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Persistent fever during active-phase IE is an indication for surgical treatment in the light of the causative organism and the underlying disease. To counter worsening hemodynamics, surgery may be the only feasible way. Surgery is performed when the patient does not respond to vasodilators and he shows FS of less than 25%. The introduction of translocation provides a solution for the treatment of active IE. Lesions, vegetations more than 5mm in diameter, periannular abscess, and mycotic aneurysm that could never be overlooked by two-dimensional echocardiography may hasten the early stage decision of ways to treat IE.

This study was undertaken to electrophysiologically find signs of rejection after heart transplantation. A donor heart with a created atrial septal defect was implanted in the retroperitoneal space by anastomosing the thoracic aorta and left pulmonary artery of the donor heart to the abdominal aorta and inferior vena cava of the recipient heart, respectively. Endocardial leads were set up in the right atrium in the vicinity of the bundle of His and in the right ventricle. Cyclosporine (10 to 18 mg/kg/day, continuously) and prednisolone (1.0 mg/kg/day, for the first 4 days) were given orally. Electrophysiologic examinations were performed 1 to 4 days (control data) after the transplantation and were compared with data obtained 5 to 21 days after operation on 12 mongrel dogs. Finally, histopathology of the donor heart was studied. Results showed that the effective refractory period (ERP) of the atrioventricular conduction system was prolonged in six animals from 120 +/- 25 to 192 +/- 35 msec (p less than 0.02) on average. The ERP of the ventricle was shortened in four dogs from 153 +/- 36 to 123 +/- 17 msec (p less than 0.05). Specimens disclosed mononuclear cell infiltration in the atrioventricular node, the bundle of His, and the right and left bundle branches in eight of 12 cases and mild to moderate myocyte damage with cell infiltration in the ventricular septum of the same eight hearts. The ERP of the atrioventricular conduction system showed no change in four cases without mononuclear cell infiltration in the conduction system. These results suggested the feasibility of electrophysiologic monitoring as a means for detecting acute rejection in the prenecrotic stage in transplanted hearts.

A small-caliber vascular graft with an excellent patency rate, which has satisfactory antithrombogenicity due to high hydrophilicity, has been developed. It is hemostatic at the anastomotic site and has an affinity for endothelial-like cells, smooth musclelike cells, and fibroblasts. Fresh carotid artery with an ID of 2.5 to 3.0 mm was obtained from a dog and sonicated to induce destruction of the cell components. It was then cross-linked with a hydrophilic polyepoxy compound. As controls, glutaraldehyde (GA) treated grafts were prepared. Twenty-one dogs were used, 14 for the new graft and the other 7 as controls. A segment of the graft, 6 cm in length, was implanted into the carotid artery. Sodium heparin was given during surgery, but no anticoagulant was used thereafter. The compliance of the new graft was similar to that of the native artery. No excessive bleeding was noticed at the anastomotic sites. The patency rate was 70.8% during the longest observation period of 145 days, but was only 10% in the controls. Microscopic observation revealed that by the seventh day after implantation, endothelial-like cells had appeared near the anastomotic lines on the inner surface of the new graft; smooth musclelike cells were observed on the 38th day after implantation. From these results, there is a good possibility that this new graft, with its many advantages, may be used clinically.

This study was undertaken to evaluate the effects of circulatory support on cardiac function in 7 patients. They were 2 men and 5 women with of age 34-54 years; Six patients underwent mitral valve replacement and one had mitral valve plasty. End-systolic pressure/volume (ESP/ESV) representing left ventricular contractility was measured just before ECC starting and after cardiac beating began in the process of rewarming. Measurements were repeated at every, interval of 10 minutes up to 60 minutes. ESP/ESV (mmHg/ml) [% of that before ECC] were as following; before ECC: 1.69 +/- 0.68 (mean +/- SD) [100], after 10 minutes; 0.40 +/- 0.24 [25.1 +/- 13.8], after 20 minutes; 0.52 +/- 0.26 [31.5 +/- 12.9], after 30 minutes; 0.77 +/- 0.28 [47.6 +/- 10.5], after 40 minutes; 0.97 +/- 0.26 [60.5 +/- 11.3], after 50 minutes; 1.18 +/- 0.46 [70.6]8.0], after 60 minutes; 1.36 +/- 0.56[80.4 +/- 12.7]. It took 39.6 minutes to recover up to 69% of that before ECC. These data suggested that the myocardial ischemia associated with aortic cross clamping continued for at least 60 minutes after cardiac beating resumed. We concluded that assist bypass should be applied to those who could not be weaned from ECC despite adequate use of catecholamine and volume loading.

A 35-year-old male with tetralogy of Fallot, who had undergone left Blalock-Taussig shunt at ten year old, developed severe dysfunction of right ventricle with decreased right ventricular ejection fraction of 25% and frequent premature ventricular contractions of right ventricular origin. Following intracardiac procedure, the venoarterial assist circulation was successfully employed for 9 hours, until his hemodynamic conditions were improved. This experience reemphasized the importance of right ventricular protection and mechanical circulatory assist in the surgical treatment of Fallot's tetralogy in older children and adults who developed severe right ventricular dysfunction as a natural history of this disease.

Percutaneous transluminal coronary angioplasty (PTCA) was reviewed with respect to its history, principles, indications and complications. We also reported our experiences with this technique. PTCA was useful in selected cases, but we encountered eight complications among 90 procedures; namely, coronary spasm, coronary dissection and recurrent stenosis. Since 1980 we have used this transluminal angioplasty for 16 patients during aorto-coronary bypass grafting surgery. We also discussed preliminary results in the use of this newly developed technique.

Precise determination of the arrhythmogenic area by the intraoperative cardiac mapping procedure is a prerequisite to successful surgical therapy for tachyarrhythmias. Because of the limitation of time during operation, mapping should be performed precisely and quickly. For this purpose we have developed and used an on-line portable minicomputer system (modified HPM-6500; Fukuda Denshi Co., Ltd.). A ventricular epicardial excitation sequence map is acquired by measuring the conduction time difference for 51 predetermined points on the whole ventricular surface. The measured data are instantaneously digitized and computed to be displayed as an isochornous map in real time basis. Similar program is available for atrial excitation map. With this system it takes only about ten minutes to get an epicardial isochornous map. Recently a multi-channel signal-processing unit has been incorporated in the HPM-6500. With the use of a sock electrode or a card electrode, a map can be obtained on a few cardiac contractions. Multi-point simultaneous mapping has been proved to be especially important to get a VT isochornous map, for induced VTs during operation are usually unstable and transient.

Cardio-Behcet's disease is not often reported; only one case to our knowledge has described complete atrioventricular (AV) block, without pathologic details. We document, from direct observation during surgery and pathologic examination of associated lesions, a case whose conduction disturbance was possibly caused by direct extension of Behcet's disease itself into the conduction system.