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Decellularized tissues have attracted a great deal of attention as regenerating transplantation materials. A decellularizing method based on high hydrostatic pressure (HHP) has been developed, and the preparation of many types of decellularized tissues has been investigated, including aorta, cornea, and dermis. The preparation of a small-diameter vascular graft was studied using a carotid artery from the viewpoint of collagen denaturation and leakage. After HHP, the carotid artery was washed at two washing temperatures (37 and 4°C). Histological evaluation, collagen content measurement and circular dichroism (CD) measurement indicated that the washing temperatures clearly affected the collagen structure of the decellularized carotid artery. The amount of collagen decreased in the carotid artery decellularized by HHP washed at 37°C (HHP/37°C). On the other hand, the amount and structure of collagen were preserved in the carotid artery washed at 4°C after HHP (HHP/4°C). In rat carotid artery syngeneic transplantation, the HHP/37°C decellularized carotid artery occluded after 2 weeks, but the HHP/4°C decellularized one did not. These results indicate that collagen denaturation and leakage of the decellularized carotid artery affect the in vivo performance of the carotid artery.

Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. IPF is associated with an increased risk of lung cancer, and lung cancer patients with IPF undergoing pulmonary resection for non-small cell lung cancer have increased postoperative morbidity and mortality. Especially, postoperative acute exacerbation of IPF (AEIPF) causes fatal status and long-term outcomes are worse than for patients without IPF, although certain subgroups have a good long-term outcome. A comprehensive review of the current literature pertaining to AEIPF and the late phase outcome after the context of a surgical intervention was performed.

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

We have previously proposed a new method of adhesion using the integrated low-level energy sources heat, vibration, and pressure. This adhesion method can be used to attach biological tissue to a metal object. Effects of surface roughness and energy of the metal subject on adhesion performance were studied by using commercially pure titanium (cpTi) and stainless steel (SUS304). Surface roughness and energy were changed by sandblast treatment and heat treatment, respectively. A porcine aorta was adhered to sandblast-treated SUS304 by use of an adhesion temperature of 80 °C, a vibration amplitude of 15 μm, a pressure of 2.5 MPa, an adhesion time of 120 s, and a surface roughness of an Ra 0.25 μm. The shear tensile strength of the adhesion was 0.45 MPa. The adhesion performance was improved by roughening the surface of the metal specimen. Surface energy has an insignificant effect on adhesive strength. The adhesion performance varied depending on metal material for the same surface roughness, Ra, and energy. Results from analysis of the surface roughness profile suggested that the size of surface asperity has an effect on adhesion performance.

We report a case of unroofed coronary sinus (URCS) in a 42-year-old female. At an outpatient clinic, she was found to have an atrioventricular septal defect and mitral regurgitation with pulmonary hypertension, and she was transferred to our institute for surgical treatment. Both atrioventricular valves were located at the same level, and both the right atrium (RA) and right ventricle were enlarged on two-dimensional transthoracic echocardiography. Color Doppler imaging demonstrated severe mitral and tricuspid regurgitation and a left-to-right shunt from the left atrium (LA) to the RA. Although an ostium primum defect of the atrial septum was suspected, the exact position of the shunt flow was unclear. Two-dimensional transesophageal echocardiography (2D-TEE) could visualize a direct communication between the LA and coronary sinus. Three-dimensional transesophageal echocardiography (3D-TEE) clearly visualized the entire route from the coronary sinus into the LA and RA. The utility of 3D-TEE as a modality complementary to 2D-TEE in diagnosis of URCS was confirmed.

Background We examined the effectiveness of right axillary arterial perfusion through an interposed Dacron graft in the prevention of cerebral embolism or complications related to ascending aortic cannulation in open proximal anastomosis technique of descending thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair under deep hypothermic circulatory arrest through left thoracotomy. Methods Between May 2000 and August 2012, 44 patients underwent TAA or TAAA repair using open proximal technique under DHCA. These patients were divided into two groups for evaluation of the effectiveness of right axillary arterial perfusion. Group A included patients who underwent TAA or TAAA repair with ascending aortic cannulation ( n  = 15). Group B was composed of patients who had TAA or TAAA repair with right axillary arterial perfusion through the interposed Dacron graft ( n  = 29). Results Mortality in this series was 4.5 % (2 of 44 patients; 1 in each group); wherein, the causes were sepsis due to graft infection and aortic dissection (Stanford type A). The incidence rates of cerebral embolism were 27 % (4 of 15 patients in group A) and 3.4 % (1 of 29 patients in group B) ( p  = 0.0392, Fisher’s exact test). The rates of complications in relation to the aortic cannulation site (dissection or bleeding) were 13 % (2 of 15 patients in group A) and 0 % (0 of 25 patients in group B). Conclusions Right axillary perfusion facilitates easy evacuation of air and allows prompt recommencement of upper body circulation. Consequently, it minimizes the risk of cerebral embolism or complications in relation to aortic cannulation through left thoracotomy.

Hydrothorax due to pleuroperitoneal communication is a rare complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). One of the problems of this complication is the need to cease CAPD, which means that the patient must shift completely to hemodialysis. Therefore, a quick, minimally invasive, and complete surgical repair of the pleuroperitoneal communication is required. We recently treated a patient who had developed a right hydrothorax soon after the introduction of CAPD. Clinical examination led to a diagnosis of pleuroperitoneal communication. The patient was successfully treated by complete thoracoscopic repair of the communication. We could precisely identify the defective site on the diaphragm using the dye-added CAPD solution method. CAPD was restarted 5 days after the operation, and there was no recurrence of hydrothorax after the operation.

Objective Early thrombosed aortic dissection is a form of aortic dissection and includes the condition called aortic intramural hematoma. It was generally considered as surgical emergency. However, the optimal treatment strategy for acute type A intramural hematoma is becoming controversial after recent studies indicated more benign clinical course for this disease. We evaluated our strategy that integrated medical therapy, serial imaging, and timed surgery. Methods We reviewed 34 consecutive patients who were admitted to our hospital for early thrombosed Stanford type A acute aortic dissection from 2006 to 2011. Medical therapy or timed surgery was offered on the basis of radiological findings. Emergency or urgent surgery was not considered for a hemodynamically stable patient unless the ascending aortic diameter was ≧50 mm or the thickness of the thrombosed false lumen was ≧10 mm. Follow-up computed tomography was performed to detect a potential progression to aortic dissection. Results During the average follow-up period of 24.3 months, there was no aortic dissection-related mortality. And aortic dissection-related event was not recorded in patients who had surgical repair; however, in patients who did not have surgery, 3 (8.8 %) surgical conversions were recorded due to aortic dissection progression during the follow-up period. Twenty-one patients (61.8 %) ultimately had surgical repair, and 13 patients (38.2 %) had complete medical therapy. The overall survival rate at 3 years was 86.5 %. Conclusions Our strategy for the treatment of early thrombosed Stanford type A acute aortic dissection is reasonable, and the mid-term results were acceptable.

The aim of this study was to investigate the effects of pressure load (pulmonary arterial pressure) on the long-term durability of second-generation xenobioprostheses in the pulmonary position in young adults. Thirteen patients survived pulmonary valve replacement for pulmonary regurgitation using the second-generation aortic porcine bioprosthesis at Sapporo Medical University School of Medicine between 1985 and 2009. The mean age at pulmonary valve replacement was 40.5 years, and the mean prosthetic valve size was 25.3 mm. Two patients developed structural valve deterioration 6 and 9 years, respectively, after pulmonary valve replacement. Both prosthetic valves with structural valve deterioration were subjected to long-term high levels of pressure load. No valve structural failure was observed in the remaining 11 patients who experience low-pressure load during a mean follow-up period of 11.9 years. The freedom from structural valve deterioration at 15 years was 75.8% for the overall population, but 100% for those with low-pressure load. Our findings suggest that the long-term durability of pulmonary-site bioprosthetic valves in young adult patients is promising but that pressure load might be a risk of the limited durability of the valve.

The use of drug-eluting stents (DES) reduces the risk of repeat revascularization without increase of death and myocardial infarction compared to standard bare metal stents. However, in-stent restenosis (ISR) after DES implantation still occurs. Here, we report a rare case with a diffuse ISR after CYPHER ® stent implantation because of chronic inflammation and hypersensitivity reactions, confirmed by pathohistological findings.