We report the Lampshade Technique : a new technique using Carbo-Seal Valsalva (Sorin Biomedica, Saluggia, Italy) to facilitate preparation of a composite graft. A Bentall operation and an ascending aorta replacement were performed with a composite graft using a Carbo-Seal Valsalva. This new technique can be considered useful as it can reduce the time required for preparing a composite graft, and create a skirt portion for continuous suturing to prevent bleeding.

Primary cardiac malignant tumors are relatively rare, and their prognosis is poor. We report a patient with sarcoma causing severe mitral regurgitation and stenosis due to rapid and specific infiltration into the mitral valve.

A 67-year-old man with ascending aortic aneurysm was referred to our hospital. Transthoracic echocardiography showed severe aortic regurgitation with annuloaortic ectasia and transesophageal echocardiography revealed a quadricuspid aortic valve. This patient underwent aortic root replacement with a valve sparing technique. Under deep hypothermic circulatory arrest with retrograde cerebral perfusion, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful. This patient is doing well 6 months after surgery without recurrence of aortic regurgitation.

A 76-year-old woman with acute myocardial infarction (AMI) suddenly fell down with cardiogenic shock. Echocardiography showed free wall rupture (FWR), therefore emergency operation was performed under IABP and PCPS assistance. Seven days after initial operation, onset of ventricular septal perforation (VSP) was recognized. Eighteen days after initial operation, the infarct exclusion technique with a bovine pericardial patch was performed. She has been doing well 4 months after the operation with trivial residual shunt. Mechanical complications after AMI are classified as FWR, VSP, and papillary muscle rupture. A combination of any two types of these is called ventricular double rupture. Ventricular double rupture is a very rare condition, and its prognosis is poor. We report here a surgical case with ventricular double rupture after AMI.

A 69-year-old man with type II right-sided aortic arch (RAA) underwent an off-pump coronary artery bypass grafting (OPCAB) in December, 2017. He underwent an abdominal aortic aneurysm resection and graft replacement in April, 2018. The postoperative computed tomography (CT) that was performed in May 2018 revealed aortic dissection from the ascending aorta to the aortic arch, although he was asymptomatic. We evaluated the native coronary artery and patent bypass grafts by coronary CT. Graft replacement of the ascending aorta and partial aortic arch was carried out on an elective basis and the proximal anastomotic site of the vein grafts was attached to the prosthetic graft. Stanford type A aortic dissection (AAD) after previous coronary artery bypass grafting differs from spontaneous AAD in presentation, management and outcome. We report here a successful surgical case with RAA and AAD after OPCAB.

Cardiovascular surgeons have strong preferences regarding basic surgical skills. However, those basic skills have never been discussed great detail. The aim of this study is to survey the approach methods for axillary and subclavian artery targeting cardiovascular surgeons in Japan aged under 40, and to share the results of those basic skills.

BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum ; Endoscopy ; Hemorrhoids ; Humans ; Potassium ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Tannins