A 51-year-old man was referred to us because of upper extremity hypertension and vascular claudication of the lower extremities. He underwent extraanatomic ascending aorta-abdominal aorta bypass with vascular graft under a median sternotomy and a midline laparotomy incision without cardiopulmonary bypass. The postoperative course was uneventful. Upper extremity hypertension and vascular claudication were completely resolved. Although the patient has done well in the three years since his operation, we continue to observe him closely. The etiology of atypical coarctation may be related to Takayasu arteritis because of the angiographic findings and positive specific alleles such as HLA-B5201 and DRB1 1502.

Tricuspid valve myxoma is extremely rare. A 33-year-old woman who had undergone clipping of a cerebral aneurysm, had a cardiac tumor pointed out incidentally while undergoing echocardiography. Echocardiography showed a mobile and solid round mass (14×12 mm) attached by a short stalk. We suspected a right ventricular tumor. Once the diagnosis of cardiac tumor has been established, prompt excision is essential to prevent complications, as well as syncope or collapse due to the transient occlusion of the tricuspid or pulmonary valves with embolization by the thrombus or fragments of the tumor tissue. Surgery was performed under cardiopulmonary bypass. The tumor was attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was extirpated along with a piece of the papillary muscle and chordae. We performed tricuspid chordoplasty with artificial chordae. The histopathologic diagnosis was myxoma. The postoperative course was uneventful and the patient was discharged on the 15th day after the operation. While the patient has done well with no recurrence of the tumor during the five years that have passed since her operation, we will continue to observe her closely in the future because there have been some reports of recurrence after complete excision of cardiac myxoma and there are no long-term follow-up results of artificial chordae in the tricuspid position.

This is a case report of an expansion of the right internal iliac artery aneurysm after an exclusion operation. A 72-year-old man, had undergone aneurysmectomy and graft replacement of a right external iliac artery aneurysm and a ruptured left iliac artery aneurysm, and exclusion of a right internal iliac artery aneurysm in 1995. Computed tomography showed an expansion of the right internal iliac artery aneurysm in 2003. We performed graft replacement and bypassing to the right external iliac artery. The patient had a satisfactory postoperative course.

We describe two patients who underwent repeat off-pump coronary revascularization by axillocoronary artery bypass grafting. A 63-year-old man (case 1), who had undergone coronary artery bypass grafting (CABG) 13 years previously, was admitted to our hospital with exertional angina. The saphenous vein grafts (SVG) to the left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) all were occluded. The left internal thoracic artery (LITA) also was occluded because it had been injured. Because the patient declined to undergo a redo CABG, percutaneous transluminal coronary angioplasty (PTCA) to the LAD was attempted. However, coronary dissection occurred, and an emergency operation was performed. A 66-year-old man (case 2), who had undergone CABG 12 years previously, was admitted with unstable angina. The LITA to the LAD and the SVG to the RCA were occluded. The SVG to the Cx had 99% stenosis in its mid-portion and was the cause of the angina. PTCA and stenting of this SVG were performed. Two weeks later, an operation was done. In both patients, the left axillary artery was selected as the site of the proximal anastomosis. Both patients underwent off-pump bypass grafting to the LAD from the left axillary artery using a SVG. Both grafts were patent postoperatively. This approach resulted in early symptomatic improvement.

A 69-year-old woman complained of general malaise. Chest X-ray film revealed massive left-sided pleural effusion and CT detected a giant aneurysm of the aortic arch. A diagnosis of ruptured aortic arch aneurysm was made and she underwent total arch replacement as emergency surgery. The intraoperative diagnosis was not a ruptured arch aneurysm but an arch aneurysm penetrating into the left pulmonary artery. The postoperative course was uneventful and the patient was discharged home on the 16th postoperative day.

The need for palliative care for heart failure patients has been attracting attention, but the system for providing such care is not yet fully established in Japan. Iizuka Hospital is a 1048-bed acute care hospital located in Fukuoka, Japan. The Heart Support Team (HST) was established to provide palliative care for heart failure at the hospital. After the HST was launched in May 2017, 168 referrals for palliative care intervention for heart failure patients by March 2022. Twenty-five (14.8%) met the intervention cases’ additional palliative care treatment criteria. The Integrated Palliative Outcome Scale was administered to 11 consecutive patients from April 1 to 30, 2021. In establishing and operating the HST, the challenge was recruiting, training, and creating a system to sustain the system. Creating the HST in collaboration with staff specializing in palliative care, psychiatric care, and cardiovascular specialists was the first step in establishing a method for palliative care to heart failure patients in an acute care hospital.