OBJECTIVES: Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis. METHODS:Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation. RESULTS:The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively). CONCLUSIONS:In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.

Factor XI (FXI) deficiency is rare and associated with bleeding after surgical procedures. We report a case of an 80-year-old woman with severe aortic valve stenosis. FXI deficiency was diagnosed due to prolonged activated partial thromboplastin time. Aortic valve replacement was performed using a porcine bioprosthetic valve. Intra-operation bleeding was controlled by the transfusion of a fresh frozen plasma. The postoperative course was uneventful.

冠動脈バイパス術は技術の進歩，動脈グラフトの使用などで成績は向上しているが，問題点の一つとして新 生内膜肥厚による吻合部狭窄があげられる．本研究の目的は，シロスタゾールと生体吸収性材料であるポリ L 乳酸・カプロラクトン共重合体(copolymer of L-lactide and h-caprolactone ; P (LA/CL))を混合した シロスタゾール徐放フィルムによるイヌ大腿動脈吻合モデルの吻合部被包が，吻合部新生内膜の増殖抑制効 果を有するかについて組織化学および組織計測学的に検討することである．総数 20 頭のビーグル犬を用い て，大腿動脈を 2 カ所切断し端々吻合を行った動脈吻合モデルを作製した．フィルムに含有させるシロスタ ゾールの量は 10，40，80 mg とし用量効果について検討した．また，フィルムを使用せず吻合のみ試行した 群をコントロールとした．手術終了 4 週間後に肉眼的所見を観察後，吻合部の病理組織学的検討を行った． シロスタゾール徐放フィルム群で有意に内膜中膜比の減少が認められた．また，proliferating cell nuclear antigen(PCNA), c-smooth muscle actin(c-SMA)および desmin に対する各抗体を用いた免疫染色によ る検討では，シロスタゾール徐放フィルム群でコントロール群と比較し PCNA index, c-SMA 陽性細胞率の 有意な低下がみられた．Desmin 陽性細胞率は 80 mg 群で有意な低下を認めた．シロスタゾール徐放フィル ムを吻合部外膜側から投与することで，新生内膜肥厚抑制効果が確認でき，血管吻合術の長期予後改善に有 望な手法となる可能性が示唆された．日心外会誌 39 巻 4 号：162-171(2010) キーワード：新生内膜肥厚，シロスタゾール，P (LA/CL) ，動脈吻合モデル