We report a very rare case of a coronary artery fistula with communication between the right coronary artery and the left atrium. The patient was a 45 year-old woman admitted for evaluation of heart murmur. Selective coronary angiography demonstrated right coronary artery-left atrial fistula. The operation was indicated due to volume overload of the left ventricle. At operation, the proximal portion of the coronary fistula was successfully ligated from the epicardial side and the entrance of the fistula into the left atrium was directly closed from the inside of the left atrium under the cardiopulmonary bypass. The post-operative course was uneventful. Post-operative coronary angiography showed disappearance of the fistula. Angiography 6 months later, demonstrated that the orifice of the right coronary artery remained dilated, while the diameter of the distal site was normalized.

To confirm the safety and efficacy of a low-calorie mayonnaise supplemented with phytosterol esters (PEM) at a daily consumption dose of 884 mg given for 12 weeks with the goal of lowering serum low-density lipoprotein (LDL) cholesterol levels, we conducted a double-blind comparative study in healthy adults with marginally high serum levels of LDL cholesterol and total cholesterol using a mayonnaise without phytosterol esters supplementation (CM) as the control food. Serum LDL cholesterol levels decreased significantly in the PEM group as compared with the CM group during the 12-week intervention period (136.3 ± 16.4 vs. 145.0 ± 19.3 mg/dL at Week 8 (P < 0.05) and 135.0 ± 17.4 mg/dL vs. 144.9 ± 17.5 mg/dL at Week 12; P < 0.05). No observable adverse effects were observed due to the ingestion of PEM in this study. The safety of PEM was again confirmed by an additional clinical study in which healthy adult subjects ingested a 3-fold greater amount of PEM (2,652 mg of phytosterol esters as a daily dose) for 4 weeks. Thus, we concluded that PEM is effective in lowing serum levels of LDL cholesterol and is safe and well tolerated without any clinical problems.

We report a case of minimally invasive cardiac surgery treated by small right intercostal thoracotomy for left atrial myxoma after substernal reconstruction of the esophagus using gastric interposition. This technique could not only alleviated risk at the second median sternotomy, but was also minimally invasive. A 63-year old man was admitted to our hospital for complaints of right upper limb asthenia and slight fever. Computed tomography showed cerebral infarction. Moreover, cardiac ultrasonography showed a giant myxoma in the left atrium. We thought that it was impossible to reperform median sternotomy, because there was high risk of injury to the reconstructed esophagus using a gastric duct behind the sternum. The patient underwent excision of the myxoma by the right intercostal thoracotomy approach, and did well. He was discharged from the hospital without any complications.

Objective. We investigated whether the aging-related decrease in gap junction expression affects myocardial response against ischemia-reperfusion injury of the rabbit myocardium. Methods. Isolated aged (≥135 weeks) or mature (15-20 weeks) rabbit hearts were perfused with Krebs-Henseleit solution via a Langendorff apparatus, and were divided into five groups as follows: 7 mature hearts served as mature controls (Group A), 7 mature hearts underwent ischemic preconditioning (IPC) consisting of two cycles of global ischemia for 5min followed by reperfusion for 5min (Group B), 7 aged hearts served as aged control (Group C), 7 aged hearts underwent IPC (Group D) and 7 mature hearts received 1mM of gap junction uncoupler heptanol for 5min (Group E). Then, all hearts were subjected to 1h of left anterior descending coronary artery occlusion followed by 1h of reperfusion. Left ventricular pressure, ischemic zone monophasic action potential and coronary flow were measured throughout the experiment and the infarct size (IS) was determined at the end of the experiment. Gap junction expression was investigated by the electron microscopy. Results. The IS of Group A was 39.1±3.8 (%) and that of Group B was 26.9±3.8 (%)^* (^*p<0.05 vs. Group A). The IS of Group C was 19.3± 1.6(%)^*. That of Group D was 43.6±5.8 (%)^# (^#p<0.05 vs. Group C). IS of Group E was 24.3±1.6 (%)^*. Electron microscopic findings demonstrated that gap junction expression in aged hearts was less prominent than in mature ones. Conclusion. These data suggested that aged myocardium might be more tolerant of ischemic insult than that of mature heart, and that the mechanism might be related to the aging-related change of gap junction expression.

A 60-year-old woman underwent surgical treatment of postinfarction ventricular septal perforation (VSP) in the early phase after receiving total cardiopulmonary bypass without aortic occlusion. VSP developed four days after anterior myocardial infarction. On admission, inraaortic balloon pumping was used to obtain hemodynamic stabilization. On the day of admission, emergency total cardiopulmonary bypass was performed. VSP was closed with a Dacron felt patch positioned on the left side of the septum. The anterior wall of the left ventricle was closed with Dacron felt strips and reinforced using a Gore-Tex sheet. Postoperative hemodynamics improved significantly. Although the operation while the heart was beating was difficult technically, the total cardiopulmonary bypass time of this method was not longer than that of operations under cardioplegic arrest. Further more, the area of infarction was easily distinguished by color and bleeding. The surgery during normothermic heart beat was effective in preventing further ischemia of the myocardium. The surgical treatment of VSP in the early phase during normothermic heart beat under total cardiopulmonary bypass was considered to be more effective and safer than operations under cardioplegic arrest.

BACKGROUNDMultislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT.

METHODSFourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson's method. True LV and RV cast volumes were determined by water displacement.

RESULTSBoth calculated LV and RV volumes correlated highly with the corresponding true volumes (all r >0.95, P <0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21 +/- 5.95) ml to (12.58 +/- 8.56) ml for LV and (10.22 +/- 8.45) ml to (23.91 +/- 12.24) ml for RV (all P <0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P <0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm.

CONCLUSIONSBoth LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.

Adolescent ; Adult ; Aged ; Cardiac Volume ; Child ; Child, Preschool ; Female ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods

Background/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees. Methods: This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. Results: The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. Conclusions Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

Aortic dissection presents with acute chest or back pain. However, it can be asymptomatic in the acute phase with delayed symptomatic presentation or incidental diagnosis upon chest imaging. We report a case of acute type B aortic dissection subsequent to chronic type A aortic dissection which was difficult to distinguish from acute type A aortic dissection. A 45-year-old man was admitted to a hospital with sudden back pain. An enhanced chest CT revealed a suspected acute type A aortic dissection. The patient was transferred to our hospital and we performed an emergent total arch replacement. Intraoperative findings showed that there were two entries at the origin of the brachiocephalic artery and the left subclavian artery. The ascending aorta presented wall thickening but the descending aorta did not present wall thickening. Histopathologically, the adventitia was obviously thickened with dissection findings in the tunica media. Thus it was diagnosed as acute type B aortic dissection subsequent to chronic type A aortic dissection. Great caution should be taken in asymptomatic chronic aortic dissection.

Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.