A case of left ventricular pseudoaneurysm formation at an atypical site in the left ventricle is described. A 32-year-old man underwent mitral valve replacement and he was taken to the intensive care unit (ICU) in good condition. Two hours later, he sustained massive bleeding from the chest drainage tubes, hypotension, and shock. We reopened the sternotomy in the ICU and found massive bleeding from the lateral wall of the left ventricle. Under cardiopulmonary bypass and cardiac arrest, the myocardial laceration was closed with Teflon felt-buttressed interrupted sutures and then the involved area was covered with a Xeno-medica^TM patch. Postoperative echocardiography, computed tomography, and left ventriculography revealed pseudoaneurysm formation at antero-lateral wall of left ventricle. Because the patient was asymptomatic, he was discharged from our hospital without reoperation. However we are closely following him in the outpatient clinic.

We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 l/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.

The surgical results of 9 patients (group II) who were treated for thoracoabdominal aneurysm using left heart bypass combined with oxygenation were compared to those of 16 patients (group I) using left heart bypass without oxygenation. The left heart bypass time in group II was longer than that in group I, and the operations performed in group II were more extensive with more intercostal and lumbar arteries being reconstructed than those in group I. Nevertheless, bleeding associated with transfusion was less in group II than in group I. Intraoperatively, hypothermia and hypoxemia developed in 44% and 31%, respectively of group I, whereas neither of these conditions occurred in group II. There were three operative deaths in group I, compared with one in group II. Paraplegia was encountered in one patient of group I, but in none of the patients in group II. There were a few patients with respiratory failure or other organ failures in both groups. Our results showed that left heart bypass combined with oxygenation offered more stable and effective respiratory as well as circulatory support for a long duration compared to conventional left heart bypass without oxygenation in the surgical treatment of thoracoabdominal aortic aneurysm.

Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.

This study aimed to examine the effects of an 8-week physical activity program, which mainly comprised home-based bench-stepping exercise training at the intensity of lactate threshold (LT), on mental health (MH), health-related quality of life (HRQOL), and physical fitness in Japanese returnees from China. Thirty Japanese returnees (63 ± 9 y) participated in the exercise program. Another six subjects were enrolled as the control group. The subjects performed 212 ± 57 min of training, and their daily step counts were increased. Aerobic capacity (LT: 4.5 ± 0.8 vs. 5.5 ± 1.1 METs), lower limb strength (30-s chair stand test [CS-30]: 19.1 ± 5.5 vs. 21.3 ± 5.1 times), and sit-and-reach flexibility (sitting-posture body anteflexion: 36.1 ± 9.4 vs. 39.0 ± 8.4 cm) were significantly increased after the intervention compared with before the intervention. Furthermore, MH, as assessed by the total score of the GHQ-28 (3.4 ± 4.4 vs. 0.3 ± 0.8 points), and the mental component score (MCS) of HRQOL, as evaluated by the SF-36v2 (55.1 ± 11.4 vs. 58.5 ± 10.0), were significantly changed in a positive manner. However, a two-way repeated measures ANOVA (group × period) showed significant interactions for LT and MCS (p<0.05), and a tendency for interactions of CS-30 (p=0.063) and the total score of the GHQ-28 (p=0.098). These results indicate that this bench-stepping exercise program could become a useful health support program for improving physical fitness, as well as MH and HRQOL, in Japanese returnees.