[Acute abdominal aortic occlusion in a patient with a giant thrombus in the left atrium and mitral stenosis; report of a case].

The patient was a 69-year-old male who had had percutaneous transvenous mitral commissurotomy (PTMC) 15 years ago, and had stopped taking warfarin after PTMC. He was transferred to our emergency room( ER) because of sudden severe pain in his both lower legs. We recognized pulselessness in his both femoral arteries, and pallor, paresthesia and poikilothermia in his lower extremities.

[Right ventricular rupture due to blunt trauma diagnosed by MDCT; report of a case].

The survival rate of cardiac rupture due to blunt trauma is generally low. We experienced a case with right ventricular rupture due to blunt trauma. The patient was a 49-year-old man who was crushed in a traffic accident and transported to a local hospital in a shock state.

Socioeconomic effects of surgical site infection after cardiac surgery in Japan.

Purpose: Surgical site infection (SSI) increases medical costs and prolongs hospitalization; however, there has been no multicenter study examining the socioeconomic effects of SSI after cardiovascular surgery in Japan.

Methods: A retrospective 1:1 matched, case-controlled study on hospital stay and health care expenditure after cardiovascular surgery was performed in four hospitals. Patients selected for the study had undergone coronary artery bypass grafting and/or valve surgery between April, 2006 and March, 2008.

Conventional surgical repair of traumatic rupture of the thoracic aorta.

Objective: Traumatic rupture of the thoracic aorta is a life-threatening injury requiring urgent surgical intervention. Despite recent improvements in resuscitation and emergency operative techniques, the outcomes of patients with multiple injuries are still associated with a high mortality rate. We retrospectively examined the preoperative demographic data, associated complications and mortality rate of these patients.

Successful staged operation for acute type A aortic dissection with paraplegia.

A 75-year-old man presented with both paraplegia and acute occlusion of the abdominal aorta at onset. Extraanatomical bypass was performed following spinal drainage. After 3 days, the ascending aorta replaced under cardiopulmonary bypass using the extraanatomical bypass graft for arterial cannulation.

Autoantigenicity of carbonic anhydrase 1 in patients with abdominal aortic aneurysm, revealed by proteomic surveillance.

Abdominal aortic aneurysm (AAA) is sometimes detected in patients with atherosclerosis. One of the histological characteristics of AAA walls is infiltration of inflammatory cells, in which autoimmunity may be involved. Thereby, we here surveyed autoantigens in AAA walls by proteomics.

[Cardiac failure caused by intrapericardial chronic expanding hematoma 18 years after CABG].

Chronic expanding hematoma(CEH)was first recognized by Reid in 1980. It begins to expand chronically more than 1 month after surgery or trauma, which is considered the possible cause of bleeding. It resembles chronic subdural hematoma.

Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance.

Purpose: This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost.

Methods: A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI.

Results: Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery.

Left atrial myxoma complicated with an acute upper extremity embolism.

Atrial myxoma is the most common benign tumor of the heart. Patients who have atrial myxoma usually present with cardiac obstruction, arrhythmia, or peripheral embolization. We encountered an unusual case of acute upper extremity ischemia due to a massive atrial myxoma in a young man.

Surgical treatment or conservative therapy for stanford type a acute aortic dissection with a thrombosed false lumen.

Objectives: Optimum treatment for acute aortic dissection (AAD) with a thrombosed false lumen (thrombosed AAD) remains controversial. We evaluated the outcome of thrombosed AAD according to treatment strategy.

Materials And Methods: We examined 280 patients with AAD, of which 30 had thrombosed AAD.

Reports of four surgical treatments of acute pulmonary embolism with a floating thrombus in the right atrium.

Acute pulmonary embolism (APE) is a serious disease. Recently, multidetector-row computed tomography (MDCT) has proven to be valuable in detecting APE and deep vein thrombosis. APE is classified as massive, submassive, and nonmassive.

Traumatic rupture of the false lumen in a patient with preexisting chronic dissection of the descending thoracic aorta.

A 63-year-old man was transported to the emergency medical center due to blunt chest trauma combined with a fractured left leg caused by a motorcycle accident. He complained of severe dyspnea. Contrast-enhanced computed tomography revealed chronic aortic dissection DeBakey III, mediastinal hematoma of high density just above the diaphragm around the aorta, and an intimal flap-like shadow in the false lumen.

Relation between sleep quality and physical activity in chronic heart failure patients.

To determine self-reported sleep quality-related differences in physical activity (PA) and health-related quality of life (HRQOL) and target values of PA for high-quality sleep in chronic heart failure (CHF) outpatients, 149 CHF outpatients (mean age 58 years) were divided into two groups by sleep-quality level determined via self-reported questionnaire: shallow sleep (SS) group (n = 77) and deep sleep (DS) group (n = 72). Steps were assessed by electronic pedometer, HRQOL was assessed with the Short Form 36 (SF-36) survey, and data were compared between groups. PA resulting in high-quality sleep was determined by receiver-operating characteristics curves.

Rupture of a pseudo aneurysm of the abdominal aorta in a patient with human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection has an impact on all systems of the body, including the cardiovascular system. A 54-year-old man presented with abdominal pain. Enhanced computed tomography revealed rupture of a pseudoaneurysm of the abdominal aorta.

Cardiac rehabilitation outcome following percutaneous coronary intervention compared to cardiac surgery.

To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156).

Successful surgical removal of long-term implantable cardioverter defibrillator lead infection caused by methicillin-resistant in patients with dilated cardiomyopathy.

The patient was a 67-year-old male who received implantable cardioverter defibrillator (ICD) due to dilated cardiomyopathy and ventricular tachycardia 10 years previously. In September 2007, he was admitted to our hospital for dilated cardiomyopathy accompanied by congestive heart failure. Since he suffered from pneumonia and respiratory insufficiency, he was treated with steroid, long-term artificial respirator, and central venous catheter placement.

[Board of cardiovascular surgery in Japan: past, present, and future].

The Japanese Board of Cardiovascular Surgery (JBCVS) was established in 2003. The criteria for board certification were raised compared with those under the previous system. For the past five years, the JBCVS has continuously made efforts to improve the quality of board-certified surgeons.

Recurrent coarctation of the aorta: a patient with bilateral persistent sciatic arteries.

A 19-year-old female was referred to our department with a diagnosis of recurrent coarctation of the aorta. She had undergone end-to-side anastomosis of the left subclavian artery with the thoracic aorta at 9 days of age and extra-anatomic subclavian-to-femoral bypass grafting at 15 years of age because of hypertensive crisis. A preoperative 4-slice computed tomography (CT) scan demonstrated recurrent obstruction of the aorta and, unexpectedly, an associated anomaly of bilateral persistent sciatic arteries.

Use of an audible ultrasonic flowmeter to locate deeply buried coronary arteries for off-pump coronary artery bypass grafting.

In patients with coronary arteries that are deeply buried in the myocardium and fat, it is difficult and sometimes risky to expose them for off-pump coronary artery bypass grafting (OPCAB), leading to unavoidable conversion to conventional coronary artery bypass grafting (C-CABG) to ensure their safety. We have developed a new search procedure for these coronary arteries using a dedicated ultrasonic flowmeter with a small tip probe for OPCAB. This technique enables the identification of intramuscular and intra-fat coronary arteries that are less diseased and thus more suited for bypass surgery instead of switching to C-CABG.

Surgery for aortic dissection involving an aberrant right subclavian artery.

On diagnosis of Stanford type A acute aortic dissection with an aberrant right subclavian artery, emergency operation was performed. Aortic arch replacement was undertaken with additional 'elephant trunk' procedure to cover the entry site and decrease the blood flow through the false lumen. We consider this technique will become one of the effective procedures for acute aortic dissection involving an aberrant right subclavian artery.

Effect of pravastatin on progression of coronary atherosclerosis in patients after coronary artery bypass surgery.

Background: Although the anti-atherosclerotic effects of HMG-CoA reductase inhibitors are well known, their specific effect on saphenous vein grafts after coronary artery bypass graft (CABG) operation is not well documented and has not been studied in Japan, so the aim of the present prospective randomized controlled study involving 27 Japanese institutions was to investigate the effects of pravastatin on the progression of atherosclerosis in such grafts and native coronary arteries after CABG.

Methods And Results: A total of 303 patients who had undergone CABG were randomly assigned to either the pravastatin group (n =168) or the control group (n = 167). Paired coronary angiograms were obtained at baseline and at the end of 5-year follow-up in 182 (60%) patients.

Left pneumonectomy for lung cancer after correction of contralateral partial anomalous pulmonary venous return.

We report the successful treatment of a 48-year-old man with left lung cancer and contralateral partial anomalous pulmonary venous return (PAPVR). He was found to have an abnormal shadow on a regular checkup. Sputum cytology revealed squamous cell carcinoma.

[Acute coronary syndrome].

The first choice of interventional treatment for acute coronary syndrome is percutaneous coronary intervention (PCI), especially when the patient is in cardiogenic shock. In cases of acute myocardial infarction, emergency coronary artery bypass grafting (CABG) is indicated when left main trunk (LMT) lesion or severe triple-vessel disease is left after PCI combined with residual or recurrent ischemic angina and/or ST-T change in electrocardiogram (ECG). Similarly, in cases of unstable angina, emergency CABG is indicated when LMT or LMT equivalent (proximal left anterior descending branch and left circumflex branch) is the culprit lesion or when severe triple-vessel disease exists.

Multiple atherosclerotic aneurysms of the bilateral subclavian artery, aortic arch and abdominal aorta.

Subclavian artery aneurysms are relatively rare in comparison with other peripheral aneurysms. We report a 65-year-old woman with multiple atherosclerotic aneurysms of the subclavian artery, aortic arch saccular aneurysm and abdominal aortic aneurysm. Two-staged operations by which the infrarenal abdominal aorta was replaced first and median sternotomy extending to the supraclavicular space for the concomitant resection of bilateral subclavian as well as aortic arch aneurysm resulted in good results.