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Background: The common femoral artery is usually the preferred access route for thoracic endovascular aortic repair (TEVAR). However, if access from the common femoral artery is challenging, other routes must be considered. We report a case of TEVAR performed by approaching the descending thoracic aorta with a right thoracotomy and using the descending thoracic aorta as an access route. Case presentation: A 70-year-old female was diagnosed with a descending thoracic aortic aneurysm (65 mm in diameter), a thoracoabdominal aneurysm (54 mm in diameter), and an abdominal aortic aneurysm (49 mm in diameter). Since the patient had severe chronic obstructive pulmonary disease, one-stage replacement of the thoracoabdominal aortic aneurysm was contraindicated and TEVAR on the descending aorta was selected. A strong tortuous section of the aorta—from the descending aorta to the abdominal aorta—hampered endovascular access to the site from the common femoral artery. A TEVAR approach from the abdominal aorta was also considered; however, an abdominal aortic aneurysm and a transverse colon loop stoma from an earlier surgery presented challenges to this technique. We chose to access the descending thoracic aorta with a thoracotomy from the right 6th intercostal space for TEVAR, because the access route that is not affected by the meandering of the aorta is considered to be the descending aorta with a right thoracotomy. The patient’s postoperative course was uneventful after the stent graft was placed. No complications were detected with postoperative contrast-enhanced computed tomography (CT). Conclusions: Our findings suggest that TEVAR can be performed by approaching the descending aorta from a right thoracotomy, if variations of vascular anatomy interfere with the more commonly used femoral artery approach.

A 51-year-old man was diagnosed as having mitral valve regurgitation( MR). Transesophageal echocardiography revealed severe MR due to A2 prolapse. We decided to perform a mitral valve plasty (MVP). The length of an artificial chord was estimated by measuring the distance from the anterior and posterior papillary muscles to A2 on cardiac computed tomography (CT). The operation was performed with a median sternotomy. The leaflet prolapse lesion was localized in A2, and one torn chord was revealed. Polytetrafluoroethylene sutures were fixed to the papillary muscle, and markings were performed. After fixing the artificial chord to A2 in the predicted length before the operation, a leakage test was performed. We confirmed that the MR had disappeared. The postoperative course was good, and no MR was detected upon postoperative echocardiography. Preoperative prediction of the artificial chord length using cardiac CT is useful because it can be adjusted relatively easily.

CsBi

CsBi4-x Pb x Te6 is synthesized and the superconductivity associated with the structural transition from Pb substitution is studied. Photoemission spectroscopy measurements are performed in order to elucidate the relationship between the electronic structure and the occurrence of the superconductivity. When Bi is substituted with Pb, an electron doping-like change in the electronic structure is directly observed which is contrary to the naive expectation of hole doping. This observation is consistent with band structure calculations and appears to be a unique characteristic of CsBi4-x Pb x Te6 because of the dissociation of Bi dimers upon Pb substitution. These results indicate that it may be possible to control the electron and hole doping via manipulating the Bi dimers through Pb substitution.

Background Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease characterized by the tumefactive lesions and infiltration of IgG4-positive plasma cells. IgG4-RD has been described in various organs, but rarely the aortic valve. There are only a few reports of aortic stenosis, and none on significant aortic regurgitation. In addition, previous case reports relating to aortic valve lesions led to surgery as a first-line treatment. The effect of steroid treatment has not yet been determined. Case Summary A 62-year-old man, receiving steroid therapy, who presented with general malaise, shortness of breath, and bradycardia. He had suspected IgG4-RD because of pancreatitis, lacrimal gland enlargement, and retroperitoneal fibrosis. An examination revealed a thickened aortic valve extending to the left ventricular outflow tract with severe aortic regurgitation and complete atrioventricular block. He received intensive steroid therapy for a suspected IgG4-related aortic valve lesion. The complete atrioventricular block improved, but worsening aortic regurgitation caused congestive heart failure. He required replacement of the aortic valve. A histopathological examination of the excised aortic valve leaflets revealed IgG4-positive lymphoplasmacytic infiltration with fibrotic tissue. The prosthetic valve was functioning well without leakage around the valve at the 1-year follow-up. Discussion This case highlights the rare possibility that IgG4-RD of the aortic valve also causes significant aortic regurgitation. Conservative treatment with steroids may induce regression of the lesion and contribute to the stability of the prosthetic valve after surgery, but it may also exacerbate heart failure due to the progression of aortic regurgitation in patients with aortic valve lesions.

Stent grafting for complex aortic anatomy remains a challenge. In particular, stent graft collapse (i.e. infolding) is possible when an excessive oversized device is needed. We describe a case of preoperative stent grafting simulation using a three-dimensional (3D) printed model for extensive aortic arch repair in a 69-year-old woman with multiple aneurysms combined with coarctation. The patient was scheduled to undergo staged hybrid repair. A stent graft larger than 28 mm in diameter was needed to deploy into a coarctation of 15 mm in diameter during the 2nd stage of the operation. Preoperative, experimental stent grafting using a 3D printed model indicated that infolding would likely not occur. Therefore, we proceeded with surgery, which was successful. This technology could be a useful application for planning complicated stent grafting.

Grain-oriented Fe-3%Si steels are industrially important soft magnetic materials that are usually used in transformer cores but have also recently started to be used in motor cores [1]. Further improvements in the magnetic properties of grain-oriented steels are required to increase the efficiency of electrical machinery. The magnetic properties of grain-oriented steels strongly depend on the magnetic domain structures. The magnetic domains in grain-oriented steels mainly consist of the 180° basic domains and supplementary domains, such as lancet domains. The lancet domains, which occur due to a tilt angle of the [001] easy axis out of the steel surface (β), affect not only iron losses but also magnetostrictive noise. Therefore, it is important to understand the behavior of the lancet domains in order to further improve the magnetic properties. Many studies of the lancet domains [2-4] have been performed, for example, under applied stresses and external magnetic fields at the room temperature (RT). However, the behavior of lancet domains in the region above RT has not yet been investigated even though the operating temperature of transformers and electric motors are generally above RT. In this paper, the changes in the lancet domains of grain-oriented steels over the range from RT to the Curie point were observed using photoemission electron microscopy combined with X-ray magnetic circular dichroism (XMCD-PEEM). Moreover, the domain theory enabled us to quantitatively explain the observed temperature dependence of the lancet domains.

Tests to measure the effects of the precipitating size of Cu on the magnetic properties of nongrain-oriented (NGO) electrical steel were carried out. The hysteresis loss had a maximum value when the diameter of the precipitates was around the thickness of the domain wall and decreased rapidly with decreasing size of the precipitates. Alternatively, yield point (YP) rose steeply with reduction in the size of Cu precipitates. It can be confirmed that the precipitating Cu has an ability of rising over 100 MPa in YP without deteriorating core loss. Regarding the effects of Cu precipitates on the hysteresis loss, the surface tension effect might be dominant for the case in which precipitates are smaller than the domain wall thickness, and internal magnetic poles are effective for the larger precipitates.

Although diabetes mellitus (DM) increases the incidence of infective endocarditis (IE), little is known about the outcome of valve surgery for active IE in patients with DM. We evaluated the clinical outcomes of valve surgery for IE in patients with DM.Between 2009 and 2016, 470 patients underwent valve surgery for definitive left-sided active IE at 12 affiliated hospitals. We compared the preoperative variables and clinical outcomes between patients without (n = 374) and with DM (n = 96).Staphylococcus and chronic hemodialysis were more prevalent in patients with DM, and these patients had greater preoperative inflammation levels and worse renal function than patients without DM. In-hospital mortality was 8% in patients without DM and 13% in patients with DM (P = .187). The overall survival rate at 1 and 5 years was 87% and 81% in patients without DM and 72% and 59% in patients with DM (P .001). The incidence of infection-related death was greater in patients with DM than in patients without DM (P .001; hazard ratio 3.74 [1.78-7.71]). Freedom from the recurrence of endocarditis at 1 and 5 years postoperatively was 98% and 95% in patients without DM, and 89% and 78% in patients with DM (P .001), respectively. The Cox hazard analysis revealed that the presence of DM was the only independent risk for recurrence (hazard ratio 3.74 [1.45-9.54], P = .007).The short- and mid-term outcome after valve surgery for active IE in patients with DM is worse because of the greater prevalence of infection-related death and IE recurrence.

The 3-D structures of the 90° closure domains in demagnetized Fe3%Si(110) steels occurring by the compressive stress were quantitatively analyzed using domain theory. The dependence of the compressive stress and the thickness in the 90° closure domains were evaluated using the proposed closure domain model with the 90° domain width. It was revealed that the 90° closure domain width decreases with an increase in compressive stress and steeply increases with a decrease in compressive stress. Moreover, our calculations predict that the critical compressive stress for the occurrence of the closure domains increase with the decrease in specimen thickness. The results suggest that when the thickness becomes thinner, enhancement of local compressive stress may be needed to refine 180° basic domains along the rolling direction. The validity of the calculation was confirmed by comparison with the past data and our presented domain observations by photoemission electron microscopy combined with X-ray magnetic circular dichroism.

Infectious complications in patients with multiple myeloma remain the main cause of mortality because of disease-related immunodeficiency. A mycotic aortic aneurysm caused by Burkhoderia cepacia, which has been recognized as nosocomial pathogen in immunocompromised populations, is very rare and only few cases have been reported in the literature. We describe an unusual case of a ruptured mycotic aneurysm of the descending thoracic aorta with a DeBakey IIIb aortic dissection caused by Burkhoderia cepacia in a patient with active multiple myeloma during chemotherapy with anti-myeloma agents. Successful treatment of this mycotic aneurysm included appropriate antibiotic therapy and replacement of the aortic arch and the descending aorta for the extensive debridement of all infected aortas. This was followed by the wrapping of a prosthetic graft with a well-vascularized tissue flap of the greater omentum and of the latissimus dorsi muscle.

This paper presents the calculation method of basic domain width in demagnetized states of (110)[001]Fe3%Si under tensile stress in the range of lancet domain occurrence. Accurately calculating the 180 ° basic domain width in demagnetized states is one of the important estimations to evaluate the anomalous eddy-current losses. Previously, stripe domain models, under sufficient strong tensile stress to annihilate lancet domains, were used so that the discrepancy between the calculated and the observed widths under tensile stress in which lancet domains occur became large. Applying the decrease of the surface magnetic charge by lancet domains to calculations of the stray field energy of basic domains enables us to accurately evaluate the 180 ° basic domain width under tensile stress in demagnetized states. Furthermore, the eddy-current losses evaluated using the calculated basic domain width show good agreement with the measured values under the tensile stress in the range of lancet domain occurrence.

To elucidate a difference of micelles formed from AB di- and ABA tri-block copolymers, PMOVE–PNIPAM–PMOVE triblock copolymers were synthesized by both living cationic polymerization of MOVE and RAFT polymerization of NIPAM using a dicarboxylic RAFT agent, where MOVE is 2-methoxyethyl vinyl ether, NIPAM is N -isopropylacrylamide. The ABA triblock copolymers consist of cationically polymerizable monomer (A), MOVE, and radically polymerizable monomer (B), NIPAM. The key to success in the triblock copolymerization is to utilize a dicarboxylic RAFT agent/SnBr 4 initiation system for living cationic polymerization. The cationic polymerization was simultaneously initiated from two protons per one dicarboxylic RAFT agent. After the cationic polymerization, the polymerization was quenched and then the RAFT carboxylate counter anion was concurrently recovered at ca. 86% efficiency, followed by the RAFT polymerization. The resulting PMOVE–PNIPAM–PMOVE triblock copolymers contain two thermoresponsive blocks. The resulting block copolymers reversibly formed or deformed micellar assemblies in water. When the chain length of the core-forming block, PNIPAM, is increased, larger micelles were invariably obtained. The triblock micellar size was larger than that of the corresponding diblock micelle. The micelles at the concentrated solution formed physical gel, and the minimum gelation concentration of the triblock micelles was lower than that of the corresponding diblock micelles.

Background: Sac behavior after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is considered as a surrogate for the risk of late rupture. The purpose of the study is to assess the sac behavior of AAAs after EVAR. Methods and Results: Late sac enlargement (LSE) (≥5 mm) and late sac shrinkage (LSS) (≥5 mm) were analyzed in 589 consecutive patients who were registered at 14 national centers in Japan. The proportions of patients who had LSE at 1, 3 and 5 years were 2.6% ± 0.7%, 10.0% ± 1.6% and 19.0% ± 2.9%. The proportions of patients who had LSS at 1, 3 and 5 years were 50.1% ± 0.7%, 59.2% ± 2.3% and 61.7% ± 2.7%. Multiple logistic regression analysis identified two variables as a risk factor for LSE; persistent endoleak (Odds ratio 9.56 (4.84–19.49), P

In cases of iatrogenic coronary embolism during cardiac surgery or percutaneous coronary intervention, small air bubbles or foreign bodies are directly injected, which usually result in serious adverse events if not treated promptly. We herein describe the case of a patient who developed acute myocardial infarction resulting in shock due to BioGlue ® (CryoLife, Atlanta, GA, USA)-induced coronary embolism during the surgical repair of aortic dissection and was treated for retrieval of the material using a thrombectomy catheter. Learning objective: Coronary embolism caused by surgical adhesives is a rare but potentially life-threatening complication. It is important for surgeons to promptly recognize and treat this serious condition in consultation with cardiologists.>

In aortic arch surgery, two pumps are required for systemic perfusion and selective cerebral perfusion (SCP). A new technique with a single centrifugal pump for systemic perfusion and SCP was developed and its efficacy and safety evaluated. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine) from January 2005 to January 2008. Cerebral perfusion lines branched from the main perfusion line. During SCP, right radial arterial pressure was maintained at 50 mm Hg and left common carotid arterial pressure at 60 mm Hg, and the regional cerebral oxygen saturation (rSO(2)) values were maintained at approximately >80% of the baseline value. Two operative deaths (9%) occurred due to pneumonia and hemorrhage in the left lung, respectively. Stroke occurred in one patient (5%). This simple circuit system can thus be easily and safely applied for aortic arch surgery.

症例は80歳男性，両側の下腿浮腫を主訴に当院を受診した．精査の心エコーにて右房内に可動性を有する33mm大の腫瘍ならびに三尖弁閉鎖不全を認めた．塞栓症の危険性を考慮し，準緊急的に手術を施行した．体外循環下に右房自由壁を含めて腫瘍摘出および三尖弁輪縫縮術を施行した．術後の病理検査では脂肪腫と診断され悪性所見は認めなかった．術後経過は良好で下腿浮腫も消失し術後12日目に軽快退院した．術後遠隔期には術前から存在していた心房細動も消失した．

A 26-year-old man had a history of severe atopic dermatitis. He was taking immunosuppressive drug. Mitral valve replacement (MVR) had been performed for infective endocarditis March 2008. He came to our hospital in July 2012 complaining of fever of 39 degrees Celsius. According to computed tomography (CT) and transesophageal echocardiography (TEE), we diagnosed that he had cerebral embolism and bacterial infection of prosthetic valve. Antibiotic treatment was performed for 2 weeks after the onset of cerebral infarction. Then we conducted re-MVR. The postoperative course was satisfactory. He showed a gradual improvement in the level of consciousness and was discharged. In patients with atopic dermatitis, bacteria can penetrate into the blood from the skin easily. So they are often affected by bacteremia. There are some reports that infective endocarditis is likely to occur in immunosuppressed patients. It is suggested that immunosuppressive drug was involved in the development of prosthetic valve endocarditis (PVE) in addition to atopic dermatitis in this patient.

ObjectivesHepatocyte growth factor plays a significant role in angiogenesis, anti-apoptosis, and anti-transforming growth factor-β1–mediated fibrosis in several organs. In this study, we investigated the effect of transfection of the hepatocyte growth factor gene in attenuation of cardiac remodeling in the hypertrophied heart.MethodsTwo weeks after banding the ascending aorta of male Sprague-Dawley rats, a hemagglutinating virus of Japan-liposome complex with (H group) or without (C group) human hepatocyte growth factor cDNA was transfected into the left ventricle wall by direct injection. The hepatocyte growth factor, c-Met, and transforming growth factor-β1 mRNA levels in the left ventricle were then analyzed by real-time quantitative reverse-transcriptase polymerase chain reaction.ResultsTwo weeks after transfection, the expression of transforming growth factor-β1 mRNA was significantly attenuated in the H group compared with the C group (P < .01). Myocardial collagen content after 4 weeks of banding was significantly lower in the H group (5.0 ± 0.6 mg/g tissue) than in the C group (7.4 ± 0.5 mg/g tissue, P < .01). Left ventricular diastolic function (E/A ratios quantified by Doppler echocardiography) showed a significant increase in the H group (1.9 ± 0.1) compared with the C group (1.1 ± 0.1, P < .01).ConclusionsOur results demonstrated that gene transfection of hepatocyte growth factor attenuated left ventricular diastolic dysfunction and cardiac fibrosis in association with a decrease in transforming growth factor-β1 in the rat heart subjected to pressure overload. Thus, the transfection of the hepatocyte growth factor gene into the hypertrophied heart may be a strategy for the hypertrophied and failing heart even for cardiac surgery.

The effects of laser irradiation on iron loss reduction for Fe-3%Si grain-oriented silicon steel sheet were investigated. The local tensile residual stress states near the laser irradiated cavity lines were observed by using the new X-ray stress measurement method for a single crystal. Although the higher laser power induced the larger tensile residual stresses, the minimum iron loss was obtained at the medium tensile residual stress conditions of about 100-200 MPa. The increase of Vickers hardness was observed with increasing laser power, which was the mark of the plastic deformations induced by the laser irradiation. The tensile residual stress reduces eddy current loss and the plastic deformation increases hysteresis loss of the material. The total iron loss is determined by the balance of these two effects of laser irradiation.

症例は69歳,女性.2001年4月人工弁(Freestyle弁)感染性心内膜炎,僧帽弁閉鎖不全症,陳旧性心筋梗塞に対し再大動脈弁置換術,僧帽弁形成術,冠血行再建術を施行した.2002年1月中旬から下痢,タール便を認め当院消化器科へ入院,絶飲食,高カロリー輸液を行っていた.1月下旬から発熱が持続,抗生剤投与を行い改善傾向にあったが,経食道心臓超音波検査にて上行大動脈に可動性を有する異常エコーを認め,β-Dグルカンの上昇,血液培養検査にてCandida parapsilosisを認め,真菌性心内膜炎の疑いにて4月5日手術を行った.大動脈を切開すると無冠洞近傍の大動脈壁に疣贅の付着を認め,機械弁による再々大動脈弁置換術,および疣贅とともに大動脈壁の一部を切除,大動脈壁欠損部の再建を行った.摘出標本からC.parapsilosisが検出され,抗真菌剤を経静脈的に8週間投与した.術後,意識覚醒遅延,一過性の左半身麻痺の合併を認めたが,術後133日目に脳梗塞後遺症なく退院,抗真菌剤内服を継続し,術後24ヵ月の時点で感染の再燃は認めていない.

Solid acidity was found to be generated in methylsiloxane-based inorganic/organic hybrids by incorporating inorganic components other than Si, such as Al and Nb, into methylsiloxane networks by combining theoretical first-principles calculations based on the density functional theory (DFT) with experimental synthesis and characterization. First-principles calculations based on the DFT indicated that the dissociation energy of protons at the surface followed the order Si

The method is presented to predict the activity coefficients and the interaction parameters of the solute elements in infinite dilute Si solutions by the use of first-principles calculations based on density functional theory. In this method, the regular solution model is assumed. The calculated activity coefficients in solid Si are converted to those in molten Si by the use of the solid–liquid partition coefficients. Furthermore, the interaction parameters in solid Si solutions are calculated and compared with reported experimental values of those in liquid Si solutions. The results show that the calculated activity coefficients and interaction parameters of Al, Fe, Ti and Pb in Si solutions are in good agreement with the tendency of the experiments. However, the calculations have some quantitative discrepancy from the experiments. It is expected that consideration of the excess entropy would reduce this discrepancy.

Solid acid-base properties of methylsiloxane-based inorganic/organic hybrids were controlled by incorporation of inorganic components other than Si into methylsiloxane networks. The effect of different inorganic components on the solid acid-base properties was estimated by first-principles calculations based on density functional theory (DFT). The deprotonation tends to occur in the order Si < Al < Nb inorganic components, suggesting that the acidity increases in the same order. Methylsiloxane-based hybrids with solid acid-base properties were also synthesized by incorporating inorganic components derived from metal alkoxides. Hammett indicators revealed that the solid acidity increased in the order Si < Al < Nb inorganic components, which was consistent with the results of first-principles calculations. Preliminary experiments revealed that the methylsiloxane-based hybrids also provided a solid basic nature by containing Ca and Y inorganic components derived from metal alkoxides. The acidic hybrids were found to have Bronsted acid sites from the FT-IR experiments of adsorbed pyridine on the hybrids.

Objective: Hepatocyte growth factor, a potent angiogenic agent, is unique in having the effects of antiapoptosis and antifibrosis. In the present study we used the rapid pacing-induced heart failure canine model to investigate the effect of gene transfection of hepatocyte growth factor on the failing heart. Methods: Four weeks after onset of rapid pacing, either the human hepatocyte growth factor gene (160 μg; hepatocyte growth factor group, n = 7) or empty vector (control group, n = 7) was directly injected into the left ventricular myocardium by means of the hemagglutinating virus of Japan liposome method. Results: At 4 weeks after gene transfection, the left ventricular global function, assessed by means of pressure-volume loop analysis, was improved in the hepatocyte growth factor group as preload-recruitable stroke work (percentage of baseline: 80% ± 20% from 38% ± 15% before gene transfection, P =.005), whereas it was not changed in the control group (50% ± 18% from 50% ± 18%). Weekly echocardiography showed that this improvement began in the week after gene transfer. The hearts in the hepatocyte growth factor group had a large wall thickness, large myocyte diameter, high capillary density, low fibrotic area fraction, and low density of apoptotic nuclei revealed by means of histologic analysis compared with that in the control group. Myocardial perfusion flow, assessed with color microspheres, was increased in the hepatocyte growth factor group (percentage of baseline: 79% ± 16% from 48% ± 14%, P =.010), whereas it was reduced in the control group (30% ± 12% from 45% ± 17%). Conclusions: Gene transfection of hepatocyte growth factor promoted angiogenesis, improved perfusion, decreased fibrosis and apoptosis, promoted recovery from myocyte atrophy, and thereby attenuated cardiac remodeling and improved myocardial function in the failing heart. It is a novel gene therapy for human heart failure. J Thorac Cardiovasc Surg 2002;124:957-63

盛岡東南地域の早池峰帯の赤色チャートからデボン紀コノドントが発見された.早池峰帯は変形した砕屑岩と緑色岩類からなる付加体で, 同時に北部北上帯と南部北上帯との境界帯を構成している.今回産出したコノドントはPalmatolepisを特徴とし, 後期デボン紀(前期ファメンヌ世)を示準する.これは, 日本列島において化石によって時代が決定されたデボン紀海洋性岩石の初めての報告である.コノドントを産出したチャートは, 層状鉄鉱床を伴い, 緑色岩中のレンズ状岩体の産状を示す.緑色岩の化学分析の結果, プレート内アルカリ玄武岩とMORB～プレート内ソレアイトの二つのタイプが認識された.特に, 層状鉄鉱床にともなうソレアイトは, N-MORB～P-MORBにまたがる組成を示す.早池峰帯の緑色岩は, 熱水活動の活発な海洋底および海洋島の火山活動によって後期デボン紀に形成されたと考えられる.

細小肝癌切除耐術42例を対象に, 肝切除範囲がその術後成績に及ぼす影響について検討する目的で, 上記対象を, HrS以下の小範囲肝切除群 (n=28) とHr1以上の広範囲肝切除群 (n=14) の2群に分類しその背景因子, 術後成績について比較検討した.その結果, 肝予備能を中心とした宿主側因子, 腫瘍側因子については両群間に有意の差を認めず, 手術因子についても切除肝重量, 術中出血量を除けば両群間に有意の差を認めなかった.術後累積生存率は, 小範囲切除群3年88%, 5年54%, 広範囲切除群3年100%, 5年75%と後者において若干良好な傾向を認めるものの統計学的に両群間に有意の差を認めなかった.また, 累積再発率においても有意の差を認めなかった.以上の結果より, 細小肝癌においては肝予備能上, 広範囲肝切除が許容されない場合, HrS以下の小範囲肝切除にても十分良好な予後が期待できるものと考える.

We describe 2 cases of extensive aortic aneurysm. One was an 88-year-old female with a diagnosis of a rupture of the distal descending aortic aneurysm and the distal arch aneurysm. The 2nd case was a 68-year-old female who had undergone graft replacement of the ascending aorta for acute type A dissection 5 years before. She was diagnosed with an enlarging aneurysm of the false lumen from the transverse arch to the distal descending aorta. We performed 1 stage replacement of the aortic arch and the descending thoracic aorta by using the pull-through technique with a long elephant trunk (LET) through a median sternotomy under selective cerebral perfusion. Distal anastomosis of LET was done by posterior mediastinal approach. Postoperative courses were uneventful without neurological deterioration or respiratory distress.

Isolated mitral insufficiency requiring surgical correction is extremely rare in Williams syndrome (WS). We report the case of a 25-year-old man with WS, who suffered congestive heart failure caused by severe mitral insufficiency and atrial fibrillation. We found extensive anterior leaflet prolapse, but no other cardiovascular disorders such as supra-aortic or pulmonary arterial stenosis. He underwent successful radical valve repair with a concomitant Cox-maze procedure. This reconstructive procedure was appropriate and effective surgical treatment for isolated mitral valve disease associated with WS.

Conventional valve replacement for aortic valve stenosis has significant operative risks in patients with dense, circumferential calcification of the ascending aorta. The apicoaortic conduit (AAC) is one of the alternative methods to eliminate the aortic manipulation. Several reports have demonstrated that a newly constructed double-outlet left ventricle maintains normally distributed blood flow throughout the systemic circulation without any deleterious physiologic effects. 1,2 However, we encountered the case of a patient who had unanticipated thrombus formation in the aortic arch that might have resulted from fractionation of the cardiac output and stagnation of the blood flow after construction of the AAC. Clinical Summary A 72-year-old woman with a history of diabetes mellitus and chronic renal insufficiency requiring hemodialysis experienced progressive dyspnea on exertion. Echocardiography demonstrated severe aortic stenosis caused by a calcified valve. Cardiac catheterization demonstrated a pressure gradient of 58 mm Hg across the aortic valve, a cardiac index of 3.5 L · min 1 ·m 2 , and 90% stenosis of the proximal right coronary artery. Computed tomography showed severe circumferential aortic calcification of the whole aorta, including the aortic root. To preclude the aortic valve procedure through a median sternotomy, we inserted the AAC through the left thoracotomy. The thoracic cavity was entered through the sixth intercostal space, and cardiopulmonary bypass was initiated with distal descending aortic cannulation and right femoral venous drainage. The patient was kept normothermic, and a 20-mm Hemashield graft (Meadox, Hemashield; Boston Scientific, Boston, Mass) was sewn to the descending aorta during side clamping. Continuous infusion of -blocker was started, and the heart rate was decreased to around 30 beats/min. In a head-down position, the left ventricular apex was enucleated with a 20-mm coring knife. The valved conduit incorporating a 23-mm stentless valve (Edwards Prima Plus; Stentless Bioprosthesis, Inc, Irvine, Calif) and a 20-mm Hemashield graft was anastomosed with the apical hole. The 2 parts of the conduit were then anastomosed. A saphenous vein graft placed from the coronary orifice of the stentless valve was grafted to the right coronary artery concomitantly. The postoperative course was uncomplicated, and the patient had improvement of symptoms. Computed tomography at 1 month after the operation demonstrated unobstructed conduit (Figure 1) and unexpected thrombus formation, possibly caused by stagnation of blood flow in the aortic arch (Figure 2). Administration of sodium warfarin was initiated immediately, and no thromboembolic events have been observed. Discussion Recent modifications of the technique and innovation of the technology has made it more feasible to accomplish the AAC for various complex lesions of the left ventricular outflow tract not easily amenable to other techniques. 3,4 In our case creation of an AAC combined with coronary revascularization was successfully performed with a pharmacologically controlled beating heart, which is a new and lessinvasive procedure even with the support of cardiopulmonary bypass. Furthermore, the use of a stentless bioprosthesis enabled us to obtain a larger valve orifice and to avoid anticoagulation. The patient was freed from heart failure symptoms, and postoperative computed to

This retrospective study was conducted to evaluate the effects of coronary artery disease (CAD) on short- and long-term survival after abdominal aortic aneurysm (AAA) repair. One hundred consecutive patients underwent elective AAA repair between 1991 and 2002. Coronary angiography was performed in all patients, revealing significant coronary artery lesions in 47 (47%). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 11 patients, 20 (median) days before the abdominal surgery. Abdominal aortic aneurysm repair was performed 60 (median) days after coronary artery bypass grafting (CABG) in five patients, and both procedures were performed simultaneously in two patients. The in-hospital mortality rate for AAA repair was 1.0%, but there was no cardiac-related operative morbidity or mortality. The 96 patients discharged were followed up for a mean period of 2.9 years (range 3–143 months). The cumulative survival rates after 1, 2, 3, and 5 years were 98%, 95%, 88%, and 77%, respectively. Only one patient (1%) died of myocardial infarction. There was no significant difference in the long-term survival of the CAD and non-CAD patients. These results emphasize the importance of routine coronary angiography and subsequent coronary revascularization to improve early and late survival rates after AAA repair.

This paper proposes the method to accurately predict the 180° basic domain width (Dw) in demagnetized states of the grooved Fe3%Si(110) single crystal with the tilt angle of [001] out of the sheet surface (β). The evaluation of Dw enables the estimation of the anomalous eddy current losses. In this paper, Dw is optimized to minimize the magnetic Gibbs free energy represented by vector potentials using the finite element method and the conjugate gradient method. The μ*-method is adopted to approximate the magnetization relaxation. The stray field energy generated by the magnetic charges occurring on both grooves cross section and sheet surfaces is considered in our proposed method. The validity of the proposed method was confirmed by comparison with the observed Dw. As a result, we could reveal the β dependence of Dw against the groove depth. Moreover, the theoretical threshold of the domain refinement due to the grooves has been suggested.

Objective: Prosthetic valve endocarditis remains a challenging complication after heart valve replacement. To identify predictive risk factors, we have reviewed 30 patients who underwent surgery for prosthetic valve endocarditis between March 1986 and May 1999.Methods: There were 15 men and 15 women (mean age 51 years). Prosthetic valve endocarditis was classified as early (≦ 1 year after operation) in 10 cases, and as late in the other 20 cases. The most common indication for surgery was moderate to severe congestive heart failure due to prosthetic valve dysfunction in 21 (70%) patients. The average follow-up period was 6.5 years, with a range of 0.3 to 14.1 years.Results: The most common microorganism was Staphylococcus epidermidis in both patients with early (50%) and late prosthetic valve endocarditis (25%). The in-hospital mortality was 13.3% (4/30). There were six late deaths. The actuarial survival at 5 years was 78% and 66% at 10 years. An early onset of prosthetic valve endocarditis was the only significant determinant of both in-hospital mortality (p=0.005) and overall mortality (p=0.1). Emergency surgery had a statistically significant relationship with in-hospital mortality (p=0.5). No significant influence on mortality after reoperation for prosthetic valve endocarditis was found in age, sex, valve position, antecedent native valve endocarditis, or in the type of pathological findings (ring abscess, valve dehiscence, and vegetation).Conclusion: Early onset of prosthetic valve endocarditis and emergency surgery were important risk factors for mortality due to prosthetic valve endocarditis.

Heat transfer process in amorphous alloy ribbon formation by single roll casting was numerically analyzed. Based on roll surface temperature and ribbon temperature measured during casting, heat transfer coefficient, h, between roll and puddle/ribbon was calculated. The results showed that h value depended on ribbon and roll temperature. This calculated h value presented that amorphous ribbon formation process corresponded to intermediate cooling between ideal and Newtonian cooling during casting.

The Children’s Cancer Association of Japan was founded 20 years ago by parents who had lost their children to cancer, with crucial support from the late Mr. Taketomi Mori and the late Dr. Taro Takemi. Since then, the association has been providing total support for families and children with cancer in an attempt to improve their quality of life. The association’s lobbying activities are essential for the public funding of medical research and the treatment of childhood cancer.

Highly ordered WO 3 nanohole-array membranes were fabricated by a two-step molding process using highly ordered anodic porous alumina as the starting material. The size and interval of the holes were controlled by changing the geometrical structure of the original porous alumina, and the depth of the holes by the amount of electrochemically deposited WO 3 . In terms of the electrochromic properties, the WO 3 nanohole-array membranes showed faster coloration and bleaching than flat WO 3 membranes of identical thickness. These coloration and bleaching properties also depended on the porosity of the WO 3 nanohole-array membranes.