Stentless bioprosthetic valves have been implanted for treatment of aortic valve disease, especially in elderly patients ; these valves have the advantage of durability and excellent hemodynamics compared with stented bioprosthetic valves. Although good long-term results in patients with stentless bioprosthetic valves have been reported recently, reoperation has been gradually increasing. We performed reoperation for the SJM Toronto SPV and Medtronic Freestyle valves in one patient each. The SJM Toronto SPV was used in a 30-year-old woman ; however, 8 years later, the valve showed severe calcification and adhesions, and could not be completely removed (Case 1). The other reoperation case, wherein a 69-year-old man underwent aortic valve replacement with the Medtronic Freestyle 4 years previously, showed no adhesion around the implanted valve, which could be easily removed from the autologous aortic annulus. Consequently, the first patient required reimplantation of a small mechanical valve (SJM #19). In contrast, we were able to use a stentless bioprosthetic valve (Prima Plus #23) for the second patient. Further observations on stentless bioprosthetic valves are required.

The use of the internal mammary artery (IMA) is now routine in most coronary artery bypass grafting (CABG) because of its improved long-term patency and survival. A small but important percentage of these patients will require valve surgery and thoracic aortic aneurysm repair following CABG. These operations present a challenging problem for the cardiac surgeon because of difficulties regarding approach, dissection around the IMA and optimal myocardial protection. We investigated surgical results and the effectiveness of various methods of myocardial protection in 8 patients who underwent reoperations between December 1983 and June 2005. The mortality was 13%. There were 2 perioperative myocardial infarctions (25%), 6 cases of prolonged ventilation (75%), 3 cases of low output syndrome (38%), 1 case of acute renal failure (13%) and 1 case of sepsis (13%). We carried out resternotomy for 6 patients without any hospital death or perioperative myocardial infarction. Our reoperation approach had acceptable risk control with resternotomy, avoidance of dissecting the IMA and hypothermic perfusion.

A 50-year-old man was referred to our hospital with a tumor in the left ventricle. He had suffered from rheumatic fever when 14 years old. He had shown signs of chronic heart failure due to atrial fibrillation and rheumatic valves (ASr, MSr) for 10 years. There was a history of unaccountable fever and rash, so infective endocarditis was suspected and echocardiography was performed. It showed a homogeneous mass with a diameter of approximately 10mm, fixed directly to the left ventricular septum 20mm below the aortic valvular ring. At operation, the tumor was excised together with endocardium and a part of the muscular coat. The rheumatic aortic and mitral valves were replaced with a 21mm SJM AHP and a 27mm SJM MTK mitral valve, respectively. Tricuspid annuloplasty (TAP) (De Vega 29mm) was also performed. Histopathological examination of the tumor revealed benign papillary fibroelastoma. It suggested that the tumors were secondary to mechanical wear and tear, and represent a degenerative process due to rheumatic valve disease.

OBJECTIVES: To investigate the link between cigarette smoking and muscle strength in Japanese men. METHODS: We used data on 4249 Japanese men, aged 43.3+/-13.9 years, in this cross-sectional investigation study. Grip strength and leg strength were measured as indicators of overall muscle strength. Meanwhile, subjects' cigarette smoking habits were recorded by trained medical staff. The effect of cigarette smoking on muscle strength was evaluated. RESULTS: A total of 1618 men (38.1%) were smokers and 1481 men (34.9%) exercised regularly. Significant differences in muscle strength were noted between men with and without a Brinkman index of 400 or greater, after adjusting for age. After adjusting for age, height, body weight and exercise habits, associations between the Brinkman index and leg strength and the ratio of leg strength to body weight were attenuated. CONCLUSIONS: Cigarette smoking might be negatively associated with muscle strength, especially grip strength in Japanese men.
Adult ; Body Weight ; Exercise ; Hand Strength/physiology ; Humans ; Japan ; Male ; Middle Aged ; Muscle Strength/*physiology ; *Smoking