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Immunocytochemical analysis of implanted artificial grafts
Poster Presentations P55
P57
Syndrome M y x o m a with the Same Diploid DNA Content as Cutaneous M y x o m a
Artrial Fibrillation After C o r o n a r y Artery Bypass Grafting T. SUG ITA, S. WA TARID A, M. O NOE, K. KA TSUYAMA, T. NOJIMA, Y. NAKAJIMA, S. MATSUNO, R. TABATA and A. MORI, Sbiga, Japan
K. TOGASHI, Y. SATO, K. YOSHIYA and K. KANEKO, Nagaoka, Japan Deoxyribonucleic acid (DNA) ploid analysis was done to estimate the probability of recurrence in a patient with syndrome myxoma. The patient was a 45-year-old man with the uneven facial pigmentation. He had undergone thyroidectomy for thyroid carcinoma, bilateral adrenectomies for primary adrenocortical nodular dysplasia (PAND), and Patty's procedure for breast cancer. He also had a myxoid tumor excised from the cheek. In addition, a myxoma originating from the right side of the atrial septum was successfully excised under cardiopulmonary bypass. DNA ploidy of the cardiac and facial myxomas was measured with flow cytometry. Both proved to have the same diploid DNA content. It is possible that these results of DNA ploid analysis as well as the non-familial tendency suggests a good prognosis for this patient in spite of the previously excised multiple malignancies.
This retrospective study was performed to investigate our hypothesis that atrial perfusion is one of the most important risk factors for atrial fibrillation after coronary artery bypass grafting (CABG). Forty-eight consecutive patients undergoing CABG were studied for the occurrence of postoperative atrial fibrillation and flutter (Af). Patients who had a history of Af, mitral regurgitation of more than Sellers degree II or who died in hospital were excluded. Af occurred in 26.5% of the patients. Atrial perfusion was scored by three cardiac surgeons during coronary angiography after CABG or by preoperative coronary angiography in patients whose atrial perfusion was not affected by graft patency. Right and left atrial perfusion was scored by perfusion of the right coronary artery, nosl and 2 and the left circumflex artery, nos 11 and 13, respectively, from which the right and left atrial branches usually arise. The right coronary artery and left circumflex artery were scored from 0 to 2. Univariate studies indicate a low total atrial perfusion score (right atrial perfusion score + left atrial perfusion score) to be the dominant factor promoting Af after CABG (P -- 0.0164). Age, pump time, aortic cross clamp time and preoperative left ventricular ejection fraction were not associated with Af. Thus, Af after CABG is strongly related to low atrial perfusion (atrial ischemia).
P56
Immunocytochemical Analysis of Implanted Artificial Grafts H. URAYAMA, H. KASASHIMA, T. KAWAKAMI, K. KAWAKAMI and Y. WATANABE, lshikawa, Japan To clarify the healing process of implanted grafts, we performed immunocytochemical analysis using antibodies to the cells and matrix of thrombi and pseudointima. Thirteen implanted grafts were obtained from revisional surgery, limb amputation, and autopsy. The materials of the grafts were 8 woven Dacron and 5 EPTFE. The periods of implantation ranged from 5 days to 148 months. The antibodies used for immunocytochemical analysis were specific to ct-actin, macrophage, on WiUebrand factor, fibrin, elastin, collagen type I-V, procollagen, CD3 and CD20. The MIB-1 antibody to Ki-67 nuclear antigen was used to detect cell proliferation. In the grafts of 5 and 24 days implantation, thrombi containing red blood cells and fibrin covered the anastomotic lines and some of the luminal surface of the grafts. Macrophages were scattered in the thrombi, and some macrophages were positive for Ki-67 antigen. In the grafts of 11-148 months implantation, a single layer of endothelial cells or a thin layer of fibrin covered the anastomotic segments of the grafts, and smooth muscle cells and collagen fibers comprised the intimal hyperplasia. Except for the anastomotic segments, a connective tissue matrix with collagen fibers covered the luminal surface, and thrombi were seen in places. The collagens seen were mostly type III, and some types I, IV, V, but no type 11 collagen was noticed. Some T cells were noticed in arterial wall near the anastomosis, but no B cells. Ki-67 positive cells were not demonstrated in anastomotic intimal hyperplasia in this study.
CARDIOVASCULAR SURGERY SEPTEMBER 1995
P58 Pulmonary Flow in Total C a v o p u l m o n a r y Connection
Using an Autologous Right Atrial Wall Flap K. SUZUKI, H. KUROSAWA and S. SHIMIZU, Tokyo, Japan Pulmonary flow (PF) was assessed in ten patients who underwent total cavopulmonary connection (TCPC). The PF pattern was obtained by pulse Doppler, using a 15 MHz transducer of 0.014 inch guide wire type (Flow Wire). Group I (6 patients) showed pulsate flow signals and group II (4 patients) was not pulsatile. Three of six patients in group I had tricuspid atresia and the other three had univentricular hearts. Three of the four patients in group II had univentricular hearts and one had pure pulmonary atresia. Mean age was 8.8 + 5.7 years in group I and 16.0 + 9.1 years in group II. In rerouting from the inferior venae cavae to the pulmonary artery, the autologous right atrial wall was used in all cases in group I and two cases in group II. PTFE grafts were used in two other cases in group II. Right atrial volume index (ml/m2) was 30.1 + 5.2 in group I and 19.3 + 7.8 in group II. The ejection fraction (%) of the right atrium was 33.0 + 10.9 in group 1 and 8.7 + 2.2 in group II. Conclusions: (1) The use of autologous right atrial wall in TCPC can provide puisatile flow in pulmonary circulation, and (2) accelerating factors of this effect are tricuspid atresia and younger age.
161
P57
Syndrome M y x o m a with the Same Diploid DNA Content as Cutaneous M y x o m a
Artrial Fibrillation After C o r o n a r y Artery Bypass Grafting T. SUG ITA, S. WA TARID A, M. O NOE, K. KA TSUYAMA, T. NOJIMA, Y. NAKAJIMA, S. MATSUNO, R. TABATA and A. MORI, Sbiga, Japan
K. TOGASHI, Y. SATO, K. YOSHIYA and K. KANEKO, Nagaoka, Japan Deoxyribonucleic acid (DNA) ploid analysis was done to estimate the probability of recurrence in a patient with syndrome myxoma. The patient was a 45-year-old man with the uneven facial pigmentation. He had undergone thyroidectomy for thyroid carcinoma, bilateral adrenectomies for primary adrenocortical nodular dysplasia (PAND), and Patty's procedure for breast cancer. He also had a myxoid tumor excised from the cheek. In addition, a myxoma originating from the right side of the atrial septum was successfully excised under cardiopulmonary bypass. DNA ploidy of the cardiac and facial myxomas was measured with flow cytometry. Both proved to have the same diploid DNA content. It is possible that these results of DNA ploid analysis as well as the non-familial tendency suggests a good prognosis for this patient in spite of the previously excised multiple malignancies.
This retrospective study was performed to investigate our hypothesis that atrial perfusion is one of the most important risk factors for atrial fibrillation after coronary artery bypass grafting (CABG). Forty-eight consecutive patients undergoing CABG were studied for the occurrence of postoperative atrial fibrillation and flutter (Af). Patients who had a history of Af, mitral regurgitation of more than Sellers degree II or who died in hospital were excluded. Af occurred in 26.5% of the patients. Atrial perfusion was scored by three cardiac surgeons during coronary angiography after CABG or by preoperative coronary angiography in patients whose atrial perfusion was not affected by graft patency. Right and left atrial perfusion was scored by perfusion of the right coronary artery, nosl and 2 and the left circumflex artery, nos 11 and 13, respectively, from which the right and left atrial branches usually arise. The right coronary artery and left circumflex artery were scored from 0 to 2. Univariate studies indicate a low total atrial perfusion score (right atrial perfusion score + left atrial perfusion score) to be the dominant factor promoting Af after CABG (P -- 0.0164). Age, pump time, aortic cross clamp time and preoperative left ventricular ejection fraction were not associated with Af. Thus, Af after CABG is strongly related to low atrial perfusion (atrial ischemia).
P56
Immunocytochemical Analysis of Implanted Artificial Grafts H. URAYAMA, H. KASASHIMA, T. KAWAKAMI, K. KAWAKAMI and Y. WATANABE, lshikawa, Japan To clarify the healing process of implanted grafts, we performed immunocytochemical analysis using antibodies to the cells and matrix of thrombi and pseudointima. Thirteen implanted grafts were obtained from revisional surgery, limb amputation, and autopsy. The materials of the grafts were 8 woven Dacron and 5 EPTFE. The periods of implantation ranged from 5 days to 148 months. The antibodies used for immunocytochemical analysis were specific to ct-actin, macrophage, on WiUebrand factor, fibrin, elastin, collagen type I-V, procollagen, CD3 and CD20. The MIB-1 antibody to Ki-67 nuclear antigen was used to detect cell proliferation. In the grafts of 5 and 24 days implantation, thrombi containing red blood cells and fibrin covered the anastomotic lines and some of the luminal surface of the grafts. Macrophages were scattered in the thrombi, and some macrophages were positive for Ki-67 antigen. In the grafts of 11-148 months implantation, a single layer of endothelial cells or a thin layer of fibrin covered the anastomotic segments of the grafts, and smooth muscle cells and collagen fibers comprised the intimal hyperplasia. Except for the anastomotic segments, a connective tissue matrix with collagen fibers covered the luminal surface, and thrombi were seen in places. The collagens seen were mostly type III, and some types I, IV, V, but no type 11 collagen was noticed. Some T cells were noticed in arterial wall near the anastomosis, but no B cells. Ki-67 positive cells were not demonstrated in anastomotic intimal hyperplasia in this study.
CARDIOVASCULAR SURGERY SEPTEMBER 1995
P58 Pulmonary Flow in Total C a v o p u l m o n a r y Connection
Using an Autologous Right Atrial Wall Flap K. SUZUKI, H. KUROSAWA and S. SHIMIZU, Tokyo, Japan Pulmonary flow (PF) was assessed in ten patients who underwent total cavopulmonary connection (TCPC). The PF pattern was obtained by pulse Doppler, using a 15 MHz transducer of 0.014 inch guide wire type (Flow Wire). Group I (6 patients) showed pulsate flow signals and group II (4 patients) was not pulsatile. Three of six patients in group I had tricuspid atresia and the other three had univentricular hearts. Three of the four patients in group II had univentricular hearts and one had pure pulmonary atresia. Mean age was 8.8 + 5.7 years in group I and 16.0 + 9.1 years in group II. In rerouting from the inferior venae cavae to the pulmonary artery, the autologous right atrial wall was used in all cases in group I and two cases in group II. PTFE grafts were used in two other cases in group II. Right atrial volume index (ml/m2) was 30.1 + 5.2 in group I and 19.3 + 7.8 in group II. The ejection fraction (%) of the right atrium was 33.0 + 10.9 in group 1 and 8.7 + 2.2 in group II. Conclusions: (1) The use of autologous right atrial wall in TCPC can provide puisatile flow in pulmonary circulation, and (2) accelerating factors of this effect are tricuspid atresia and younger age.
161