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.

We report a case of secondary aortoenteric fistula (SAEF). A 76-year-old man who had undergone bifurcated graft replacement for an abdominal aortic aneurysm 18 years previously was admitted to our hospital on 2008. Since the patient was in hemorrhagic shock and had several comorbidities, he first underwent emergency endovascular aneurysmal repair (EVAR). The patient recovered from shock, and then the duodenal fistula was closed and a temporary tube enterostomy was made on the next day. The patient's recovery was uneventful and he was discharged 34 days after EVAR without any sign of infection. However, the patient was admitted for a recurrent SAEF 16 months after the procedure. Although emergency surgery was performed, he died due to sepsis 11 days after surgery. EVAR could be useful to control bleeding associated with SAEF ; however, it would be necessary for a long-term results to perform additional radical surgery subsequently to ensure the patients' hemodynamic recovery.

We investigated the training system of a young cardiovascular surgeon in Japan. We presented the result of surveillance at the 49th Annual Meeting of the Japanese Society for Cardiovascular Surgery 2019, and report here the summary.

A 75-year-old man with a heart murmur and fatigability was referred to our hospital. We diagnosed unruptured giant right sinus of Valsalva aneurysm that obstructed the right ventricular outflow tract by echocardiography (UCG), computed tomography (CT) and magnetic resonance imaging (MRI). The right ventricle was dilated and its ejection fraction was decreased to 9.3% by MRI. Successful surgical repair involved the right sinus of Valsalva plasty using a bovine pericardial patch and resection of the aneurysm through only a right ventricular outflow incision. His postoperative course was uneventful.

The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.

Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.