations increased by the end of bypass (C3a: 806% of its preoperative value, C4a: 341% of its preoperative value). The activated complements were significantly higher in the group II patients (C3a: 124% of its preoperative value, C4a: 236% of its preoperative value) than in the group I patients (C3a: 75% of its preoperative value, C4a: 113% of its preoperative value) on the first postoperative morning. It is suggested that hepatic mitochondrial function is related to recovering the complements and to reducing the activated complements after CPB.

Pb2+ reduces the current from NMDA receptors expressed in Xenopus oocytes

We compared the effects of Pb2+ on four types of NMDA receptors expressed in Xenopus oocytes. Pb2+ reduced the currents evoked by glutamate and glycine. The Ki values of the receptors, epsilon 1/zeta 1, epsilon 2/zeta 1, epsilon 3/zeta 1 and epsilon 4/zeta 1, were 39, 34, 54 and 42 microM, respectively, and their Hill coefficients were 0.53, 4.6, 0.52 and 0.37, respectively. The epsilon 2/zeta 1 receptor that was inhibited in the presence of over 30 microM Pb2+ was not recovered to the control level after a Pb2+ washout for over 30 min, suggesting that epsilon 2/zeta 1 is responsible for the chronic Pb2+ intoxication in the nervous system.

New surgical technique for repair of ventricular septal perforation

We describe a technique for repairing the ventricular septal perforation using porcine pericardium tailored in a conical shape. This technique may allow a good operating view and facilitate suturing to the left ventricular cavity.

Oxime depression of the fast sodium current in myocardial cells

Effects of diacetyl monoxime on the fast Na+ current were examined by the whole-cell voltage-clamp method in embryonic chick ventricular myocytes. Diacetyl monoxime (10-20 mM) decreased the duration and amplitude of the action potential and depressed the amplitude of the peak fast inward Na+ current by about 25 (10 mM)-45% (20 mM), without affecting other I-V parameters. Neither the activation and inactivation kinetics of the Na+ channels, such as the time to peak current and the time constant of inactivation, nor the steady state characteristics of the inactivation and activation were affected by diacetyl monoxime. It also did not alter the window conductance and the recovery kinetics from inactivation (reactivation). Hence, diacetyl monoxime suppresses the fast Na+ current, without affecting the time-dependent and voltage-dependent kinetics.

Developmental change in fast Na channel properties in embryonic chick ventricular heart cells

To assess development changes in kinetic properties of the cardiac sodium current, whole-cell voltage-clamp experiments were conducted using 3-, 10-, and 17-day-old embryonic chick ventricular heart cells. Experimental data were quantified according to the Hodgkin-Huxley model. While the Na current density, as examined by the maximal conductance, drastically increased (six- to seven-fold) with development, other current - voltage parameters remained unchanged. Whereas the activation time constant and the steady-state activation characteristics were comparable among the three age groups, the voltage dependence of the inactivation time constant and the steady-state inactivation underwent a shift in the voltage dependence toward negative potentials during embryonic development. Consequently, the steady-state (window current) conductance, which was sufficient to induce automatic activity in the young embryos, was progressively reduced with age.

Role of the steady-state Na+ channel current in pacemaker depolarizations in young embryonic chick ventricular myocytes

To assess the age-related changes in kinetic properties of the cardiac Na+ channel, whole-cell voltage-clamp (v-c) experiments were conducted using 3-, 10- and 17-day-old embryonic chick ventricular heart cells. In line with the first-order kinetic model, kinetic parameters for the activation and inactivation of the channel were determined from the v-c results. Simulation studies using kinetic parameters so determined have reproduced the current-voltage relations and the steady-state inactivation characteristics observed in cells in the three age groups. The rate of depolarization of the simulated action potentials was also comparable to that experimentally recorded. In conclusion, the steady-state Na+ conductance can play a significant role in the automatic depolarizations observed in young embryonic ventricular cells.

[Surgical treatment of congenital aortic stenosis by aortoseptal approach]

Between 1975 and 1994, six patients under 15 years old with congenital aortic stenosis underwent relief of left ventricular outflow tract obstruction (LVOTO) by aortoseptal approach. Although we got satisfactory relief of LVOTO in all patients, there were two late deaths. In one patient with residual ventricular septal defect (VSD), intractable ventricular arrhythmia developed 12 years postoperatively. Although the residual VSD closure was performed, the patient died of the arrhythmia. The another one who was the youngest 4-year-old boy suddenly died 4 months postoperatively. The detail about his death was unknown, but we presumed ischemic heart attack as the cause of his death. In 3 of remaining survived 4 patients, we encountered a few complications. They were right ventricular outflow obstruction, coronary artery injury and conduction system injury. All complications and problems we encountered in this series were related to the incision and the reconstruction of aortoseptal approach. In conclusion, the aortoseptal approach is effective technique for relief of LVOTO, but on the other hand it is invasive and not so safe operation. So we should be cautious about these complications and problems.

A magnetically suspended centrifugal pump. In vitro and in vivo assessment

To overcome problems derived from the shaft within conventional centrifugal pumps, we have developed a new centrifugal pump, the magnetically suspended centrifugal pump (MSCP), which has no shaft and operates as a bearingless centrifugal pump. The impeller is suspended freely and centrally by magnetic force within the pump. Hemolysis tests were performed in comparison with the Biopump. Index of hemolysis and destruction of platelets were significantly lower in the MSCP than in the Biopump. Animal studies were designed to evaluate the durability and antithrombogenicity of the MSCP. Short-term animal studies were performed using two mongrel dogs. Left heart bypass was established with the MSCP. After 3 hr, the layer of thrombus adherent to the surface of the polycarbonate impeller impaired pumping efficiency. However, using the impeller coated with silicone, no thrombus was observed on the impeller after continuous pumping for 24 hr. In addition, long-term animal studies were performed using two sheep. Left heart bypass was established with the MSCP containing an impeller coated with silicone. In one sheep, the MSCP ran for 14 days without problems in pumping performance and showed no thrombus within the pump. In the other sheep, the MSCP ran for 15 days, and showed no thrombus on the impeller. During each experiment, plasma free hemoglobin levels were less than 15 mg/dl. The MSCP induced less hemolysis than did the Biopump, and the MSCP containing an impeller coated with silicone demonstrated the potential to run for 14 days without thrombus formation within the pump.

Applicability of the latissimus dorsi muscle in situ as a biomechanical energy source

The purpose of this study was to assess the applicability of the latissimus dorsi muscle in situ as an energy source for a circulatory assist device. A pneumatic chamber, devised by the authors, was inserted beneath the muscle and compressed by contractions of the muscle so that muscle contractile power was converted into pneumatic pressure. The optimal insertion position of the chamber beneath the latissimus dorsi muscle, and the influence of chamber size on generated pneumatic pressure, were investigated. The pneumatic chamber functioned better when it was placed in a proximal position (third intercostal space) than in a middle or distal position. Using a mock circuit, the performance of the pneumatic chamber as an energy source for a circulatory assist device was evaluated. The pneumatic chamber was able to generate power sufficient to drive a right ventricular assist device as far as stroke work was involved. When the pneumatic chamber was operated with a high afterload, it could even be an energy source for aortic counterpulsation.

Hepatic circulation during nonpulsatile cardiopulmonary bypass

The arterial ketone body ratio, which reflects the hepatic mitochondrial redox potential (NAD+/NADH), decreases markedly during cardiopulmonary bypass (CPB). One of the reasons for arterial ketone body ratio reduction may be hepatic hypoperfusion during CPB. To evaluate the hepatic circulation under nonpulsatile CPB, the authors used color Doppler ultrasonography to measure the portal venous flow (PVF) in 24 adult patients before, during (aortic clamping and rewarming period), and after CPB. Nonpulsatile hypothermic CPB was performed at a flow rate of 2.4 L/min/m2. PVF was calculated from the product of mean flow velocity and cross-sectional area of the portal vein. PVF was maintained during CPB at 0.44 +/- 0.13 and at 0.54 +/- 0.18 L/min/m2. PVF (%) in relation to systemic blood flow was obtained by calculating PVF/CI or PVF/PI, where CI is the cardiac index and PI is the perfusion index. PVF (%) before, during, and after CPB was 18.3 +/- 9.3, 18.5 +/- 5.5, and 17.4 +/- 6.7%, respectively. In conclusion, PVF was maintained during nonpulsatile CPB at a flow rate of 2.4 L/min/m2 and depended upon systemic blood flow.

Right ventricular function evaluated by volumetric analysis during left heart bypass in a canine model of postischemic cardiac dysfunction

Right ventricular function during left heart bypass was evaluated by volumetric analysis with a conductance catheter in 12 dogs with postischemic cardiac dysfunction. The conductance catheter was used to assess the volumetric status of the right ventricle and thereby allowed a right ventricular pressure-volume curve to be obtained, in which transient volume loading on the right ventricle was applied. The following right ventricular properties during left heart bypass were assessed and compared with properties measured without left heart bypass, by means of load-independent parameters: maximum elastance, stroke work/end-diastolic volume relation, end-diastolic pressure/volume relation, and stroke work/end-diastolic pressure relation. The stroke volume derived from the conductance catheter and the electromagnetic flow probe showed good linear correlation (r2 = 0.733 to 0.975). After initiation of left heart bypass, maximum elastance did not change significantly, although volume intercept significantly increased, from 1.2 +/- 7.3 to 3.6 +/- 7.9 ml (p < 0.05). End-diastolic pressure/volume relation was well fitted to the exponential curve (EDP = e(k1.EDV+k2)) and was shifted to the right and downward during left heart bypass; the slope k1 significantly decreased, from 0.12 +/- 0.06 to 0.10 +/- 0.07 (p < 0.01). Stroke work/end-diastolic volume relation and stroke work/end-diastolic pressure relation were closely fitted to the linear regression, and their slopes were significantly increased during left heart bypass, from 0.14 +/- 0.08 to 0.18 +/- 0.08 (p < 0.05) and from 0.22 +/- 0.15 to 0.34 +/- 0.19 (p < 0.01), respectively. These results suggest that the decompression of the left ventricle and septal shifting by left heart bypass provide good diastolic compliance and good systolic performance because of afterload unloading of the right ventricle. Thus the left heart bypass improved the overall right ventricular performance, particularly at higher end-diastolic pressures, in dogs with postischemic cardiac dysfunction.

Immunoprecipitation isolates multiple TSH receptor forms from human thyroid tissue

Attempts to purify the thyroid-stimulating hormone receptor (TSHR) have been complicated by its susceptibility to proteolysis and its low level of expression in thyrocytes and many transfected cells. Controversy exists over its size and structure. Multiple, single-polypeptide forms of the TSHR (230, 187, and 95-100 kDa) have been recently identified in immunoblots of crude plasma membranes prepared from COS-7 cells transfected with rat or human cDNA, but the relationship of these receptor species to the TSHR in human thyroid tissue has been heretofore unknown. We have developed a technique for immunoprecipitation of the TSHR which employed IgG purified from a polyclonal rabbit antiserum to TSHR residues 352-366. We have used immunoprecipitation to isolate the previously characterized 95-100 kDa TSH-holoreceptor, 187 kDa intermediate, and 230 kDa precursor forms of the TSHR from plasma membrane prepared from transfected COS-7 cells and human thyroid tissue. The presence of all three forms was not altered by the addition of reducing agent to the sample buffer, demonstrating the single polypeptide structure of the TSHR. This is, to our knowledge, the first report of the purification from transfected COS-7 cells of these TSHR species identified previously only in immunoblots of crude plasma membrane, and the first report of the identification by any means of these TSHR forms in human thyroid tissue. The isolation of TSHR from human thyroid tissue requires confirmation by direct means, but promises to make the receptor available in a soluble form for studies of its structure and function.

Prediction of reversible ischemia after revascularization. Perfusion and metabolic studies with positron emission tomography

BACKGROUND

Accurate noninvasive determination of myocardial viability is of paramount importance for the clinical identification of patients who will benefit most from revascularization. The preserved metabolic activity in the myocardium, as studied with positron emission tomography (PET), has been considered a gold standard for this purpose. However, recent reports show that moderate hypoperfusion or stress-induced ischemia may represent reversible ischemia. The present study was undertaken to compare the value of perfusion and metabolic studies with PET for predicting improvement in wall motion after revascularization.

METHODS AND RESULTS

Of 61 patients who had regional asynergy and underwent PET before revascularization, 43 patients who had successful revascularization were included in the study. Each patient underwent rest-stress 13N-ammonia perfusion scans and 18F-fluorodeoxyglucose (FDG) scan at rest while in a fasting state. Reversible ischemia was considered to be present when the resting perfusion was > or = 50% of the peak value, stress-induced hypoperfusion was present, or an increase in FDG uptake was observed. Of 130 asynergy segments, 51 segments had improved wall motion after revascularization. The positive and negative predictive values for improvement in asynergy were 48% and 87% by the rest perfusion study, 63% (P = .05 versus the rest value) and 87% by the rest-stress perfusion study, and 76% (P < .01 versus the rest value) and 92% by the FDG study.

CONCLUSIONS

FDG PET provided the best predictive value for improvement in wall motion after revascularization. On the other hand, 13N-ammonia PET is useful for predicting nonreversible myocardial scarring when it shows severe hypoperfusion at rest or hypoperfusion without stress-induced ischemia.

Selective blockade of P-type calcium channels by lead in cultured hippocampal neurons

The effects of lead ions (Pb2+) on neuronal calcium channels were examined in cultured hippocampal neurons. Pb2+ blocked calcium channels in a concentration-dependent manner. The current-voltage relationship of the inhibition suggested a selective blockade of high-threshold calcium channels by Pb2+ up to a concentration of 3 microM. Pb2+ (3 microM) preferentially suppressed the omega-agatoxin IVA-sensitive components of the calcium channels. These findings suggest that Pb2+ mainly affects the P-type calcium channels at low concentrations.

[Effects of volatile anesthetics on force interval relationships in guinea-pig atrial preparations]

Depressant effects of halothane, enflurane and isoflurane on isolated guinea-pig left atrial muscles bathed in Tyrode's solution at 30 degrees C were examined. Contractions were elicited by stimulation through external field electrodes while tension was recorded continuously. Frequency-force relationships at stimulation rates of 0.1, 0.2, 0.5 and 1 Hz were studied. The pD2 values of these volatile anesthetics at each stimulation rates were not different significantly, suggesting the frequency-independent depressions of these anesthetics. Interval-strength relationships at time intervals of 0.3-20 sec during 1 Hz-stimulation were also studied. Mechanical restitution curves after converting to logistic function reached a peak at 8-20 sec and were fitted well to double exponential functions with time constants of 200-600 msec (k1) and 2-6 sec (k2). All volatile anesthetics depressed the magnitude constants for fast response in a dose dependent manner. Accordingly, at high concentrations, mechanical resuscitation curves tended to fit single exponential function. Halothane and enflurane did not alter time constant k1, k2 significantly, while isoflurane increased k2 significantly. These results suggest that the mechanisms of myocardial depressant effects are different between these anesthetics.

Fetal bovine serum is not necessary for the cryopreservation of aortic valve tissues

The purpose of this study was to estimate the protective effects of fetal bovine serum on the cryopreservation of aortic valve tissues. Ten porcine aortic valves were divided into two groups according to the nutrient content of the medium used for sterilization and cryopreservation. Group A valves were preserved in Dulbecco's modified Eagle medium containing 10% fetal bovine serum, whereas group B valves were preserved in Dulbecco's modified Eagle medium alone. The fibroblast viability of the cryopreserved tissues was assessed autoradiographically with the use of tritiated proline at the following points: fresh control, after sterilization, and after storage for 1 week or 3 months. The proportion of viable fibroblasts decreased to a similar extent in both groups of tissues after 1 week of storage, 81.1% +/- 2.5% in group A and 80.4% +/- 3.3% in group B, and after 3 months of storage it decreased slightly to around 73% for both groups of tissues. No significant difference was observed between the two groups at any time. These result suggest that fibroblasts are adequately preserved even after 3 months of cryopreservation, and that the addition of fetal bovine serum to the medium does not further improve their viability. Thus, from a point of view of fibroblast viability, it is not necessary to use fetal bovine serum for the cryopreservation of aortic valve tissues.

[Effect of left heart bypass on right ventricular function in normal and acute heart failure dogs--an application of the conductance catheter to the right ventricle]

We investigated right ventricular function during left heart bypass (LHB) with 18 mongrel open-chest dogs, in normal and acute heart failure (AHF) dogs which underwent aortic cross clamp. Left ventricular unloading was completely accomplished with a centrifugal pump. For more accurate evaluation of right ventricular volume, conductance catheter was employed to assess right ventricular function. Analysis were performed with right ventricular pressure-volume curve which was changed by transient volume loading on right ventricle. And right ventricular properties with and without LHB were compared by the use of load independent parameters as follows. Right ventricular systolic property was evaluated by maximum elastance (Emax) and stroke work-end-diastolic volume relation (SW/EDVR), and its diastolic function was evaluated by end-diastolic pressure-volume relation (EDP/VR). Overall right ventricular performance was assessed by stroke work-end-diastolic pressure relationship (SW/EDPR). In the normal heart, only a parallel shift to the right in EDP/VR and SW/EDVR was noted without any significant changes in slope with LHB. On the other hand, in AHF dogs, the slope of SW/EDVR and SW/EDPR were increased from 0.14 +/- 0.08 to 0.18 +/- 0.08 (p < 0.05), from 0.22 +/- 0.15 to 0.34 +/- 0.19 (p < 0.01), respectively, and the curve of EDP/VR was shifted right and downward. These result suggested that decompression of the left ventricle and septal shifting by LHB provided good diastolic compliance and afterload unloading of the right ventricle, and these effects had a more significant role in acute heart failure than in the normal heart.