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We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, Med Tech Mag- Lev, in a 3-week extracorporeal membrane oxygenation ( ECMO) study in calves against a Medtronic Bio- Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH- R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the Med Tech group and two in the Bio- Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the Med Tech ECMO calves completed the study duration. However, the Bio- Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the Med Tech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the Med Tech ECMO circuits (plasma-free hemoglobin [ PFH] < 5 mg/d L), while severe hemolysis ( PFH > 20 mg/d L) and large thrombus were observed in the Bio- Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the Med Tech ECMO without circuit exchanges. The Med Tech Mag- Lev could help extend the durability of ECMO circuits by the improved biocompatible performances. [ABSTRACT FROM AUTHOR]

Introduction: Angioscopy is the only devices that can directly visualize the lumen of blood vessels. However, clinical judgment is not technically straightforward in all operators but requires some experience. This study aims to design two-class classification models by deep machine learning based on angioscopic images in patients with PAD and to visualize the pictures considering prognosis so that even inexperienced operators can receive the benefit. Hypothesis: We hypothesized that the prediction model of deep machine learning could be used for the analysis of angioscopic images to obtain the same accuracy as experienced operators. Methods: 12 consecutive patients with PAD were performed the invasive assessment of vascular physiology. Image data were trained using Keras on TensorFlow which are framework and library of deep machine learning. In the first phase of the study, raw RGB data (640x480 pixels) were input to the neural network, but the accuracy was low, and there was a problem that the models did not converge. However, it was possible to solve it by devising the pretreatment of the data. We finally created a two-class classification model that classifies amputated and non-amputated cases. Results: In the 2-D histogram of the amputated case shows low chromatic color and contains the broad range spectrum in red to magenta as compared to the healed case. By using the trained prediction model in the analysis, it is possible to discriminate the poor prognosis findings at the accuracy of 97.5% which seemed to be the ability almost equal to a skilled operator. Besides, it is especially beneficial for treatment devising because high-risk areas in the entire movie frame can be efficiently visualized. In summary, these results show that the accuracy, loss, sensitivity, specificity, and AUC are 97.5(%), 0.0818, 94.0(%), 92.0(%) and 0.93, respectively. Conclusions: This is the first research to investigate angioscopic images using the predicted model trained by a deep machine learning. Through image analysis using predict model, it is possible that operators with low experience can efficiently obtain judgment with high experience values. The technology that we have designed therefore assists in our understanding of the role of angioscopy in PAD patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We studied the concordance of transgene expression in the transplanted heart using bicistronic adenoviral vector coding for a transgene of interest (human carcinoembryonic antigen: hCEA – beta human chorionic gonadotropin: βhCG) and for a marker imaging transgene (human sodium iodide symporter: hNIS). Methods: Inbred Lewis rats were used for syngeneic heterotopic cardiac transplantation. Donor rat hearts were perfused ex vivo for 30min prior to transplantation with University of Wisconsin (UW) solution (n =3), with 109 pfu/ml of adenovirus expressing hNIS (Ad-NIS; n =6), hNIS-hCEA (Ad-NIS-CEA; n =6) and hNIS-βhCG (Ad-NIS-CG; n =6). On postoperative day (POD) 5, 10, 15 all animals underwent micro-single photon emission computed tomography/computed tomography (SPECT/CT) imaging of the donor hearts after tail vein injection of 1000μCi 123I and blood sample collection for hCEA and βhCG quantification. Results: Significantly higher image intensity was noted in the hearts perfused with Ad-NIS (1.1±0.2; 0.9±0.07), Ad-NIS-CEA (1.2±0.3; 0.9±0.1) and Ad-NIS-CG (1.1±0.1; 0.9±0.1) compared to UW group (0.44±0.03; 0.47±0.06) on POD 5 and 10 (p <0.05). Serum levels of hCEA and βhCG increased in animals showing high cardiac 123I uptake, but not in those with lower uptake. Above this threshold, image intensities correlated well with serum levels of hCEA and βhCG (R 2 =0.99 and R 2 =0.96, respectively). Conclusions: These data demonstrate that hNIS is an excellent reporter gene for the transplanted heart. The expression level of hNIS can be accurately and non-invasively monitored by serial radioisotopic SPECT imaging. High concordance has been demonstrated between imaging and soluble marker peptides at the maximum transgene expression on POD 5. [Copyright &y& Elsevier]

We performed infarct exclusion repair of ventricular septal perforation(VSP) in a 63-year-old woman who was diagnosed with acute myocardial infarction(AMI) of the inferior wall. As VSP existed behind a fragile posterior papillary muscle, we excised the papillary muscle and sutured a bovine pericardial patch to exclude the infarct area of the whole septum and a part of the inferior wall. Mitral valve replacement and coronary artery bypass were also performed. The postoperative course was uneventful. There was no residual shunt and the left ventricular function was preserved. Selection of surgical procedures taking account of complete closure of VSP is important.

Non-ischemic mitral regurgitation( MR) is classified in degenerative MR, infective endocarditis( IE) and rheumatic MR. For degenerative MR, although 100% achievement of successful mitral valve plasty (MVP), it still important to evaluate mitral morphology preoperatively and to select suitable procedure.MR due to IE, the most important thing is to exclude vegetation completely. Then MVP is considered depends on its area of defect. Rheumatic MR is still difficult to accomplish MVP. Mitral valve replacement(MVR) is a main strategy for rheumatic MR.

Basic mechanism of ischemic mitral regurgitation (MR) is augmented leaflet tethering because of the out ward displacement of the papillary muscle by the left ventricular dilation. In 30% of ischemic MR, subvalvular procedure is necessary to eliminate MR. We propose subvalvular procedure aiming at a comprehensive remodeling of the entire mitral complex. This remodeling procedure consists of 3 major concepts; undersized mitral annuloplasty, division and reconstruction of secondary chords, and bilateral papillary muscle relocation. Subvalvular procedure under beating heart is effective to decide the length of artificial chord or papillary muscle relocation.

Owing to development of device technology, off-pump coronary artery bypass grafting (OPCAB) has become a safe, reproducible and reliable procedure. Surgeons must understand the advantages and limitations of each device and select appropriate devices in individual case to avoid device-related complication and a waste of cost. The directions and pitfalls of heart positioners, stabilizers and proximal anastomotic devices were described. With the improved heart positioners and stabilizers all coronary targets have been well visualized and accessible, maintaining hemodynamic stability. Automated proximal anastomotic devices and proximal anastomotic assist devices have reduced the occurrence of cerebral complications compared with the side-clamp of the ascending aorta. The appropriate use of devices in OPCAB would be a promising and cost-effective procedure for revascularization of ischemic heart disease.

Isolated tricuspid valve regurgitation (TR) is a rare clinical entity. We report 2 patients, 80 and 74-year-old with isolated TR. They underwent valve replacement with the Carpentier-Edwards bioprosthesis because of resistance to medical treatment. The causes of insufficiency were suspected as congenital in case 1 and infective endocarditis in case 2, respectively. Postoperative course was free from major complications in both patients. Valvuloplasty and/or annuloplasty are recommended for TR, however, replacement of the tricuspid valve is sometimes necessary in isolated TR patients. The higher occurrence of thrombosis of mechanical prosthesis in the tricuspid position has been reported. The bioprosthesis in tricuspid position may reduce the rate of thromboembolism, thrombosis and structural dysfunction, therefore it may be an option for radical therapy in isolated TR especially in aged patients.

A 62-year-old man who underwent coronary artery bypass grafting (CABG) [left internal thoracic artery (LITA)-left anterior descending (LAD), saphenous vein graft (SVG) right coronary artery (RCA)] 13 years previously developed angina pectoris and congestive heart failure because of occlusion of SVG and native vessels. Coronary angiography (CAG) revealed that inflow to the coronary artery remained only from LITA. Repeat off-pump CABG (OPCAB) with SVG to the circumflex artery via left thoracotomy was performed. The proximal end of SVG was anastomosed to the left axillary artery because of the porcelain aorta and the patent LITA graft. The patient developed no complications and was discharged from hospital on postoperative day 21. OPCAB for circumflex artery by left thoracotomy is an effective and safe approach in redo CABG, particularly in instances of patent LITA.