No abstract

Interventricular septal hematoma (IVSH) is extremely rare, and most cases are reported to occur in pediatric patients as a complication after the repair of a ventricular septal defect (VSD). We present a case of a giant IVSH after patch closure of a perimembranous VSD and review of the relevant literature. CLINICAL SUMMARYA 3-month-old boy was admitted to the University of Tsukuba hospital with a diagnosis of VSD and severe pulmonary hypertension. The patient weighed 5.3 kg. Echocardiography revealed a large (6 mm) perimembranous trabecular VSD, which was surgically closed using cardiopulmonary bypass (CPB) and antegrade cardioplegia. A standard closure using a Dacron patch and a continuous suture technique along the edge starting with a pledgeted horizontal mattress suture placed near the base of the medial papillary muscle was performed. FIGURE 1. TEE showing changes in the interventricular septum hematoma over time. Longitudinal (top) and short-axis (bottom) views on postoperative day 1, month 1, and month 2. Arrows indicate hematoma. POD, Postoperative day; IVSH, interventricular septal hematoma; LV, left ventricle; Ao, aorta.

The vasorelaxant effects of FK409, a new nitrovasodilator synthesized from a microbial product, were compared with those of nitroglycerin in isolated coronary artery rings of the dog contracted with U46619 (10−7 m). FK409 (10−11–10−5 m) and nitroglycerin (10−9–10−4 m) each produced a concentration‐dependent relaxation. Comparison of EC50 values showed that FK409 was about 25 times more potent than nitroglycerin. Submaximum concentrations of nitroglycerin (10−6 m) and FK409 (3 × 10−8 m) elevated guanosine 3′:5′‐cyclic monophosphate (cyclic GMP) levels, effects associated with vasorelaxation. Adenosine 3′: 5′‐cyclic monophosphate (cyclic AMP) levels were unaffected. The concentration‐relaxation curves for nitroglycerin and FK409 were shifted to the right by methylene blue (3 × 10−6–3 × 10−5 m), an inhibitor of soluble guanylate cyclase, and to the left by M&B22,948 (3 × 10−6–3 × 10−5 m), an inhibitor of cyclic GMP phosphodiesterase. After exposure of coronary arteries to the maximally‐effective concentration of nitroglycerin (10−4 m), the mean EC50 value of FK409 did not change significantly, although that of nitroglycerin increased about 60 fold. After exposure to the maximally‐effective concentration of FK409 (10−5 m), the mean EC50 value of FK409 increased about 6 fold and that of nitroglycerin about 11 fold. These results suggest that the vasorelaxant effect of FK409, like that of nitroglycerin, is due to activation of soluble guanylate cyclase and a resultant increase in intracellular cyclic GMP. However, compared with nitroglycerin, there was less self‐tolerance to the relaxant effects of FK409 and relatively little cross‐tolerance between the two agents.

No abstract

Landiolol rapidly suppresses junctional heart rate in junctional ectopic tachycardia after pediatric heart surgery without significant blood pressure compromises. Subsequent atrioventricular sequential pacing was effective at restoring atrioventricular synchronicity and stabilizing hemodynamics. Combining junctional rate control with landiolol and atrioventricular sequential pacing is therefore suggested as a promising option for prompt management of postoperative junctional ectopic tachycardia.

Nicorandil has a hybrid property between nitrates and potassium (K)-channel openers. In order to clarify which mechanism of action is responsible for its effect in increasing coronary blood flow, we investigated how this effect was antagonized by glibenclamide, which was recently found to behave as a pharmacologic antagonist of K-channel openers. Cromakalim, one of the most specific K-channel openers currently available, and nitroglycerin were used as reference drugs. In isolated, blood-perfused papillary muscle preparations of dogs, intraarterial injections of nicorandil and cromakalim increased (coronary) blood flow, and at high doses a negative inotropic effect and ventricular fibrillation occurred. Dose-response curves for the increase in coronary blood flow produced by nicorandil or cromakalim were shifted to the right in a parallel manner and to similar extents by glibenclamide given intravenously to support dogs. Schild analysis yielded pA2 values of 6.08 and 6.34 for glibenclamide versus nicorandil and cromakalim, respectively. Nitroglycerin injected intraarterially produced only an increase in coronary blood flow. This effect was not affected by glibenclamide. These results indicate that the effect of nicorandil in increasing coronary blood flow, like that of cromakalim, is predominantly due to its mechanism of action as a K-channel opener. The negative inotropy and ventricular fibrillation seen with high doses of nicroandil and cromakalim were also antagonized by glibenclamide, indicating that these effects are also due to K-channel opening.

An 8-month-old boy with a left-sided incarcerated inguinal hernia involving the appendix, cecum, and terminal ileum was successfully managed via an inguinal approach during an emergency operation. A mobile cecum seemed to have contributed to the left-sided incarceration. Only 13 similar cases with the left-sided Amyand’s hernia have been reported in the literature.

A 68-year-old female with no previous history of coronary artery disease, hypertension, or hyperlipidemia presented with abnormal electrocardiographic changes which was ST elevation in V1 and V2 lead. The electrocardiogram was performed for regular medical checkup. An echocardiogram revealed an aneurysmal structure along the intraventricular septum ( Figure 1A). A computed tomogram (CT) demonstrated a coronary artery aneurysm, 5.0 × 2.8 cm, with a 1.3 × 1.0-cm pseudoaneurysm (Figure 2A). A coronary angiogram revealed that the aneurysm appeared to arise from the left anterior descending (LAD) artery and was fed by a septal artery ( Figure 1B). At the time of surgery, following institution of cardiopulmonary bypass and cardioplegic arrest, the feeding artery was identified and divided and each end closed with a running 6-0 polypropylene suture ( Figure 3A). The aneurysm and pseudoaneurysm were opened and no fistulas or other vascular communications could be identified. The aneurysmal wall was obliterated with a running 3-0 prolene suture ( Figure 3B). The patient tolerated the procedure and had no coronary ischemia. A postoperative CT scan showed a patent LAD without any aneurysmal changes ( Figure 2B). ACKNOWLEDGMENT