We performed cardiac resynchronization therapy (CRT) in addition to coronary artery bypass grafting (CABG), mitral valve replacement (MVR) and tricuspid valve annuloplasty (TAP) in a 72-year-old patient with poor cardiac function (New York Heart Association functional class III, ejection fraction 38%), triple coronary vessel disease, and mitral and tricuspid valve insufficiency after three-area old myocardial infarction. Electrocardiography showed no change in the QRS interval after CRT. However, tissue Doppler echocardiography showed synchronicity of the septum and posterior segments in the left ventricle, and that contraction of the septum was in the systolic phase of the cardiac cycle after CRT. New York Heart Association functional class improved from III to I after the operation. CRT of the dyssynchronized myocardium in which ischemia and volume overload were improved by CABG, MVR and TAP may improve regional cardiac function and synchronicity.

In 306 patients who underwent elective coronary artery bypass graft (CABG) between January 2005 and July 2008, low cardiac functions (EF<35%) were seen in 24 patients. Of these, 7 (EF, 22.7±5.4%, NYHA 3.4±0.4) had a left ventricular epicardial lead implanted during surgery. On completion of bypass anastomosis, a screw-in-type epicardial lead was implanted. The mean threshold at implantation was satisfactory (1.1±0.4 V). There were no complications related to intraoperative lead placement. In the aforementioned 7 patients, combined Cardiac resynchronization therapy defibrillator (CRT-D) implantation was performed in 4 during the postoperative period while they were still in the hospital. In 1 other patient, the procedure was conducted when he was readmitted for heart failure 3 months after discharge. The threshold for the left ventricular myocardial lead was satisfactory (1.0±0.1 V). No postoperative complications, such as infections, hemorrhage, or twitching, were noted. For those patients who are likely to have a CRT-D placed after CABG, a left ventricular lead showed be implanted if possible for the safe and fast postoperative placemens of a defibrillator. However, the indications of myocardial lead implantation must be considered carefully.

In 306 patients who underwent elective coronary artery bypass graft (CABG) between January 2005 and July 2008, low cardiac functions (EF<35%) were seen in 24 patients. Of these, 7 (EF, 22.7±5.4%, NYHA 3.4±0.4) had a left ventricular epicardial lead implanted during surgery. On completion of bypass anastomosis, a screw-in-type epicardial lead was implanted. The mean threshold at implantation was satisfactory (1.1±0.4 V). There were no complications related to intraoperative lead placement. In the aforementioned 7 patients, combined Cardiac resynchronization therapy defibrillator (CRT-D) implantation was performed in 4 during the postoperative period while they were still in the hospital. In 1 other patient, the procedure was conducted when he was readmitted for heart failure 3 months after discharge. The threshold for the left ventricular myocardial lead was satisfactory (1.0±0.1 V). No postoperative complications, such as infections, hemorrhage, or twitching, were noted. For those patients who are likely to have a CRT-D placed after CABG, a left ventricular lead showed be implanted if possible for the safe and fast postoperative placemens of a defibrillator. However, the indications of myocardial lead implantation must be considered carefully.

We performed cardiac resynchronization therapy (CRT) in addition to aortic valve replacement (AVR) in a 74-year-old patient with poor cardiac function (New York Heart Association functional class III, ejection fraction 15%), complete right bundle branch block (CRBBB), left posterior hemiblock (LPH), and aortic valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and posterior segments in the left ventricle, and that contraction of the septum was in the systolic phase of the cardiac cycle after CRT. The New York Heart Association functional class improved from III to I after the operation. CRT of the dyssynchronized myocardium in a patient with CRBBB and LPH can improve regional cardiac function and synchronicity.

We performed cardiac resynchronization therapy (CRT) in addition to mitral valve replacement (MVR) in a 66-year-old patient with dilated cardiomyopathy (DCM) associated with complete left bundle branch block (CLBBB) and mitral valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and lateral wall in the left ventricle after CRT. New York Heart Association functional class improved from III to I after CRT and MVR. CRT of the dyssynchronic myocardium in a patient with DCM associated with CLBBB improves regional cardiac function and synchronicity.

We encountered a case of pseudoaneurysm of the ascending aorta, aortic stenosis and regurgitation, and infected popliteal aneurysm discovered 24 years after cardiac operation. A 34-year-old male who had undergone radical operation for subaortic stenosis at age 10 had infectious endocarditis. Pseudoaneurysm of the ascending aorta and aortic stenosis and regurgitation were noticed after diagnosis of a popliteal aneuyrsm, and operation was performed in two stages. Resection of the popliteal aneurysm, direct suturing of the entry as well as resection of the pseudoaneurysm of the ascending aorta, patch plasty of the defect and replacement of aortic valve were performed with satisfactory results.

Background: Despite the recent increase in the number of institutions introducing nurse practitioners to perioperative management following cardiovascular surgery, limited reports have evaluated their performance. Objective: The current study aimed to evaluate nurse practitioners' intervention based on perioperative outcomes following cardiovascular surgery. Methods: We performed a retrospective visualization of perioperative data following open-heart surgeries conducted at our hospital from April 1, 2019 to May 31, 2021, with the NP (99 patients) and DR (109 patients) groups consisting of patients whose first assistant was a nurse practitioner and physician, respectively. Results: No significant differences in patient characteristics were observed between the two groups. There were no significant differences in the operative time (304.4±92.7 vs. 301.4±86.8: min; p=0.947), death within 30 days (n)(2 vs. 2; p=0.923), and ICU stay (5.72±4.42 vs. 6.65±5.43: days; p=0.302), between the two groups. No significant difference was observed in the occurrence of postoperative complications between the two groups. The NP group had significantly shorter hospital stay (18.6±6.7 vs. 23.0±9.8: days; p<0.001) and duration of ventilator management (19.7±22.6 vs. 28.8±50.2: h; p=0.047) than the DR group. Discussion: The NP and DR groups exhibited comparable surgical outcomes. Perioperative management by a team including nurse practitioners, rather than by physicians alone, has been considered to reduce the duration of time spent on ventilator management and enable earlier hospital discharge, resulting in shorter hospital stays. This suggests that nurse practitioners, including surgical assistants under the direct supervision of physicians, may be able to safely perform perioperative management.

A 74-year-old male with exertional breathlessness was referred to our hospital by his general physician. Echocardiography revealed severe mitral regurgitation. An aortic and coronary computed tomography scan revealed aortic arch thrombosis and coronary artery stenosis in the left anterior descending (LAD) artery. In consideration of the risk of embolization, the patient underwent emergency surgery on the same day. The surgical procedure involved the replacement of the aortic arch with a fenestrated frozen elephant trunk, mitral valvuloplasty, and coronary artery bypass graft for the LAD artery. Blood tests revealed no underlying coagulopathy. The patient did not develop any postoperative complications. He was discharged home on his own on postoperative day 19. One year after the surgery, no recurrence of thrombosis or heart failure was observed. Severe mitral regurgitation complicated with intraaortic thrombosis is rare. This case report indicates that intraaortic thrombosis can occur even in patients without any underlying blood coagulation abnormalities. We report this case with a review of the literature.