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Dual-energy subtraction (DES) imaging can obtain chest radiographs with high contrast between nodules and healthy lung tissue, and evaluating of chest radiography and evaluating exposure conditions is crucial to obtain a high-quality diagnostic image. This study aimed to investigate the effect of the dose allocation ratio of entrance surface dose (ESD) between high- and low-energy projection in low-contrast resolution of soft-tissue images for two-shot DES imaging in digital radiography using a contrast-detail phantom (CD phantom).A custom-made phantom mimicking a human chest that combined a CD phantom, polymethylmethacrylate square plate, and an aluminum plate (1-3 mm) was used. The tube voltage was 120 kVp (high-energy) and 60 kVp (low-energy). The ESD was changed from 0.1 to 0.5 mGy in 0.1 mGy increments. Dose allocation ratio of ESD between 120 kVp and 60 kVp projection was set at 1:1, 1:2, 1:3, and 2:1. Inverse image quality figure (IQFWhen the total ESD and aluminum thickness were constant, no significant difference in IQFUsing IQFThe present results provide useful information for determining exposure conditions for two-shot DES imaging.

Background Unlike age, frailty is often not taken into account in treatment indications of Endovascular treatment (EVT). One of the reason is that there was little known the relationship between frailty and the outcome of EVT for super elderly patients with peripheral artery disease (PAD). We investigate impacts of frailty on the super elderly patient prognosis who underwent EVT. Purpose To investigate impacts of frailty on the super elderly patient prognosis who underwent EVT. Methods From August 2015 to July 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we selected and analyzed 91 super elderly PAD patients (≥80 years-old) and divided them into two groups:those with moderate or higher frailty (Clinical Frailty Scale (CFS) ≥6, n=28) and those without (CFS ≤5, n=63). The primary endpoints were cardiovascular death and major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation and revascularization. Results The median follow-up period was 2.7 years. Freedom rate from cardiovascular death and MACLE were significantly lower among patients with moderate or higher frailty than among those without (47.0% vs. 58.0%, P=0.03; 39.1% vs. 68.5%, P Conclusion The prognosis of super elderly patients with moderate or higher frailty is worse than those without. Funding Acknowledgement Type of funding source: None

Background Although catheter ablation of atrial fibrillation (AF) has recently been shown to improve the cardiac function and even mortality in patients with heart failure (HF) and reduced ejection fraction (HFrEF), few studies have examined the outcomes of AF catheter ablation in patients with HF with preserved ejection fraction (HFpEF). Purpose To verify the impact of AF catheter ablation on the cardiac function and HF status in patients with HFpEF. Methods We studied 306 patients with HF who had a history of an HF hospitalization and/or preprocedural serum BNP levels >100pg/ml (age, 68.9±8.2 years old; male, 66.3%; non-paroxysmal AF, 63.1%, left atrial diameter [LAD], 42.5±6.3 mm; left ventricular ejection fraction [LVEF], 60.6±12.0%) out of 596 consecutive patients who underwent pulmonary vein isolation-based catheter ablation of AF. The patients with an LVEF ≥50% were defined as having HFpEF (n=262; age, 69.0±8.2 years old; male, 64.5%; non-paroxysmal AF, 61.8%, LAD, 42.1±5.9 mm; left LVEF, 64.0±8.2%) and the remaining patients with an LVEF Results AF recurred in 60 patients with HFpEF (22.9%) and in 14 with HFrEF (31.8%) during the 12 month follow-up (p=0.27), however, sinus rhythm was maintained at 12 months in most of the patients (253 patients with HFpEF [96.6%] and 42 patients with HFrEF [95.5%]) (p=0.71). Figure 1 compares the changes in the cardiac function parameters and NYHA functional class from baseline to the 12-month follow-up stratified by the HF subgroup. Both the patients with HFpEF and HFrEF had significant improvements in the serum BNP levels, chest thorax ratio, and LVEF determined by echocardiography. LA reverse remodeling as shown by a significant reduction in the LAD was observed in both HF subgroups, however, the E/E', an index of the LV diastolic function, did not significantly change in either of the subgroups. Similar to the patients with HFrEF, an improvement in the NYHA functional class was seen in those with HFpEF. Conclusions Catheter ablation of AF may benefit patients with HFpEF as well as those with HFrEF. Sinus rhythm maintenance achieved by AF catheter ablation in patients with HFpEF may lead to LA reverse remodeling and a better LV systolic function, thereby improving the NYHA functional class. It is unclear whether changes in the LV diastolic function may contribute to this favorable process. Funding Acknowledgement Type of funding source: None

Introduction Long-acting loop diuretics have a possibility of better prognosis compared to short-acting loop diuretics in patients with heart failure with preserved ejection fraction (HFpEF). Purpose To investigate the effect of long- and short-acting loop diuretics in patients with HFpEF. Methods From the Clue of Risk Stratification in Patients With Heart Failure Registry (CURE-HF Registry), we enrolled 301 consecutive patients with HFpEF (median age, 84 years; 55% female). Long-acting loop diuretics (azosemide) were administrated in 127 patients, and short-acting loop diuretics (furosemide) in 174 patients. We constructed Cox models for MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure [HF] hospitalization). Results During a median follow-up of 317 [174–734] days, the primary endpoint occurred in 129 patients (42.8%). On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, patients treated with long-acting loop diuretics had a significantly lower incidence of adverse events than those treated with short-acting loop diuretics (hazard ratio [HR], 0.39; 95% confidence interval [CI] 0.23–0.67; P=0.001). Furthermore, on multivariate IPTW Cox modeling for the secondary endpoints, all-cause mortality (HR, 0.50; 95% CI, 0.20–0.80; P=0.01) and unplanned hospitalization for decompensated HF (HR, 0.50; 95% CI, 0.28–0.89; P=0.018) were also reduced in patients treated with long-acting loop diuretics. Conclusions Long-acting loop diuretics reduced the risk of MACE compared to short-acting diuretics in patients with HFpEF.

Background Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and interact to initiate and perpetuate each other. Several retrospective or small cohort studies have suggested that successful catheter ablation of AF may help to waive device implantations in patients with paroxysmal AF plus SSS, however, no prospective large studies are so far available on this scenario. Purpose We aimed to elucidate the device implantation-free survival after catheter ablation of paroxysmal AF with coexisting SSS in a prospective large-scale registry. We also determined the risk factors for device implantations after catheter ablation of paroxysmal AF. Methods The Kansai Plus Atrial Fibrillation (KPAF) study is a multi-center prospective registry that enrolled 5,019 consecutive patients that underwent an initial pulmonary vein isolation-based radiofrequency catheter ablation of AF. This study was comprised of 3,226 patients with paroxysmal AF registered in the KPAF study (age, 64.8±10.5 years old; female, n=999 [31.0%]; left atrial diameter [LAD], 37.5±8.0 mm; left ventricular ejection fraction [LVEF], 65.3±8.4%, CHADS2 score, 1.09±1.05). The atrial tachyarrhythmia-free and device-free survivals after catheter ablation were compared between patients with SSS (n=368; tachy-brady syndrome, 88%) and without SSS (control; n=2,858). Results The atrial tachyarrhythmia-free survival was almost identical between the two groups both after the first ablation session (Fig.1A) and after the last procedure with an average of 1.3±0.5 sessions. At baseline, the devices had already been implanted in 53 (14.4%) SSS and 36 (1.3%) control patients. In the remaining patients, devices were newly implanted in 54 (17.1%) SSS and 62 (2.2%) control patients during the follow-up of 3 years after the catheter ablation (Figure 1B). In the SSS group, devices were implanted predominantly within 6 months after the catheter ablation, and atrial tachyarrhythmia recurrence preceded the device implantation in 48 (89%) patients. Multivariate predictors of device implantations after the paroxysmal AF ablation included: SSS (hazard ratio [HR] 6.85, 95% confidence interval [CI] 4.61–10.19, p75 years old (HR 1.69, 95% CI 1.08–2.64, p=0.019), a female gender (HR 2.16, 95% CI 1.44–3.24, p Figure 1 Conclusions Device implantations could be waived in >80% of patients with SSS at 3 years of follow-up after the catheter ablation of paroxysmal AF in this real world all comer prospective registry. In addition to coexisting SSS, predictors of device implantations after paroxysmal AF ablation included: the elderly, a female gender, a large LA, and a reduced LVEF. Acknowledgement/Funding None

Short-channel effects in SiC MOSFETs have been investigated. Planar MOSFETs with various channel lengths have been fabricated on p-type 4H-SiC (0001), (000-1) and (11-20) faces.^Short-channel effects such as punchthrough behavior, decrease of threshold voltage and deterioration of subthreshold characteristics are observed. Furthermore, the critical channel lengths below which short-channel effects occur are analyzed as a function of p-body doping and oxide thickness by using device simulation. The critical channel lengths in the fabricated SiC MOSFETs are in agreement with those obtained from the device simulation. The results are also in agreement with the empirical relationship for Si MOSFETs.

Design and fabrication of lateral SiC reduced surface field (RESURF) MOSFETs have been investigated. The doping concentration (dose) of the RESURF and lightly doped drain regions has been optimized to reduce the electric field crowding at the drain edge or in the gate oxide by using device simulation. The optimum oxidation condition depends on the polytype: N/sub 2/O oxidation at 1300/spl deg/C seems to be suitable for 4H-SiC, and dry O/sub 2/ oxidation at 1250/spl deg/C for 6H-SiC. The average inversion-channel mobility is 22, 78, and 68 cm/sup 2//Vs for 4H-SiC(0001), (112~0), and 6H-SiC(0001) MOSFETs, respectively. RESURF MOSFETs have been fabricated on 10-/spl mu/m-thick p-type 4H-SiC(0001), (112~0), and 6H-SiC(0001) epilayers with an acceptor concentration of 1/spl times/10/sup 16/ cm/sup -3/. A 6H-SiC(0001) RESURF MOSFET with a 3-/spl mu/m channel length exhibits a high breakdown voltage of 1620 V and an on-resistance of 234 m/spl Omega//spl middot/cm/sup 2/. A 4H-SiC(112~0) RESURF MOSFET shows the characteristics of 1230 V-138 m/spl Omega//spl middot/cm/sup 2/.

The dynamic behavior of oil films formed between a band-shaped nitrile rubber specimen with a D-shaped or lip-shaped cross section and an oscillating glass plate is directly observed by means of the mono-chromatic optical interferometry technique. The friction force is also measured. The effects of the cross sectional shape of the seal and the length of the stroke on the film formation and friction characteristics are discussed together with the effects of surface defects. On the basis of analyses of experimental data, the conditions which bring about the film collapse are clarified. It is also claimed that the distinction of lubrication modes by the Stribeck curve might be reconsidered. [S0742-4787(00)02304-3]

For a selective excitation of spin-flip strength, ( 6 Li, 6 He) reactions can be a useful tool, because: a) 6 Li and 6 He have ground-state spin and parity values J π = 1 + and 0 + , respectively; b) 6 He has no particle-stable excited state, thus effects from ejectile excitation can be avoided. The ( 6 Li, 6 He) experiments were performed at 100 MeV/nucleon, at which incident energy the reaction is expected to be single-step dominant. Through the analysis of the good-resolution ( 6 Li, 6 He) data on 13 C, 26 Mg, 27 Al and 58 Ni targets, the evidence for a proportional relationship between 0° cross sections and the corresponding Gamow-Teller transition strengths is examined. Suppression of non-spin flip excitations is discussed based on the hindrance of the excitation of the isobaric analog state.

Primary knock-on atom (PKA) energy spectrum extends up to several hundreds of keV in fusion reactor materials irradiated with 14 MeV neutrons. When we are going to evaluate materials behavior in an expected d-Li type intense neutron source, fundamental knowledge on effects of high energy PKA on formation of cascade damage, microstructural evolution and properties of irradiated materials is required. In this study, 170 MeV self-ion irradiation of thin foils of gold were performed to estimate effects of very high energy PKA on formation of defect clusters by cascade damage and its interactions. Defect clusters of vacancy type were observed in the thin foils of gold irradiated to 5 × 10 13 –1 × 10 15 ions/m 2 . In the case of irradiation with 170 MeV self-ions of which the projected range exists at 6.3 μm from the ion incident surface, films of gold, 1.1, 3.0, 4.3, 6.3 and 7.2 μm in thickness, were placed in front of the 50 nm thick specimens to change PKA energy spectrum within the specimens. The number of vacancy clusters within a cluster group formed by a PKA varied with the thickness of gold film. High energy PKA was found to increase the number of defect clusters. However, size distributions of defect clusters were not strongly dependent on PKA energies. Interactions of high energy cascades result in the appearance of new defect clusters near the existing defect cluster groups in the higher dose range. Dose dependence of defect cluster density was similar to that observed in 14 MeV and fission neutron irradiated specimens. The contribution of PKA higher than 400 keV to the interactions of cascades is estimated from the calculated PKA energy spectrum and low energy self-ion irradiation data.

MgF2 composite films with Ag or Au nanoparticles were prepared by a sol-gel method. Absorption spectra due to the surface plasmon resonance are analyzed based on the dielectric analysis considering the effective medium approximation.

To understand cascade damage formation as a function of primary recoil energy, thin foils of gold were irradiated with 20–400 keV self-ions to a fluence of 1.0 × 10 14 ions/m 2 at 300 K. The yield of groups of vacancy clusters per irradiated ion saturated at an ion energy higher than 100 keV. The number of clusters in a group was found to vary even for the same energy ions. The size distribution of the clusters was not strongly dependent on the number of clusters in a group and the ion energy. An attempt was made to predict the distribution of defect clusters in thin foils of gold irradiated with 14 MeV neutrons from the present data based on a primary recoil energy spectrum.

Time course studies of electrocochleography and the auditory brain stem response were performed in guinea pigs that were passively sensitized by sera containing antidinitrophenyl reaginic antibody and specifically challenged by dinitrophenyl—bovine serum albumin injected through the stylomastoid foramen. A negative summating potential on electrocochleography was observed from 12 to 48 hours, but not at 72 hours, after the specific challenge. A threshold increase on the auditory brain stem response was observed 15 minutes after the specific challenge; the threshold recovered to the prechallenge level within 7 days. Further, we used Tranilast, a blocking agent of chemical mediator release from mast cells, before the specific challenge. A negative summating potential and head deviation were not observed after the use of this agent. These results suggest that the auditory change provoked in the inner ear of the sensitized guinea pig may have been induced by type I allergy.

Guinea pigs were passively sensitized by sera containing antidinitrophenyl reaginic antibody and specifically challenged by dinitrophenyl-bovine serum albumin injected through the stylomastoid foramen. Nystagmus, head deviation, negative summating potentials on electrocochleography, and an increase of threshold and wave I peak latency on auditory brain stem response testing were observed after local challenge. These physiologic changes were reversible and resolved within several days. We also used Tranilast before the specific challenge. It is a blocking agent of chemical mediator release from mast cells. Negative summating potentials and head deviation were not observed after the use of this agent. In the animals that showed physiologic changes, we observed endolymphatic hydrops, mast cell degranulation, and eosinophil infiltration histologically in the challenged side of the inner ear. These results suggest that the physiologic and histologic changes provoked in the inner ear of the sensitized animals may have been induced by type I allergy.

Isospin is a good quantum number under the assumption that the nuclear interaction is charge independent. An analogous structure of excited states is expected for nuclei with the same mass number A but with different z components T{sub z} of the isospin T, where T{sub z}=(N-Z)/2. The analogous structure has been studied for the isobaric nuclei {sup 58}Ni and {sup 58}Cu by comparing the transitions from the {sup 58}Ni ground state (initial isospin T{sub i}=1 and J{sup {pi}}=0{sup +}) to the M1 and the Gamow-Teller (GT) states (J{sup {pi}}=1{sup +}) in {sup 58}Ni and {sup 58}Cu, respectively. For this purpose, proton inelastic scattering (p,p{sup '}) at E{sub p}=160 MeV and the charge-exchange ({sup 3}He,t) reaction at 140 MeV/nucleon were both measured at 0 deg., exciting final states with isospin T{sub f}=1 and 2 and T{sub f}=0, 1, and 2, respectively. High energy and scattering-angle resolutions were achieved by applying complete beam matching techniques. On the basis of the correspondence between excitation energies and transition strengths, isospin values T{sub f}=1 and 2 of analog GT and M1 states were identified. The distribution of T{sub f}=2 states was also compared with results of {sup 58}Ni(d,{sup 2}He), {sup 58}Ni(t,{sup 3}He), and {sup 58}Ni(n,p)more » experiments, in which only T{sub f}=2 states are excited. The obtained GT strength distribution is compared with the results of shell-model calculations.« less

Silicon carbide (SiC) has attracted increasing attention as a promising wide bandgap semiconductor projected to high-power and high-temperature electronics. Although SiC MOSFETs are recognized as ideal power switches, SiC MOSFETs have still suffered from low effective channel mobility. In recent years, post-oxidation nitridation in an NO ambience is widely used to improve SiO/sub 2//4H-SiC(0001) interface properties and thereby to increase effective channel mobility of MOSFETs as presented in S. Dimitrijev et al. (1997) and G. Y. Chung et al. (2001). Direct oxidation with N/sub 2/O has been also proposed as an alternative to form the "nitrided" MOS interface for the safety reason according to L. A. Lipkin et al. (2002). In this study, the interface state density and MOSFET performance have been investigated on 4H-SiC(0001), (000-1), and (11-20) stated in H. Yano et al. (1999) by using N/sub 2/O oxidation. Effects of doping concentration in the p-body on MOSFET performance are discussed.

4H-SiC(0001), (000-1), and (11-20) have been directly oxidized by N2O at 1300°C, and the MOS interfaces have been characterized. The interface state density has been significantly reduced by N2O oxidation on any face, compared to conventional wet O2 oxidation at 1150°C. Planar n-channel MOSFETs fabricated on lightly-doped 4H-SiC(0001), (000-1) and (11-20) faces have shown an effective channel mobility of 26, 43, and 78 cm2/Vs, respectively. The mobility decreased with increasing the doping concentration of p-body. SIMS analyses have revealed a clear pile-up of nitrogen atoms near the MOS interface. The thickness of interfacial SiCxOy layer can be decreased by utilizing N2O oxidation. The crystal face dependence of interface structure is discussed.

For the successful application of a genetic algorithm (GA) to the traveling salesman problem (TSP), a suitable distance between two Hamiltonian circuits on a complete graph is useful to estimate the problem landscape. This paper presents a new distance between two Hamiltonian circuits, or phenotypes. The phenotypic distance is defined by the least Hamming distance between isomorphic genotypes. Therefore, it is convenient to analyze and control the behavior of genotypes in the search space. In this paper, a new crossover technique based on the phenotypic distance is also proposed. The crossover technique works together the conventional crossovers arranged for the TSP such as partially mapped (PMX), order (OX) and cycle (CX) crossovers. Because a new child is sure to be located between two parents in the problem space, the local search performance of the conventional crossovers is enhanced with the proposed crossover technique.

Systolic pulmonary venous flow reversal identified by pulsed Doppler echocardiography is useful for the diagnosis of severe mitral regurgitation. The direction of the mitral regurgitant jet in severe mitral regurgitation significantly influences the systolic pulmonary venous flow reversal in an experimental model. This study investigated the influence of the site of mitral valve prolapse on the incidence of systolic pulmonary venous flow reversal in patients with severe mitral regurgitation using transthoracic color Doppler echocardiography.This study included 59 consecutive patients with severe mitral regurgitation (regurgitant fraction50%) due to mitral valve prolapse. Exclusion criteria were left ventricular ejection fraction45%, non sinus rhythms, associated aortic valve disease, bileaflet prolapse, and inadequate Doppler recordings. Right upper pulmonary venous flow was recorded and regurgitant fraction of mitral regurgitation measured by transthoracic color Doppler echocardiography. The sites of mitral valve prolapse were confirmed at operation in all patients.The incidence of systolic pulmonary venous flow reversal was 78% (14/18) in the patients with anterior leaflet prolapse, 82% (9/11) in the patients with medial commissure prolapse, 75% (12/16) in the patients with posterior middle scallop prolapse, 20% (2/10) in the patients with posterior medial scallop prolapse, and 25% (1/4) in the patients with posterior lateral scallop prolapse. There were no significant differences in regurgitant fraction between the five groups. The incidence of systolic pulmonary venous flow reversal was significantly lower in the patients with posterior medial scallop prolapse compared to the other sites of mitral valve prolapse (p0.01).Assessment of the severity of mitral regurgitation by systolic pulmonary venous flow reversal using transthoracic color Doppler echocardiography may be underestimated in patients with prolapse of the posterior medial scallop.

1. The in vivo metabolism of 2-nitrofluorene (NF), an environmental pollutant, and 2-aminofluorene (AF) and its acylated derivatives, 2-formylaminofluorene (FAF) and 2-acetylaminofluorene (AAF), was examined in rat and dog. 2. 7-Hydroxy-2-nitrofluorene, 5-hydroxy-2-nitrofluorene, AF, AAF, FAF, 7-hydroxy-2-aminofluorene, 5-hydroxy-2-aminofluorene, 7-hydroxy-2-acetylaminofluorene, 5-hydroxy-2-acetylaminofluorene, 7-hydroxy-2-formylaminofluorene and 5-hydroxy-2-formylaminofluorene were identified as urinary and faecal metabolites of NF in rat and dog. 3. AAF and its hydroxylated derivatives were detected as major metabolites of NF in rat, but FAF and its hydroxylated metabolites were mainly excreted in dog. 4. AF, AAF, FAF and their hydroxylated metabolites were also identified as urinary and faecal metabolites of AF, AAF or FAF in rat, suggesting that AAF and FAF are interconverted via AF. 5. Treatment of rat and dog with antibiotics significantly decreased the urinary and faecal excretion of AF and its derivatives after oral administration of NF, and partly decreased the excretion of acylated metabolites after an oral dose of AF. 6. The caecal contents of untreated rats and some species of intestinal bacteria exhibited nitro-reductase activity toward NF, and acylating activity toward AF, affording AAF and FAF.

Scanning electron microscopy (SEM) with secondary electron emissions is useful for the study of cardiomyocyte architecture, however, the information is limited from the cell surface. Whereas backscattered electron (BSE) emission can give a high-resolution image of the specimen's intracellular structure after heavy metal staining. In this study, we applied BSE imaging analysis to the study of the arrangement of cardiomyocytes in the myocardium. The tissue specimens from a normal fresh monkey heart, normal human heart obtained at autopsy, and surgically resected tissue from a patient with old myocardial infarction in the left ventricular aneurysmectomy were used. The tissue specimens were fixed in neutral formalin, treated with NaOH and then stained with Gomori's silver methenamine reagent followed by tannic acid and osmium tetroxide. After dehydration and drying, the specimens were coated with carbon and examined by SEM with a BSE detector. In the tissue preparations, the A bands of sarcomeres were selectively stained with silver so that the arrangements of subsarcolemmal myofibrils and the intercalated discs were clearly seen in the BSE images. In the left ventricular aneurysmal walls of old myocardial infarction, atrophied cardiomyocytes with disarray of subsarcolemmal myofibrils were observed. The results strongly suggest that BSE images are further applicable to the study of the architecture of cardiac myocytes and their branches, and the arrangement of intracellular myofibrils in various diseased myocardium.

Recent development of an automated contour tracking (ACT) method using the energy minimization principle provides automated edge detection and tracking of the endocardial boundary of the left ventricle, without tracing a region of interest. This study determined whether left ventricular filling indexes obtained from the ACT method provide a reliable estimate of left ventricular diastolic filling. Fourteen patients were examined by the ACT method and equilibrium radionuclide ventriculography. The volume-time wave form for ACT measurements was obtained from the 4-chamber views. Peak filling rate and time to peak filling rate measured by the ACT method were compared with those determined by radionuclide ventriculography. Peak filling rate and time to peak filling rate by the ACT method were closely correlated with those determined by radionuclide ventriculography (peak filling rate: r = 0.88, y = 0.71x + 0.36, SEE = 0.54 ml/end-diastolic volume/sec, time to peak filling rate: r = 0.89, y = 0.72x + 30.0, SEE = 0.02 msec, respectively) The ACT method is useful for the assessment of left ventricular diastolic filling.

Recognition of the involved lesions is extremely important in mitral valve repair for infective endocarditis. Transesophageal echocardiography (TEE) is more sensitive for the detection of lesions than transthoracic echocardiography, but localization of the lesions is sometimes difficult by TEE. Three-dimensional (3D) TEE provides images of the mitral valve similar to the view from the left atrium. This study evaluated the value of 3D echocardiography for the diagnosis of involved lesions in 12 patients who underwent surgery for mitral regurgitation due to infective endocarditis. The location of the lesion in the mitral valve was classified as the medial, central and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet, respectively. In all patients, the involved sites were confirmed at operation. The sensitivities of 3D TEE for detecting the lesions at the medial, central and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet were 100%, 78% and 67%, and 100%, 100% and 100%, respectively. The specificities were 90%, 100% and 78%, and 100%, 100% and 100%, respectively. The lesions diagnosed by 3D TEE coincided with lesions confirmed at operation in 23 (92%) of 25 lesions. 3D TEE is useful for the assessment of the involved lesion of the mitral valve in patients with infective endocarditis.

Recently, use of heparin-coated circuits during normothermic cardiopulmonary bypass has become a trend in cardiovascular surgery. In light of this, heparin administration protocols during bypass should be reevaluated. In twenty patients who underwent cardiac surgery using a heparin-coated circuit under normothermia, heparin concentration was measured with Hepcon/HMS. Before initiating bypass, 300 IU/kg of heparin was administered with additional heparin to maintain activated clotting time (ACT) at more than 400 seconds. The heparin dose response (HDR) was measured before heparin administration. HDR is a heparin concentration calculated to correspond to an ACT of 480 seconds. As an index of heparin control during bypass, average heparin concentration/HDR (HC/HDR) was calculated. HC/HDR was correlated with Fibrinogen degradation products E (R = -0.52). D dimer (R = -0.45). Thrombin antithrombin complex (R = -0.54). Antithrombin III (R = 0.50) and platelet number (R = 0.44), but not with 24-hour postoperative blood loss. In conclusion, even when using a heparin-coated circuit plasma coagulation activity was not sufficiently suppressed by use of a conventional ACT monitoring protocol during normothermic bypass. Therefore, the maintenance of HC/HDR at a higher level may be indicated.

Since 1994, three patients more than 80 years of age underwent early repair of ventricular septal rupture complicating acute myocardial infarction at our hospital. The infarction exclusion technique introduced by David and Komeda was employed. Average aortic clamp time, cardiopulmonary bypass time and operation time were 83 minutes, 129 minutes and 228 minutes, respectively. No hemostatic suture were required to the left ventricular suture line. All patients survived. One patient with posterior ventricular septal rupture had residual shunt and necessitated transient hemodialysis but recovered. Thus, the infarction exclusion technique seems to be useful in the elderly with unfavorable tissue fragility.

A case of extracardiac noncoronary sinus Valsalva aneurysm was reported. A 11-year-old male with history of mild AR was admitted to the hospital due to severe AR. Echocardiography revealed that the severe AR and an aneurysm in the posterior part of the ascending aorta. Angiography revealed that the origin of the aneurysm was noncoronary sinus. Operative findings showed that the aneurysm sized 23 mm by 25 mm was an extracardiac type which grew posteroinferiorily at the left side of noncoronary sinus and that the dilation. Neither aortic valve nor the aortic route showed degenerative change. The ptosis of the valvular ring due to aneurysmal dilation of the noncoronary sinus caused AR. Then, valve repair composed by commissuroplasty and commissural suspension was carried out. And intraluminal patch closure technique in which the longitudinal diameter of patch was half of that of the aneurysm was effective on suspension of the valvular ring. Postoperative echocardiography showed decreasing of AR.

Purpose: Although Atrial Fibrillation (AF) is commonly seen in patients with acute Myocardial Infarction (MI), clinical implications of the condition have not fully elucidated. Since transition from sinus rhythm to AF in the acute phase of MI may further deteriorate hemodynamics, the study objective was to elucidate the impact of new-onset AF on prognosis of acute MI patients. Methods: The study included 722 consecutive patients with acute MI. During index hospitalization period, AF was documented in 113 patients (AF group). The remaining 609 patients consist of non-AF group. The AF group was further divided into two groups; new-onset AF after admission (New-AF) group (n=76, 10.5%), and preexisting AF (Pre-AF) group (n=37, 5.1%). The cardiac mortality during 90 days after the onset of MI was compared among the subgroups. Results: The AF group was older and had more impaired renal function and a higher Killip class than the Non-AF group on admission. During the follow-up period, 62 patients (8.6%) died due to cardiac causes: pump failure (n=44), ventricular arrhythmias (n=9), cardiac rupture (n=8), and re-infarction (n=1). Cardiac mortality was significantly higher in AF group (n=25, 21.2%) than in Non-AF group (n=37, 6.1%) (HR of 4.0, 95% CI 2.4-6.7, p

Purpose: About 30% of patients with heart failure do not respond to Cardiac Resynchronization Therapy (CRT); ischemic cardiomyopathy negatively influences the response. The study objective was to determine the impact of global and regional myocardial scar burden on CRT outcomes by using AutoQUANT. Methods: We studied 38 consecutive CRT recipients (28 men; age 70±7 years old; ischemic cardiomyopathy, n= 12; Left Ventricular [LV] ejection fraction 23.5±9.4%; QRS duration 158±30ms). All the patients underwent resting 99mTc-MIBI gated-myocardial perfusion SPECT prior to CRT. The SPECT images were analyzed by AutoQUANT 7.2 to quantify the global Defect Extent (DE), an index of global scarring, as well as the regional DE in each of the 17 segments of the LV, an index of regional scar burden. CRT response was defined as a decrease of >10% in the LV end systolic volume at 6 months after CRT device implantation based on the QGS analysis of the SPECT images. Results: Twelve patients did not respond CRT. The response rate was lower in patients with ischemic cardiomyopathy than those with non-ischemic cardiomyopathy (25% vs. 85%, p

We reviewed 22 cases with surgical repair for subacute left ventricular free wall rupture complicating acute myocardial infarction. Different operative technique was used. Direct closure or patch repair with infarctectomy was preformed in first patients with a great difficulty in hemostasis. Since 1988 we sutured a large pericardial patch covering the infarcted myocardium under extra corporeal circulation in 11 patients (pericardial patch suture technique). From 1993 we began to glue a pericardial patch with Aron alpha without cardiopulmonary bypass (pericardial patch gluing technique). There were eight early death and four late death. Most common cause of death was low cardiac output syndrome (LOS). With medical therapy 13 patients in cardiogenic shock improved before surgery and only three developed postoperative LOS, but all six patients with sustained shock developed LOS without survivor (p = 0.007). Two of the five patients underwent direct closure or infarctectomy and seven of the 11 employed pericardial patch suture technique developed LOS, but none of the six used pericardial patch gluing technique developed LOS. Medical treatment such as intraaortic balloon pumping, catecholamine and subxyphoid drainage in order to improve hemodynamic condition before surgery is extremely important. Pericardial patch gluing technique seems to be useful since cardiac function would be maximally preserved.

A case of traumatic pseudoaneurysm of the ascending aorta occurring in a postoperative patient who underwent an arch replacement and Bentall's operation was reported. A bleeding point was clear at the graft of the ascending aorta, and a pseudoaneurysmal formation was suspected following an echocardiogram. An aortogram demonstrated the presence of an aneurysm approximately 8 cm by 4 cm in size originating 5 cm above the right coronary ostia. An emergency operation was carried out. A Trans-femoral bypass was established before sternotomy. The Operative findings showed that adhesive connective tissue covered a pseudoaneurysm 8 cm by 4 cm in size, and that there was a tear in the anastomosis of the grafts between the ascending aorta and the arch 5 cm above the coronary ostia. Direct suture was performed, using hypothermic circulatory arrest. In this paper, We discuss the mechanism, classification, and operative strategy of traumatic pseudoaneurysm.

We reviewed the repair of nonconfluent pulmonary artery using a roll to clarify indication of this operation, operative technique (especially the material and the size of conduit) and possibility of total correction. Eleven patients (mean age: five years) and 13 operations including two reoperations were reviewed. The material of the roll was xenopericardium in nine and artificial graft in four operations. No operative death and late death occurred. Five patients required reoperations from three occlusion and two severe stenosis of the roll. Three of nine xenopericardial roll needed reoperations and in two reoperated cases, the roll had been placed behind the aorta. In contrast, one artificial graft needed reoperation. The diameter of the roll was compared with that of normal pulmonary artery estimated from the body surface area. If the roll was too large (more than 125% normal) or too small (less than 100% normal), the luminal diameter of the roll became significantly smaller than appropriate-sized roll (p = 0.002). The size of nonconfluent side of the pulmonary artery also affect the result of repair. In occluded or stenotic cases, the unilateral PA index was significantly smaller than good patent cases (p = 0.014). Total correction was possible in eight cases (73%) including four Rastelli operation, two right ventricular outflow patch enlargement, and two modified Fontan operations without operative death. Thus preoperative evaluation of the pulmonary artery size and anatomy, selection of roll material and size matching seemed to be important for successful roll repair of nonconfluent pulmonary artery.