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H MAYUMI, K MATSUZAKI, Y KAWACHI, K KINOSHITA, R TOMINAGA, K TOKUNAGA
1991 Volume 20 Issue 3 Pages
932-934
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Stainless steel-made 11 protractor rings which had been equally divided and carved to 10-20 arcs were used for partitioning a prosthetic sewing ring. After completing interrupted sutures along the host aortic or mitral annulus, one of the protractor rings was chosen according to the number of the sutures. The interrupted mattress sutures kept on a suture holder were then passed through the prosthetic sewing ring straightly from one end to the other. So far we have used these rings for 31 valve replacement procedures in 25 patients. The rings were considered to be beneficial to saving time and simplifying the operation.
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M YAMADA, K MORIYASU, H TANAKA, K SAIDA, H YOKOKAWA, M FUNAMI, N YAMAM ...
1991 Volume 20 Issue 3 Pages
935-939
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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From January 1980 to April 1990, 122 patients underwent aortic and/or mitral value replacement with the St. Jude Medical valve prosthesis. Early mortality was 10.7% overall and 23.1% after aortic, 8.0% after mitral and 4.8% after double valve replacement. The total follow-up was 425 patient-years(follow up rate 99.2%).
The 8-year suvival excluding early death was 81%±13% after aortic, 93%±3% after mitral, 63%±26% after double valve replacement. The overall incidences of thranboembolsim, anticoagulant-related hemorrhage and paravalvular leak during follow-up period were 0.71%, 0.24%, and 0.24%/patient-year, resoectively. There have been no instances of primary structural deterioration or prosthetic valve endocarditis.
These results clarify that the St. Jude Medical valve prosthesis is excellent alternative of aortic and mitral position.
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H. SATOKAWA, F. IWAYA, T. IGARI, T. ABE, K. HAGIWARA, M. TANJI, M. WAT ...
1991 Volume 20 Issue 3 Pages
940-944
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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To investigate changes in coagulability after surgery to replace posthetic valve, we studied the hemostatic parameters in 20 patients who underwent replacement of prosthetic heart valve (Redo group) and compared them with those of 30 patients who underwent initial valve replacement because of combined cardiac valvular disease (control group). The Redo group showed a significantly longer operative time (p<0.05) and slightly greater bleeding volume than the control group. In the Redo group the platelet count, fibrinogen and antithrombim III were significantly lower than in the control group on the first postoperative day (p<0.05). In the Redo group, on the first operative day, values of thrombotest were lower and prothrombin time and activated partial thromboplastin time were more prolonged due probably to preoperative anticoagulant therapy but those parameters in the two groups were similar after the third postoperative day. There was no difference in DIG scores and DIG cases between the two groups. Because in the Redo group the effect of the preoperative anticoagulant therapy as well as the tendency to hemorrhage is thought to be limited to the early postoperative stage, it is recommended that in redo surgery as well as initial valve replacement anticoagulant therapy should be begun as soon as possible after surgery to prevent thromboembolism.
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—PRELIMINARY REPORT—
H NISHIDA, Rk GROOTERS, J HIROTA, M ENDO, A HASHIMOTO, H KOYANAGI
1991 Volume 20 Issue 3 Pages
945-947
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We have developed a bicuspid atrioventricular prosthesis constructed from a glutaraldehyde treated bovine pericardium. This valve has an artificial chordae made of dacron, and this is inserted through papillary muscle and left ventricular wall using Cook introducer and Seldinger technique. The leaflet portion of the valve has a flexible sewing ring, and is sutured to the annulus with mattress suture. This valve was inserted in the mitral position of three sheep. All weaned from pump without any problems, and survived for 1, 3, and 9 days, No mitral insuficiency was detected, and valvular gradient was 5 mmHg. In all cases, chrdae were well fixed. Possible advantages of this valve are (1) preservation of left ventricule size, configuration, and function, (2) minimum transvalvular gradient, and (3) elimination of ventricular perforations. Although our preliminary results has been positive, further study is necessary especially for valve design to prevent convolutions of valve leaflet.
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T SHIMONO, T SATO, M TAKAO, Y KATAYAMA, I YADA, M KUSAGAWA
1991 Volume 20 Issue 3 Pages
948-951
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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From Febrary 1985 through June 1990, we performed 78 mitral valve replacements using Monostrut Björk-Shiley valves in 76 cases. Early death was observed in 3 cases (3.8%) and there were 4 late deaths among the remaining patients. Actuarial survival rate at 5 years was 89.1±4.0%. There were 2 thromboembolic episodes, one case of valve thrombosis and 2 cases of periprosthetic leakage. Freedom from all valve related complications was 94.1±2.8% at 5 years. We measured the peak valve pressure gradient and effective orifice area by doppler echocardiography in 30 cases. The peak valve gradient of the 27mm valves (n=13) was 9.3mmHg and of the 29mm valves (n=17) was 7.4 mmHg. The effective orifice area of the 27mm valves (n=13) was 2.9cm
2 and of the 29mm valves (n=17) was 3.3cm
2. We concluded that the Monostrut Björk-Shiley prosthesis was an acceptable prosthesis for mitral valve replacement.
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R INNAMI, H NAGAOKA, S MUNEAKI
1991 Volume 20 Issue 3 Pages
952-954
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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For hemodynamic analysis of the cause of decrease in opening angle of aortic Omnicarbon, 15 patients were catheterized in late postoperative period. Three modes of opening were observed; maximal, delayed and lowered opening. Mean values of 21 mm(6 patients) and 23 mm (9 patients) were as follows valve flow were 225ml/sec and 214ml/sec, valve gradient were 25mmHg and 14mmHg, valve area were 1.04cm
2 and 1.36cm
2. Delayed or lowered opening were observed only if valve flow was less than 200ml/sec. Decrease in valve flow was associtated with decrease in MOA. Decrease in valve area according to decrease in MOA was trivial. In conclusion, delayed or lowered opening of aortic Omnicarbon might be due to decrease in valve flow and decrease in valve area was negligible clinically if MOA was more than 50 degrees.
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S MIYAZAWA, M MATSUI, K SUZUKI, K KOYANAGI, Y SAKAMOTO, Y YATA, T SHIB ...
1991 Volume 20 Issue 3 Pages
955-958
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The purpose of this study is to know how valve orientation influences on closing movement. 26 cases were devided into 2 groups, group A: valves were fixed in same direction as normal valve, group B: valves were rotated in a 90 degree. (1)ESM was observed in 82% of group A and 60% of group B. (2)Position of the leaflet which shows ESM was posterior (100%) in group A and left-sided leaflet(78%), right-sided(11%) both leaflet(11%) in group B. (3)The time interval from leaflet opening to early closing was devided by the R-R interval. The value was 0.29±0.06 in group A and 0.41±0.10 in group B(P<0.01).
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Y YAO, K OSADA, T FUJIKAWA, T HIRAYAMA, H YAMAGUTI, M ISHIKAWA, M KITA ...
1991 Volume 20 Issue 3 Pages
959-962
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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Functional property of the Björk-Shiley monostrut prosthetic valve implanted in the mitral position of 30 patients was investigated by cineradiography. The maximum opening angle of the tilting disc was 70.6±4.6° There was no change in the maximum opening angle, opening time, closing time and tilting disk angle of the disc observed during follow up period. It is noteworthy that the rotation of the valve leaflet is not observed in long term.
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Y OHTA, T HORIUCHI, T DOHI, H MATSUMOTO, H IDE, Y TANAKA
1991 Volume 20 Issue 3 Pages
963-967
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Motion of the implanted bi-leaflet valves, especially with asynchronous motion, was analyzed quantitatively using X-ray cinefllms. Test cinefilms were 6 SAM valves (5 MVR and 1 AVR). The cinefilm image processing system we have developed were used as a method for the analysis. As a result asynchronous motion of the two leaflets was calculated quantitatively. Maximum difference between two leaflets' angle was found to be 11.3 degree, and any asynchronous form was not similar to each other. The asynchronous motion is considered to be attributed to valve orientation, atrial fibrillation, thrombus, etc. Though X-ray cinefllms are generally investigated qualitatively in the clinical field, quantitative motion analysis of the implanted heart valves will bring new findings and contribute to the advance in the clinical and research field.
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Tetsuro TAKAYAMA, Hisayoshi SUMA, Yasushi TERADA, Sachito FUKUDA, Susu ...
1991 Volume 20 Issue 3 Pages
968-971
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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In 11 cases of 28 recent re-MVR (group A), the same type of PTF of Carpentier-Edwards porcine valves by detaching the two cusps as a mass from the strut without showing calcification (PTF type A) were found. Re-MVR was performed earlier after the onset of PTF (0.9±0.6 months)in these patients including 4 emergency operations than the cases of other type of PTF(p<0.01). Pathologically collagen degradation and cusp detachment from the strut leaving the suture thread at the strut side were detected.
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Y KAWACHI, K MATSUZAKI, T ASOU, H MAYUMI, K KINOSHITA, R TOMINAGA, H Y ...
1991 Volume 20 Issue 3 Pages
972-976
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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From February 1985 to Descember 1989, 146 Carpentier-Edwards pericardial (CEP) valves were implanted in 129 patients (75 male and 54 female; age 12 to 74, mean 55.5). The procedure include 47 AVR, 59 MVR, 17 combined valve replacement (CVR), 6 T/PVR. Hospital mortality was 7.8%. Follow-up rate was 92% during 0.6 to 5.5 (mean 3.3) years. Overall actuarial survival rate at 5 years was 84±6% for AVR, 88±4% for MVR, 75±11% for CVR, and 100% for T/PVR. Thromboembolism occurred in each patient of AVR and MVR (0.8%P-Y and 0.6%P-Y, respectively). Anticoagulant-related hemorrhage occurred in one patient of MVR. There were no cases of primary tissue failure, but three patients with valvular regurgitation of CEP valve were going on follow-up. Five patients underwent redo-operation with 2 mortality (1.4%P-Y). Freedom rate from overall valve-related complications at 5 years was 93±5% for AVR, 89±5% for MVR, 100% for CVR and 100% for T/PVR.
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T GODA, T MURAKAMI, J OKUDE, K GO, Y MATSUI, K SAKAI, K YASUDA, T TANA ...
1991 Volume 20 Issue 3 Pages
977-980
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The hemodynamic effects of MVR and functions of both the SJM and the Omniscience valve were studied in twenty-six patients with severe pulmonary hypertension (systolic pressure greater than 60mmHg). MVR resulted in significantly decreased pulmonary arterial pressure, pulmonary vascular resist-ance and pulmonary arterial wedge pressure with both valves. The differences between the pulmonary wedge and left atrial pressures decreased after nitroglycerin administration in six patients with persistent pulmonary hypertension after MVR suggesting the contribution of pulmonary venoconstriction to severe pulmonary hyper-tension in patients of mitral valvular disease. Continuous wave Doppler echocardio-graphy revealed better valve function with the SJM valve, although there was no significant difference between two kinds of valve.
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T. TANAKA, T. HOTTA, M. MASEKI, E. TAKEUCHI, T. ABE
1991 Volume 20 Issue 3 Pages
981-985
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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147 patients underwent mitral valve replacement with the Björk-Shiley prosthesis [convexconcave disc valve with an opening angle of 60 degrees (60CC), n=44; and Monostrut (MS) valve, n=106]. Early mortality was 4%. There were 10 late deaths (2.6% per pat-yr in 60CC and 1.5% per pat-yr in MS). Three with 60CC underwent reoperation, linearized occurrence rate of 1.3% per pat-yr. Three patients with MS required reoperation, linearized occurrence rate of 1.1% per pat-yr. Five patients survived reoperation. The management of patients who sustained dysfunction of the Björk-Shiley mitral valve is described.
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Y KIKUTA, T YUHTA, T SHIMOOKA, Y MITAMURA
1991 Volume 20 Issue 3 Pages
986-989
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A new accelerated fatigue tester for artificial heart valves was developed. The test apparatus consists of a water supply duct rotor, two heart valve housings, a centrifugal pump, a reservoir tank and a drive motor. The test were performed at duct cyclic rates of 250-1500 rpm under flow rate into the valve housing of 13.3-27.0l/min. The pressure across the valve and the valve motion operating the tester were monitored to evaluate character-istics of the tester. The water hammer (WH) pressures were observed as the valves closed. The NH differential pressures were at maximum loads to fracture the valves in the tester. In this system the NH dif-ferential pressures increased in proportion to the flow rates. The NH pressures decreased in proportion to the duct cyclic rates. The valve motions were checked by using an image process-ing system at 1000, 1300, 1500 rpm of the duct rotations. The valves opened best at 1000 rpm and operated well at 1300, 1500rpm.
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Yukio KUNIYOSHI, Kageharu KOJA, Kiyoshi IHA, Mituru AKASAKI, [in Japan ...
1991 Volume 20 Issue 3 Pages
990-993
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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In this study, we compare the results of using the monocusp (Björk-Shiley) valve and the bicusp (SJM and Duromedics valve) in AVR+MVR operations. Monocusp valves were used in 13 cases (Gruop I), and bicusp valves were used in 59 cases (Group II) . The improvement in cardiac function was satisf-actory in both groups. In comparison of hemolysis, the LDHmeasurement (IU/L) and reticulocyte counts (‰) were higher in group II. we conclude that the post-operative improvement in hemodynamics is satisfactory with either monocusp or bicusp valves. Our preferrance is for monocusp valves as of present.
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Toshio ONITSUKA, Kuryhide NAKAMURA, Yasunori KOGA
1991 Volume 20 Issue 3 Pages
994-999
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The patients who underwent mitral valve replacement (MVR) or aortic valve replacement (AVR) or mitral plus ortic valve replacement (DVR) with St. Jude Medical (SJM) valve prosthesis were evaluated for chronic hemolysis. The serum LDH levels were low in DVR when we used the procedure in which the pivot axis of the SJM valve prosthesis oriented perpendicular to the mitral commissure in MVR and oriented perpendicular to the right coronary orifice in AVR. In patients with mild residual aortic regurgitation, the serum LDH levels were significantly higher in both perpendicular and non-perpendicular orientation (axis of the SJM being oriented parallel to the mitral commissure). There was no significant difference in serum LDH levels between the patients with preservation of mural posterior leaflet and subvalvular tissues and the patients who underwent conventional procedure.
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Tatsuhiko KUDO, Takashi UCHINO, Tetsuya OSADA, Masafumi HASHIMOTO, Nao ...
1991 Volume 20 Issue 3 Pages
1000-1003
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Hemolytis of six patients with slight perivalvular leakage after mitral valve replacement using St. Jude Medical prosthesis was studied in the early and late postoperative periods. Hemolytic anemia and high levels of lactate dehydrogenasis observed in early post-operative period patients were improved to nearly normal conditions at the late post-operative period. In comparison of six patients that had perivalvular leakage and twelve patients that had no leakage after surgery there were no significant differ-ences in the levels of plasma haptoglobin and ciol planet centrifuge system however plasma free hemoglobin showed high levels in patiens with perivaluular lealage.
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OBSERVATION WITH NON-INVASIVE BLOOD PRESSURE MONITORING
Y YAMAMOTO
1991 Volume 20 Issue 3 Pages
1004-1008
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Pulse to pulse blood pressure(BP) was monitored with a non-invasive monitoring system (FINAPRES) in 36 patients with cardiac pacemakers for complete atrio-ventricular block. In contrast to stable BP in DOD pacing, periodical fluctuation of BP was observed in VVI pacing in relation to changing sequence of P-waves and QRS. The mean range of the fluctuation of systolic BP, diastolic BP and pulse pressure in a supine position was 30.3±13. 8mmHg (15-65mmHg), 10.2±5.9mmHg(5-25mmHg) and 21.0±9.3mmHg(10-45mmHg), respectively at 70 ppm. The fluctuation range was similar at 100ppm and was relatively small at 50ppm . In a sitting position, the fluctuation was smaller at 50ppm, greater at 100ppm and various at 70ppm, comparing to that in a supine position. As the wide fluctuation of BP may cause pacemaker syndrome and means a significant role of atrial kick, maintenance of atrio-ventricular sequence is essential to prevent pacemaker syndrome and to maintain good cardiac function. ODD pacemaker should be indicated for all patients with atrio-ventricular block. Noninvasive continuous BP monitoring provides a handy and useful method for physiological evaluation of cardiac pacing.
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Y. TAKAGI, Y. MIYATA, T. ISHIHARA
1991 Volume 20 Issue 3 Pages
1009-1012
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Fourteen patients with VVI or DDD pacemaker were studied. Their coronary arteries were angiographically nor-mal. Left ventriculograms were recorded at 30 degree RAO during on and off RV pacing. During on pacing bulging of the apical region was observed. But during off pacing this movement was not observed. Regional wall motion was analized by centerline me-thod. Wall motion of five segments was compared between on and off pacing. Apical wall motion during on pacing was significantly reduced compared with that during off pacing. This paradoxical movement during on pacing may lead to the impaired left ven-tricular function, and it may be associated with impaired myocardial blood flow and unfavorable VPC.
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H. SHIRAKAWA, T. SHIMIZU, H. SASAKI, S. SAKAMOTO, Y. KANETO, T. TOYODA
1991 Volume 20 Issue 3 Pages
1013-1017
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Eleven cases of permanent pacemaker infection were observed in 439 cases of permanent pacemaker implantation. The mean follow up period was 4.4 years (1949 patient years). Among the eleven cases with infected pacemakers, nine cases were seen before 1981, and they made use of the older types of pacemakers of large size. In recent years, the number of infected of pacemaker decreased by use of generators of smaller size. In most cases, infection was controlled by chang-ing the generator and its location, and by removal of the electrode by traction. There were two cases whose infection developed to septicemia. In one case, electrode was taken out from the right atrium through a small incision in closed method. The other case was successfully treated by removal of the infected electrode under cardiopulmonary bypass. Open heart surgery may be necessary in case of septicemia due to infected pacemaker because of recent use of tined lead.
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H MIZUNUMA, K IKEDA, A MIZUNO, K SUDO, T KOISIZAWA, H MORITA, H YANAGI ...
1991 Volume 20 Issue 3 Pages
1018-1022
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We tested a total of 50 generators (37hardware base pacemakers and 13 software base pacemakers/37 VVI, 3 VVIR and 10 DOD) using electrosurgery unit. We concluded that pacemaker and its electrode should not be located between reference and active electrode of the electrosurgery, active electrode of the electrosurgery should not be touch the pacemaker, electromagnetic interference (EMI) protected monitors should be require all the time the electro-surgery is used, and complete re-examination of the all parameters of the generator should be done postoperatively to confirm the proper function of the pacemaker.
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Akira SHIIKAWA, Hitoshi KOYANAGI, Masahiro ENDO, Kazuhide HAYASHI, Ken ...
1991 Volume 20 Issue 3 Pages
1023-1027
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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5 patients (pts) with life-threatening ventricular techyarrhythmias (VF: 3pts, VT/VF; lpt, VT; lpt) underwent surgery of AICD. Implantation of AICD was indicated for patients who survived circulatory arrest due to documented VT and/or VF. The patient should be medically refractory or madical treatment precluded by hemodynamic instability; other surgical treatment should not be possible. In a operation, VT/VF were induced 1 to 6 times for the measurement of defibrillation threshold (DFT). In all our pts, the AICD appropriatly discharged at postoperative EPS and in 2 pts, it discharged appropriate shock for spontanious VT. As for complications, in 1 pt with severe LV dysfudction, inccesant form of VT/VF occured after DFT testing and LV assist circulation and IABP were needed. Inappropriate discharge was recognized in 2 pts and pericarditis in 2pts postoperatively. It was considered that this system was effective for the treatment of life-threatening ventricular techyarrhythmias. AICD, life-threatening ventricular tachyarrhythmia, ventricular fibrillation, ventricular tachycardia, sudden cardiac death.
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S TOGAWA, S MIZUSHINA, T SUGIURA, Y FUKUI, M KIMURA, N ISHIGAMI, Y HAR ...
1991 Volume 20 Issue 3 Pages
1028-1031
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A system for experimental studies of pacing rate and optimum AV interval in rate responsive dual chamber pacing have been developed and two types of preliminary experiments have been performed on 4 mongrel dogs. The methods are as follows. 1) The system was programmed as a dual chamber pacemaker with a fixed rate, and the cardiac output and right atrial pressures were measured while AV interval was varyed. 2) The system was programmed as a rate res-ponsive pacemaker using a right atrial blood temperature as a guide parameter. Cardiac output and right atrial pressures in the canines in feverish condition were measured varying the AV interval. All experi-ments were performed under anesthesia. Maxmum cardiac output and minimum right atrial pressurs were obser-ved at AV intervals of 100-125ms both at rest and during feverish condition with higher rates. It can be considered that optimum AV intervals during feverish condition with higher rates are not very different from those at rest.
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S SUGIURA, S TOGAWA, S MIZUSHINA, Y FUKUI, M KIMURA, N ISHIGAMI, T KIM ...
1991 Volume 20 Issue 3 Pages
1032-1036
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Fuzzy theory was applied to the rate control of a cardiac pacemaker which uses two parame-ters, respiratory rate and temperature, as guide parameters for rate regulation. Membership functions of respiratory rate and temperature and 25 fuzzy reasoning rules were derived from 5 mongrel dogs during fever under anesthesia. Using these rules and membership func-tions, heart rates in mongrel dogs during fever under anesthesia were simulated through the respiratory rate and temperature and compared with the intrinsic rates. The agreement was satisfactory over a wide temperature range from 36°C to 42°C. Doctors can easily make the appropriate membership functions and the control rules for each patient and therefore can simulate the heart rate variation before implantation. This allows us a multi-guide cardiac pacemaker with a custom-made rate control program.
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Keiichiro KATSUMOTO, Tatsuru NIIBORI
1991 Volume 20 Issue 3 Pages
1037-1043
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A new shape of tip for pacemaker leads, which induces a convergent electrical field and has a high current density at its distal end was clinically studied. This new electrode tip has a convex concave shape and is made of activated vitreous carbon. These leads were used either for AAI or VVI pacing. Comparison with a regular hemispherical tip (Siemens 412 S) which has the same electrical surface area and is made of the same material, showed that this new type of lead presented a lower threshold rise and offered a better safety margin during the longterm follow-up time.
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—EFFECT OF PHYSIOLOGICAL PACING—
Y NISIMOTO, T KODAMA, M OHZEKI, S SASAKI, A TAKEUCHI
1991 Volume 20 Issue 3 Pages
1044-1047
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Wehaveimplantedcardiac pacemakers for 483 patients during the past 24 years. Their ages ranged from 1 to 91 years ( average 60.6). The indications in implantation were complete A-V block (AVB) in 244, sick sinous syndrome (SSS) in 179, atrial fibrillation with brady cardia in 48, AVB+SSS in 10 patients and so on. The pacing modes employed were nonphysiolosical pacing (NP) in 282 and physiological pacing (PP) in 201 patients. One hundred and thirty-three patients were dead, and the cause of death was cardiac in 35, thromb-embolic in 24 patients and so on. There was no difference of servival rate in terms of the four major indications. However, survival rate of PP was significantly superior to that of NP. Although, there was no difference in cardiac death-free rate between NP and PP, PP was superior to NP as to thrombo-embolism-free rate. The reduction of thrombo-embolic complication was obvious especially in the case of NP for SSS. The results suggest that PP reduces the incidence of thrombo-emblism and thus impro-yes survival rate in patients with cardiac pacemaker.
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M NAITOH, M SENOH, T DOHI
1991 Volume 20 Issue 3 Pages
1048-1052
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Although DDD mode physiologic pacing has a superior function to VVI pacing, A-V sequential pacing is often not necessary. We challenged to study which factor is most important for determining cases who truly require DDD pacing, by changing patient's pacing-mode from DDD to VVI. We divided 40 patients in two groups (symptomatic; Group. 1, asymptomatic; Group. 2). First, Group. 1 was older than Group. 2 (average 66.9 to 63.1). Secondly, cardiac function (EF. % FS. mVcf) and hemodynamic regulation in Group. 1 were detereiolated compared to those in Group. 2. Our data demonstrated three factors; eg. 1) older age, 2) deteriolated cardiac function, 3) failure of hemodynamic regulation are important for decision making on pacemaker selection.
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T. HIRANAKA, F. NOMURA, T. NISHIOKA
1991 Volume 20 Issue 3 Pages
1053-1055
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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To analyze the useruiness of DDD pacemaker for sick sinus syndrome (SSS), we compared 19 patients with DDD pacemaker and 11 patients with AAI pacemaker. The mean duration of follow-up was 55 months in DDD group, and 53 months in AAI group. The re-operation rate due to pacemaker trouble was not higher in the DDD group compared to the AAI group. Change of pacing mode was needed in 3 patients of the DDD group (a. f. 2, atrial pacing failure 1), and in one patient of the AAI group (A-V block). Pace-maker replacement due to battery depletion was performed in 3 patients of the DDD group. We conclude that DDD pacemaker is desirable in the treatment of aged SSS patients.
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R. MURAKAMI, G. SHINDO, K. HIGUCHI, A. FURUSE
1991 Volume 20 Issue 3 Pages
1056-1059
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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DD PACEMAKER. We evaluate the usefuliness of bodyactive DDDR pacemaker by treadmill tes t. there are 5 patients who is implantedDDDR pacemaker ( one of them is CoiapleteAV block and others are Sick sinussyndrome). The results are as follows. The heart rate change of DDDR mode issmoother than that of DDD mode during Treadmilltest. Rapid initial mere ase atthe begining, smoother incrementaldecreasing at the end of exercise andlonger exercise tolerance time were obtained in DDD node, DDDR pacemakerseems better choic e for SSS patient. and Treadmill Test is essential examinationfor evaluation pacemaker funct ion.
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Y. FUKUI, M. KIMURA, T. SUGIURA, T KIMURA, Y. HARADA
1991 Volume 20 Issue 3 Pages
1060-1065
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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An intramuscular diaphragm stimulator with feedback control of the end-tidal CO
2 tension (PETCO
2) was developed. Pacing rate is controlled to maintain the measured P
ETCO
2 at desired level according to the linear relationship between the deviation of measured P
ETCO
2 from desired level and the change of pacing rate. In two anesthetized mongrel dogs, the diaphragm pacing was done. A pyrogenic drug was administerd to elevate the metabolism. During metabolic elevation, pacing rate increased, maintaining P
ETCO
2 at desired level. P
aCO
2 was maintained at normal level. The effective ventilation controal was carried out.
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T TSUJI, K TANISHITA, M TAKAHASHI, T TOGAWA
1991 Volume 20 Issue 3 Pages
1066-1070
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A hyperbaric oxygenator made of ethylene and vinyl alcohol copolymer (EVA) hollow fiber (capillary) was developed for ECMO. Gas carrier solution oxygenated with hyperbaric (up to 3 ATA) oxygen gas (O
2) was perfused or hyperbaric O
2 itself was ventilated extracapillarily and saline or bovine blood was perfused intracapillarily in in vitro experiments. Oxygen transfer was increased as trans-EVA membrane pressure (TEMP) was elevated. The membrane resistance was decreased down to zero as the TEMP increased up to 1060 mmHg because oxygenated carrier solution shift into the capillary increased. This oxygenator can alternatively work as oxygenator and dialyzer in liquid-liquid mode or as an oxygenator in gasliquid mode.
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K TANISHITA, T TSUJI, A SEKIDO, T TOGAWA
1991 Volume 20 Issue 3 Pages
1071-1076
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Gas transfer and membrane resistance of a recently developed capillary oxygenator (0.3m
2) consisting of multilayered hollow fiber (MHF) with polyurethane membrane (thickness less than 1 μm) sandwitched by microporous polyethylene membrane was compared with those of a silastic hollow fiber (SHF) oxygenator (0.28m
2, thickness 100μm) in both the gas-gas (G-G) and gas-water (G-W) tests in
in vitro experiments. O
2 and CO
2 transfer and membrane resistance were almost the same in the MHF and SHF in the G-G test. However, CO
2 transfer of the MHF was better than that of the SHF in the G-W test.
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OXYGENATOR WITH A MICROBUBBLE DETECTOR
K. SATO, A. GOTO, M. ANNO, H. YAMAZAKI, M. SHIMAMOTO
1991 Volume 20 Issue 3 Pages
1077-1080
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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In this study, we compared the ability to trap microbubbles among four different of membrane oxygenators. The four models were as follws; VPCML, EXCELUNG α, EXCELUNG and CAPIOXII. The former two models were operated with an integrated open reservoir, which had a cardiotomy filter, and the latter two were with a closed flexible reservoir. The number of the microbubbles were counted by a detector (BD-100), at the outlet of the venous reservoir and the oxygenator. In terms of the ability to trap microbubbles, the open reservoir with a cardiotomy filter appeared to be superior to the closed one. Even with the closed flexible reservoir, microbubbles of a 41-100μm size could barely be detected at the outlet of the oxygenator. We, therefore, concluded that each membrane oxygenator studied an acceptable ability to remove microbubbles of a 41-100μmsize.
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H KANEYASU, T HINO, M MURASUGI, Y SONE, K ONO, T ISIKURA, T YHO, H FUK ...
1991 Volume 20 Issue 3 Pages
1081-1086
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We intended to make the fuzzy automatic controlsyste m of the P
aO
2 at the outlet of the membrane oxygenat or in orderto do some groundwork toward physiologically acceptable automatic regulation of CPB.
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Kenz SETOJIMA, Masayasu YAMASHITA, Yoshio ISAMOTO, Kenichi OONO, Hiros ...
1991 Volume 20 Issue 3 Pages
1087-1090
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We clinically evaluated HF-5000 membrane oxygenator comparing with Sarns 16310. HF-5000 membrane oxygenator(group-H) used for open heart surgery in 15 adult patients and Sarns 16310 (group-S) used for 17 adult patients. The priming volume of group-H was increased about 200ml than that of group-S. group-H has excellent O
2 transfer performance, good CO
2 transfer performance, good heat exchange efficiency and low pressure drop. Inactivation of complement, there seemed to be no significant difference between group-H and group-S.
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Shogo NAKAYAMA, Toshihiko BAN, Yoshifumi OKAMOTO, Shin-ichi NOMOTO, Hi ...
1991 Volume 20 Issue 3 Pages
1091-1094
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Clinical study of extracapillary blood flow type membrane oxygenator, D 703 COMPACTFLO. Newly developed D 703 COMPACTFLO contains extracapillary type membrane oxygenator, venous reservoir and heat exchanger in one compact body. D 703 COMPACTFLO (7 cases, group C)and Sarns 16310(7 cases, group S)were applied for open heart surgery to evaluate their performances in clinical use. COMPACTFLO provided adequate oxygen and carbon dioxide transfer as well as Sarns 16310. Platelet index(platelet counts/hematocrit)was not significantly decreased in both groups and serum free hemoglobin increasing rate in group C was 0.39±0.19mg/dl/min, which proved less adverse effect on blood component. COMPACTFLO has a priming volume of 270 ml and small pressure drop, and can process blood flows of up to 7.51/min. The present study indicates that COMPACTFLO is suitable for clinical application, paticularly for non-hemic primed extcacorporeal circulation.
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IN COMPARISON WITH MAXIMA
O. SHIGEMITSU, T. HADAMA, Y. KAWAWAKI, H. TAKASAKI, Y. MORI, K. OKA, Y ...
1991 Volume 20 Issue 3 Pages
1095-1099
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We evaluated clinically a newly developed oxygenator, HF-5000 in comparison with MAXIMA for open heart surgery in 17 patients and 19, respectively. HF-5000 has a heat exchanger made of polyurethan. Both oxygenator had a good performance of gas transfer. Platelet preservasion rate showed a high tendency and the increase of serum free hemoglobin showed a low tendency in patients used HF-5000, but these differencies were not significant.
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Mera-Excelung α, HF-5400 and Maxima
N KIMURA, H SATOU, T KAZUI, T ABE, S KORRATSU
1991 Volume 20 Issue 3 Pages
1100-1104
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Three extacapillry blood flow type hollow fiber membrane oxygenators (Mera-Excelung α, HF 5440 and Maxima) were compared for the simplicity of their set-up and operation, gas transfer capability and hemocompati-bility. Data were analyzed in 39 adult patients(pts.)who underwent open heart surgory(Excelung α, 15pts.; HF-5400, 11 pts. ard Maxima, 13pts.). The Exceluing α had the lowest priming volume, including that of the circuit, proved the simplest to set up, prime and operate, and was almost equal to the bubble oxygentor in its simplicity. The HF-5400 and. Maxima provided a more adequate oxygen transfer capability than did the Excelling α. There were no statistical differences in hemocompatibility between the three types of oxygenators, in terms of δ plasma free hemoglobin and platelet preservation ratio. Therefore, the Excelung α was characterizeed as a membrane oxygenator which compared with the bubble oxygenator in its simplicity and operability. On the other hard, the HF-5400 was also a membrane oxygenator having a better oxygen transfer capability than previous membrane oxygenators.
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OXYGENATOR IN COMPARISON WITH THE MERA EXCELUNG MEMBRANE OXYGENATOR
T HIGAMI, K OGAWA, T ASADA, N MUKOHARA, M NISHIWAKI, T KAWAMURA
1991 Volume 20 Issue 3 Pages
1105-1109
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The gas transfer characteristics and blood damage of the Bentley-10 plus bubble oxygenator was clinically evaluated in 10 patients with open heart surgery comparing with the Mera Excelung membrane oxygenator in other 10 patients. The P
aO
2 and the P
aCO
2 regulated by alpha-stat method were independently controlled within preset ranges in almost all phases during cardiopulmonary bypass(CPB) in the Bentley-10 plus as well as the Mera Excelung. Platelet was reserved reasonably well during CPB in the both groups. Although plasma free homoglobin increased progressively according to the length of CPB in the both groups, there was no clinical problem. The complement(C3, C4) decreased during CPB in the both groups but there was no statistical difference. The results of this study demonstrate that the gas tranfer performance and the independent controllability of the P
aO
2 and the P
aCO
2 of the Bentley-10 plus bubble oxygenator are as excellent and blood damage is as little as the membrane oxygenator.
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H SATOU, K KOMATSU, S SUGIMOTO, N KIMURA, T KAZUI, T ABE, S KOMATSU
1991 Volume 20 Issue 3 Pages
1110-1113
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A clinical study of the bubble type oxygenator BEN-IOPLUS was performed on 16 patients. The PO
2 Control Valve, integrated on top of this oxygenator, regulates the ratio between bubbling and filming gas transfer. By controlling the ratio of oxygen being diffused into the blood, with the PO
2 Control Valve, the desired arterial PO
2 can be obtained. Carbon dioxide transfer, which is controlled by the total gas sweep rate, remains largely unaffected by the filming or bubbling process due to the higher diffusability of CO
2. This oxygenator provided adequate O
2 and CO
2 transfer capability without time dependent deterioration. No deleterious hematologic consequences were observed. In hematological data, platelet index (platelet counts/hematocrit) did not significantly decrease during perfusion. The rate of plasma free hemoglobin increase was 0.41±0.24mg/dl/min. Because of low priming volume (static 70ml, dynamic hold up 790ml), this oxygenator can be used for non-hematic primed extracorporeal circulation. The present study indicates that this oxygenator would be suitable for clinical application.
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H DOI, Y SASAKO, E TATSUMI, K KUMON, K NISIGAKI, F YAMAMOTO, H KISIMOT ...
1991 Volume 20 Issue 3 Pages
1114-1117
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A newly developed membrane oxygenator “KMO” (KURARAY Co., Ltd., Kurasiki, Japan) was clinically used for extracorporeal membrane oxygenation (ECMO) in infant. This oxygenator is excellent in size (11×6.5×5cm), with low priming volume (45ml). The membrane, in which micropores are blind at the blood-contacting surface, prevents serum leakage, arid has long-term stability in gas-exchange performance. So we conclude, this oxygenator is suitable for ECMO.
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M NAGAYA, M TSUDA
1991 Volume 20 Issue 3 Pages
1118-1123
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We started to use extracorporeal membrane oxygenation(ECMO) for newborns in 1985. Since then nineteen patients were selected to apply ECMO, including 10 cases of diaphragmatic hernia, 2 of gastric rupture, 2 of meconium aspiration, 2 of sepsis and so on. The veno-arterial bypass using cervical vessels was employed in all cases. The mean body weight was 3.0kg and the onset time of ECMO was 82.7 hours old. The mean ECMO time was 96.1 hours. 13 patients(68.4%) survived.
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T OTSU, H TERASAKI, T MORIOKA
1991 Volume 20 Issue 3 Pages
1124-1128
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A long term Extracorporeal Lung Assist (ECLA) for full 38 days was carried out in a 14-month-old infant manifesting severe respiratory failure and unconsciousness due to measles pneumonia. The patient regained consciousness within a few days under ECLA, but many troubles in ECLA management and patient treatments occurredin the course. Venovenous perfusion was changed to the venoarterial on the 12th day. Chest tube insersion for pneumothorax and repo-sittioning of the ECLA perfusion cannula for proper site triggerred bleeding from the wound, but was fixed by haptoglobin. Six artificial lung were necessitated in total during 38 days because of intra-circuit clotting and tube cracking. Besides routine care by antibiotics andγ-globulin for pneumonia, special treatments such as intermittent massive steroid administration (pulse th-erapy), intratracheal lavage by normal saline, urokinase and f ibrinolysin, intratracheal artificial surfactant supplementation and immunological treatment by interleukin-2 or lymphocyte-rich plasma boosted in his mother for 2 weeks by measles vaccine, were tried without salutary results. During ECLA, the patient consciousness was kept clear until near the end. ECLA was disconti-nu ed when he lost consciousness and all the treatments were found unfruitful. Though this case wa s unsuccessful, the feasibility of ECLA as total life support system was demonstrated.
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A FUNAKUBO, [in Japanese], Y FUKUI, T KAWAMURA
1991 Volume 20 Issue 3 Pages
1129-1133
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We developed a prototype of a compact ECMO (Extra Corporeal Membrane Oxygenation) system for neonates with respiratory failure. A single cannula system would make ECMO simpler to operate and less aggressive. The blood flow rate the ratio of drainage/infusion time could be controlled by a microcomputer. By setting flow rate of blood drainage smaller than that of blood infusion, we could avoid excessive negative pressure in the blood circuit without decrease of total blood flow rate. Its potential application as a respiratory support system was evaluated in animal experiments. The system offerd favorable gas transfer not only as ECMO but also as an ECCO
2R. The carbon dioxide removal was 40.4±8.6 ml/min and arterial carbon dioxide tension was maintained within normal limit during ECCO
2R. The total intermittent V-V bypass flow was 25-30 ml/min/kg. The system was considered applicable to respiratory aid for neonates.
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H OKUYAMA, S KAMATA, T HASEGAWA, S ISHIKAWA, N USUI, A OKADA
1991 Volume 20 Issue 3 Pages
1134-1137
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The effect of synchronous pulsatile cardiopulmonary bypass (pulsatile ECMO) for neonatal cardiopulmonary failure was studied on the hemodynamics. Eight normal puppies weighing 2.0-4.9kg (mean 3.1kg) were placed on nonpulsatile ECMO for 1-2 hours followed by pulsatile ECMO for 1-2 hours. During pulsatile ECMO, arterial peak pressure, arterial pulse pressure, endocardial viability ratio, renal blood flow and urinary output were significantly higher than during nonpulsatile ECMO. These results suggested that pulsatile ECMO may be more effective for neonates with cardiopulmonary failure than nonpulsatile ECMO.
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Y MORI, S MURAKAWA, S SASAKI, T YAMADA, S SAKAI, K AZUMA, M KOKUBO, S ...
1991 Volume 20 Issue 3 Pages
1138-1143
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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During clinical hypothermic cardiopulmonary bypass, performances of three groups of membrane oxgenators (Bard HF-5000(H), MERA EXCELLING α(M), Capiox-E (C)) have been studied in 39 patients with aortocoronary bypass operation for ischemic heart disease. (1) O
2transfer performance was more excellent in (H) than in (M) and (C). (2) Plasma free hemoglobin was higher in (C) group than (H) and (M) group. (3) Platelet count postoperatively was higher in (H) group than in (M) and (C) group. (4) Coagulation factors were not significantly different in each three group.
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A COMPARISON AMONG MAXIMA, SARNS 16310, AND MERA-EXCELUNG α
Y HATTORI, S SUGIMURA, K OZAWA, T IRIYAMA, M MATSUTA, M HIRANO, T MATS ...
1991 Volume 20 Issue 3 Pages
1144-1147
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Clinical performances were compared of MAXIMA (M), Sarns 16310 (S), and MERA-EXCELUNGα(E) on 81 patients who underwent open-heart surgery at our institution be-tween January 1989 and June 1990. There were 29 patients for MAXIMA, 36 patients for Sarns, and 16 patients for Excelungα. The age, body weight, total priming volume, dilution factor, and extracorporeal circulation time were, 54 years 55kg, 2030ml, 20% 168min, for MAXIMA group; 24 years, 30kg, 1487ml, 23%, and 137min for Sarns group; and, 44 years, 55kg, 1911ml, 21%, and 153min for Excelung group. Age, body weight and total priming volume were significantly smaller for S-group but otherwise there was no statistically significant difference. Oxygen concentration was set at 70% at the start of cardiopulmonary bypass and then adjusted if necessary. All of three groups had satisfactory oxygenation, but 2.4% of PaO
2 measurements with S- and E-groups showed values below 200mmHg, whereas all values for Mgroup were above 200mmHg. The ratio between gas flow (V) and pump flow (Q) (V/Q) was 0.19 for M-group, 0.37 for S-group, and 0.32 for E-group. PaCO
2 values were 31mmHg for M-group, 32mmHg for S-group, and 28mmHg for E-group; thus CO
2 clearance of M-group was better than S-group, and S-group was inferior to E-group. The V/Q ratio needed to be doubled in all three groups during the rewarming phase, but nevertheless PaCO
2 during this phase was higher than that during the cooling phase.
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A AMEMIYA, M KANEKO, K KADOBA, Y MIYAMOTO, R MATSUWAKA, N SAKAGOSHI, M ...
1991 Volume 20 Issue 3 Pages
1148-1151
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Gas transfer performance of a new hollow fiber membrane oxygenator(Compactf lo) was evaluated in our laboratory. As the results, a higher gas transfer in terms of oxygen transfer and CO
2 removal was found compared with the previously evaluated membrane oxygenators. The optimum membrane index was 0.5-2.0L/min/m
2 and control index was also obtained. This oxygenator was utilized in 13 patients with satisfactory results.
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H. NAKAHARA, T. YAMADA, M. YOKOYAMA, N. OHSHIMA, S. TANABE, Y. IRIE, M ...
1991 Volume 20 Issue 3 Pages
1152-1156
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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In comparison of HF-5400 membrane oxygenator with H-1700 bubble oxygenator, both oxygenator showed good gas exchange capability. Hemolysis was relatively less in cases of HF-5400. Complement activation during CPB resulted numerous increase of C3a (23-26 times values of pre-CPB) and C4a (2.4-9.4 times values of pre-CPB). C3a increased significantly in cases of HF-5400 more than in cases of H-1700, but inversely, C4a increased in cases of H-1700. Suppression of complement activation during cardiopulmonary bypass seemed to be a most important problem to achieve more physiological extracorporeal circulation.
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I NAKADA, Y TAKAHARA, H MURAYAMA, Y SUDOH, T NAKAMURA, T NAGANO
1991 Volume 20 Issue 3 Pages
1157-1160
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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This study investigates clinical evaluation of membrane oxygenators, VPCML (V) vs MASTERFLO (M). Six patients were for V group, and 7 patients for M group. There were no significant differences between the two groups in serum free hemoglobin, white blood cell counts, GOT, OPT, LDH, CPK, total bilirubin, creatinine and BUN, except platelet counts at 60min. after starting cardiopulmonary bypass. There was almost no differences in clinical use between the two membrane oxygenators.
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