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Background and aim of the study: Coronary artery fistula (CAF) is a relatively rare cardiac anomaly. We investigated long-term outcomes following surgical repair of CAF in adults. Methods: We retrospectively investigated 13 consecutive patients undergoing surgical repair of CAF in our institution between 2008 and 2019 (67.3±10.4 years old, 38% male). CAF types were coronary artery-pulmonary artery fistula (77%), coronary artery-coronary sinus fistula (15%), and both (8%). CAFs originated from the left coronary artery (38%), right coronary artery (8%), and bilateral coronary arteries (38%). Pulmonary and systemic flow (Qp/Qs) was measured in seven patients (54%), with a mean value of 1.52. Seven patients underwent surgery for CAFs alone, and others simultaneously underwent surgery for comorbid cardiac diseases. Results: All procedures were conducted under cardiopulmonary bypass. Surgical procedures were direct epicardial ligation of fistula (92%), direct closure of CAF through pulmonary artery incision (38%), direct closure of CAF through coronary sinus incision (8%), or patch closure of CAF through coronary artery incision (8%). Myocardial perfusion scintigraphy showed asymptomatic myocardial ischemia in the right coronary area after surgery in one patient. There were no deaths perioperatively or during follow-up (mean 66.6 months). There were no coronary or other CAF-related events. Conclusions: Several anatomical variations in CAF were observed which coexist with cardiac disease. Long-term outcomes following surgical repair were satisfactory, and the concurrent intervention of CAFs during surgery for comorbid cardiac disease is useful to prevent future complications related CAFs in adults.

BACKGROUND The effect of multiple prior percutaneous coronary interventions (PCIs) before subsequent coronary artery bypass grafting (CABG) on long-term outcomes has not been well elucidated.Methods and Results:Between 2007 and 2016, 1,154 patients undergoing primary isolated CABG in our institution had no prior PCI (Group N), 225 had a single prior PCI (Group S), and 272 had multiple prior PCIs (Group M). Cumulative incidences of all-cause death, cardiac death and myocardial infarction (MI) at 10 years post-CABG were highest in Group M. After adjusting for confounders, the risk of all-cause death was higher in Group M than in Group N (hazard ratio [HR] 1.45; 95% confidence interval [CI], 1.10-1.91; P

BackgroundOptimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism. Case PresentationA 47-year-old male presented with weakness in his left arm upon awakening. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a mobile pedunculated object suggestive of a thrombus arising from the ascending aorta and extending to the left common carotid artery. It was removed under hypothermic circulatory arrest and direct cannulation of the left carotid artery to avoid carotid thromboembolism. Histopathological examination revealed that the object was a thrombus. The patient had an uneventful postoperative course and was discharged 9 days after surgery. ConclusionWhen a thrombus in the aortic arch extends to the neck arteries, direct cannulation of the neck arteries with selective cerebral perfusion via cervical incision is a useful technique.

Although surgical ventricular restoration for ischemic cardiomyopathy is expected as an alternative or bridge to heart transplantation, post-operative remodeling of left ventricle (LV) needs to be addressed. This study aimed to examine the effect of basic fibroblast growth factor (bFGF), which induces angiogenesis and tissue regeneration in ischemic myocardium, to prevent remodeling after surgical ventricular restoration (SVR) using a rat ischemic cardiomyopathy model. Four weeks after coronary artery ligation, rats were divided into two groups: rats treated with SVR alone (SVR; n = 21), and rats treated with SVR and local sustained release of bFGF using gelatin hydrogel sheet (SVR + bFGF; n = 22). Cardiac function was assessed by serial echocardiography and cardiac catheterization. Cardiac tissue sections were histologically examined for vascular density and fibrosis. Higher systolic function and lower LV end-diastolic pressure (LVEDP) were observed in rats treated with SVR + bFGF (SVR vs SVR + bFGF; Ees: 0.22 ± 0.11 vs 0.33 ± 0.22 mmHg/μL, p = 0.0328; LVEDP: 12.7 ± 7.0 vs 8.5 ± 4.3 mmHg, p = 0.0230). LV area tended to be lower in rats treated with SVR + bFGF compared to rats treated with SVR alone (left-ventricular end-diastolic area: 0.66 ± 0.07 vs 0.62 ± 0.07 cm2, p = 0.071). Vascular density tended to be higher in rats treated with SVR + bFGF than those without bFGF (23.3 ± 8.1 vs 28.8 ± 9.5/mm2, p = 0.0509). BFGF induced angiogenesis and attenuated remodeling after SVR which secured the efficacy of SVR in a rat ischemic cardiomyopathy model.

OBJECTIVES To determine the incidence of bioprosthetic structural valve deterioration in dialysis patients undergoing aortic valve replacement compared to that in patients without dialysis. METHODS This single-centre retrospective observational study included 1159 patients who underwent aortic valve replacement using bioprosthetic valves for aortic stenosis and/or regurgitation at our institution between 2007 and 2017 [patients with dialysis (group D, n = 134, 12%) or without dialysis (group N, n = 1025, 88%)]. To adjust for potential differences between groups in terms of initial preoperative characteristics or selection bias, a propensity score analysis was conducted. The final sample that was used in the comparison included 258 patients, as follows: 129 patients with dialysis (group D) and 129 patients without dialysis (group N). The cumulative incidences of all-cause death, cardiac death and moderate or severe structural valve deterioration were estimated using the Kaplan–Meier method. RESULTS Operative mortality was significantly higher in group D than group N (9% vs 0%, P = 0.001). Kaplan–Meier analysis revealed that in group D, the incidence was significantly higher for all-cause death (P CONCLUSIONS The incidence of structural valve deterioration in dialysis patients undergoing aortic valve replacement was higher than that in patients without dialysis. Bioprosthetic valves should be carefully selected in dialysis patients undergoing aortic valve replacement.

As Japan has one of the most rapidly aging populations in the world, transcatheter aortic valve implantation (TAVI) is likely to be performed in increasing numbers of older people. There is little information on either the efficacy or the safety of TAVI in nonagenarians in Asia.From October 2013 to June 2015, 112 consecutive patients underwent TAVI with Edwards SAPIEN XT valves in our institution. We compared 25 patients aged at least 90 years (mean 91.6 ± 1.7 years) with 87 patients aged under 90 years (mean 82.5 ± 6.0 years) at the time of TAVI. All definitions of clinical endpoints and adverse events were based on the Valve Academic Research Consortium 2 definitions.The median follow-up interval was 561.5 days (the first and third quarters, 405.0 and 735.8 days). Nonagenarians had a higher logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), Euro II score, and the Society of Thoracic Surgeons predictive risk of mortality (STS) score, and a prevalence of clinical frailty scale ≥ 4. The rate of device success, and the 30-day and 6-month mortalities were not different between patients aged ≥ 90 years and < 90 years (96.0% versus 92.0%, P = 0.68; both 0%, P = 1.00; 4.0% versus 3.5%, P = 0.32, respectively). At six months, clinical efficacy and time-related valve safety were also similar in the two groups (12.5% versus 13.4%, P = 1.00; 4.5% versus 10.3%, P = 0.68, respectively). The cumulative 1-year mortalities were not significantly different between the two groups (8.4% versus 9.4%, P = 0.94, respectively).TAVI can contribute to acceptable clinical results and benefits in a carefully selected group of nonagenarians in Asia.

Effective reuse of mechanical parts is one of the important challenges to achieve sustainable society. In this paper, the authors propose a method to exchange modules between manipulators based on part agent system to promote reuse of mechanical parts. The paper describes a plan of experiment with ten manipulators.

To realize effective reuse of mechanical parts for the development of a sustainable society, it is essential to manage individual parts over their entire life cycle. Part agent system that supports maintenance of part and/or product using network agent and RFID technology has been developed to support reuse of products by giving users advices on replacement of products. We have reported the development of a function of part agent that supports disassembly of products. For that purpose, assembly model and disassembly process model relating to it were developed. Based on this information that is predefined and stored in a part agent of used product, the part agent shows the user the procedure how to disassemble an appropriate part from the product by displaying it using augmented reality. In this paper, a prototype system is proposed that supports disassembly of used products with improved function that deals with possible deterioration of parts. The paper shows a preliminary result of the experiment with the implemented system and discusses remaining issues.

To realize effective reuse of mechanical parts for the development of a sustainable society, it is essential to manage individual parts over their entire life cycle. Product users have difficulties carrying out appropriate maintenance on the multitude and variety of parts in their products. Addressing these considerations, we propose a scheme whereby a part manages itself and supports user maintenance activities. In previous work, we proposed and developed an application of Bayesian estimation to a part agent system that advises a user regarding the replacement of hard disk drives (HDDs). In this study, we create a Bayesian network on the deterioration of the HDD to find the probability of an unobservable event. We also discuss the application of this method to life cycle simulation performed by part agents.

The J Graft Open Stent Graft, the first commercialized stent graft in Japan, has been available since February 2014, and we have used this new device as a frozen elephant trunk technique for distal aortic arch aneurysm. Here, we present our surgical method and result with this new device. Between October 2014 and October 2016, 30 patients (26 males, mean age 74.3 ± 9.7 years) underwent total aortic arch replacement using the frozen elephant trunk technique with the J Graft Open Stent Graft for distal aortic arch aneurysm. The follow-up period was 10 months. In-hospital mortality and 30-day mortality were 0%. Stroke occurred in three cases (10%), paraplegia in one case (3.3%), respiratory complication in two cases (6.7%), and renal failure in two cases (6.7%). During the follow-up period, there was no aorta- related death, and two patients needed an aortic operation (re-hemiarch replacement for pseudoaneurysm of proximal anastomotic site; axilloaxillary bypass for occlusion of the left subclavian artery), and two patients needed catheter embolization for type II endoleak for reopening of the left subclavian artery. Our short-term surgical results were acceptable. This new device is useful for distal aortic arch aneurysms.

Replacement of parts is a crucial task for the reuse of parts. In this paper, functions of part agent we are developing that support the reuse are described. A part agent manages life cycle of a part using a network agent and an RFID tag attached on the part and generates advices for the user on the maintenance of the part in order to promote the reuse. Part agent we are developing to support the replacement has the following functions. First function is to detect deterioration of the part from its sensory data. As an example, simple 3d of manipulator is developed with modularized link structure. Part agent is assigned for each module and generates advice on its replacement. Second function is to calculate the possibility of failures of part based on causal relation among user operations and detected events. Third function is to support users to disassemble used parts. Part agent generates disassembly procedure of the part and shows it to the user using augmented reality technique. In this paper, the planned scheme for part agent to support reuse of part with these functions is described and preliminary result of the development is shown.

Background There are contradictory reports on outcomes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. We evaluated short-term clinical outcomes and predictors of adverse outcomes. Methods We retrospectively analyzed 59 symptomatic patients with type A acute IMH and AAD with thrombosed thoracic false lumens who initially received treatment. Survival, aortic death (death from aortic events and sudden deaths), and aortic event-free survival rates were investigated. False lumen thickness ratios (FTR [false lumen thickness/aortic diameter]) were measured by computed tomography scan and the relationship with aortic events was evaluated. Results Survival, aortic death-free survival, and aortic event-free survival rates at 2 years were 90.0%, 96.6%, and 55.8%, respectively. Ascending aortic diameters, false lumen thickness of the ascending aortas, and rate of penetrating aortic ulcers in the ascending aortas were higher among patients with aortic events. The FTR of the ascending aorta (FTRA)/FTR of the descending aorta (FTRD) was also higher in these patients (1.3 ± 0.9 versus 0.8 ± 0.5, p = 0.0021). Multivariate analysis revealed FTRA/FTRD greater than 0.98 (odds ratio 5.35; 95% confidence interval: 0.05 to 1.72; p = 0.0431) as an independent predictor of aortic events. An FTRA/FTRD greater than 0.98 predicted aortic events with 87.1% sensitivity and 58.4% specificity. Conclusions High aortic event rates were seen after treatment for type A acute IMH and AAD with thrombosed thoracic false lumens. Nevertheless, short-term survival rates were favorable. An FTRA/FTRD greater than 0.98 may be a highly sensitive predictor for aortic events.

症例は73歳，男性．遠位弓部大動脈の最大径66 mmの嚢状瘤に対し全弓部置換術を施行した．胸骨正中切開，上行大動脈送血と上下大静脈脱血で人工心肺を確立し，中等度低体温循環停止，選択的順行性脳灌流を行いエレファントトランク，ステップワイズ法にて遠位側吻合を行った．その後頸部3分枝再建を先行し，最後に中枢側吻合を行った．手術時間515分，人工心肺時間305分，大動脈遮断時間213分，脳分離灌流時間143分，下半身循環停止時間97分であった．術後5日目に発熱と右側腹部痛，炎症反応上昇を生じ，翌日になっても症状は改善せず，CTで急性胆嚢炎および急性腹膜炎と診断し，術後6日目に緊急開腹胆嚢摘出術を施行した．胆嚢周囲に漏出した胆汁性腹水が存在したが，培養結果は陰性であった．病理所見は，胆嚢頸部に虚血による非細菌性非貫璧性の胆嚢壊死が存在するとの結果であった．胆嚢摘出術術後は経過良好であり，初回手術から16日目に独歩退院となった．全弓部置換術後は下半身循環停止やdebrisの飛散など消化管虚血のリスクは高く，術後の急性腹症の鑑別診断として稀ではあるが重篤化することもある胆嚢梗塞を考慮する必要があると考えた．

僧帽弁位の活動期IEに対して積極的にMVPが試みられるようになっているが，弁組織が感染により高度に破壊され，広範囲の郭清を必要とした場合には，形成困難となりMVRが必要となる場合も多い．症例は27歳，男性．発熱が持続するために当院を受診し，心エコー検査で僧帽弁前尖に径13 mmの可動性のある疣贅が判明し，IEと診断され緊急入院となった．後交連を中心として広範囲に逸脱し，MRはsevereであった．巨大疣贅による塞栓症のリスクが高いと判断し，入院2日後に手術を施行した．僧帽弁を観察すると，後交連（PC）を中心にA3からP3の一部にかけて腱索の断裂による逸脱と弁尖の破壊，多数の疣贅の付着を認め，断裂した腱索の先端にも疣贅が付着していた．破壊の著しいPCとA3，P3の一部を疣贅とともに切除したが，比較的形態の保たれたA3は弁尖を温存して表面の疣贅を鋭匙，剪刀などで可及的に郭清するにとどめた．切除した弁尖に対応した弁輪部をcompression sutureにより縫縮し，弁尖を結節縫合で閉鎖した．28 mmのphysio ringを用いてMAPを施行し，逆流試験でMRの消失を確認した．術後経過は良好で，術後9カ月が経過し心機能は良好でMRの再発はなく，NYHA I°で外来通院中である．

This paper describes a maximum power point tracking (MPPT) control method for propeller-type compact wind power generators with passive self-pitch-controlled blades, which quickly makes the output current and voltage converge on the maximum power point based on wind speeds detected from an anemometer. The voltage and current output from these wind power generators vary with wind speeds at locations such as the roofs of buildings. Transient characteristics of the voltage output from compact wind power generators have two modes because of the self-pitch-controlled blades: mode I in which the output voltage hardly increases and mode II in which it rapidly increases. Thus, in order to acquire the generated power effectively, irrespective of how the wind speeds may change, a method to perform the MPPT control while searching for mode II is needed. Thus, by judging the mode from the change of the sign of the time differential of the voltage deviation between sampling times, the MPPT control method proposed here makes the output current converge on the maximum point using relationships between the maximum power and optimal current which give the maximum power and the wind speed. Effectiveness of the proposed MPPT control method is verified through simulations and experiments using a wind tunnel. IEEJ Trans 2010 DOI: 10.1002/tee.20609

Our research group has developed an ultra slim and bendable backlight system, which was manufactured by a continuous roll-to-roll process, with a unified component for liquid crystal display (LCD). This backlight system, which has a thickness of 0.26 mm, is simply composed of a light guide film and an optically patterned film made of photocurable resin with micro particles, consequently it does not require any additional optical films such as prism sheets or diffuser. In addition, we have developed a new light guide component which is composed of bundled optical fibers in order to collimate light from the light source to the light guide film. We found that the backlight system could be radiated uniformly across the LCD surface whether plane or curved, and we were able to realize an advanced LCD with good flexibility, high efficiency and high productivity.

An 86-year-old woman was referred for transcatheter aortic valve implantation (TAVI) because of recurrent severe aortic stenosis after balloon aortic valvuloplasty in May 2014. We planned to implant a 23-mm Sapien XT valve by transfemoral approach. During procedure, aortic dissection was detected by transesophageal echocardiography (TEE). The dissection limited to the descending aorta and did not include the ascending aorta. Therefore, our team decided to implant the 23-mm Sapien valve as planned. After the procedure, the dissection was treated conservatively without surgical repair. Three weeks later, she was discharged without any complications.

Background The usefulness of sustained-release erythropoietin for improving left ventricular (LV) function without polycythemia was evaluated in a rat chronic myocardial infarction model. Methods and Results Four weeks after left coronary artery ligation, 50 Sprague-Dawley rats were assigned to 5 groups (n=10, each). Control group had a gelatin sheet (20×20 mm) containing saline applied to the infarct area, whereas the 4 treatment groups had gelatin sheets incorporating erythropoietin 0.1 U, 1 U, 10 U and 100 U, respectively. Endpoint measurements performed at 8 weeks after the coronary ligation revealed that the fractional area change was larger for erythropoietin 1 U and 10 U than in the other 3 groups. The LV end-systolic elastance and the time constant of isovolumic relaxation were better for erythropoietin 1 U and 10 U than in the other 3 groups. The density of vessels larger than 50 μm in diameter was the highest in the erythropoietin 1 U group. The number of red blood cells was significantly increased in groups receiving erythropoietin 10 U and 100 U. Conclusions Gelatin hydrogel sheets incorporating 1 U erythropoietin improved LV function without inducing polycythemia in a rat chronic myocardial infarction model. (Circ J 2007; 71: 132 - 137)

This paper describes a maximum power point tracking (MPPT) control method for propeller type compact wind power generators with passive self-pitch controlled blades that quickly makes the output current and voltage converge on the maximum power point based on wind speeds detected from an anemometer. The voltage and current output from these wind power generators change variously with wind speeds at locations such roofs of building which are suited to these generators. Transient characteristics of the voltage output from compact wind power generators have two modes caused by the self-pitch controlled blade structure: mode I in which the output voltage hardly increases and mode II in which it rapidly increases. Thus, in order to acquire the generated power effectively, however wind speeds may change, a method to perform the MPPT control while searching for mode II is needed. Thus, by judging the mode from the change of the sign of the time differential of the voltage deviation between sampling times, the MPPT control method is proposed here that makes the output current converge on the maximum point using relationships between the maximum power and optimal current which give the maximum power and the wind speed. Effectiveness of the proposed MPPT control method is verified through simulations and experiments using a wind tunnel apparatus.

Objective: Recent reports have demonstrated that long-term patency of the gastroepiploic artery (GEA) in coronary artery bypass grafting (CABG) is less satisfactory compared with the internal thoracic artery (ITA). However, the reason has not been fully elucidated. Angiotensin II is known to play an important role in the development of intimal hyperplasia, we hypothesized that the GEA is different from the ITAwith respect to angiotensin II-forming ability. Accordingly, we measured activities of angiotensin II-forming enzymes, angiotensin-converting enzyme (ACE) and chymase, in human GEA and ITA. Methods: Remnant of the GEAs and ITAs were obtained from 24 patients who underwent CABG in which both conduits were used simultaneously. Activities of ACE and chymase were measured by using the extract form the GEA or ITA. Sections of the GEA or ITA were immunohistochemically stained with anti-human chymase antibody. Results: The ACE activity of the GEA (0.28 0.16 mU/mg protein) was greater than that of the ITA (0.18 0.11, p < 0.001). The chymase activity of the GEA (11.11 7.15 mU/mg protein) was also greater than that in the ITA (7.13 4.89, p < 0.001). The density of chymase-positive cells in the GEA (3.8 4.2 cells/mm 2 ) was greater than that in the ITA (1.1 1.2, p < 0.01). Conclusion: Activities of both ACE and chymase were significantly greater in the GEA compared with the ITA. The GEA may be different from the ITA with respect to potential ability of angiotensin II-formation.

This paper describes a maximum power point tracking (MPPT) control method for propeller type compact wind power generators with passive self-pitch controlled blades that quickly makes the output current and voltage converge on the maximum power point based on wind speeds detected from an anemometer. The voltage and current output from these wind power generators change variously with wind speeds at locations such roofs of building which are suited to these generators. Transient characteristics of the voltage output from compact wind power generators have two modes because of the self-pitch controlled blades: mode I in which the output voltage hardly increases and mode Π in which it rapidly increases. Thus, in order to acquire the generated power effectively, however wind speeds may change, a method to perform the MPPT control while searching for mode II is needed. Thus, by judging the mode from the change of the sign of the time differential of the voltage deviation between sampling times, the MPPT control method is proposed here that makes the output current converge on the maximum point using relationships between the maximum power and optimal current which give the maximum power and the wind speed. Effectiveness of the proposed MPPT control method is verified through simulations and experiments using a wind tunnel apparatus.

The early results of coronary artery grafting with an aortic connector system were assessed in Japanese patients. From May 2002 through April 2003, 24 consecutive patients underwent off-pump coronary artery bypass using an aortic connector system. Another patient was excluded because the saphenous vein was insufficient for the smallest available aortic connector system. Saphenous veins were harvested from the thigh in 17 (70.8%) patients, and from the lower leg in 7. The size of the aortic connector system was 4.5–5.0 mm in 19 (79.2%) patients. Intraoperative epiaortic echo indicated that a side-clamp was contraindicated in 15 cases. Hemostasis was instantaneous in all patients. There were no hospital deaths and no neurologic morbidity. Pre-discharge angiography revealed 100% patency of the anastomoses. Use of the aortic connector system demonstrated excellent early results with low neurologic morbidity even when employed in the context of an atheromatous ascending aorta. However, smaller sizes of the device are required for some Japanese patients.

Cold agglutinin disease is an uncommon condition characterized by hemagglutination and microvascular thrombosis of red blood cells at low temperatures during cardiopulmonary bypass. We report the rare case of an ambulatory 74-year-old woman with a relatively high thermal amplitude for antibody activation. We performed aortic arch repair for type A aortic dissection using moderately hypothermic cardiopulmonary bypass and warm blood cardioplegia in a retrograde manner. This case report provides evidence that these are safe and suitable techniques for selected aortic arch repair patients with cold agglutinin disease.

Objective(s): To report the early and mid-term results of surgical plasty of the left main coronary artery in 12 patients operated upon between 1993 and 1997.Methods: The anterior approach was used in all patients. Saphenous vein (n=4) or glutaraldehyde treated autologous pericardium (n=8) were used as patch material. Additional coronary artery bypass grafting was performed in 7 patients, the first 3 as a safety back up, and for coexisting stenosis of other coronary branches not revascularized by the plastic procedure in the remaining 4.Results: Pathologic specimens of the left main coronary artery in 5 revealed atheroma in 3 and myxomatous intimal thickening in 2. The left main coronary artery was widely patent angiographically in all patients prior to discharge. Six patients consented to angiographic restudy 5–40 months after the procedure and revealed excellent results in 5. One patient upon whom autologous pericardial patch had been used underwent percutaneous coronary angioplasty for restenosis of the left main coronary artery and a new lesion of the proximal left anterior descending branch 5 months after the operation. There were no late deaths nor other cardiac events. All patients were in CCS class 1 at their last follow-up.Conclusions: Surgical angioplasty of the left main coronary artery could be used to revascularize the left heart safely in patients with a discrete localized lesion of the left main coronary artery and is particularly useful in the face of unavailability of other conduits.

We have developed a new precise fabrication technology of a lenticular lens sheet with black stripe patterns for a rear-projection television. The black stripe patterns have to be accurately aligned to cylindrical lenses on the lenticular lens sheet and be able to absorb ambient light. Our proposed technology utilized a photo-sensitive material with a surface modifier which controls surface free energy for surface modification. Using this material, we could obtain two patterned areas which had different surface free energies. Furthermore, fabrication of black stripe patterns on the lenticular lens sheet was carried out by a self-alignment method. This lenticular lens sheet with black stripe patterns had similar optical properties compared with a conventional one.

We have developed an ultra slim backlight system using optical-patterned film (OPF backlight), which has a lot of advantages to be composed of a single component and less than 0.4 mm in total thickness. Moreover, we have obtained the possibility to manufacture the sheet of OPF backlights by roll-to-roll continuous process.