MRSA infection was an independent risk factor for PSM-related in-hospital mortality. NPWT may improve the prognosis for patients with MRSA mediastinitis.

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SummaryThe goal of this prospective study was to examine the effects of landiolol hydrochloride on prevention of atrial fibrillation and on hemodynamics in the acute postoperative phase after heart valve surgery. The subjects were 60 patients who underwent valve surgery at our hospital from April 2008 to July 2010. The patients were randomly divided into two groups: the landiolol group (30 patients) and the control (no landiolol) group (30 patients). In the landiolol group, continuous intravenous landiolol was initiated immediately on admission to the intensive care unit at a dose of 10 μg/kg/ minute. Occurrence of atrial fibrillation was compared between the groups over an observation period of 72 hours after surgery. Atrial fibrillation occurred in 6 patients (20%) in the landiolol group and 16 (53.3%) in the control group during the observation period. Landiolol hydrochloride significantly reduced the occurrence of atrial fibrillation in the acute postoperative phase after heart valve surgery. Heart rate was significantly decreased by landiolol, but aggravation of hemodynamics was not observed. These results suggest that landiolol is a useful drug for prevention of atrial fibrillation after valve surgery. (Int Heart J 2012; 53: 359-363) Key words: Heart valve disease, Ultra-short acting β -blocker A trial fibrillation or flutter (Af) is frequently observed during the perioperative period of cardiac surgery, with a reported incidence of 17% to 65%. 1,2) Postoperative Af may aggravate hemodynamics and cause embolic diseases, including cerebral infarction, and therefore prevention of this condition is an important issue in postoperative management. Various drugs have been developed for Af, including β -blockers that are useful for treatment of arrhythmia by decreasing heart strain through an antihypertensive effect. However, excessive inhibition of myocardial contraction and the strength of the antihypertensive effect are of concern in administration of a β -blocker after cardiac surgery.Landiolol hydrochloride (Ono Pharmaceutical Co., Ltd., Osaka, Japan) is highly selective for the β 1 receptor 3) and exerts a lower antihypertensive effect compared with its effect in decreasing heart rate. 4) Thus, landiolol has less impact on hemodynamics in the acute phase after cardiac surgery, compared to conventional β -blockers. Furthermore, since landiolol has a very short serum half-life of approximately 4 minutes, 4) it is easy to adjust the blood concentration without decreasing blood pressure or cardiac output. Recently, the utility of landiolol has been reported for prevention of Af after coronary artery bypass grafting (CABG).5-8) However, to our knowledge, the efficacy of landiolol for prevention of Af after heart valve surgery has not been examined. Therefore, in this study, we examined the effect of landiolol on Af and hemodynamics after heart valve surgery. Methods Patients and protocol:The study was performed in 60 patients who underwent valve replacement or valvuloplasty at our hospital from April 2008 to ...

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neurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical condition, 1 and usually remains asymptomatic until later in life. 2 The therapeutic strategy, including the timing of surgical treatment, is not well defined, especially in asymptomatic patients, and surgical repair is quite challenging. 3 Regarding surgical intervention, whether to leave or exclude a diffusely aneurysmal Cx, in addition to ligation of the fistula, is a big issue, considering the risk of later rupture when leaving the aneurysm and sacrifice of the native coronary circulation when excluding the aneurysm. 1 We report a case of an aneurysmal Cx, which finally ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus. Case ReportIn 2001, an asymptomatic 59-year-old man with a continuous heart murmur underwent cardiac catheterization, which revealed an aneurysmal Cx with fistulous connection to the coronary sinus. The pulmonic-to-systemic flow ratio (Qp/Qs) was 2.05 with an anomalous oxygen step-up at the right atrium. However, he rejected any intervention, because of the lack of symptoms. In 2006, he started to feel worsening dyspnea on exertion, and his Qp/Qs became 4.1. The aneurysmal Cx was grossly dilated from its origin and its maximum diameter was 2.5 cm. It pursued a tortuous course along the left posterior atrioventricular groove (Fig 1). In another institution, he underwent external ligation of the fistula and closure of its distal opening into the coronary sinus under cardiopulmonary bypass. He became symptom-free with an equal Qp/Qs and was discharged without any additional dilatation of the aneurysmal Cx in early angiographs.However, at 6 weeks after the operation, he complained of severe, abrupt chest and back pain and was transferred to our institution as an emergency case. On arrival, his blood pressure was 70 mmHg with ST depression in all leads of the electrocardiogram. Several cardioversions were needed to treat the ventricular tachycardias. He was emergently intubated and required intra-aortic balloon pump support, followed by establishment of percutaneous cardiopulmonary support. Echocardiography revealed akinetic inferior and posterolateral left ventricular walls with generalized hypokinesis and an anomalous penetrated shunt from the aneurysmal Cx to the left atrium. Emergency cardiac repair was undertaken under cardiac arrest using cardiopulmonary bypass. The aneurysmal Cx was opened after transection of the pulmonary trunk (Fig 2). The dilated Cx contained a massive adherent thrombus. Saphenous vein grafts were individually bypassed to the left anterior descending coronary artery and a posterolateral branch of the Cx. A right-side left atriotomy clearly showed perforation of the aneurysmal Cx into the left atrium with a 3×4-cm fragile-ended foramen, which was successfully closed using a bovine pericardial patch. After ensuring that there was no bleeding from the excluded portion, the operation Circ J 2007; 71: 1996 -1998 ...

Background-Therapeutic effect of stem cell transplantation (SCTx) for myocardial neovascularization has been evaluated by histological capillary density in small animals. However, it has been technically difficult to obtain imaging evidence of collateral formation by conventional angiography. Methods and Results-Peripheral blood CD34ϩ and CD34Ϫ cells were isolated from patients with critical limb ischemia. PBS, CD34Ϫ cells, or CD34ϩ cells were intramyocardially transplanted after ligating LAD of nude rats. Coronary angiography of ex vivo beating hearts 5 and 28 days after the treatment was performed using the third generation synchrotron radiation microangiography (SRM), which has potential to visualize vessels as small as 20 m in diameter. The SRM was performed pre and post sodium nitroprusside (SNP) to examine vascular physiology at each time point. Diameter of most collateral vessels was 20 to 120 m, apparently invisible size in conventional angiography. Rentrop scores at day 28 pre and post SNP were significantly greater in CD34ϩ cell group than other groups (PϽ0.01). To quantify the extent of collateral formation, angiographic microvessel density (AMVD) in the occluded LAD area was analyzed. AMVD on day 28 post SNP, not pre SNP, was significantly augmented in CD34ϩ cell group than other groups (PϽ0.05). AMVD post SNP closely correlated with histological capillary density (Rϭ0.82, PϽ0.0001). Conclusions-The SRM, capable of visualizing microvessels, may be useful for morphometric and physiological evaluation of coronary collateral formation by SCTx. The novel imaging system may be an essential tool in future preclinical/translational research of stem cell biology. (Arterioscler Thromb Vasc Biol.

Cardiotomy suction, but not open venous reservoirs, causes perioperative coagulofibrinolysis activation, although neither affects the inflammation system. The use of cardiotomy suction needs to be examined further in association with postoperative PAI-1 elevation and early vein graft occlusion.

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