Neutrophil elastase activity(NEA) was measured before and during cardiopulmonary bypass(CPB) in elective adult cardiac surgery(n＝8). Duration of CPB was 126±52min(mean±SD). NEA was under the detectable level before CPB, and tended to increase at 30 and 60 min of CPB. At the end of CPB, the NEA was significantly higher than that before CPB. It was concluded that it took a few hours for neutrophil elastase to be activated during CPB.

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Introduction: Modified ultrafiltration(MUF) can remove excess water and inflammatory mediators from the circulation after cardiopulmonary bypass(CPB) in pediatric patients. However, the value of MUF in adult patients remains unknown.
Methods: We retrospectively investigated hemodynamic functions after MUF in 70 adult patients who had undergone cardiovascular surgery.
Results: Systolic blood pressure was significantly increased after MUF. The hematocrit after CPB decreased in the control, but not in the MUF group. The MUF group required less red blood cell products, colloids and crystalloid solution resuscitation than the control group. No adverse events were associated with MUF.
Discussion: Modified ultrafiltration can safely achieve hemoconcentration, resulting in increases of systolic blood pressure after CPB, less intraoperative red blood cell transfusion and lower postoperative fluid resuscitation.
Conclusion: Modified ultrafiltration can improve hemodynamic function and diminish transfusion requirements not only for pediatric, but also for adult patients.

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Case Study: Male, 82 years old.
Present Illness: Enhanced CT scan revealed an infrarenal abdominal aortic aneurysm(60mm) and an aortic arch aneurysm(45mm). We placed a stent graft on the abdominal aortic aneurysm using a Gore Excluder^®. The post-operative period passed without incident and led to outpatient observation. A follow-up CT scan revealed expansion(50mm) of the aortic arch aneurysm and the decision was made to operate.
Operation: First we performed a right axillary-left common carotid artery-left subclavian artery bypass operation using Ringed Gelsoft 8mm. We placed a Talent^® thoracic stent graft just distal of the brachiocephalic trunk. Just subsequent to balloon fixation, INVOS^® values fell. It was determined that the stent graft had covered the inlet of the brachiocephalic trunk, resulting in stenosis. We immediately inserted a balloon catheter through the right radial artery, avoiding the stent graft at the inlet of the brachiocephalic trunk, and placed a stent at the inlet of the brachiocephalic trunk. INVOS values improved.
Results: Whole brain ischemia occurred for about 5 minutes. Postoperative recovery from anesthesia was delayed and there was right hemiplegia. This gradually improved and the patient was able to walk unassisted at time of discharge.
Summary: INVOS^® was an effective cerebral blood flow monitor during TEVAR in the aortic arch.

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A St. Jude Medical(SJM) Trifecta valve was developed as a new tissue valve by improving the previous tissue valve. The effective orifice area is wider than that of Epic tissue valve. The efficacy of the new valve has not been reported yet. Recently, we first performed aortic valve replacement(AVR) with the SJM Trifecta valve for aortic valve stenosis. A case 74-year-old female was admitted to our hospital with dyspnea and angina on exertion. She was diagnosed aortic valve stenosis. She underwent AVR with a 19 mm Trifecta^TM tissue valve. According to the intra-operative direct simultaneous pressure measurement conducted after weaning of cardio pulmonary bypass, the peak pressure gradient of the prosthetic valve was 11 mmHg, the mean pressure gradient was 5 mmHg. According to the results of echocardiography conducted 10 days postoperatively, the peak pressure gradient of the prosthetic valve was 24.4 mmHg, the mean pressure gradient was 16.5 mmHg. She was discharged 18 days after surgery without complications. Implantation of a 19mm SJM Trifecta^TM valve produced excellent result reflected by lower pressure gradient and absence of patient-prosthetic mismatch. In the future, the new valve is expected to be the optimum tissue valve for a narrow annulus.

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