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A 63-year old lady who had a history of aortic and mitral valve replacement developed acute cardiac failure and haemolysis. Four-dimensional computed tomography revealed an obvious stuck aortic mechanical valve leaflet (Figs 1 and 2, Supplementary Videos 1 and 2). The patient underwent an emergency aortic valve replacement and was discharged 2 weeks after surgery. Supplementary material (Video 1 and Video 2) is available at EJCTS online.

Background The temperature at circulatory arrest during open distal anastomosis is the most significant issue for aortic arch repair. In many institutions, there has been trend toward raising the temperature during circulatory arrest. Methods Between 2004 and 2011, 164 consecutive patients underwent aortic arch repair with antegrade selective cerebral perfusion (ASCP) and moderate hypothermia. The patients were divided into two subsets (n = 84 each): group A (circulatory arrest at less than 27.9°C) and group B (at more than 28°C). Results In group A compared with group B, mean temperature at circulatory arrest was 26° ± 1.0°C vs 29° ± 1.0°C, mean ASCP time was 72 ± 23 minutes vs 67 ± 17 minutes, and mean circulatory arrest time was 47 ± 21 minutes vs 44 ± 13 minutes. The 30-day mortality was 6.1% in both groups. Permanent neurologic deficit occurred in 8 patients (9.8%) in group A and in 5 (6.1%) in group B ( p = 0.39). The incidence of renal failure requiring hemodialysis was 14.6% in group A and 3.6% in group B ( p = 0.02). Postoperative respiratory failure requiring mechanical ventilation exceeding 3 days occurred in 12.2% of patients in group A and in 7.3% in group B ( p = 0.04). Conclusions The temperature during ASCP can be safely increased to more than 28°C without increasing the rate of mortality and morbidity. ASCP with moderate hypothermia offered sufficient cerebral and distal organ protection.

Etofenprox 1 (experimental code number : MTI-500) is a new synthetic insecticide discovered and developed by Mitsui Toatsu Chemicals, Inc.In 1978, we began searching a compound with low toxicity to fish as to be used in paddy fields, and after two years, we found a second lead compound 16. We tried to optimize the skeleton of compound 16, and as a result, 2- (4-ethoxyphenyl) -2-methylpropyl 3-phenoxybenzyl ether was selected as a candidate for development. It is now registered for agricultural use in Japan and some countries in Southeast Asia. Etofenprox 1 is low in acute mammalian toxicity and fish toxicity, and has several favorable properties compared with conventional insecticides.

Etofenprox 1 (experimental code number : MTI-500) is a new synthetic insecticide discovered and developed by Mitsui Toatsu Chemicals, Inc.In 1978, we began searching a compound with low toxicity to fish as to be used in paddy fields, and after two years, we found a second lead compound 16. We tried to optimize the skeleton of compound 16, and as a result, 2- (4-ethoxyphenyl) -2-methylpropyl 3-phenoxybenzyl ether was selected as a candidate for development. It is now registered for agricultural use in Japan and some countries in Southeast Asia. Etofenprox 1 is low in acute mammalian toxicity and fish toxicity, and has several favorable properties compared with conventional insecticides.

Irrigation and packing with iodoform gauze are often employed for the treatment of mediastinitis after heart surgery. Using this procedure we experienced a case of a patient, who suffered from iodine toxicity. The patient was a 78-year-old male who underwent off-pump coronary artery grafting, using bilateral internal mammary artery. He suffered from mediastinitis and was treated with irrigation and packing with iodoform gauze. The patient gradually entered into a stupor. Brain computed tomography revealed no abnormal findings. However, the serum iodine concentration was significantly high. Therefore, we stopped the iodoform gauze packing, and the neurological findings improved as the serum iodine concentration decreased.

Tricuspid atresia (TA) coexisting with common arterial trunk (CAT) is extremely rare, and successful surgical treatment has been reported in only one case until now. We have recently performed surgical treatment for TA with CAT on a 6-year-old boy using the staged Fontan procedure.

Traumatic pseudoaneurysm is usually located at the aortic isthmus. We undertook surgical repair of a traumatic pseudoaneurysm located at the distal part of the descending aorta.

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2007.02.008. Fig. 1. The view of On-X valve from ascending aorta in systole and diastole. Surface of the mechanical valve leaflets could be seen clearly without contrast medium. They opened symmetrically and the opening angle of this artificial valve was appropriate. Fig. 2. The motion of the left ventricle and mechanical valve motion could be evaluated simultaneously.

Coronary artery bypass grafting was performed successfully on a patient by anastomosing the left internal thoracic artery and its pericardiacophrenic branch to the obtuse marginal and the posterior descending coronary artery, respectively, to form a Y graft. Preoperative angiography of the internal thoracic artery had revealed the presence of an unusually large pericardiacophrenic branch almost the size of the main trunk, which allowed us to plan for bifurcated artery grafting.

A 34-year-old man with protein S deficiency and deep vein thrombosis was admitted to our hospital because of chest discomfort. Transthoracic echocardiography demonstrated mobile hyperechoic masses in the right and left atria (Figure 1). Contrast-enhanced, ECG-gated, multidetector-16 row CT (Aquilion 16, Toshiba) revealed homogeneous lesions located on the atrial septum in both the right and left atria (Figure …

The remodeling process of the decellularized allograft after implantation remains unclear. Herein, the hemodynamics, recellularization and immunological response of the decellularized allograft were evaluated at four weeks after implantation in a mini-pig model, and compared with a cryopreserved allograft.Six porcine pulmonary allografts were harvested from mini-pigs, and cryopreserved for four weeks. In two pigs, the grafts were decellularized with Triton X solution, after which static reseeding of the valve surface was performed for 48 h with autologous endothelial cells harvested from a leg artery. Decellularization, but not reseeding, was carried out in two mini-pigs, and cryopreservation alone in two mini-pigs. Whilst under right heart bypass, the right ventricular outflow tract was replaced in six minipigs. The grafts were explanted after four weeks; analysis included direct pressure measurement, echocardiography, macroscopy, light microscopy with hematoxylin and eosin staining, and immunohistochemical studies to identify macrophages, T lymphocytes, and endothelial cells.Hemodynamically and macroscopically, there were no major differences between the three groups. In the cryopreservation-only group, immunohistochemistry showed an influx of macrophages, and T lymphocytes at the cusps. Endothelial cell coverage was found in the decellularized and decellularized + cell-seeded groups, but no macrophages and T lymphocytes were found at the cusps.Decellularization of the cryopreserved allograft may reduce the inflammatory response and improve its long-term durability.

Objective: Right axillary artery (AxA) perfusion, which can prevent cerebral embolism caused by retrograde perfusion via the femoral artery (FA), was used for selective cerebral perfusion (SCP) as well as cardiopulmonary bypass (CPB) in aortic arch repair. We review the outcome of aortic arch surgery using SCP with right AxA perfusion to clarify its efficacy. Method: Between 1998 and 2002, 120 patients underwent aortic arch repair using SCP with right AxA perfusion. The mean age was 69 ^ 10 years. Aneurysms were atherosclerotic in 79, dissecting in 32, and others in nine patients. Twenty of them (16.7%) required emergency surgery. CPB was initiated with right AxA and FA perfusion, and following SCP was established using right AxA and left common carotid artery perfusion. Results: With right AxA perfusion, hospital mortality was 5.8%. Multivariate analysis showed only ruptured aneurysm was an independent determinant for hospital mortality. Permanent neurological dysfunction developed in one patient (0.8%), while seven (5.8%) suffered from temporary one. In univariate analysis, SCP time, stenosis of the carotid arteries, past history of cerebrovascular events, and atherosclerotic aneurysm were not related to temporary neurological deficits Conclusion: Right AxA perfusion in conjunction with SCP is a safe and useful alternative for brain protection in total arch replacement. q 2003 Elsevier Science B.V. All rights reserved.

Figure 1: Preoperative computed tomography showed hourglass type of supravalvular aortic stenosis and aneurysmal changes of the innominate and the left subclavian artery. When she underwent ventricular septal defect repair at the age of 4 months, transverse aortotomy was made for evaluating a bicuspid aortic valve. Probably the transverse aortotomy was closed by a continuous suture, which, by definition, could not develop and grow with time, resulting in a tight aortic stenosis. Figure 2: Postoperative computed tomography after aortic root replacement with mechanical-valved conduit and total arch replacement with a fourbranched graft. The patient tolerated the procedure well and was discharged 2 weeks after surgery.

We experienced a rare case of ruptured left ventricular pseudoaneurysm penetrating into the left pleural cavity. A 77-year-old woman was first diagnosed with unstable angina due to sudden chest pain onset and abnormal electrocardiographic findings. In 2 days, massive left pleural effusion was recognized by chest X-ray, though subsequent computed tomographic scans did not show any aortic pathology. We observed her with left thoracentesis alone. Two days later, cardiac arrest suddenly occurred and emergency surgery was undertaken after resuscitation by percutaneous cardiopulmonary support. In surgery, a moderate amount of intrapericardial hematoma caused by rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity was found and successfully repaired. This rare rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity generated massive hemo-hydrothorax.

A 55-year-old healthy man was referred to our hospital after a cardiac tumor was detected incidentally by echocardiography during a routine medical checkup. The patient was asymptomatic and had no particular medical and family history. Echocardiography revealed an echogenic mass (14 mm 15 mm) attached to the right ventricular posterior wall (Fig 1A). Further assessment by a 256-row computed tomography showed a well-defined solid mass in the right ventricle. Contrast medium administration showed inhomogeneous enhancement (Fig 1B). Coronary angiography revealed no significant coronary artery stenosis or tumor blushing.

We read with great interest the article by Urbanski et al. [1] about aortic arch surgery using a mild-to-moderate hypothermic circulatory arrest. They evaluated a large series of patients who underwent aortic arch surgery in an elective setting. The mean temperature at circulatory arrest was 29.9°C and the mean duration of circulatory arrest was only 18 min. Surgical results were remarkable. Thirty-day mortality was only 0.9%, permanent neurological deficits and temporary neurological deficits were both also 0.9%, respectively, and there was no paraplegia. They showed quite a low incidence of postoperative acute renal failure and respiratory failure. In this series, an acute aortic dissection was excluded and most of the patients’ indication for surgery was degenerative or atherosclerotic disease. Interestingly, 299 (86%) patients had aortic valve disease and 312 (90%) patients underwent concomitant aortic valve surgery, although the reports of other large series showed that only 8% of patients had an aortic root replacement and 3.8% of patients had an aortic valve replacement [2]. Probably, in these authors’ report, many patients had aortic valve stenosis and/or regurgitation with an ascending aortic aneurysm. For this pathology, it is often an aneurysm which extends to the proximal aortic arch; therefore, sometimes a proximal arch replacement is required in addition to aortic valve or root surgery. In this setting, open distal anastomosis is an appropriate procedure to repair the proximal aortic arch. However, compared to a distal aortic arch aneurysm, the atherosclerotic change in the anastomosis site would be mild and the anastomsis technique would not be as complex and time-consuming. For repairing the distal aortic arch aneurysm, the distal anastomosis site could be deep inside the chest cavity and the aortic arch usually has significant atherosclerotic changes. Therefore, selective cerebral perfusion time and circulatory arrest time could be longer than the proximal arch repair and the risk of permanent neurological deficit could be higher. We believe that it is difficult to generalize the authors’ technique and strategy to all kinds of patient pathologies, because patient characteristics are extraordinary in this report.

(1) The relative stabilities between 17-substituted C/D trans- and cis-fused 11-oxoetiojervanes were investigated by treatment of both or either one of these 12-epimeric compounds under equilibrating conditions. The equilibrium ratios thus obtained were estimated qualitatively in terms of the configuration and bulkiness of substituent(s) at C17. (2) The chemical shifts of 19- and 18-methyl protons in a number of etiojervanes were examined collectively. The “principle of additivity” holds satisfactorily for the 19-methyl protons of all etiojervanes, with two exceptional cases, irrespective of the configuration at C12 and also for the 18-methyl protons of 12β-etiojervanes. However, the principle is not applicable for the latter protons of 12α-etiojervanes, suggesting that the D ring would take different conformations depending on the 17-substituents.

The synthesis of the titled bromohydrooxocin (2), one of model compounds for synthetic approaches to laurencin (1), is described, trans- and cis-2,5-Diethyl-2,5-dihydrofurans (25), prepared by treatment of furan with bromine and then with ethyl magnesium bromide, was submitted, after oxidation with ozone, to the Robinson-Schopf condensation with methylamine to give trans- and cis-2,4-diethylbicyclononanones (19a and 19b), whose configurations were discussed on the NMR spectra. These compounds were converted into trans- and cis-diethylhydrooxocinones (38a and 38b), respectively, according to a six-step process analogous to the Paguette procedure. It is to be noted that (i) thermally induced, intramolecular dienyl 1,5-hydrogen transfer (36 to 37), one of the key reactions in the process, took place without difficulty with cis-aminodiene (36b), while the rearrangement did not proceed smoothly with trans-aminodiene (36a), and (ii) trans-ketone (38a) was isomerized readily into cis-ketone (38b). Further hydrid...

The configurations of C 12 , C 13 (and C 17 ) in an acetolysis product (IVa) of diacetyltetrahydrojervine (IIIa) and its derivatives (Va to VIIIa) have been established. It follows that dihydro- and tetrahydrojervine are correctly represented by formulas II and III, (C/D trans , 12βH) rather than XXXV and XXIX (C/D cis , 12αH), respectively. The stereochemistry of the hydrogenation results of jervine (I) and the related compounds is rationalized on the basis of these formulas and the spectral data. The ORD curves of 12-epimeric 11-oxoetiojervanes and 11-oxoiminojervanes with established configurations are also presented and the summarized result reveals that the amplitudes fall within the limits of −150 ∼ −190° for the C/D trans -fused compounds and of −70 ∼ −100° for the cis -fused.

This paper describes a new optical logic gate for optical digital processing and computing in parallel. The gate is developed from the logic gate that uses two spatial light modulators based on the Pockels effect (PROM device) and consists of a linear polarizer, analyzers, and three PROM devices. The gate can perform the sum and the carry operations in a full-adder circuit for binary variables and various logic functions of two or three binary variables. The gate has wide potential use and the capability of operating on large arrays of binary variables.

The syntheses of C-nor-D-homo-cortisone 21-acetates (XIX and XVI), one of which possesses the cortisone configuration at each of the ring junctions has been described. Treatment of etiojerv-5-en-3β-ol-3,11-dione (III), obtained by degradation of jervine (I), with ethynylmagnesium bromide yielded stereoisomeric 17-ethynylcarbinols VII and VIII. Spectral and chemical studies show that (i) both the compounds possess C/D- trans and 13β-Me configurations and (ii) the 17-ethynyl group is oriented β in VII and α in VIII. Partial hydrogenation of VII in the presence of Lindlar catalyst gave rise to 17-vinylcarbinol XI, which on Oppenauer oxidation was converted into Δ 4 -3-ketone XIII. Compound XIII was then derived, by oxidation with osmium tetroxide followed by partial acetylation, into C/D trans - and C/D cis -fused 20,21-glycol 21-acetates XIV′ and XIV, although the former was not isolated in pure state. Oxidation of the acetates with Jones reagent led to formation of XIX and XVI, The configurational assignments for both compounds are based on spectral and chemical evidence.

This paper describes applications of an optical logicgate consisting of three spatial light modulators with the Pockels effect to fundamental components in an optical digital computing system. An SR flip-flop, data sampler, and decoder are proposed, and simple experimental results for these components are shown. The components are the most fundamental ones in a digital computing system and have many applications to various digital circuits..