Decellularized biological scaffolds have been used for the tissue engineering of heart valves with good results in the pulmonary circulation. However, little information is available on the recellularization of plain decellularized biological scaffolds in the systemic circulation. The aim of this study was to determine whether plain decellularized xenografts (PDXs) can recellularize with specific cell characterization in the systemic circulation. The xenogenic aortic valved conduit grafts of rabbits were implanted in the abdominal aorta of dogs after decellularization. The grafts were explanted at 4, 12, or 24 weeks after implantation for histological, immunohistochemical examination, scanning electron microscope, and Western blot analysis. Although the valvular structures were completely lost after implantation, supravalvular conduits showed normal shapes and endothelialization. The PDXs were repopulated with basic vascular cell components in approximate natural proportions without immunological responses. The PDXs had been recellularized with specific cell characterization in the systemic circulation.

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The patient presented with a history of recurrent aphthous stomatitis, genital ulceration, and a family history of positive for collagen disease. Echocardiography and retrograde aortography revealed aneurysm formation of the sinus of Valsalva, and dilatation of the aortic valve annulus with severe aortic regurgitation. On diagnosis of an aneurysm of the sinus of Valsalva and aortic regurgitation associated with Behçet's disease, aortic root replacement with the modified Bentall technique was successfully performed.

SummaryThis study was conducted to evaluate the safety and efficacy of tolvaptan following open heart surgery. We retrospectively reviewed 109 patients who were administered tolvaptan following open heart surgery between August 2011 and July 2014. We divided the patients according to their urine output index (amount of urine output/body surface area) into tertiles as follows: T1 (low responders; n = 36), T2 (intermediate responders; n = 36), and T3 (high responders; n = 37). No fatal adverse events were observed following tolvaptan administration. The factors that showed a significant difference among the 3 groups were body surface area (BSA) and preoperative body weight. Body weight rapidly decreased and a greater increase in the serum sodium level was observed on day 1 in the T3 group than in the other 2 groups. No decrease in blood pressure and no significant differences in the occurrence of atrial fibrillation were observed among the 3 groups during tolvaptan administration.Tolvaptan can be safely and effectively administered to increase the urine output without adversely affecting the cardiovascular system or renal function following open heart surgery. However, careful attention is required regarding the possibility of a rapid increase in the serum sodium level so it is important to monitor changes in serum Na levels. ( open heart surgery in recent years, volume control is one of the most important factors in the perioperative management of open heart surgery. Tolvaptan, a vasopressin V2-receptor antagonist, is available as a diuretic drug that can be used in the treatment of fluid accumulation in heart failure. Several studies have reported the efficacy of tolvaptan in patients with chronic congestive heart failure and acute heart failure. [1][2][3][4][5] According to previous reports, the use of tolvaptan for acute heart failure at an early stage of hospitalization prevents exacerbation of acute kidney injury, improves patient prognosis, 6) is superior to carperitide in terms of treatment cost of acute heart failure, 7) and is effective for correcting hyponatremia. [8][9][10] Although there are case reports indicating the efficacy of tolvaptan after open heart surgery, the number of patients reported is small. [11][12][13][14] Open heart surgery using cardiopulmonary bypass is often followed by symptoms such as circulatory inflammatory response, capillary hyperpermeability due to low body temperature, decreased intravascular colloid oncotic pressure due to hemodilution, and stromal edema as a result of decreased lymph flow.15) Blood vasopressin concentration also increases after cardiac surgery because of hypotension during cardiopulmonary bypass and sympathetic nerve activation caused by operative stress.16) Therefore, it is believed that reabsorption of water in the collecting tubules is excessive following open heart surgery. Because the diuretic effect of tolvaptan reduces the accumulation of intercellular fluid through an increase in the serum Na level or a difference in osmotic pressure, tolvaptan ...

A 71-year-old woman was admitted for examination of a heart murmur and anemia. She had a history of mitral valve replacement and tricuspid ring annuloplasty 8 months prior to admission. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract to the right atrium and a small defect between the left ventricle and the right atrium. No periprosthetic leaks were detected in the mitral position. At operation, a communication just beneath the detached prosthetic ring at the anterior-septal commissure of the tricuspid valve, and a jet of bright red blood entering the right atrium through the defect at the atrial septum just cephalad to the commissure, were found. After removing the ring, the defect was closed using a mattress suture. In this case, the tricuspid annuloplasty ring was probably placed on the atrio-ventricular portion of the membranous septum, rather than the tricuspid annulus, at the antero-septal commissure of the tricuspid valve in the previous operation, and its dehiscence may have created a tear in the atrio-ventricular membranous septum, leading to left ventricular-right atrial communication.