Cardiovascular surgeons have strong preferences regarding basic surgical skills. However, those basic skills have never been discussed great detail. The aim of this study is to survey the approach methods for axillary and subclavian artery targeting cardiovascular surgeons in Japan aged under 40, and to share the results of those basic skills.

The U-40 generation of cardiovascular surgeons is receiving training as cardiovascular surgeons, including daily surgeries, ward responsibilities and other important tasks, young surgeons are on their way to becoming skilled cardiovascular specialists. However, it is said that it takes a long time to become a full-fledged surgeon, and in particular, the way to becoming a full-fledged cardiovascular surgeon varies greatly among individuals and is not standardized. Therefore, the U-40 generation is always concerned and worried about their future career development. At the 54th Annual Meeting of the Japanese Society for Cardiovascular Surgery, we will discuss what the U-40 generation needs to become full-fledged surgeons, what they are worried about, and how their seniors who are actually active as independent cardiovascular surgeons think and what their career paths have been like. I had an opportunity to reflect on the gap between the two. This time, we conducted a questionnaire survey to visualize the conditions and future prospects for becoming an independent surgeon as considered by the U-40 generation.

As part of U-40 activities, chapters have traditionally held sessions of lectures and hands-on as the Basic Lecture Course (BLC) to improve the basic skills and knowledge of young cardiovascular surgeons. Because of the COVID-19 epidemic, we have shifted our activities from onsite to online. This column focuses on “management of postoperative delirium and pain” in the lecture of “Postoperative Management in Cardiovascular Surgery” given by the Chubu Chapter in 2020. We summarize the lecture and report the results of a questionnaire survey of the U-40 members.

We report on a rare case of valvular regurgitation caused by methotrexate-associated lymphoproliferative disorder (MTX-LPD). A 60-year-old woman was on methotrexate (MTX) for rheumatoid arthritis. She had developed ulcerative lesions on her extremities, which were diagnosed as lymphoproliferative disorder (LPD) by skin biopsy. She had small intestinal perforation during the same time period, and underwent partial bowel resection. MTX was withdrawn perioperatively. The patient experienced congestive heart failure immediately after the operation and was diagnosed with severe mitral valve regurgitation and moderate-to-severe aortic valve regurgitation. She underwent mitral valve plasty and aortic valve replacement. We observed mitral valve perforation, surrounded by a cauliflower-shaped elevation. Meanwhile, the aortic valve leaflets degenerated into cauliflower-like structures. Pathological findings suggested infiltration of B lymphocytes and Epstein–Barr virus infection in the valve tissue. These findings were similar to those of the prior skin ulcer diagnosed as LPD, which healed spontaneously after MTX withdrawal. She was diagnosed with MTX-LPD based on the pathological findings and clinical history. The patient was discharged on postoperative day 19.