A 28-year-old woman with no underlying health issues was injured in a motorcycle accident and taken to our hospital by ambulance when she was 26 years old. Though she was diagnosed with multiple trauma, upon arrival at the hospital neither cardiac murmurs nor cardiac abnormalities on transthoracic echocardiography were detected. She was managed conservatively, and discharged on hospital day 16. She experienced dyspnea upon mild effort, and an early diastolic murmur appeared. She was again referred to our hospital, and diagnosed with severe aortic regurgitation. We scheduled an aortic valve replacement using an bioprosthetic valve because she intended to give birth. We also considered simultaneous aortic root enlargement as her aortic annulus was small. We performed the surgery 2 years after the initial motorcycle accident. Perioperatively, we noticed that her non-coronary cusp was torn. We converted the procedure to an aortic valve repair using an autologous pericardial patch. Her aortic regurgitation disappeared after the operation, and she was discharged on postoperative day 14. We successfully preserved the aortic valve cusps and avoided the need for anticoagulant therapy.

The number of operations performed for cardiovascular disease has increased since recent improvements in diagnostic and the therapeutic technology have led to a remarkable increase in the life expectancy of patients with Marfan syndrome. On the other hand, operative procedures can be difficult when patients have complications of connective tissue abnormalities such as thoracic deformities, lung diseases and ophthalmic lesions. Although recent surgical outcomes have improved, those of secondary surgery are more difficult. We describe aortic root replacement to treat perivalvular leakage after aortic valve replacement in a patient with Marfan syndrome with a severe thoracic deformity.

We participated in the “Advanced Objective Structured Clinical Examination (OSCE) Osaka Trial, ” which was part of the 10th Medical Education Seminar and Workshop in Osaka. OSCEs have been used to assess students' clinical ability before the clinical clerkship program, where the medical interview and the medical examination are introduced as basic clinical skills. The Advanced OSCE is used to assess students' clinical ability after they have done clinical clerkships; it will soon be a part of the national board examination. In the present trial, the students and residents took the Advanced OSCE with 6 themes: pharyngeal pain, palpitations, dyspnea, abdominal pain, hypertension, and cardiac arrest. We examined questionnaires completed by students and residents just after they had taken the Advanced OSCE. We believe that the use of simulators is important for medical students and residents to improve their clinical skills and that appropriate feedback is also extremely important.