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Unlike sex steroids, mineralocorticoids have attracted limited attention in ovarian physiology. Recent studies on primates have indicated possible local synthesis and action of mineralocorticoids in the ovary. Here, we examined developmental changes in the levels of mineralocorticoids and expression of genes encoding their biosynthetic enzymes and receptor in the bovine ovary. The follicles and corpora lutea (CL) were collected from F1 heifers. Expression levels of 21α-hydroxylase (CYP21A2), 11β-hydroxylase-1 (CYP11B1), and the mineralocorticoid receptor (NR3C2) in granulosa cells (GC), thecal layers (TL), and CL tissues were quantified by real-time PCR, whereas mineralocorticoids in the follicular fluid were measured by enzyme immunoassay (EIA). TL and GC expressed CYP21A2 and NR3C2, whereas CYP11B1 was expressed at very low or undetectable levels. The expression levels of these genes were not significantly different among small/large and healthy/atretic follicles but were higher in TL than in GC. CYP21A2 and NR3C2 were expressed in all CL stages with higher expression observed in the mid-stage. CYP11B1 expression was only apparent in the mid-stage CL. Aldosterone was detected in all follicles, and its concentration was not significantly different among the follicular groups. In paired large-healthy/atretic follicles, the concentration of deoxycorticosterone, a precursor of aldosterone, was approximately ten-fold higher than that of aldosterone and not significantly different between healthy and atretic follicles. In conclusion, the presence of mineralocorticoids and expression of NR3C2 in the bovine follicle together with the developmental change in the expression of CYP21A2, CYP11B1, and NR3C2 in the CL suggest possible endocrine/paracrine/autocrine roles of mineralocorticoids in the bovine ovary.

Objective: Patients of aorto-iliac aneurysms who undergo endovascular aortic repair (EVAR) require internal iliac artery (IIA) occlusion with coil embolization and its coverage with the stent graft to prevent type II endoleak after extending the endograft into the external iliac artery. However, it has become well recognized that IIA occlusion cause buttock claudication and other various sequelae due to pelvic ischemia. We retrospectively analyzed IIA occlusion outcomes. Methods: From October 2008 to February 2015, 71 patients with aorto-iliac aneurysms underwent IIA occlusion prior to EVAR. The relationship between pelvic circulation and symptom of pelvic ischemia was studied. Results: Buttock claudication occurred in 17 patients (22.9%) of all. Eight patients (14.8%) in unilateral IIA occlusion group (54 patients) and nine patients (52.9%) in bilateral IIA group (17 patients) had sequelae of claudication. The sacrifice of the communication of superior gluteal artery (SGA) and inferior gluteal artery (IGA) led to buttock claudication in 18 (64.3%) of 28 limbs. Instead, only 4 of 60 limbs had buttock claudication, when we preserved the communication between SGA and IGA. In all patients, staged treatment of aorto-iliac aneurysms with IIA occlusion and EVAR were done successfully without pelvic ischemic complications except for buttock claudication, and postoperative CT scanning showed no endoleakage. Conclusion: IIA occlusion prior to EVAR is recognized as a safe and reasonable strategy. It is emphasized that preservation of the communication of SGA and IGA is important to prevent buttock claudication. (This is a translation of Jpn J Vasc Surg 2016; 25: 240-245.).

We report a rare case of cystic adventitial disease of popliteal artery with venous aneurysm of popliteal vein. A 46-year-old woman had sudden-onset intermittent claudication and coldness in her right leg. The right-sided ankle-brachial pressure index (ABI) was 1.01, but peripheral arterial pulsation was decreased at knee venting position. Computed tomography revealed simple cystic lesion of the popliteal artery and stenosis of the arterial lumen in this lesion. The patient was treated by complete resection of the cystic adventitial layer of popliteal artery. A venous aneurysm of popliteal vein was revealed by intraoperative echo and was simply ligated. The patient had uneventful postoperative course and no symptoms of relevance during the two years of follow-up.

症例は62歳男性．感染性心内膜炎を発症．抗菌剤で感染徴候は改善したが大動脈弁および僧帽弁での重度の逆流を認め手術適応となった．術前CT検査で無冠尖直上の大動脈後壁に径約20 mm大の仮性瘤を認め，感染性心内膜炎に合併した上行大動脈仮性瘤の診断で手術を行った．大動脈弁は無冠尖弁尖に感染を認めたが，弁輪には明らかな変化を認めなかった．瘤は大動脈内壁が陥没したような形状で，同部の外側面には血液の浸出を認めたが，無冠尖弁尖と動脈瘤間の大動脈壁には感染の連続性はなかった．Composite graftを用いたベントール手術および僧帽弁形成術を行い，術後一過性に右冠動脈の閉塞を生じたものの概ね良好に経過した．病理組織検査では無冠尖に著明な炎症細胞浸潤があり，動脈瘤は内膜，中膜を欠いた仮性動脈瘤であった．感染性心内膜炎の診療に際しては，全身のあらゆる血管に動脈瘤形成の可能性があることを念頭におく必要があると考えられた．

症例は77歳,女性.両側交連部の腱索断裂による僧帽弁閉鎖不全症に対し両側交連部のfolding plastyとCarpentier ringによる弁輪形成を行った.術後の心エコーでは僧帽弁逆流を認めず弁口面積も良好に保たれていた.Folding plastyは交連部腱索断裂による僧帽弁閉鎖不全症の弁形成にも有用な術式と考えられた.

We present a modified elephant trunk technique with a novel indication for aortic arch aneurysm with ragged, undilated descending thoracic aorta. Our modification is simple and effective for minimizing bleeding from the distal anastomosis and has the possibility of preventing distal embolization of atheromatous plaque by ensuring sufficient contact area between the graft and the aortic wall.

An 86-year-old man was admitted for abdominal pain. Dissected descending thoracic aortic aneurysm and infrarenal abdominal aortic aneurysm were observed under computed tomographic (CT) scan. Hematologic studies revealed low platelet count and an increase in fibrin degradation products (FDP), and disseminated intravascular coagulation( DIC) associated with dissecting aortic aneurysm was highly suspected. Platelet transfusion was performed and gabexate mesilate was administered, however, no improvement of DIC could be obtained. An increase in aortic diameter was observed under CT scan and surgery was performed. The infrarenal aneurysm was replaced with a bifurcated prosthetic graft under open repair. Simultaneously, an endovascular stent-graft was delivered from the left limb of the abdominal graft and implanted into the descending thoracic aorta. The postoperative recovery was uneventful but platelet count did not improve in this case.

Pulse wave velocity is widely used as an index of arterial stiffness. The aim of this study is to assess the usefulness of pulse wave velocity as a risk factor in patients who underwent off-pump coronary artery bypass grafting (CABG) [OPCAB].Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV) and the ratio of patient's baPWV to age-matched normal value was calculated in 90 OPCAB patients. The mean age and male/female ratio were 69.1 years old and 68/22, respectively. baPWV was higher in CABG patients (1,891 +/- 511 cm/s) than that in age-matched normal value (p0.01). Preoperatively, baPWV ratio did not correlate to the severity of coronary artery diseases. There were 1 (1.1%) in-hospital death and 48 incidences of postoperative complication in 38 patients. The baPWV ratio in the group with postoperative major complications except atrial fibrillation tended to be higher than that in the non-complication group (1.38 +/- 0.36 vs 1.26 +/- 0.30, p = 0.09).The elevated baPWV may be a useful predictor of operative risk in patients who undergo CABG.

We report a long-term survivor with Uhl's anomaly who underwent one and a half ventricle repair combined with a partial right ventriculectomy in infancy, followed by successful total cavopulmonary conversion with right ventricular exclusion 5 years later. The combination of total cavopulmonary connection and right ventricular exclusion could be the optimal surgical option for a critically ill infant with Uhl's anomaly.

Objectives: Leaflet folding plasty was introduced for avoiding systolic anterior motion and coronary artery injury after mitral valve repair. We report the application and early outcome of this technique for mitral valve regurgitation. Methods: From January 1997 to January 2004,16 patients with mitral valve regurgitation were operated on using leaflet folding plasty. The group comprised 9 men and 7 women, with a mean age of 61.6 years. There were 15 patients with degenerative and 1 with ischemic mitral valve disease. The causes of mitral regurgitation were posterior mitral leaflet prolapse in 11 patients and commissural prolapse in 5 patients. Results: Mitral valve reconstruction could be performed in all patients. There were no perioperative deaths. Postoperative mitral regurgitation fell to 0.13±0.52 compared with 3.6±0.51 preoperatively. Systolic anterior leaflet motion was not observed in any patients after the procedure. The mean follow-up period was 22 months. There were no late deaths and reoperation was not required during follow-up. Conclusions: Early outcome of leaflet folding plasty for mitral valve repair was satisfactory. This technique may have advantages to accomplish mitral valve repair safely in patients with mitral regurgitation due to posterior or commissural prolapse.

We describe a new technique of mitral valve repair based on two reconstructive techniques: (1) the folding leaflet method, and (2) the classic annular plication. This combination appears to be useful in cases with a large prolapsing posterior mitral leaflet with excessive leaflet height or in cases with commissural prolapse involving both the anterior and posterior leaflets.

Patients with a functional single ventricle, unrestricted pulmonary blood flow, and aortic arch obstruction require staged palliation aimed at the Fontan circulation. Obstruction of the bulboventricular foramen (BVF), the communication between the left ventricle and the rudimentary right ventricle, may complicate the clinical course of patients with double-inlet left ventricle (DILV). In this report we present a new reconstructive approach for such morphology, applying a modifi

Hypoplastic left heart syndrome (HLHS) often involves abnormalities in atrial septal morphology, including a restrictive atrial communication and anomalous attachment of a malaligned septum primum. Cor triatriatum is a rare congenital heart abnormality in which the left atrium (LA) is divided into 2 chambers by a diaphragm. Association of cor triatriatum with HLHS is rare, and cor triatriatum is difficult to diagnose preoperatively. We herein describe an unusual case of HLHS with cor triatriatum.