Ischemic cardiomyopathy with a severe left ventricular dysfunction and enlargement, is a dismal prognosis, but can be a surgical candidate. So, differential diagnosis of ischemic cardiomyopathy from other cardiomyopathies and evaluation of myocardial viability are important. We successfully performed coronary artery bypass in a 68-year-old patient with ischemic cardiomyopathy. His preoperative left ventricular function showed an end-diastolic volume of 281.8cc/M/m², pressure of 30mmHg, and ejection fraction of 13.1%. We conclude that coronary artery revascularization provides significant benefits for ischemic cardiomyopathy with reversible myocardial ischemia.

A 51-year-old woman with a 12-year history of chronic hemodialysis and secondary hyperparathyroidism suffered dyspnea induced by massive mitral regurgitation due to severe circular mitral annular calcification. Her anterior mitral leaflet was resected and successfully replaced with a 25mm SJM valve in the supra-annular position. The posterior leaflet was heavily calcified and adhered to the left ventricle. The flangeless prosthesis was directly implanted into the left atrial wall on the calcified annulus. Postoperative cine fluoroscopy and echocardiography showed good hemodynamic performance of the prosthesis without perivalvular leakage. In cases of mitral annular calcification due to chronic renal failure, the SJM valve is a more suitable valve prosthesis for replacement of the mitral valve in the supra-annular position. Supra-annular mitral valve replacement without a flange may give superior valve-performance compared to valves with a flange considering thrombogenicity and left ventricular function. However, we may still have to consider the indication of a supra-annular mitral valve replacement with a flange in cases with wide mitral annular calcification in the giant left atrium.

An 80-year-old woman who had been suffering from atrial fibrillation and recurrent cerebral infarction was admitted to our hospital. Transesophageal echocardiography revealed a giant mobile thrombus in the left atrial appendage. The patient underwent thrombectomy and left atrial appendage obliteration under cardiopulmonary bypass. Her postoperative course was uneventful. The patient showed no recurrence of the left atrial thrombus nor thromboenbolism postoperatively. Based on the present results, we recommend cardiac thrombus be investigated by transesophageal echocardiography in cases of atrial fibrillation accompanied by recurrent thromboembolism. This should be followed by thrombectomy under cardiopulmonary bypass, even in the elderly.

Background: A workshop for training clinical clerkship staff has been held since 2009. We examined how the participants felt about the workshop.
Method: The questionnaire was sent to the participants of the workshop.
Result: Of the participants, 82％ thought that the workshop was helpful and that the benefits had continued for more than 2 years. Their motivation for undergraduate medical education was improved. They started to consider how medical students become members of a medical team and to think about the goals of medical practice. To promote further increases in the numbers of clinical clerkships, the participants cited the necessity of increasing the number of faculty advisors, encouraging medical students’ positive attitudes, changing attitudes about patients, extending the training period, and holding such workshops.
Conclusion: The workshop was beneficial for the staff, and the beneficial effects continued long after the workshop was held.

A 68-year-old male was admitted as an emergency case because of two severe back pain episodes in one week. Chest X-ray showed a marked prominence of the aortic knob. A remarkable bulging of the distal aortic arch and a crescentic low density area along the descending aorta on enhanced chest CT suggested a closing aortic dissection. Operation revealed extensive collapse of the very fragile intima of the aneurysmal wall and extraluminal hematoma along the descending aorta due to bleeding from the ruptured site. The ruptured aneurysm of this type should be accurately differentiated from the DeBakey type III closing aortic dissection which can be followed up medically.