We describe our surgical treatment in a patient with subvalvular aortic stenosis due to pannus formation beneath a monocusp mechanical valve. In this case, transvalvular removal of subvalvular pannus using a CUSA (Cavitron ultrasonic surgical aspirator) was performed successfully. A 77-year-old woman underwent aortic valve replacement with a monocusp tilting-disk mechanical valve (Björk-Shiley, 23 mm) 30 years previously. Reoperation for severe aortic stenosis due to calcified subvalvular pannus formation was required. Intraoperative findings revealed no limitation of leaflet motion of the valve but presence of left ventricular outflow tract obstruction caused by subvalvular pannus formation under the major orifice of the prosthesis. Because of difficulty of exposure of the prosthetic valve due to severely calcified valsalva sinus wall, simple re-do aortic valve replacement seemed to be almost impossible. Therefore, we tried transvalvular removal of the pannus. A scalpel could not be applied due to severe calcification of the pannus. Then we used CUSA and removed the pannus successfully. Finally, subvalvular stenosis (LVOTO) was ameliorated and a decrease of trans-aortic valve velocity was recognized. She is doing well without recurrence 1.5 years after the surgery.

Objectives: As the population ages worldwide, including in Japan, there is a growing expectation for older adults to remain active participants in society. The act of sharing one’s experiences and knowledge with younger generations through social engagement not onlyenriches the lives of older individuals, but also holds significant value for our society. In thisstudy, we examined both positive and negative perceptions of older adults and investigated the correlation between these perceptions and generativity among older citizens. Additionally, we evaluated the impact of life satisfaction on these factors. Methods: We conducted a survey of 100 older adults in Japan (mean age, 71.68 years) and utilized multiple regression analyses, using positive and negative perceptions of older adults, life satisfaction, and demographic factors as independent variables. The sub-categories of generativity—namely, generative action, concern, and accomplishment—were used as dependent variables. Results: Participants who held a more positive perception of older adults demonstrated a higher level of generative actions and concerns. Additionally, participants who reported higher levels of life satisfaction also exhibited more generative actions, concerns, and accomplishments. Conversely, those who held a more negative perception of older adults were found to have higher levels of generative actions. Conclusion Enhancing positive perceptions of older adults among them can boost the subcategories of generativity. This study, which was conducted from an exploratory perspective, has several limitations, including a potential sampling bias. A more comprehensive examination of the relationship between perceptions of older adults and generativity is anticipated in future research.

A 55-year-old woman with fever and consciousness disorder diagnosed as infective endocarditis was transported to our hospital. She had atopic dermatitis. A mobile vegetation at the mitral valve was revealed by the transesophageal echocardiography, and a computed tomography (CT) scan showed cerebral infarction, left renal infarction and suspected embolization of the vegetation. Streptococcus aureus was detected in the blood culture test. We conducted emergent surgery, mitral valve plasty was performed. On the second day after the operation, the hemoglobin began to decrease, and the hemodynamics became unstable. The contrast CT examination revealed arterial bleeding from the left kidney, which had an infarction before the operation. We performed emergent catheter liquid embolization for the superior polar branch of the left renal artery, and the hemodynamics improved thereafter. There has been no report of renal hemorrhage after cardiac surgery for infective endocarditis. This case reminded us that cardiac surgery for infective endocarditis may cause various complications of organs.

Azoospermia ; Cysts ; Humans ; Male ; Prostate ; Prostatic Diseases ; Saccule and Utricle ; Urethra