We evaluated the relation of changes in skin temperature, measured by thermography, to clinical symptoms and findings in patients who underwent coronary artery bypass surgery using the radial artery. All had a negative Allen test before operation. Ten consecutive patients who underwent surgery at least 3 months prior to the study were selected. Left radial artery grafts were harvested in all patients. Skin temperature was measured twice, before and after exercise. Two patients had a cold sensation at the arterial harvest site at rest. Three, including these two, complained of pain along the harvest site after exercise. No differences in temperature were observed before and after exercise in the ulnar aspects of the palm or forearm on either the left or right side. On the other hand, the increase in radial aspect temperature on the left side was smaller than that on the right. Skin temperature was clearly decreased after loaded exercise in 3 patients. We believe that the indications of grafting should be carefully considered because patients can show findings associated with circulatory disturbance at arterial harvest sites.

A 75-year-old man who presented with fever and cough was given a diagnosis with active pulmonary valve endocarditis and transferred to our institution. Blood cultures were positive for Enterococcus faecalis, and transthoracic echocardiography showed a mobile vegetation attached to the pulmonary valve. Despite an 8-week treatment with antibiotics, a relapse of the infection required surgery. During the surgical procedure, we found that the vegetation had destroyed all of the pulmonary valve leaflets. After excising the pulmonary valve leaflets, we implanted a bioprosthetic valve and closed the pulmonary artery with autologous pericardium. The patient completed a 6-week course of intravenous antibiotics and was discharged on postoperative day 68. Postoperative transthoracic echocardiography demonstrated an adequate effective orifice area index. Our case report of isolated pulmonary valve endocarditis without predisposing factors is rare. The implantation of a bioprosthetic valve and enlargement with an autologous pericardial patch is an effective option for achieving a satisfactory hemodynamic profile.

A 79-years-old female underwent total arch replacement for an aortic arch aneurysm. A postoperative CT scan showed no abnormalities on the anastomotic sites, including the supra-aortic neck vessels. However, 10 months after the operation, she visited our outpatient clinic to complain of left shoulder pain. A CT scan demonstrated complete occlusion of the left subclavian artery, and doppler echography detected a subclavian steal phenomenon. Eleven months after the operation, the patient was transferred to our hospital because of the transient loss of consciousness and progressive aphasia. MRI revealed hyperintensive lesions in the boundary area between the left temporal and occipital lobes, enlarged in a DWI (diffusion-weighted image) with time. Axillary-axillary bypass grafting was performed to suppress the progression of cerebral ischemia caused by a subclavian steal phenomenon. Aphasia seemed to be improved soon after the bypass and diminished on postoperative day 2. The hyperintensive area on DWI regressed, and no other lesion was found on a postoperative MRI. She was discharged without apparent sequelae, including aphasia. We report a successful case of revascularization for subclavian steal syndrome with aphasia.

A 45-year-old male presented to a hospital for shortness of breath and palpitations, and an electrocardiogram abnormality was identified. Coronary angiography showed multiple spontaneous coronary artery dissection (SCAD) on the left anterior descending artery (LAD) and the right coronary artery (RCA）. Optical coherence tomography showed the LAD had two lumens, and the RCA had multiple lumens by SCAD. Furthermore, computed tomography depicted a bulky thrombus on the left ventricular apex. All lesions were revascularized with arterial grafts, and the concomitant thrombectomy was performed for the thrombus on the apex. The coronary arteries were clearly dissected, and the anastomosis was made to what appeared to be a true lumen based on various intraoperative assessments. The flow pattern and flow volume through the grafts were satisfactory using the ultrasound Doppler method. The patient's postoperative course was uneventful, and he was discharged on postoperative day 22. All grafts have been patent, and the cardiac function has remained improved for 2.5 years of follow-up in our outpatient clinic.