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Oshima K, Tsutsumi H, Takeyoshi I, Mohara J, Nameki T, Matsumoto K, Morishita Y. The inhibition of cyclooxygenase-2 improves donor heart function following long-term preservation. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Singhal A, Abrams J, Mohara J, Hasz R, Nathan H, Fisher C, Furukawa S, Goldman B. Potential suitability for transplantation of hearts from human non-heart beating donors: Data review from the Gift of Life Donor Program. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.11.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oshima K, Takeyoshi I, Mohara J, Tsutsumi H, Ishikawa S, Matsumoto K, Morishita Y. Long-term preservation using a new apparatus combined with suppression of proinflammatory cytokines improves donor heart function following transplantation in a canine model. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ishikawa S, Takahasi T, Oshima K, Mohara J, Morishita Y. 2P-0592 Cost-effectiveness of screening for abdominal aortic aneurysm Japan-based estimates. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ishikawa S, Takahashi T, Ohtaki A, Sato Y, Suzuki M, Hasegawa Y, Ohki S, Mohara J, Oshima K, Morishita Y. Peripheral pulmonary atelectasis and oxygentation impairment following coronary artery bypass grafting. J Cardiovasc Surg (Torino) 2002; 43:419-22. [PMID: 12124545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Severe pulmonary oxygenation impairment occurred in some patients with pleurotomy during the harvest of the internal mammary artery graft followed by coronary artery bypass grafting (CABG). Peripheral pulmonary atelectasis in the postoperative chest X-ray was detected in these patients. We studied the efficacy of intraoperative positive end-expiratory airway pressure (PEEP) therapy for the prevention of postoperative pulmonary oxygenation impairment. METHODS The pleural cavity was intraoperatively opened in 40 patients with solitary CABG procedure performed during 5 years since January 1992. These patients were divided into two groups. Intraoperative PEEP therapy, which is initiated just after pleurotomy, was not used in 32 patients before May, 1996 (control group) and used for recent 8 patients with pleurotomy (PEEP group). The mean age of patients was 60 years old in the control group and 68 in the PEEP group. RESULTS Respiratory insufficiency (A-aDO2 >400 mmHg and RI >1.5) was detected in 6 patients in the control group. Three out of these 6 patients required long-term mechanical respiratory support over a week. No respiratory insufficiency occurred in patients of the PEEP group. Values of PaO2, A-aDO2, respiratory index and shunt ratio were significantly worse in the control group than in the PEEP group. CONCLUSIONS In conclusion, PEEP therapy may prevent pulmonary atelectasis and oxygen impairment after CABG.
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Affiliation(s)
- S Ishikawa
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Ishikawa S, Takahashi T, Sato Y, Suzuki M, Murakami J, Hasegewa Y, Mohara J, Oshima K, Ohtaki A, Morishita Y. Growth of the pulmonary arteries after systemic-pulmonary shunt. Ann Thorac Cardiovasc Surg 2001; 7:337-40. [PMID: 11888472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Pulmonary artery growth after a systemic-pulmonary shunt was angiographically evaluated in 19 out of 35 patients. The mean age of the subjects at the time of the initial operation was 18+/-18 months including 12 patients under a year old. The preoperative diagnosis was tetralogy of Fallot (TOF) in 10 patients, TOF plus pulmonary atresia in five and transposition of great arteries in four. A Blalock-Taussig shunt (BTS) operation was performed in 16 patients (15 classical and 1 modified) and a central shunt was performed in three patients as an initial operation. The preoperative pulmonary artery index (PAI) was 129+/-42 in all patients and there were no significant differences between patients under or over a year old (139+/-42 vs. 115+/-49). Postoperative angiography was performed 32+/-13 months after the surgery. Room air arterial O2 pressure increased significantly from 29+/-5 mmHg to 42+/-5 mmHg just after an initial palliative shunt operation. PAI change in patients under a year old was 214+/-73%, which was higher than 145+/-27% in patients over a year old after a palliative shunt operation. On the ipsilateral side, PAI change was almost the same between patients under and over a year old. On the contralateral side, PAI change in patients under a year old was 216+/-68%, which was significantly higher than the 116+/-21% in patients over one year old. There was a significant negative correlation (r=-0.65, p<0.05) between PAI change and arterial O2 pressure as measured just after a palliative shunt operation. In conclusion, a palliative shunt operation prior to a year old is desirable in order to produce sufficient and bilateral pulmonary artery growth.
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Affiliation(s)
- S Ishikawa
- Second Department of Surgery, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Japan
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Yamagishi T, Oshima K, Hasegawa Y, Mohara J, Kanda T, Ishikawa S, Morishita Y. Cytokine induction by LVAD in the canine kidney. J Cardiovasc Surg (Torino) 2001; 42:759-68. [PMID: 11698942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The outcome of left ventricular assist device (LVAD) support is reported to be associated with proinflammatory cytokines. We investigated the effect of LVAD support on renal function and the resultant cytokine induction. METHODS A prospective experimental study was performed using 15 mongrel dogs weighing 14 to 36 kg. LVAD was introduced in nine dogs (LVAD group) and the remaining six dogs were managed without LVAD support (control group). All animals were observed for six hours after thoracotomy. Renal regional blood flow was measured, and albumin-creatinine ratio (ACR) and N-acetyl-beta-D-glucoseaminidase index (NAGI) were evaluated as parameters of glomerular and tubular function, respectively. Tumor necrosis factor alpha (TNF-alpha) concentrations in the blood and homogenate of renal tissues were measured and immunohistological examination of renal tissues was conducted by means of anti-nuclear factor kappa B (NF-kappa B), TNF-alpha and interleukin 1 beta (IL- 1 beta) antibodies. RESULTS In the LVAD group, the renal cortex-medullar blood flow ratio significantly (p<0.05) decreased, and ACR was significantly (p<0.05) higher than in the control group, indicating glomerular insufficiency. There were no significant differences in NAGI and TNF-alpha levels in the blood and renal tissues between the two groups. Immunohistological examination of renal tissues demonstrated an accumulation of NF-kappa B, TNF-alpha, and IL-1 beta in the LVAD group. CONCLUSIONS An LVAD alters renal regional blood flow and induces a small amount of cytokines. We speculate that if an LVAD is introduced during systemic inflammatory response syndrome, the LVAD will induce a second attack resulting in multiorgan failure. For successful LVAD support, the appropriate selection of time periods is essential.
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Affiliation(s)
- T Yamagishi
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Suzuki M, Hamada Y, Ishikawa S, Mohara J, Koike N, Nameki T, Kado H, Morishita Y. [Right ventricular outflow tract reconstruction using a three-valved extracardiac conduit of expanded polytetrafluoroethylene vessel graft in the Ross operation: a pediatric case report]. Kyobu Geka 2001; 54:1118-20. [PMID: 11761897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 16-year-old boy was diagnosed as having severe aortic regurgitation and moderate aortic stenosis due to congenital aortic bicuspid valve. A chest X-ray film showed the cardiothoracic ratio (CTR) of 64% and echocardiography revealed severe dilation of the left ventricular dimension with severe wall thickness. An electrocardiogram showed multiple ventricular arrhythmias. The patient underwent the Ross operation with the reconstruction between the right ventricle and the pulmonary arteries using a three-valved conduit which was made by an expanded polytetrafuloroethylene vessel graft. Ventricular arrhythmia disappeared just after the operation and left ventricular dimensions improved with the CTR of 53% except mild regurgitation of the neo-aortic valve three months later.
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Affiliation(s)
- M Suzuki
- Gunma Children's Medical Center, Gunma, Japan
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Tsutsumi H, Oshima K, Mohara J, Takeyoshi I, Aizaki M, Tokumine M, Matsumoto K, Morishita Y. Cardiac transplantation following a 24-h preservation using a perfusion apparatus. J Surg Res 2001; 96:260-7. [PMID: 11266282 DOI: 10.1006/jsre.2001.6077] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We developed a new apparatus for heart preservation and have already reported successful transplantation following 12 h of preservation using this apparatus. The efficacy of coronary perfusion with an oxygenated Celsior solution was investigated through transplantation following 24 h of preservation using the apparatus. MATERIALS AND METHODS After being harvested, grafts were preserved with a combination of immersion in a 4 degrees C Celsior solution and perfusion with an oxygenated Celsior solution using the apparatus in the coronary perfusion (CP) group and simply immersed in a 4 degrees C Celsior solution in the simple immersion(SI) group. beta-Adenosine triphosphate (beta-ATP), phosphocreatine (Pcr), and inorganic phosphate (P(i)) levels and myocardial pH (pH(i)) were measured immediately after the heart was excised and at 12 and 24 h after preservation. Following preservation, orthotopic transplantation was performed. Cardiac function was measured 2 h after weaning from cardiopulmonary bypass (CPB). RESULTS beta-ATP/P(i), Pcr/P(i), and pH(i) levels were significantly higher in the CP group than in the SI group at 12 and 24 h after preservation. Four of six animals in the CP group and two of six in the SI group were successfully weaned from CPB. The recovery rates of cardiac function were better in the CP group than in the SI group. CONCLUSION Twenty-four hours of heart preservation may be possible with a combination of immersion in a 4 degrees C Celsior solution and perfusion with an oxygenated Celsior solution using the perfusion apparatus.
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Affiliation(s)
- H Tsutsumi
- Second Department of Surgery, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Mohara J, Takahashi T, Oshima K, Aiba M, Yamagishi T, Takeyoshi I, Matsumoto K, Morishita Y. The effect of Celsior solution on 12-hour cardiac preservation in comparison with University of Wisconsin solution. J Cardiovasc Surg (Torino) 2001; 42:187-92. [PMID: 11292930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Celsior is a new extracellular-type preservation solution which has been developed to act not only as a storage medium but also as a perfusion fluid during initial donor heart arrest, poststorage graft reimplantation and early reperfusion. We designed this experimental study to evaluate the effect of the Celsior solution in comparison with the University of Wisconsin solution from the viewpoint of energy depletion. METHODS Adult mongrel dogs weighing 9 to 13 kg were divided into two groups. In the UW group (n=7), a 4 degrees C University of Wisconsin solution was used for coronary vascular washout and storage following cardiac arrest using a glucose-insulin-potassium solution. In the Celsior group (n=7), the Celsior solution was used to obtain cardiac arrest, coronary vascular washout and storage. High energy phosphate levels and myocardial pH were measured using (31)P-nuclear magnetic resonance spectroscopy immediately after preservation and at 3, 6 and 12 hours after preservation. After 12-hour cold storage, left ventricular free wall tissues were harvested for histological examination. RESULTS High energy phosphate levels and myocardial pH were significantly better preserved in the Celsior group than in the UW group. In the histological findings, glycogen granules were preserved well in the Celsior group. CONCLUSIONS We conclude from our study that the Celsior solution is comparable to the University of Wisconsin solution for use in 12-hour heart preservation in canine models.
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Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan
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Mohara J, Tsutsumi H, Takeyoshi I, Tokumine M, Aizaki M, Ishikawa S, Matsumoto K, Morishita Y. The optimal pressure for initial flushout in heart procurement with the UW solution. J Heart Lung Transplant 2001; 20:181-182. [PMID: 11250300 DOI: 10.1016/s1053-2498(00)00371-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Mohara
- 1Gunma University School of Medicine, Maebashi, Gunma, Japan; 2Second Hospital of Nippon Medical School, Japan
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Mohara J, Oshima K, Tsutsumi H, Takeyoshi I, Matsumoto K, Morishita Y. FK409 enhances posttransplant cardiac function following 12-hour cold preservation. Transplant Proc 2000; 32:2407-8. [PMID: 11120219 DOI: 10.1016/s0041-1345(00)01718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Gunma, Japan
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Tsutsumi H, Takeyoshi I, Ohshima K, Mohara J, Aizaki M, Morishita Y. Effect of coronary perfusion with an oxygenated Celsior solution on 24-hour preservation in canine hearts. Transplant Proc 2000; 32:2415-6. [PMID: 11120223 DOI: 10.1016/s0041-1345(00)01722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- H Tsutsumi
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Oshima K, Takeyoshi I, Mohara J, Tsutsumi H, Ishikawa S, Tokumine M, Aizaki M, Morishita Y. The effects of FR167653 on long-term heart preservation in dogs. Transplant Proc 2000; 32:2411-2. [PMID: 11120221 DOI: 10.1016/s0041-1345(00)01720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- K Oshima
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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15
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Aizaki M, Takeyoshi I, Oshima K, Mohara J, Tsutsumi H, Koyano T, Tokumine M, Ishikawa S, Morishita Y. Effects of Celsior solution on long-term preservation of canine hearts with a new portable hypothermic perfusion apparatus: a preliminary study. Transplant Proc 2000; 32:2409-10. [PMID: 11120220 DOI: 10.1016/s0041-1345(00)01719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Aizaki
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Mohara J, Oshima K, Tsutsumi H, Takeyoshi I, Matsumoto K, Morishita Y. FK409 ameliorates ischemia-reperfusion injury in heart transplantation following 12-hour cold preservation. J Heart Lung Transplant 2000; 19:694-700. [PMID: 10930819 DOI: 10.1016/s1053-2498(00)00122-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE FK409 is the first spontaneous nitric oxide donor to increase plasma guanosine 3':5'-cyclic monophosphate. We designed this study to investigate whether the administration of FK409 during reperfusion ameliorated ischemia-reperfusion injury and enhanced post-transplant graft function in orthotopic heart transplantation following 12-hour cold preservation in a canine model. METHODS We used 10 pairs of adult mongrel dogs, weighing 9.5 to 13.5 kg. Following cardiac arrest using cardioplegia, we washed out the coronary vascular beds with cold University of Wisconsin solution followed by 12-hour preservation. After preservation, we performed orthotopic transplantation. The experimental animals were divided into 2 groups. In the FK group (n = 5), FK409 (5 microg/kg/min) was administered intravenously, beginning 15 minutes before the onset of reperfusion and continuing for 45 minutes after reperfusion. In the control group (n = 5), saline vehicle was administered in the same manner. Two hours after transplantation, we assessed cardiac function, including cardiac output, left ventricular systolic pressure (LVP), and the maximum rates of positive and negative increase of LVP (+/-LV dP/dt) by comparing the recovery rate (%) of the cardiac function of the donor animal. We measured endothelin-1 levels in blood obtained from a catheter inserted into the coronary sinus 30, 60, and 120 minutes after reperfusion. RESULTS Cardiac output was higher in the FK group than in the control group, but the difference was not significant (p = 0.08). Left ventricular systolic pressure and +/-LV dP/dt were significantly (p < 0.05) higher in the FK group than in the control group. Endothelin-1 levels were significantly (p < 0.05) lower in the FK group than in the control group 30 minutes after reperfusion. Transmission electron microscopy showed that the basal lamina of capillary vessels, glycogen granules, and mitochondrial structure were well-preserved in the FK group. CONCLUSIONS In orthotopic transplantation models, FK409 is effective in ameliorating ischemia-reperfusion injury following preservation and in enhancing post-transplant cardiac function.
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Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan
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Mohara J, Morishita Y, Takahashi T, Oshima K, Yamagishi T, Takeyoshi I, Matsumoto K. A comparative study of Celsior and University of Wisconsin solutions based on 12-hr preservation followed by transplantation in canine models. J Heart Lung Transplant 1999; 18:1202-10. [PMID: 10612379 DOI: 10.1016/s1053-2498(99)00092-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Celsior is a recently developed extracellular-type preservation solution that is effective in organ preservation. This experimental study was designed to compare the effects of Celsior and University of Wisconsin (UW) solutions in myocardial protection, using 12-hour preservation followed by orthotopic transplantation. METHODS Fourteen pairs of adult mongrel dogs were divided into 2 groups. In the UW group (n = 7), UW solution at 4 degrees C was used for coronary vascular washout and storage following cardiac arrest with glucose-insulin-potassium (GIK) solution. In the Celsior group (n = 7), Celsior solution was used to produce cardiac arrest, for coronary vascular washout, and for storage. After 12-hour cold preservation, orthotopic transplantation was performed under cardiopulmonary bypass (CPB). The rate of recovery (%) of cardiac function of donor hearts was compared 1 and 2 hours after weaning from CPB, and then the transplanted hearts were harvested for histological study. RESULTS Hemodynamic parameters including cardiac output, left ventricular pressure (LVP), and the maximum rates of positive and negative increase of LVP after transplantation were significantly (p < 0.05) higher in the Celsior group than in the UW group 2 hours after weaning from CPB. The transmission electron microscopic study found that degeneration of the mitochondria in the Celsior group was less extensive than in the UW group. CONCLUSION Celsior solution enhanced the cardiac function of hearts preserved for 12 hours prior to transplantation compared to UW solution. Our results indicate that Celsior solution is equivalent or superior to UW solution for cardiac preservation.
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Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Ohki S, Ishikawa S, Ohtaki A, Takahashi T, Koyano T, Otani Y, Murakami J, Mohara J, Isa Y, Kunimoto F, Morishita Y. Hemodynamic effects of alpha-human atrial natriuretic polypeptide on patients undergoing open-heart surgery. J Cardiovasc Surg (Torino) 1999; 40:781-5. [PMID: 10776705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND A cardiac hormone, alpha-human atrial natriuretic polypeptide (alpha-hANP), acts as a vasodilator and a diuretic by activating cyclic GMP formation. We studied the hemodynamic effects of continuous intravenous infusion of alpha-hANP on patients undergoing open-heart surgery. METHODS A total of 15 patients, including 7 with CABG, 4 with AVR, 2 with CABG plus AVR, and 2 with AVR plus MVR were involved in the study. They underwent open-heart surgery in our institute between July 1996 and April 1997. The mean age of patients was 68 years, ranging from 63 to 77. A dosage of 0.05 microg/kg/min of alpha-hANP was administered to all patients on postoperative day 1. Hemodynamics and blood and urine samples were measured at the following times: 2 hours before continuous intravenous infusion of alpha-hANP, 0, 1, 2, 3, 6, 12 and 24 hours after continuous intravenous infusion. We concomitantly measured urine volume and the plasma concentration of alpha-hANP. RESULTS The plasma concentration of alpha-hANP increased sufficiently after the beginning of continuous intravenous infusion without any side effects, and the urine volume increased too. The administration of alpha-hANP induced a decrease in central venous pressure, pulmonary capillary wedged pressure and the pulmonary vascular resistance index. Systemic vascular resistance index and cardiac output remained unchanged. CONCLUSIONS It is useful for the management of patients with associated volume overload following open-heart surgery because the administration of alpha-hANP decreases preload and facilitates satisfactory urination.
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Affiliation(s)
- S Ohki
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Oshima K, Morishita Y, Yamagishi T, Mohara J, Takahashi T, Hasegawa Y, Ishikawa S, Matsumoto K. Long-term heart preservation using a new portable hypothermic perfusion apparatus. J Heart Lung Transplant 1999; 18:852-61. [PMID: 10528747 DOI: 10.1016/s1053-2498(99)00046-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Perfusion storage is not often used clinically compared with simple immersion because of complicated circuits and demanding management. We developed a new apparatus for preservation combined with simple immersion and continuous coronary perfusion. METHODS The main characteristics of this apparatus are as follows: (1) hypothermic storage, (2) does not require any energy source, (3) variable perfusion pressure, and (4) portability. The perfusion apparatus is composed of a storage chamber, a cooling chamber, and metal bars from which a perfusate bag is suspended. Adult mongrel dogs were divided into two groups: the coronary perfusion group (CP, n = 6) and the simple immersion group (SI, n = 6). Coronary vascular beds of the dog were washed out with a University of Wisconsin (UW) solution following cardiac arrest obtained using a GIK solution. The hearts were then excised. In the CP group, the heart graft, which was immersed in a 4 degrees C UW solution, was perfused with the same solution at a flow rate of 35 approximately 50 ml/hr. In the SI group, the heart graft was immersed in a 4 degrees C UW solution only. The heart graft was preserved for 12 hours in both groups. Beta-adenosine triphosphate (beta-ATP), phosphocreatine (Pcr), and inorganic phosphate (Pi) levels were measured immediately after excision of the heart, and at 3, 6, and 12 hours after preservation. Beta-ATP, Pcr, and Pi values were expressed as a percentage of control values, which had been obtained immediately after excision of the heart. Water content of the myocardium was measured prior to and after 12-hour preservation. The preserved graft was then evaluated through orthotopic transplantation. RESULTS Beta-ATP/Pi levels at 6 and 12 hours after preservation were significantly higher in the CP group than in the SI group (62 +/- 5 versus 39 +/- 7%, 48 +/- 5 versus 22 +/- 8%, respectively, p < 0.05). Pcr/Pi levels at 6 and 12 hours after preservation were 30 +/- 9% and 22 +/- 8%, respectively in the CP group, while Pcr/Pi levels in the SI group were detected in only one case. There was no significant difference in water content either prior to or after 12-hour preservation between the two groups. Histopathologically, irregular expansion and/or contraction of myocardial fibers were more severe in the SI group than in the CP group. The recovery rate of hemodynamic parameters 2 hours after heart transplantation was significantly (p < 0.05) higher in the CP group than in the SI group. CONCLUSION Stable and safe long-term canine heart preservation with continuous coronary perfusion associated with immersion is possible using this new apparatus, and may have broad clinical application.
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Affiliation(s)
- K Oshima
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Affiliation(s)
- T Yamagishi
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Kawahito K, Mohara J, Misawa Y, Kato M, Fuse K. Assessment of the myocardial protective effect of antegrade warm blood cardioplegia by measuring the release of biochemical markers. Surg Today 1999; 29:322-6. [PMID: 10211562 DOI: 10.1007/bf02483056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intermittent warm blood cardioplegia has been reported as a valuable alternative for myocardial protection in cardiac surgery; however, conflicting experimental data have been published. To assess the clinical effectiveness of intermittent warm cardioplegia, we measured the release of troponin-T (Tn-T), a highly sensitive and specific marker of myocardial damage, and creatine kinase MB isoenzyme (CK-MB), in 12 patients who underwent elective coronary artery bypass grafting (CABG) with antegrade intermittent warm blood cardioplegia (37 degrees C) being the warm group, in comparison with 16 patients who underwent CABG with antegrade intermittent cold blood cardioplegia (4 degrees C) being the cold group. Blood samples were taken to determine the serum concentrations of CK-MB and Tn-T, at the induction of anesthesia, then 3, 6, 12, and 24h after the termination of cardiopulmonary bypass (CPB). The peak increase in serum CK-MB levels, 3h after CPB, was significantly lower in the warm group than in the cold group, at 27.8+/-7.8 IU/l vs. 40.8+/-12.6 IU/l, respectively (P = 0.0042). The serum Tn-T 12 h after CPB was significantly lower in the warm group than in the cold group, at 1.40+/-0.71 ng/ml vs. 2.06+/-0.95 ng/ml, respectively (P = 0.049). In conclusion, intermittent antegrade warm blood cardioplegia showed effective myocardial protection in elective CABG.
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Affiliation(s)
- K Kawahito
- Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Kawachi, Tochigi, Japan
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Oshima K, Morishita Y, Yamagishi T, Mohara J, Takahashi T, Ishikawa S, Hasegawa Y. A new portable hypothermic perfusion apparatus for long-term heart preservation in canine models. Transplant Proc 1999; 31:1072-3. [PMID: 10083480 DOI: 10.1016/s0041-1345(98)01910-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K Oshima
- Second Department of Surgery, Gunma University School of Medicine, Japan
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Abstract
BACKGROUND/PURPOSE Prenatally diagnosed cystic lymphangioma (CL) is often associated with chromosomal anomalies, hydrops fetalis, and, in the case of cervical CL, occasionally respiratory distress just after birth. Often it is difficult to treat prenatally diagnosed CL because of the large size and associated symptoms. METHODS Between 1988 and 1997, 11 cases of prenatally diagnosed CL were treated. Five pregnancies were terminated electively and one aborted spontaneously (nondelivered, non-D group), and another five delivered (delivered, D group). Thirteen infants nondiagnosed prenatally were also seen in the same period (prenatally nondiagnosed, without pre-D group). RESULTS In the non-D group, massive CLs were diagnosed by ultrasound scan between 16 and 20 weeks' gestation. They occurred in the head and neck in all six cases, and four had associated pleural effusions or hydrops. In the D group, CL occurred in the face and neck in four cases. Three were born by cesarean section with neonatologists and surgeons standing by, then transferred to our hospital immediately after birth. Respiratory distress appeared in two cases; tracheostomy was carried out in one case. One patient with a huge CL in the chest and abdominal wall necessitated partial resection after OK-432 sclerotherapy. In the without pre-D group, there was CL in the face or neck in 10 cases, abdominal wall in two cases, and chest wall in one case. Respiratory distress was observed in three cases of cervical CL, and tracheostomy was required in two cases. One patient with hypoxic brain damage sequela died of pneumonia afterward. CONCLUSIONS Prenatal diagnosis permits planned delivery, prompt postnatal resuscitation, and improve prognosis. Infants with massive CL diagnosed early in pregnancy have other associated anomalies as well as hydrops fetalis, and a poor outcome or difficult management can be expected.
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Affiliation(s)
- N Suzuki
- Department of Surgery, Gunma Children's Medical Center, Setagun, Japan
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Mohara J, Kawahito K, Misawa Y, Fuse K. Evaluation of platelet damage in two different centrifugal pumps based on measurements of alpha-granule packing proteins. Artif Organs 1998; 22:371-4. [PMID: 9609343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mechanical trauma caused by centrifugal pumps is usually evaluated in terms of hemolysis. However, platelet damage caused by centrifugal pumps has not been studied well. We evaluated platelet damage in 2 different centrifugal pumps, the Medtronic BioMedicus BP-80 and the Terumo Capiox, in vitro and compared the results in terms of hemolysis. To evaluate platelet damage, the rate of increase (RI) for beta-thromboglobulin (beta-TG) and platelet factor-4 (PF-4) were measured by enzyme immunoassay. RI was defined as follows: RI for beta-TG is deltabeta-TG/deltaN and RI for PF-4 is deltaPF-4/deltaN where deltabeta-TG is the increase in beta-TG, deltaPF-4 is the increase in PF-4, and deltaN is the increase of the passing number, which is defined in the following equation: N = Qt/V (t, time; V, priming volume; Q, flow rate). Each pump was tested in a mock circuit for 3 h under a flow rate of 5 L/min and a pressure head of 100 mm Hg using fresh human heparinized blood (n = 5). For comparison, the normalized index of hemolysis (NIH) values were calculated for both pumps. The NIH values did not indicate a significant difference between the Capiox and the BP-80 pumps (Capiox vs. BP-80, 0.0021 +/- 0.0004 vs. 0.0034 +/- 0.0007, NS). However, the RI values for beta-TG and PF-4 in the Capiox were significantly lower than in the BP-80 (beta-TG, 0.198 +/- 0.047 vs. 0.376 +/- 0.049; PF-4, 0.080 +/- 0.014 vs. 0.268 +/- 0.043, p < 0.05). In conclusion, although there was no significant difference between the 2 pumps in terms of hemolysis, the Capiox centrifugal pump induced less platelet damage than the BP-80. The results suggest that measurements of RI for beta-TG and PF-4 are more sensitive parameters than NIH values for evaluating blood cell damage.
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Affiliation(s)
- J Mohara
- Jichi Medical School, Department of Thoracic and Cardiovascular Surgery, Tochigi, Japan
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Abstract
An elderly woman underwent coronary artery bypass grafting, which was followed 1 month later by pseudoaneurysmal rupture at the distal anastomosis of a saphenous vein graft. Emergency repair of the suture line dehiscence was made, and the postoperative course was uneventful. Pseudoaneurysm formation of a saphenous vein graft after coronary artery bypass grafting is a rare but potentially lethal complication requiring urgent operative intervention.
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Affiliation(s)
- J Mohara
- Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan
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26
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Kawahito K, Mohara J, Misawa Y, Fuse K. Platelet damage caused by the centrifugal pump: in vitro evaluation by measuring the release of alpha-granule packing proteins. Artif Organs 1997; 21:1105-9. [PMID: 9335369 DOI: 10.1111/j.1525-1594.1997.tb00450.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Platelets are more vulnerable to damage than erythrocytes because platelets are easily activated by contact with extracorporeal circuits and by exposure to shear forces. However, the degree of platelet damage caused by centrifugal pumps is unclear. To evaluate platelet damage in different pumping conditions, the rates of increase for specific proteins in platelet alpha-granules, beta-thromboglobulin (beta-TG), and platelet factor 4 (PF-4) were measured in both in vitro simulated left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) conditions and compared with the erythrocyte trauma. A flow of 5.0 L/min with deltaP of 100 mm Hg for LVAD (low pressure head condition) and a flow of 5.0 L/min with deltaP of 350 mm Hg for CPB (high pressure head condition) were investigated. Each condition was tested 4 times for 3 h in a mock circuit with a Capiox (Terumo, Tokyo, Japan) centrifugal pump using fresh human blood. Blood was sampled at 1 h intervals, measuring plasma free hemoglobin (fHb), beta-TG, and PF-4. To evaluate the degree of damage, the rates of increase of fHb, beta-TG, and PF-4 were calculated for each condition as deltafHb/deltaN, deltabeta-TG/deltaN, and deltaPF-4/deltaN where deltafHb is the increase in plasma free hemoglobin, deltabeta-TG is the increase in beta-TG, deltaPF-4 is the increase in PF-4, and deltaN is the increase in the passing number. The passing number is defined in the following equation: N = Qt/V where t is the time, V is the priming volume, and Q is the flow rate. There was no significant difference between the 2 conditions (low pressure head condition versus high pressure head condition) in the rate of increase of fHb (0.0035+/-0.0004 vs. 0.0034+/-0.0010 g/100 L, NS). Contrary to this, the rates of increase for specific proteins in platelet alpha-granules in the high pressure head condition demonstrated a significantly higher rate of increase than in the low pressure head condition. The mean rate of increase for beta-TG in the low pressure head condition was 0.22+/-0.03 ng/ml and in the high pressure head condition was 0.51+/-0.05 ng/ml (p < 0.05). The rate of increase for PF-4 in the low pressure head condition was 0.11+/-0.02 ng/ml and in the high pressure head condition was 0.30+/-0.06 ng/ml (p < 0.05). These results suggest that measurements of beta-TG and PF-4 may be more sensitive parameters than hemolysis for evaluating blood cell trauma and that platelets are more vulnerable to mechanical damage by a centrifugal pump than erythrocytes.
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Affiliation(s)
- K Kawahito
- Jichi Medical School, Department of Cardiovascular Surgery, Tochigi, Japan
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Mohara J, Ishikawa S, Ohtaki A, Takahashi T, Ohki S, Yamagishi T, Morishita Y, Koyano T, Isa Y, Kunimoto F. [Application of alpha-hANP for the management following open-heart surgery: report of two cases]. Kyobu Geka 1997; 50:466-8. [PMID: 9185442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Alpha-human atrial natriuretic peptide (alpha-hANP) has a vasodilating and diuretic action. Intravenous continuous administration of alpha hANP (0.05 microgram/kg/min) was attempted for two patients with low urine output despite good hemodynamics following open-heart surgery. Following the administration of alpha-hANP, urine volume increased markedly, and central venous and pulmonary capillary wedge pressures immediately decreased. Intravenous continuous administration of alpha-hANP is useful for the management of patients associated with the volume overload following open-heart surgery.
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Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Japan
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