A 69-year-old woman was given a diagnosis of moderate aortic stenosis (AS) associated with congenital bicuspid valve in 2011. In 2014, surgery was indicated because of progression of AS and dilatation of the sinus of Valsalva and ascending aorta. Preoperative contrast-enhanced CT and echocardiography showed the saccular space (2×2 cm) located at the left ventricular outflow tract just below the aortic annulus. At surgery, the saccular aneurysm was located just below the aortic annulus of the noncoronary cusp. We resected the aneurysm and closed the orifice with interrupted sutures from the inside of the LV and the outside. Aortic subannular left ventricular aneurysm is a very rare malformation with only 25 reported cases and its natural course is largely unknown. Rupture of aneurysms, infection, thrombus formation, arrhythmia, and heart failure etc. has been reported as complications. We reported a case of aortic subannular left ventricular aneurysm with bicuspid aortic valve stenosis with a literature review.

A 68-year-old man underwent percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery (LAD) seg 7 after acute anteroseptal myocardial infarction 8 years previously. He was admitted because of syncope attack due to sustained ventricular tachycardia and subsequent fibrillation. He was treated medically in the ICU after cardiopulmonary resuscitation. Medical treatment with amiodarone and lidocaine was not successful and he was transferred to our hospital for surgical treatment of malignant ventricular tachycardia (VT) associated with left ventricular aneurysm and acute cholecystitis that occurred during admission. Left ventriculogram showed left ventricular aneurysm (ejection fraction: 35%) without any significant coronary lesions. The patient successfully underwent a Dor operation (left ventriculoplasty), double encircling endocardial cryoablation without endocardial resection, and preoperative and intraoperative endocardial mapping. Cholecystectomy was simultaneously performed after complete closure of the median chest incision. The recurrence of VT was never recognized clinically or electrophysiologically. The extended encircling endocardial cryoablation without endocardial resection and preoperative and intraoperative electrophysiological study, was a simple and effective method for ventricular tachycardia.

We report the succesful treatment for improvement of orthostatic hypotension of a case of Shy-Drager syndrome (SDS).
CASE REPORT
A 56 year-old man diagnosed with SDS was admitted to our hospital on July 8, 1988 because of orthostatic hypotension. He had been suffering from dizziness, dysuria and muscular rigidity for 2 years. He had been treated with drug-therapy, but these sympton had progressed. Physical examination on admission revealed severe orthostatic hypotension due to disorders of autonomic nervous system, so he could not stand still.
For the treatment, we performed Yushi and punctured its points (Geshu. Hachiyu, Danshu, Pishu, Weishu) or 3 points (Sanyinjiao, Taixi, Taichong) that is located on legs. Acupuncuture therapy was applied from July 13, 1988 to December 10, 1988, every day except on holiday. We estimated the effect of acupuncture therapy with transition of blood pressure and orthostatic hypotension. Transition of acupuncture therapy were as follows.
(1) Yushi were performed alone.
(2) 3 points of legs (Sanyinjiao, Taixi, Taichong) were punctured alone.
(3) Yushi were performed, and 3 points of legs were punctured.
(4) Geshu, Genshu, Pishu and 3 points of legs were punctured.
(5) Subcutaneous needle at Yushi points.
(6) Punctured depth of 1cm to Yushi points.
Symptomatical respons was observed at about 70th treatment, and blood pressure was stabilized constantly and activity of daily life was improved.
Kinoshita et al. reported that Yushi act to sympathetic nervous system inhibitory, so serve to treat for hypertension. But in this case, its act was accelerate. It is speculated that Yushi act to autonomic nervous system homeostatically.

Mitochondria activation factor (MAF) which is high-molecular weight polyphenol contained in black tea and oolong tea can increase the mitochondrial membrane potential. MAF supplementation to mice facilitates endurance running performance after 9-week endurance training and muscle hypertrophy induced by synergist ablation. In this study, we examined the effect of oral MAF supplementation on overall physical fitness (expressed as physical fitness age) in physically active middle-aged and older women. This study is a randomized double-blind placebo-controlled trial implemented between January and May 2019 at three fitness facilities in Ibaraki, Japan. Seventy middle-aged women aged 55 to 69 years were randomly assigned into placebo (n = 35) and MAF groups (n = 35). The placebo participants took cornstarch-containing capsules, and the MAF participants took MAF-containing capsules twice a day for 80 days consecutively. During the intake period, all participants were instructed to follow 30-min circuit training program at least twice a week. Physical fitness age was computed with eight physical fitness items assessing upper-extremity muscle strength, locomotion, and postural change. The physical fitness age decreased by 1.48 years (95% confidence interval [CI]: -2.66, -0.30) in the placebo group and 3.01 years (95% CI: -4.16, -1.86) in the MAF group. The reduction was greater in the MAF group, but did not reach statistical significance (p = 0.06). The combination of 80-day of MAF intake and circuit exercise showed beneficial results. However, our results did not indicate clear effects on physical fitness age because of low statistical power. Further studies are necessary to reveal the effects of MAF supplementation.