Traditional dental education focuses on providing adequate knowledge and skills to students. Dental care was delivered on the basis of this knowledge-and skills-oriented concept. Recently the relationship between dentists and patients has been emphasized, and the improvement of dental education, such as the introduction of attitude education, has been discussed. Our department has used attitude education, which creates a close human relationship between doctors and patients. One training program requires patients' participation. Understanding health creation (holistic medicine) could not be taught with traditional educational methods or without patients' participation. In this program, students interacted with patients in the classroom and came to understand the stable doctor-patient relationship, not as the idealized relationship taught by traditional dental education but as a human-human relationship founded on understanding mutual existence and reality. Consequently, the students could understand the meanings for the following questions: “What are characteristics of a stable relationship?” and “How should health be created?”. In this paper, the contents and the methods of our programs are introduced and the students' evaluation is discussed.

We report a case of emergent redo-mitral valve replacement during pregnancy at 23 week and 4 days of gestation. A 23-year-old woman, who underwent mitral valve replacement with a bioprosthetic valve (Carpentier-Edwards Perimount^® 27 mm) for infective endocarditis 5 years ago, was transferred to our hospital due to severe congestive heart failure. Echocardiography revealed structural valve deterioration of the mitral prosthesis and severe mitral stenosis. Emergent redo-mitral valve replacement with a bioprosthetic valve was performed to save the patient with top priority. Cardiopulmonary bypass was operated under normothermic, high flow, high pressure and pulsatile fashion. Fetal heart rate was continuously monitored during the operation. Although her baby was delivered vaginally just after operation weighing only 520 g, she was treated by the neonatologists successfully.

A 37-year-old man presented with extensive myocardial infarction due to total occlusion of the left main trunk, complicated with near-fatal heart failure. An extracorporeal left ventricular assisted system LVAS (NIPRO-Toyobo LVAS) was implanted in our hospital. Although his postoperative course was relatively good, acute cholecystitis occurred on the 31st postoperative day, and emergeney cholecystectomy was indicated. His PT-INR was 4.13 because of taking Warfarin orally, and the cannulas of LVAS passed through his skin at the subxiphoid region. Therefore, we preoperatively transfused fresh frozen plasma quickly to reverse the PT-INR (approximately 2.0) and performed open cholecystectomy via the right side of the para-rectus abdominal muscle. His postoperative course was uneventful, and he is waiting for heart transplantation in our hospital.