Hypoplastic left heart syndrome with anomalous origin of left coronary artery from the right pulmonary artery: successful surgical treatment in a neonate.

Anomalous origin of the left coronary artery from the right pulmonary artery in association with hypoplastic left heart syndrome is a rare congenital anomaly. We describe a successful simultaneous surgery for both anomalies during the first stage palliation in a neonate.     

Development and Initial Testing of a Permanently Implantable Centrifugal Pump

Abstract: To be able to salvage heart failure patients, the need for an economical permanent ventricular assist device is increasing. To meet this increasing demand, a miniaturized centrifugal blood pump has been developed as a permanently implantable device. The Gyro permanently implantable model (PI-601) incorporates a sealless design with a blood stagnation free structure. The pump impeller is magnetically coupled to the driver magnet in a sealless manner. This pump is atraumatic and antithrombogenic and incorporates a double pivot bearing system. A miniaturized actuator was utilized in this system in collaboration with the University of Vienna. The priming volume of this pump is 20 ml. The overall size of the pump actuator package is 53 mm in height and 65 mm in diameter, 145 ml of displacement volume, and 305 g in weight. Testing to date has included in vitro hydraulic performance and hemolysis. This pump can provide 5 L/min against a 110 mm Hg total pressure head at 2,000 rpm and 8 Limin against 150 mm Hg at 2,500 rpm. The normalized index of hemo-lysis (NIH) value of this pump was 0.0028 g/100 L at 5 Limin against 100 mm Hg. A preliminary anatomical study revealed the possibility of the implantability of 2 such systems in biventricular bypass at a preperitoneal location. This system is feasible for use as a permanently implantable biventricular assist device.     

Low-pressure Pneumoperitoneum for Laparoscopic Surgery Using a Disposable,Flexible Abdominal Wall Retractor

Abstract: Since April 1991, we have studied 160 patients who had had a successful laparoscopic cholecystectomy. Nine patients who presented with chronic cholecystitis with severe local adhesion and who were also considered to require a longer operative time were selected as suitable candidates for this procedure. They were successfully treated under a zero- to four-mmHg low-pressured pneumoperitoneum procedure combined with total abdominal wall lifting using a disposable, flexible vinyl tube retractor. This method enabled exactly the same clear laparoscopic vision as is possible in the routinely-used high-pressure pneumoperitoneum even in the marginal portions of the abdominal cavity. Moreover, it facilitated early reinsufflation after the cauterization-produced smoke was exhausted, which minimized the operative time and reduced the surgeon's anxiety concerning the maintenance of a sufficiently airtight condition. We believe that this low-pressure pneumopeqitoneum procedure also benefits the poor-risk patient who has restricted cardiopulmonary function, especially during advanced laparoscopic surgery which requires a longer operative and anesthetic time.     

The fourth-generation centrifugal blood pump

 The NEDO Gyro permanently implantable (PI) centrifugal blood pump has been developed as a simple, durable, centrifugal blood pump without a complex magnetic suspension system. In vitro studies were performed using a Gyro PI pump with the transparent pump housing in a mock circuit. These studies revealed that the impeller transfers to a floating or a top contact condition, which was dependent on the revolutions per minute (RPM). This pump can be easily converted from a left ventricular assist device (LVAD) to a right ventricular assist device (RVAD) by simply adding a spacer between the pump and the actuator. In order to optimize the impeller suspension for the LVAD and RVAD, spacers of the proper thickness are inserted between both of the pumps and the actuators to regulate the magnetic force. Two Gyro PI pumps were implanted in a bovine model in a 3-month biventricular assist device (BVAD) animal study. This experiment was electively terminated 90 days after implantation. All of the parameters, including pump flow rate, power consumption, and plasma free hemoglobin, were in acceptable ranges. No thrombus formation was observed in either pump. Antithrombogenesis and effectiveness were demonstrated in this animal study. The NEDO Gyro PI pump is ready to move on to the 3-month preclinical system evaluation. Received: February 28, 2002 / Accepted: May 30, 2002 Acknowledgment The New Energy and Industrial Technology Development Organization (NEDO) under the Ministry of Economy, Trade and Industry of Japan financially supported this project. Correspondence to:S. Ichikawa