Improvements in hemoglobin-based oxygen-carrying (HBOCs) solutions have overcome the toxicities that plagued earlier efforts. However, limitations of the efficacy of HBOCs are emerging. The potential limitations of an HBOC were studied in an ovine model (n = 6) of exchange transfusion. Hemodynamic, oxygen transport, and hemoglobin kinetic parameters were examined during isovolumic blood exchange to a final hematocrit of 3.2 +/- 0.7% and a plasma hemoglobin concentration of 8.1 +/- 0.4 g/dl while sheep were awake and breathing room air. However, the infusion of HBOC was associated with immediate increases in systemic and pulmonary arterial pressures. Despite hemodilution with HBOC, systemic and pulmonary vascular resistance increased 43.9% (P < 0.001) and 204.2% (P < 0.001), respectively, after HBOC infusion. After blood exchange, the plasma hemoglobin level exhibited a circulatory half-life of 52.7 +/- 18.0 h. The formation of methemoglobin was significant, accounting for 33.0 +/- 7.1% of the total circulating plasma hemoglobin at 24 h; the half-life of HBOC capable of carrying oxygen was 30.1 +/- 5.4 h. This relatively short period of oxygen-carrying efficacy and the observed vasoconstriction properties may constrain the potential applications of HBOC solutions.

No abstract

A 53-year-old man with Behçet's disease was admitted to our hospital for investigation of back and lower abdominal pain. Computed tomography (CT) showed a projecting saccular aneurysm below the right renal artery. We placed a stent-graft just below the right renal artery, successfully excluding the abdominal aortic aneurysm (AAA). His C-reactive protein level and white blood cell count remained elevated after stent-grafting. About 5 months later, he was readmitted with recurrent back and lower abdominal pain and CT showed progression of the AAA. Thus, we performed straight grafting using a woven Dacron graft just below the right renal artery. The patient had an uneventful postoperative course. We discuss the controversial issue of treating AAA in patients with Behçet's disease, focusing on the indications and timing of surgery.

hronic ischemic mitral regurgitation (MR) is a cause of congestive heart failure in patients with ischemic cardiomyopathy. Various mitral valve plasty (MVP) techniques have been reported, but the best surgical intervention is still controversial and the development of new techniques is necessary to give better outcome for patients with ischemic MR. We initiated our original procedure called "papillary muscle sandwich plasty" 1 in 2004 and in this study, we evaluated its early and late surgical results. Methods PatientsOf 602 ischemic heart disease patients, 46 underwent MVP for ischemic MR between 1999 and 2007 and of them, 23 patients since 2004 underwent papillary muscle sandwich plasty. The mean age of the patients was 67 (47-82) years and there were 16 men and 7 women. The patients' preoperative characteristics, examination results and operative procedures are summarized in Table 1.According to preoperative echocardiography, the mean left ventricle diastolic and systolic diameters were 54±6 mm and 43±7 mm, respectively. The mean mitral annulus diameter and tenting height was 29.5±2.4 mm and 12.0±2.8 mm, respectively. The grade of preoperative MR was severe in 10 patients and moderate in 13. Mitral ring-annuloplasty was performed in 9 (39%) patients and left ventricular volume reduction in 5 (22%). Postoperative early and late results were evaluated. The mean follow-up period was 24±10 months (range 7-39 months). TechniqueOur technique of "sandwich plasty" is usually performed (Received June 16, 2008; revised manuscript received January 12, 2009; accepted February 19, 2009; released online May 18, 2009 Methods and Results:The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR. Conclusions: "Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure. (Circ J 2009; 73: 1240 -1242