[Successful treatment by Konno's operation for congenital aortic stenosis associated with hypoplastic valve ring]

A 47-year-old woman with congenital aortic stenosis associated with hypoplastic aortic valve ring underwent aortic valve replacement by Konno method. We have to be careful preventing residual VSD because the left ventricular muscle was weak in the aged with congenital aortic stenosis. In early postoperative period, we also have to do a careful treatment in case by Konno's operation, particularly in the patient of advanced age. However, she made a satisfactory recovery with adequate size of aortic valve replacement.

Effect of 21-aminosteroid lipid peroxidation inhibitor, U74006F, in the rat middle cerebral artery occlusion model

The aim of this study was to evaluate the effect of 21-aminosteroid lipid peroxidation inhibitor, U74006F, on ischaemic brain tissue damage using the rat middle cerebral artery occlusion model. Under anaesthesia, the left middle cerebral artery was exposed without cutting the dura mater via a subtemporal craniotomy, under an operating microscope. Photo-illumination (wave length; 540 nm) was applied to the middle cerebral artery and then rose bengal (20 mg/kg) was administered intravenously. The middle cerebral artery was completely occluded by thrombus about 6 min after the administration of rose bengal. U74006F (1.0 mg/kg) was then injected intravenously just after the cessation of illumination. Twenty four hours after the operation, the extent of ischaemic damage was measured by magnetic resonance imaging technique. After measuring the extent of ischaemic damage, the brain was immediately removed from animals treated with or without U74006F for determination of lipid peroxidation, and the generation of free arachidonic acid in the brain. U74006F significantly (P < 0.01) reduced the size of ischaemic damage. Twenty-four hours after the operation, lipid peroxidation and the concentration of free arachidonic acid in the left hemisphere (infarction side) were significantly (P < 0.05) higher than in the right hemisphere. U74006F significantly (P < 0.05) decreased the content of lipid peroxidation products and free arachidonic acid. There was a significant (P < 0.05) correlation between the extent of ischaemic damage and the concentration of lipid peroxidation products in the left hemisphere 24 h after the operation. In conclusion, U74006F might reduce the extent of ischaemic damage by inhibiting lipid peroxidation in the brain, thus minimizing oxidative damage to neural tissues.

Right atrial myxoma with right to left shunt and coronary artery disease

Surgical treatment of a right atrial myxoma with a right-to-left shunt and coronary artery disease was successfully performed in a 61-year-old man. The interatrial shunt occurred through a patent foramen ovale and was the result of a high central venous pressure due to tricuspid stenosis and regurgitation. Instead of right heart catheterization and cardioangiography, we chose an intraoperative blood-gas study to diagnose the intracardiac shunt. Preoperative polycythemia and hypoxemia were improved after removal of the tumor and closure of the patent foramen ovale.

Variation of the jaw-opening reflex during spontaneous mastication in rabbits

To understand the modulation of periodontal mechanoreceptor activity on mastication, the jaw-opening reflex (JOR) evoked by electrical stimulation of the inferior alveolar nerve (IAN) was studied during chewing in freely behaving rabbits. Spontaneous chewing movements were intact from the IAN stimulation below two times the threshold (T) which was measured at rest. As the stimulus intensity was increased to more than 2.5 T, the amplitude of the masseter activity decreased or it was abolished; however, the chewing rhythm was still maintained up to 3.0 T. When the low-threshold primary afferents were tested while the rabbit chewed pellets rhythmically, the amplitude in the JOR was inhibited below the prior control level. The inhibitory effect on the JOR was larger in the opening phase than that in the closing phase. In conclusion, the JOR was tonically depressed during the masticatory cycle and the inhibition of the JOR was rhythmically modulated in a phase-linked manner that was larger in the opening phase than in the closing phase.

Pharmacokinetic and pharmacodynamic profiles of CS-518, a selective, long-lasting thromboxane synthase inhibitor, after single and multiple oral administration to healthy volunteers

A selective thromboxane (TX) synthase inhibitor, CS-518, was orally administered to healthy male Japanese volunteers and the pharmacokinetic and pharmacodynamic properties were investigated. The time profile of drug concentrations in plasma was determined, and the effects of the drug on platelet aggregation in plasma induced by arachidonic acid (AA) and adenosine diphosphate (ADP) ex vivo were examined. The production of TXB2 and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) in serum during whole blood coagulation ex vivo also were examined. In the single-dose study (50, 100, and 200 mg), plasma concentrations of the drug were well fitted to a one-compartment open model with first-order absorption. The area under plasma concentration curve (AUC) and maximum plasma concentration (Cmax) showed dose-related increases, whereas the mean elimination half-lives remained rather constant (.68-.92 hour). The drug was recovered in urine by 32 to 37% and 62 to 65% as unchanged and conjugated forms (acylglucuronide), respectively, showing almost complete absorption of CS-518. The effect of food intake on the pharmacokinetics of CS-518 was determined at the dose of 100 mg. The time to reach Cmax was prolonged from .42 to 2.08 hours and the Cmax was decreased by about 66%, whereas the AUC and urinary recovery showed no significant changes. The platelet aggregation in plasma induced by AA was markedly inhibited, whereas the secondary aggregation induced by ADP was inhibited to a much less degree. Platelet aggregation by AA was almost completely inhibited 2 hours after administration of any dose and the duration for maintaining the significant inhibition tended to depend on the dose ranging from 48 to 72 hours after administration, which was much longer than expected from the plasma concentration of drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma glucagon responses to insulin-induced hypoglycemia and arginine in spontaneous non-insulin-dependent diabetes mellitus (NIDDM) rats, Otsuka Long Evans Tokushima Fatty (OLETF) strain

Pancreatic A-cell function in the newly developed Otsuka Long Evans Tokushima Fatty (OLETF) strain of non-insulin-dependent diabetes mellitus (NIDDM) rats was examined in relation to the morphological changes in their islets and the plasma glucagon responses to insulin-induced hypoglycemia and an arginine test by chronological studies in seven male OLETF and seven male non-diabetic control Long Evans Tokushima Otsuka (LETO) rats each at 10, 16 and 24 weeks of age and eight male OLETF rats that were placed in a cage with a wheel for exercising from 5 to 24 weeks of age. The hormonal contents and morphological features of the pancreas of these rats were examined. After iv injection of insulin, the plasma glucagon level rose significantly from the basal level in OLETF rats at 10 weeks old, but little if at all in those of 16 and 24 weeks old. The pancreatic A cells of LETO rats of all age groups responded equally well to glucopenia. The areas under the response curves of plasma glucagon (sigma delta IRG) during the 90 min of insulin-induced hypoglycemia were 14496 +/- 7860 vs 9588 +/- 3930, 2257 +/- 3018 vs 9235 +/- 5447 (p < 0.05) and 826 +/- 985 vs 9707 +/- 2510 (p < 0.01) ng.min-1.l-1 in OLETF rats vs LETO rats of 10, 16 and 24 weeks old, respectively. The plasma glucagon responses during the arginine test were higher in OLETF rats than in LETO rats at 10 and 16 weeks but not at 24 weeks of age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Excellent exposure for the mitral valve by means of dissection of the interatrial groove]

A technique to approach the mitral valve through a left atrial incision under dissecting the interatrial groove is described. The dissection of the interatrial groove makes the left atrial incision more anterior and medial. Therefore excellent mitral valve exposure was obtained. 40 of 61 mitral valvular procedures during past 1.5-year period were approached through this incision. We could achieve better exposure of the mitral valve than that of conventional atrial incision technique. This technique takes not so long time and rarely carries complications including dysarrhythmia and bleeding.

Aldose reductase inhibitory and uricosuric activities of FK366 in healthy volunteers

The pharmacokinetics, and aldose reductase (AR) inhibitory and uricosuric activities of FK366 were studied in healthy volunteers given a single oral dose of 150, 300, or 600 mg after fasting, 600 mg after a meal, or 300 mg twice a day for 8 days after meals. The AR inhibition was assessed by the percent reduction from the predrug dulcitol values in red blood cells converted from exogenous galactose by AR. Aldose reductase inhibition paralleled the plasma concentrations of FK366, with maximum inhibitions of 31.6, 48.0, and 56.9% at doses of 150, 300, and 600 mg, respectively. With multiple dosing, the inhibition scarcely differed between the first (41.8%) and last doses (41.5%). Serum uric acid decreased dose dependently, with a minimum concentration of 4.0 mg/dL (predrug: 5.5 mg/dL) 8 hours after receiving 600 mg. With multiple dosing, serum uric acid levels declined rapidly and remained at a concentration of 3.1 mg/dL beginning at day 3. Urinary excretion of uric acid was high on day 1 (879 mg/day), but decreased significantly to 654 mg/day on day 2 and then stabilized. The pharmacokinetics of FK366 were linear over the dose range studied, with an elimination half-life of 8.2 hours and urinary recovery of 27.2% as unchanged drug. FK366 was well tolerated by all subjects.

[Surgical treatment for impending rupture of distal aortic arch aneurysm: a case report using "elephant trunk" prosthesis]

A 75-year-old man with impending rupture of distal aortic arch aneurysm was operated on using the "elephant trunk" prosthesis. A long graft was anastomosed only to the proximal aortic stump and its distal free portion was inserted through the exit of the aneurysm into the descending aorta. Postoperative CT scan and MR image showed complete thrombosis formation in the dead space between the graft and the aneurysmal wall, which precluded necessity for further operation. However the graft was looped and kinked in the aneurysm. Furthermore the patient suffered from incomplete paraplegia, probably caused by the extremely long graft. In terms of promoting thrombosis formation in the aneurysmal inner space the longer prosthesis is feasible, but one should keep it in mind that an excessively long graft can lead to the kinking of the graft and paraplegia.

An animal model for subperiosteal tissue expansion

An animal model for subperiosteal tissue expansion is described. Small tissue expanders were placed bilaterally and inflated in the buccal subperiosteal pockets of the mandible. Additionally, subcutaneous expansion was performed in the breast region. Twenty-one dogs were used in three experimental groups to evaluate the optimal size of an expander for this model, the optimal inflation regimen, and the histologic changes following subperiosteal expansion. Hemicylindrical expanders, 20 mm in width, 10 mm in height, and 30 mm in length, inflated with 1 mL saline every four days, were used for this model. It was found that the periosteum was replaced by fibrous connective tissue during expansion. Capsule formation following subperiosteal expansion was much more rapid than that following subcutaneous expansion. A greater increase in vascularity was noted in the subperiosteal expansion group and the subperiosteal control group than in the subcutaneous expansion group. In the subperiosteal expansion group, a thick fibrous capsule, with minimal inflammatory response, was observed 1 week after full inflation. Leaving the fully inflated subperiosteal expanders in place more than 1 month accelerated the resorption of the underlying bone. These results support the previously reported empirical regimens of subperiosteal tissue expansion. Furthermore, the excellence of the subperiosteal expanded bed as a recipient site for onlay grafting was confirmed.

[Extraction of infected pacemaker electrode using catheter and snare]

A 85-year-old man had undergone implantation of a transvenous pacemaker system in 1982. Nine years later the generator was explanted and he was underwent implantation of a new generator and electrode. After one year of the second operation, infection of the old electrode had been noted and it was not cured in spite of partial explantation of the infected electrode and appropriate antibiotic therapy. We decided to remove the infected electrode and succeeded in extraction using catheter and snare. The patient's recovery was uneventful. We suggest catheter and snare is useful for explantation of chronic transvenous pacemaker electrodes.

Activation of the human immunodeficiency virus type 1 long terminal repeat by BTEB, a GC box-binding transcription factor

BTEB, a GC box-binding transcription factor, was tested for its ability to activate the human immunodeficiency virus type 1 long terminal repeat (HIV-1 LTR). An electrophoretic mobility shift assay demonstrated specific binding of BTEB to GC boxes of the HIV-1 LTR. When a BTEB expression vector was cotransfected into A3.01 cells with a fusion gene of HIV-1 LTR and chloramphenicol acetyltransferase (CAT) structural gene, the CAT activity was increased. This increase was accompanied by an increase in the content of CAT mRNA. Transcriptional activity of the HIV-1 LTR, stimulated by Tat, was further enhanced by the expression of BTEB. BTEB also activated the LTR activity in cooperation with phorbol 12-myristate 13-acetate. Northern blot analysis showed that various T cell and macrophage/monocyte cell lines expressed the BTEB mRNA to a level comparable with that of Sp1, another GC box-binding transcription factor. These results suggest that BTEB, like Sp1, is involved in transcriptional activation of the HIV-1 LTR.

Is exercise training effective in preventing diabetes mellitus in the Otsuka-Long-Evans-Tokushima fatty rat, a model of spontaneous non-insulin-dependent diabetes mellitus?

We determined whether exercise training is effective in preventing the development of diabetes mellitus in a model rat (Otsuka-Long-Evans-Tokushima Fatty [OLETF]) with non-insulin-dependent diabetes mellitus (NIDDM). Thirty male OLETF rats aged 5 weeks were assigned to one of the following three groups: trained rats placed individually in an exercise wheel (EW) cage, EW-control rats housed in the same cages equipped with a fixed rotatory wheel, and sedentary rats maintained two or three to a conventional cage. Eight male diabetes-resistant Long-Evans rats were used as nondiabetic controls. At 24 weeks of age, the trained, EW-control, sedentary, and nondiabetic control rats weighed an average of 445, 559, 621 and 513 g and had abdominal fat deposits of 16, 55, 67, and 23 g, respectively. The mean amount of exercise of trained rats was 5,243 m/d. At 24 weeks of age, the cumulative incidences of diabetes mellitus in sedentary and EW-control rats were 78% and 50%, respectively, while neither trained nor nondiabetic control rats became diabetic. Fasting and 120-minute plasma immunoreactive insulin (IRI) levels after oral glucose administration were significantly lower in the trained group than in the other groups. In vivo insulin-stimulated glucose uptake as measured with a euglycemic clamp was reduced 37% in sedentary rats and increased 35% in trained rats compared with that in nondiabetic control rats. Morphological studies on the pancreas of sedentary and EW-control rats showed enlarged multilobulated fibrotic islets, whereas sections of islets from trained rats appeared normal but slightly enlarged.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclophosphamide-induced diabetes in Long-Evans Tokushima Lean rats: influence of ovariectomy on the development of diabetes

We studied the effect of treatment with cyclophosphamide (CY) on the incidence of diabetes in Long-Evans Tokushima Lean (LETL) rats, a newly established strain of spontaneously type I diabetic rats. The overall incidence of diabetes among 356 LETL rats treated with CY was 25.6%, which was significantly higher than the 10.5% among 857 untreated LETL rats at 27 weeks of age, and there was no significant sex difference. The incidence of CY-induced diabetes in adult (> 16 weeks of age) female LETL rats was 7.7% (10/130), which was significantly lower than that in other CY-treated groups of LETL rats. No diabetes mellitus was induced by administration of CY to 23 diabetes-resistant LETO rats. There were no significant differences in the degrees of hyperglycemia or hyperketonemia in spontaneously and CY-induced diabetic LETL rats, but the plasma glycated albumin level of CY-induced diabetic rats (10.3% +/- 2.1%) was significantly higher than that of spontaneously diabetic rats (8.2% +/- 1.3%), suggesting that plasma glucose levels increased more rapidly in the latter. More than half of the diabetic rats showed type C or D morphological changes of the islets, ie, atrophic change with little mononuclear cell infiltration or almost complete loss of the islets. However, distributions of various types of morphological changes in the islets were not significantly different in the two groups. Ovariectomy (OVX) significantly increased the incidence of CY-induced diabetes in adult female rats from 7.7% to 20.8%. The number of CD8+ cells was significantly increased in noncastrated adult female LETL rats and decreased to the level of other groups after OVX.(ABSTRACT TRUNCATED AT 250 WORDS)

[Successful treatment of supravalvular mitral stenosis associated with ventricular septal defect]

Supravalvular mitral stenosis is a rare congenital anomaly. A case of a 2-year-old girl with supravalvular mitral stenosis and ventricular septal defect was successfully treated. The preoperated echocardiogram showed supravalvular mitral stenosis associated with congenital mitral stenosis and ventricular septal defect. However, the mitral valve was found to be normal after the excision of the ring. The ring has been attaching itself to the mitral valve, so it required a meticulous surgical technique to avoid injury to the mitral valve itself.

Vascular dysfunction detected by a simplified venous occlusion test in NIDDM patients

OBJECTIVE

To elucidate the relationship between angiopathies and vascular function evaluated by a simplified venous occlusion test in patients with NIDDM.

RESEARCH DESIGN AND METHODS

The serum concentration of FDP was measured before and 5 min after venous occlusion in 23 NIDDM patients, 11 patients with cerebrovascular accident, and 10 age-matched healthy control subjects.

RESULTS

The increment of serum FDP level after venous occlusion was significantly less in patients with NIDDM (60.6 +/- 33.5 to 81.5 +/- 49.6 ng/ml) and in those with cerebrovascular accident (101.4 +/- 51.5 to 116.2 +/- 47.2 ng/ml) than in control subjects (79.9 +/- 41.0 to 148.8 +/- 65.4 ng/ml). The increment of serum FDP after venous occlusion in NIDDM patients with macroangiopathy was significantly lower than that in those without macroangiopathy.

CONCLUSION

The responsiveness of fibrinolytic activity to venous occlusion was significantly less in NIDDM patients with macroangiopathy, as in patients with cerebrovascular accident, compared with that in healthy control subjects.

[Analysis of water content in young rats brain edema by Raman spectroscopy]

Cerebral edema, classified into vasogenic edema and cytotoxic edema, has long been studied and recognized to be complicated. The authors studied the cerebral edema models of young rats suffered from cryo-injury and triethyl tin chloride (TET) injury by Raman spectroscopy which can physiologically evaluate the cerebral water content (%) of very restricted area. The cryo-injury model was conducted in the following manner. A cryo-probe (-196 degrees C) was contacted to the exposed cranium for 20 seconds in an anesthetized 4-5-week-old Sprague-Dawley young rat. A coronal section of the injured brain covered with a slide glass and wrapped by Parafilm was obtained 2, 4, 6, 8, 12, 24, 48, 72 hours after the cryo-injury in order to measure the water content by Raman spectroscopy employed by Tashibu and Huizinga. TET injury model was obtained by intraperitoneal administration of TET (4.5 mg/Kg). The water content was observed by the same manner as for the cryo-injury model. Subsequent to the cryo-injury, the water content of the white matter which seemed to be higher than in adult rats increased rapidly and persisted in the same condition within 72 hours. Subsequent to TET injury, the water content of the white matter increased more rapidly than that of the gray matter, however, in adult rats the water content of the gray matter showed more rapid increase than that of the white matter. Increased water content followed by TET injury was higher in adult rats than in young rats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Successful repair of total anomalous pulmonary venous connection and incomplete endocardial cushion defect associated with left isomerism]

Successful repair of a 8-month-old girl with polysplenia was reported. The cardiovascular anomalies were TAPVC (II b), incomplete ECD, interruption of inferior vena cava with hemiazygos continuation, bilateral superior vena cava, and left superior vena cava draining into the coronary sinus. Cardiopulmonary bypass was established with ascending aortic perfusion and caval cannulation. A left superior vena cava was directly cannulated after establishing partial bypass. In this case the left pulmonary vein drained into the right atrium near the orifice of the coronary sinus, so the atrial septal flap was made and sutured between the orifice of the left pulmonary vein and the coronary sinus in order to avoid late pulmonary vein obstruction. Then, atrium was separated by an intraatrial baffle which was sutured to the atrial septal flap. Recently, it becomes possible to surgical repair of polysplenia syndrome according to the advancements of the diagnostic methods, cardiopulmonary bypass, and the technique of the open heart surgery.

Analysis of nicotine content of hair for assessing individual cigarette-smoking behavior

The concentration of nicotine in hair was measured by a capillary gas chromatograph with a nitrogen-phosphorus detector after hair was dissolved in 2.5 N sodium hydroxide and nicotine was extracted using diethyl ether. In hair samples obtained from 36 smokers, who had smoked > or = 3 years, there was a significant positive correlation between the concentration of nicotine and the number of cigarettes consumed daily (r = 0.685; p < 0.001). The nicotine content of white hair was much less than that of black hair collected from the same subjects with grizzled hair. The above findings were confirmed by an animal experiment, in which nicotine (0.2, 0.6, and 2 mg/kg/day for 2 weeks) was administered intraperitoneally to pigmented rats whose hair had been removed beforehand by plucking from an area of the back of each rat. The hair which grew back in the denuded area was plucked and collected one week after the last administration of nicotine. The nicotine concentration in the brown hair of the back correlated with the given dose (r = 0.824; p < 0.001). In a separate experiment, hairs were removed from areas of back and thorax, and nicotine delivered to the rats for 4 weeks by an osmotic pump implanted under the skin, showing that the concentration in the whitish hair was much lower than that in brown hair. Finally, hair samples were collected from 14 subjects who had participated in a smoking cessation program over 6 months and who abstained from cigarette smoking. The axial distribution of nicotine along the hair shafts was determined for each subject.(ABSTRACT TRUNCATED AT 250 WORDS)

The plunging ranula

Five cases of "plunging ranula" are reported. In one case, treatment consisted of exteriorization and obturation by a removable, partial-denture-like splint. A second case was treated by total removal of both the ranula and the sublingual gland by a combined extraoral-intraoral approach. In the other three cases, treatment consisted of excision of the sublingual gland and marsupialization of the cyst by an intraoral approach. Since a plunging ranula is due to extravasation from the sublingual gland herniating through the mylohyoid muscle, excision of the sublingual gland followed by transoral drainage of the plunging ranula is regarded as the best treatment.

[Anomalous origin of the left coronary artery from the pulmonary artery: a case report in an adult]

A 37-year-old female with anomalous origin of the left coronary artery from the pulmonary artery was surgically treated by creation of intrapulmonary aorto-coronary tunnel. Postoperative cardiac catheterization showed a minimal pulmonary stenosis at the baffle. But the remarkable preoperative ST-depression in a treadmill exercise test disappeared completely after operation and the normograde blood flow of the left coronary artery was detected from the ascending aorta.

Phase I study of DQ-2556, a new parenteral 3-quaternary ammonium cephalosporin antibiotic

The safety and pharmacokinetic properties of DQ-2556, a new parenteral cephalosporin, were evaluated using healthy volunteers after 5-minute intravenous infusion of doses of 250, 500, 1000, or 2000 mg and a 1-hour infusion of 2000 mg, and an intramuscular dose of 500 mg. The half-lives of DQ-2556 ranged from 1.64 to 2.15 hours. The peak serum concentrations and area under the curve values were linearly correlated to the doses. The mean urinary recoveries were 80.0 to 85.5% of a dose within 24 hours. Salivary concentrations of the drug were low. There was no accumulation of DQ-2556 after 9 administrations every 12 hours. DQ-2556 was well tolerated.

Correlation between residual beta-cell function and age at onset of spontaneous diabetes in Long Evans Tokushima lean rats

We studied the natural course of disease in spontaneously diabetic rats, Long Evans Tokushima Lean (LETL) rats, to determine whether it showed similar pathogenetic heterogeneity to that of patients with insulin-dependent diabetes mellitus (IDDM) with regard to the relationships between age at onset, rapidity of disease progress, and degree of beta-cell function at the time of its manifestation. Type 1 diabetes developed in 35 rats (6.3%) between 40 and 140 days of age. Eight rats that became diabetic at age 69 days or less were more severely ketotic at the time of first detection of glycosuria and showed more rapid deterioration than seven rats that became diabetic later after birth (mean plasma 3-hydroxybutyrate levels, 4,707 +/- 1,215 pmol/L v 1,390 +/- 859 pmol/L; mean +/- SEM, P < .01). The mean plasma levels and pancreatic content of immunoreactive insulin (IRI) of the early onset rats, 47 +/- 13 pmol/L and 19 +/- 12 pmol/g tissue weight, were significantly lower (P < .01) than the corresponding values of the late-onset rats, 262 +/- 52 pmol/L and 348 +/- 87 pmol/g tissue weight, respectively. Both values were markedly lower than the mean values of 25 nondiabetic LETL rats, 976 +/- 122 pmol/L and 3,488 +/- 628 pmol/g tissue weight. Plasma immunoreactive glucagon (IRG) levels were significantly increased in the diabetic groups (early onset, 57 +/- 13 pmol/L; late-onset, 51 +/- 12 pmol/L; nondiabetic, 18 +/- 1 pmol/L; P < .01). These changes in pancreatic hormone levels of the early onset and late-onset rats were compatible with the histological features of their pancreatic islets.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment of coarctation of the aorta]

Repair of coarctation of the aorta was performed in 37 cases (31 patients, 6 patients of reoperation) ranging from 4 days old to 15 years old. Subclavian flap repair were performed in 15, resection and end-to-end anastomosis in 14, patch aortoplasty in 6, and interposition graft in 2. Subclavian flap angioplasty or end-to-end anastomosis is considered the procedure of choice in infants. However, the incidence of reoperation significantly increased in patients younger than age one month at initial subclavian flap repair. Mechanism of recurrent coarctation may be possibly related to retention of abnormal tissue, which is possibly ductal and/or intimal shelf, with the potential for proliferation and luminal narrowing. We suggest that in applicable case end-to-end anastomosis rather than subclavian flap angioplasty may be the surgical technique of choice in infants less than one month of age, and the most common reoperation technique was patch aortoplasty in re-stenosed cases.