Intraoperative fluorescence imaging in hepatobiliary surgery facilitates better understanding of the anatomy of arteries, the portal vein, and bile ducts.

Advanced age was a major risk factor for postoperative AF. Furthermore, inflammatory response induced by surgical trauma was also associated with the development of AF after off-pump CABG.

Persistent sciatic artery (PSA) is a rare congenital anomaly, but in many cases it is a clinically important condition. PSA is susceptible to atherosclerotic degeneration, resulting in aneurysmal dilatation, occlusive thrombosis, or thromboembolization. PSA aneurysm is associated with distal embolization, sciatic neuropathy, or rupture. We describe a case of a patient with a ruptured PSA aneurysm treated by exclusion of the aneurysm and bypass between the common iliac artery and the PSA distal to the aneurysm, and discuss treatment of PSA aneurysm.

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We have used two techniques of hypothermic cerebral perfusion (CP) for the surgical treatment of aortic arch aneurysm in the last 10 years. Between March 1985 and December 1993, 83 patients underwent surgery for aortic arch aneurysm. Fifty-one cases had aortic dissection (AD) in the transverse arch and/or its branches, and 32 cases showed true aneurysm (TA) of the aortic arch. In those 83 patients, 37 cases received antegrade CP and 46 cases underwent retrograde CP. Surgical results were compared among the groups by Kaplan-Meier actuarial method and Cox-Mantel statistical analysis. The early mortality after surgery for aortic arch aneurysm was 11.8% in the AD group and 21.9% in the TA group. The early mortality was 21.6% with antegrade CP and 10.9% with retrograde CP. The 6-year actuarial survival rate was 71.7% in the TA group and 67.1% in the AD group. In the AD group, the 3-year survival rate was 93.9% with retrograde CP and 61.1% with antegrade CP (P < 0.005). In the TA group, the 3-year survival rate was similar for antegrade CP (73.3%) and retrograde CP (69.2%). These results suggest that current surgical results of aortic arch aneurysm with hypothermic CP are acceptable and the retrograde CP technique might be recommended, especially for surgery of aortic arch aneurysm with AD.

Pulmonary thromboendarterectomy is an effective surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we review our short- and mid-term results in the recent series of patients undergoing pulmonary thromboendarterectomy. Twenty-three patients (54+/-12 years) were re-evaluated 7-59 months (mean, 34 months) after surgery. Nine patients were in New York Heart Association functional class II, 11 patients in class III and three patients in class IV. All patients used supplemental oxygen therapy. After surgery, pulmonary hemodynamics were significantly improved: pulmonary vascular resistance (PVR) decreased from 925+/-342 to 337+/-260 dynes x s x cm(-5) (P<0.01); mean pulmonary artery pressure (MPAP) decreased from 47+/-12 to 25+/-10 mmHg (P<0.01). Three patients developed severe residual pulmonary hypertension and one of them died soon after surgery. During the follow-up period there were no deaths, but one recurrence of pulmonary embolism. Nineteen patients (86%) were in New York Heart Association functional class I or II and thirteen patients (59%) were weaned from oxygen therapy. In conclusion, pulmonary thromboendarterectomy provided remarkable early and late results with acceptable hospital mortality rate, normalization of pulmonary hemodynamics, and improvement in clinical functional status with relief of hypoxemia.

The median sternotomy approach for the treatment of chronic pulmonary thromboembolism was recently improved by Daily, Jamieson, and coworkers who adopted it for use under cardiopulmonary bypass with intermittent circulatory arrest; however, we have sometimes found that the circulatory arrest time was too short to complete thromboendarterectomy. Therefore, we attempted to perform a selective cerebral perfusion technique to extend the endarterectomy time. Although we noted slight back-bleeding from the bronchial arteries, we were able to extend the endarterectomy time without causing any postoperative delirium. We conclude that the median sternotomy approach using cardiopulmonary bypass with selective cerebral perfusion may be the best option for extending the thromboendarterectomy time.

Background and purpose: It has been postulated that isoflurane, a volatile anaesthetic, produces vasodilatation through activation of ATP-sensitive K þ (K ATP ) channels. However, there is no direct evidence for the activation of vascular K ATP channels by isoflurane. This study was conducted to examine the effect of isoflurane on vascular K ATP channels and compare it with that on cardiac K ATP channels. Experimental approach: Effects of isoflurane on K ATP channels were examined in aortic smooth muscle cells and cardiomyocytes of the mouse using patch clamp techniques. Effects of the anaesthetic on the K ATP channels with different combinations of the inward rectifier pore subunits (Kir6.1 and Kir6.2) and sulphonylurea receptor subunits (SUR2A and SUR2B) reconstituted in a heterologous expression system were also examined. Key results: Isoflurane increased the coronary flow in Langendorff-perfused mouse hearts in a concentration-dependent manner, which was abolished by 10 mM glibenclamide. In enzymically-dissociated aortic smooth muscle cells, isoflurane evoked a glibenclamide-sensitive current (i.e. K ATP current). In isolated mouse ventricular cells, however, isoflurane failed to evoke the K ATP current unless the K ATP current was preactivated by the K þ channel opener pinacidil. Although isoflurane readily activated the Kir6.1/SUR2B channels (vascular type), the volatile anesthetic could not activate the Kir6.2/SUR2A channels (cardiac type) expressed in HEK293 cells. Isoflurane activated a glibenclamide-sensitive current in HEK293 cells expressing Kir6.2/SUR2B channels. Conclusion and implications: Isoflurane activates K ATP channels in vascular smooth muscle cells and produces coronary vasodilation in mouse hearts. SUR2B may be important for the activation of vascular-type K ATP channels by isoflurane.