A 59-year-old man presented with sporadic febrile illness. Echocardiography showed multiple vegetations on the mitral valve. Blood culture yielded Viridans streptococci. Mitral valve replacement was performed, and a high dose of penicillin G sodium (24 million U/day) was administrated for 4 weeks postoperatively. On the 28th postoperative day, the patient developed severe back pain and bloody sputum. Chest CT showed a false aneurysm of the distal aortic arch (5.5cm). The patient was placed on cardiopulmonary bypass with the arterial return in the mid-aortic arch. The aneurysm was resected and replaced with a Dacron tube during deep hypothermic circulatory arrest. The aortic wall was interspersed with mobile nodules that appeared to be colonized. The aorto-pulmonary fistula was directly closed. The whole procedure was carried out through the 4th intercostal space. The tissue culture was negative but histopathology suggested a persistent inflammatory process. Excavating aortic sepsis may occur following active endocarditis. Even if cardiac infection is controlled, continuous search should be undertaken for possible dilatation in remote parts of the arterial system.

Atherosclerotic morbidity of the ascending aorta is associated with an increased risk of perioperative cerebral damage during cardiac surgery. To minimize the risk, we developed a refined method for occluding the diseased ascending aorta. From April 2005 to December 2007, 18 patients underwent cardiac surgery. Just before aortic cross-clamping, the aorta was opened during brief circulatory arrest in order to flush out any possible remaining atheromatous debris. The specially designed intra-aortic occluder was applied to an extremely calcified aorta. There were no hospital mortalities or cerebrovascular accidents. In conclusion, our technique can greatly contribute to the prevention of embolic complications in patients with a severely diseased ascending aorta.

Background: Operative blood loss during open-heart surgery has been decreasing recently. We have stopped predonated autologous blood transfusions to reduce hospital stay and cost. Material and methods: In 70 consecutive elective open-heart cases, we used intraoperative hemodilutional autologous transfusions and intraoperative autotransfusions to avoid homologous blood transfusion. Predonated autologous blood transfusion was not used. All patients received an infusion of high-dose tranexamic acid prior to and after cardiopulmonary bypass (CPB). Results: Homologous blood transfusion was not required in 77.1% of patients who underwent open-heart surgery. When further classified, 84.5% of patients who underwent primary open-heart surgery, 41.7% of patients who underwent a reoperation, and 33.3% of patients who were preoperatively anemic did not require homologous blood transfusion. In patients who undergo reoperation and who are preoperatively anemic, the rate of homologous blood transfusion is high. Therefore, during the reoperation, intraoperative autologous blood transfusion should be used before starting CPB, and iron should be given to anemic patients prior to reoperation. Conclusion: Our strategy of blood conservation consists of intraoperative hemodilutional autologous transfusion, intraoperative autotransfusion, infusion of high-dose tranexamic acid prior to and after CPB and, avoiding predonated autologous blood transfusion. Based on our experience, predonated autologous blood transfusion is usually unnecessary for cases who undergo surgery for the first time and are not anemic. Predonated autologous blood transfusion should be reserved only for high risk patients with anemia and reoperation cases. For further blood conservation, we need to study the safety limits of non-transfusion in open-heart surgery.

We evaluated the surgical strategy for thoracic aortic aneurysm associated with abdominal aortic aneurysm. From January 1982 to March 1999, 24 consecutive patients underwent surgical treatment for thoracic aortic aneurysm with abdominal aortic aneurysm. Staged operation was performed if one was only slightly dilated, but extensive operation was needed if the size of both aneurysms was greater than 6cm. In cases of thoracic aortic aneurysm with abdominal aortic aneurysm up to 4cm in size, surgical treatment was performed only for the thoracic aortic aneurysm. Circulatory support during operation was established from the ascending aorta, and circulatory arrest with deep hypothermia and retrograde cerebral perfusion were used for brain protection during surgery for thoracic aortic arch aneurysm. Hospital mortality was 12.5% (3/24 cases). The causes of death were cerebral infarction and respiratory failure. Antegrade systemic perfusion and aortic no-touch technique were an effective method of surgery for thoracic aortic aneurysm with abdominal aortic aneurysm to avoid perioperative embolism and major complications. We successfully performed staged operation, but regular radiographic follow-up was needed.

BACKGROUND : Norm-referenced equations to predict the 6-minute walk distance (6MWD) in healthy Japanese subjects have not been established. The current study aimed to determine the reference values for 6MWD in healthy Japanese adults.
METHODS : Ninety-seven healthy Japanese men and women aged 40-79 years were recruited from Kyoto city using posters and flyers. Measurements of 6MWD were performed twice on an indoor 30 m track with 20 minutes rest between the two tests. Before performing the tests, age, gender, height, body weight, waist circumference, a questionnaire for health status, spirometry, and a 12-lead electrocardiogram were recorded. The 6MWD was measured following guidelines published in 2002 by the American Thoracic Society.
RESULTS : The mean age of the study subjects was 57.0±9.4, and 63 of the 97 subjects were female. The mean 6MWD for all subjects was 672±83 m, with a range of 483-903 m. The 6MWD is significantly correlated with age, height, waist circumference, forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁). A multiple linear model showed age, waist circumference, and FVC were significantly associated with 6MWD and the model explained 35% of the variability in 6MWD. When FVC was replaced by height, the regression model also explained 32% of the variation. The measured 6MWD of Japanese subjects was similar to the predicted 6MWD using the equations derived from Caucasian subjects.
CONCLUSIONS : The 6MWD was affected to a substantial degree by age, waist circumference, height, and FVC in healthy Japanese adults.

The aim of the present study is to characterize the burden of parents who care for their children with disabilities with the use of a Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) that has been successfully used to quantify the caregiver burden for caring for the disabled elderly. We performed a survey in which questionnaires including the J-ZBI (adapted for the subjects of this study) were given to 135 parents of children in a school for the physically challenged. We obtained 69 valid responses. For the parents, the mean J-ZBI score was 25.6 points and the mean CES-D score was 10.8 points. A lowered QOL for these parents was suggested by the finding that the mean SF-36 score was lower than for other persons of the same year and age in Japan. The parents reported physical strain more frequently than mental stress as the main caregiver burden. According to the parent group's mean J-ZBI score, we classified them into either a heavier or a lighter burden group. The parents who were in a state of depression as judged by the CES-D were more frequently found in the heavier burden group, while those with children who showed complete or modified independence in more items of FIM were more frequent in the lighter burden group. Services to support the physical aspects of parents caring for children with disabilities would reduce their caregiver burden effectively.

Massive thrombi are sometimes present in aortic aneurysms, which cause severe complication such as distal arterial thromboembolism, and greatly influence the prognosis. Such thrombi can be easily detected by CT scan and ultrasound. However these imaging techniques can only demonstrate the presence of thrombi, and are not able to indicate these activity. We performed ¹¹¹In-labeled-platelet scintigraphy (platelet scinti.) in 27 cases of aortic aneurysms (13 true aneurysms and 14 dissecting aneurysms) and 13 postoperative cases of dissecting aneurysms, and compared the findings of CT scan. In some cases, the findings of platelet scinti. were markedly different from the findings CT scan. And our results suggested that the radioisotope deposit revealed by platelet scinti. was reflected thrombotic activity. In one case of dissecting aneurysm, marked RI deposit was revealed by platelet scinti., and subsequently the false lumen was occluded. One postoperative case of dissecting aneurysm showed marked RI deposit and, distal arterial thromboembolism developed. ¹¹¹In-labeled-platelet scintigraphy is thought to be useful to estimate thrombotic activity in aortic aneurysm, and to predict complications and the prognosis.

An internal felt-reinforced patch-plasty was performed in 11 patients with dissecting aortic aneurysm (DeBakey type I: 4 cases, type II: 1 case, type III: 5 cases, aortic arch dissection: 1 case). The aortic cross-clamp time was 84±19 min on the average. The initial tear of the aortic intima was closed on 10 patients. Minor leakage through a felt inserted in the false lumen was observed in one patient of type I. There was no operation-related death except one patient of type III who died from arrythmia encountered following termination of centrifugal pump bypass. Thrombotic occlusion of the false lumen developed in the ascending aorta in type I and II cases, and in the desceding aorta in type III one month after operation. The false lumen localized in the aortic arch was completely occluded by thromi. Postoperative course was excellent in all patients after 16 months on the average. Internal felt-reinforced patch-plasty is a simple and reliable procedure for closing the intial tear of dissecting aortic aneurysms.