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Background: For coronary to pulmonary artery fistulas, operations are often indicated by the existence of myocardial ischemia or aneurysmal formations. Because lesions do not form in identical ways, a variety

We report a case of tricuspid regurgitation (TR) that increased markedly after pericardiectomy for constrictive pericarditis. Preoperative mild-to-moderate TR increased to severe following surgery. The patient was asymptomatic

Extraaortic counterpulsation using skeletal muscle powered ventricles (SMPVs) has been studied mainly for the purpose of assisting the systemic circulation. The purpose of this study was to investigate the possibility of assisting both the systemic and pulmonary circulations using a single SMPV. An SMPV that counterpulses the systemic circulation is placed beside the right atrium (RA) or the right ventricle (RV), the former after procedures such as a Fontan operation, and the latter in cases of biventricular failure. Because the SMPV dilates passively during cardiac systole, it is designed to press the RA or the RV directly from outside. This study is a preliminary report, and only the ability of a specially constructed SMPV to dilate was assessed. Using seven dogs with heart failure, the SMPV dilated with an internal pressure of 88 mmHg and 1.0 cm, while the volume inside increased by 10.8 ml. From these results, it is suggested that the SMPV has enough dilating power to press the RA or to assist the RV while counterpulsing the systemic circulation.

We present the results of numerical analysis of wave drag reduction by a single-pulse energy deposition in a supersonic flow field around a sphere. The wave drag for the sphere was reduced as a result of the interaction between a low-density core following the blast wave produced by the energy deposition and the bow shock developed in front of the sphere. We investigated the drag reduction mechanism in terms of the unsteady flow field induced by the interaction. The effects of deposited energy and deposition location on energy reduction were examined by parametric study. From the obtained results, we refined the parameters, utilizing the baroclinic source term that produced vorticity in the vortex equation when the gradients of density and pressure were not parallel. The baroclinic vortex driven by Richtmyer–Meshkov-like instability was strong enough to contribute to the temporary low-entropy shock formation that caused low wave drag for the supersonic object. We determined that the reduced energy had a l...

We report the outcome of the iliac vein approach for permanent pacemaker implantation in 4 patients in whom the conventional pectoral approach was not possible. The reasons for using the iliac vein approach were: recurrent lead infections at bilateral pectoral positions in 1 patient; superior vena cava obstruction following cardiac surgery in 2 patients; and a postoperative dermal scar due to right radical mastectomy secondary to a persistent left superior vena cava with absence of the innominate vein in 1 patient. This technique was safe and effective during the mean follow-up period of 24.3 months. At the latest follow-up, no patients showed signs of electrophysiological abnormalities. No short- or long-term complications were seen. Conclusions: The iliac vein approach is a less invasive and more feasible alternative without any complications for patients in whom the pectoral approach cannot be used.

Background Ascending aortic cannulation for an antegrade central perfusion during surgery for type A aortic dissection is simple and can be performed within median sternotomy. This cannulation is performed routinely without problems in our hospital. Using our experience, the skills and pitfalls were clarified to make this challenging procedure successful. Methods 29 cases of ascending aortic cannulation using the Seldinger technique for insertion were studied. All insertions were performed with the guidance of transesophageal echocardiography alone. The cannulas were inserted after decompressing the aorta by initiating cardiopulmonary bypass with femoral artery cannulation. From our experience, the skills required for this procedure are the abilities to carefully assess the needle insertion site preoperatively, sense resistance to needle insertion twice, and ensure the guide wire is in the descending aorta and distal arch. The pitfalls are entrance of the guide wire into the false lumen and dilatation of the false lumen during the insertion procedure. Results There were no complications associated with ascending aortic cannulation. Regarding morbidity, 2 cases of brain infarction occurred. There were 3 hospital deaths unrelated to the procedure. Conclusions In surgery for type A aortic dissection, ascending aortic cannulation using the Seldinger technique is simple to perform. We found that some practical skills and precautions were required to make this procedure successful.