The volume reduction of BDG preceding TCPC allows for any afterload mismatch to be corrected, thereby improving ventricular energetics after TCPC.

This initial report from J-MACS focuses on patients' demographics, device types, survival, competing outcomes, adverse events and successful examples of system failure detection.

The formin family proteins play pivotal roles in actin filament assembly via the FH2 domain. The mammalian formin Fhod3 is highly expressed in the heart, and its mRNA in the adult heart contains exons 11, 12, and 25, which are absent from non-muscle Fhod3 isoforms. In cultured neonatal cardiomyocytes, Fhod3 localizes to the middle of the sarcomere and appears to function in its organization, although it is suggested that Fhod3 localizes differently in the adult heart. Here we show, using immunohistochemical analysis with three different antibodies, each recognizing distinct regions of Fhod3, that Fhod3 localizes as two closely spaced bands in middle of the sarcomere in both embryonic and adult hearts. The bands are adjacent to the M-line that crosslinks thick myosin filaments at the center of a sarcomere but distant from the Z-line that forms the boundary of the sarcomere, which localization is the same as that observed in cultured cardiomyocytes. Detailed immunohistochemical and immuno-electron microscopic analyses reveal that Fhod3 localizes not at the pointed ends of thin actin filaments but to a more peripheral zone, where thin filaments overlap with thick myosin filaments. We also demonstrate that the embryonic heart of mice specifically expresses the Fhod3 mRNA isoform harboring the three alternative exons, and that the characteristic localization of Fhod3 in the sarcomere does not require a region encoded by exon 25, in contrast to an essential role of exons 11 and 12. Furthermore, the exon 25-encoded region appears to be dispensable for actin-organizing activities both in vivo and in vitro, albeit it is inserted in the catalytic FH2 domain.

The staged strategy used for all Fontan candidates provides excellent clinical results. The main risk factor for death, takedown, or out of indication for completion of TCPC was elevated pulmonary arterial pressure. Appropriate surgical interventions such as atrioventricular valvuloplasty and total anomalous pulmonary venous connection repair, before and/or on BDG for the control of pulmonary circulation are of great importance to prevent elevation of pulmonary arterial pressure.

College of Cardiology guidelines revised in 2014 recommend BP for the patients aged >70 years, mechanical prosthesis (MP) for the patients aged <60 years, and either a BP or MP for the patients aged 60-70 years. 7 Due to the lack, however, of longterm results for the use of BP in AVR 8 and the small number of comparative studies 9 of different age groups in Japan, it remains debatable as to which type of prosthesis, BP or MP, is better for AVR in Japanese patients in their 60 s.The purpose of this study was to analyze our 30-year clinical experience with bileaflet MP and Carpentier-Edwards Perimount (CEP) BP for AVR in different age groups in order to clarify the optimal age for using BP for AVR. MethodsThis study involved human subjects and was reviewed and approved by the Institutional Review Board at Kyushu University. Between 4 November 1981 and 16 December 2013, 737 patients underwent AVR excluding aortic root replacement with bileaflet MP (n=424) or CEP BP (Edwards Lifesciences, Irvine, CA, he use of bioprostheses (BP) has been increasing worldwide along with improvements in durability. 1,2 The use of BP in Japan soared from 9.6% (707/7,364) in 1996 3 to 64.3% (9,832/15,284 valves) in 2011. 4 In our previous study, however, we found that the use of BP should be delayed until 70 years of age in the case of mitral valve replacement (MVR) in Japanese patients. 5 Editorial p 2627The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines revised in 2012 indicate that the use of BP for aortic valve replacement (AVR) should be considered in patients aged >65 years (class IIa) and both valves are acceptable, and the choice requires careful analysis of factors other than age in patients aged 60-65. 6 The guidelines published by the Japanese Circulation Society in 2012 also recommend the use of BP in patients aged ≥65 years if the patient has no risk of thromboembolism (class I). Recently, the American Heart Association and American T Conclusions:The use of BP is suitable in patients aged ≥70 years, while the use of bileaflet MP is preferable in patients aged <60 years. Among patients aged 60-69 years, the use of BP is acceptable because of the lower incidence of anticoagulant-related events and the equivalent long-term survival. (Circ J 2014; 78: 2688 -2695