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AbstractBackground:Cardiac dysfunction, arrhythmia, and hepatic fibrosis are well-known complications after right heart bypass surgery in patients with single-ventricle physiology. However, little is known about coronary arterial fistulae, and only a few reports have been published. This study aimed to elucidate the clinical characteristics of these rare coronary arterial fistulae that developed as complications in cases of single-ventricle physiology after right heart bypass surgery.Methods:We retrospectively investigated the clinical features and courses of patients who developed acquired and progressive coronary arterial fistulae after right heart bypass surgery in our hospital.Results:We identified three cases of coronary arterial fistulae out of 21 patients who underwent right heart bypass surgery. All three cases underwent cardiac catheterisation for post-operative evaluation and were administered pulmonary vasodilators of phosphodiesterase type V inhibitors, antiplatelet, anticoagulation, and diuretics. Moreover, they had common clinical features such as right-dominant single ventricle and long-term exposure to chronic hypoxia. Serial angiograms revealed acquired and progressive coronary arterial fistulae. In addition, coronary arterial fistulae contributed to their symptoms of heart failure.Conclusion:Patients with chronic hypoxia and dominant right ventricle, who are treated with phosphodiesterase type V inhibitors, should be followed up after right heart bypass surgery to monitor the possible development of coronary arterial fistulae. Moreover, the indication for pulmonary vasodilators in single-ventricle physiology after right heart bypass surgery should be optimised to avoid adverse effects.

Herein, a practical synthesis of the macaranoyl group contained in ellagitannins, i.e., a C–O digallate structure with a tetra-ortho-substituted diaryl ether bond, is described. The methodology involved an oxa-Michael addition/elimination reaction between a brominated ortho-quinone monoketal and a phenol with a hexahydroxydiphenoyl moiety in the presence of 18-crown-6 under dark conditions, followed by reductive aromatization. The existence of rotamers originating from the constructed ether moiety is discussed as well.

Introduction:A novel synthetic hybrid warp-knit with non-biodegradable (polyethylene terephthalate: PET) and biodegradable (poly-L-lactic acid: PLLA) yarns coated with crosslinked gelatin (OFT) has been used to induce in situ canine aortic wall regeneration. A recent pivotal clinical trial in Japan revealed the effectiveness and safety of this approach in pediatric cardiac surgery.Hypothesis:The regenerated aortic wall will show long-term extensibility with tissue maturation as the biodegradable yarns dissolve.Methods:An oval-shaped defect created in the canine descending aorta was filled with a patch using OFT or a currently used material (ePTFE or bovine pericardium). At 2 to 4 years after implantation, the patch-implanted aorta was explanted for histological examination and stretch-testing.Results:OFT induced a well-matured aortic wall characterized by a layered endothelium and an intima of aligned collagen fibers and smooth muscle. Bridging tissues containing capillaries developed across the remaining non-absorbable yarns. Material degradation indicated by calcium deposition was not apparent in the OFT-regenerated wall, but was clear in walls generated by currently used materials, in which only avascular collagen layers developed. The OFT-regenerated wall maintained physiological strength and was extensible by 80 to 200% of the starting width.Conclusions:The aortic wall regenerated over the OFT patch continued to mature without material degradation in the long term and showed favorable extensibility that could not be achieved with currently used materials. These long-term findings provide strong support for the suitability of use of OFT as a surgical material in pediatric cardiac surgery.