Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.

Objective: In Japan, only a few reports of the Ross procedure in neonates and infants have been published. The objective of this study was to evaluate the outcome of patients undergoing a Ross procedure before the age of one year, and to review the validity of opting for this procedure at this age. Methods: The records of 13 infants (including three neonates) undergoing a Ross procedure between December 1996 and June 2017 were reviewed. Major outcomes studied included graft-associated morbidity, autograft function, and the need for reoperation. Results: The median age at the time of Ross procedure was 166 days, and median weight was 5.7 kg. Primary diagnoses were aortic stenosis in 10 cases and aortic insufficiency in three. Nine cases required emergent Ross procedure due to left ventricular dysfunction refractory to medication, requirement of mechanical ventilation or intravenous inotropic drugs. Concomitant procedures included three aortic coarctation repairs, two annular enlargement procedures with a Konno incision and one each of aortic and mitral annuloplasty. The mean cross-clamp time was 131 min and the mean extracorporeal circulation time was 178 min. Two cases required extracorporeal membrane oxygenation. Seven underwent delayed sternal closure and four required postoperative peritoneal dialysis. The median duration of mechanical ventilation was five days and the median length of intensive care unit stay was seven days. Survival was 100% at a median follow-up of 9.9 years. The diameter of the aortic annulus mostly stayed within normal limits, although sinus of Valsalva's enlargement beyond normal value was noted in some cases. Trans-aortic valve pressure gradient was less than 20 mmHg and aortic insufficiency was less than mild in all cases, thus requiring no reintervention for the valve. Two cases required coronary arterial bypass and release of the subaortic stenosis. Freedom from reoperation for the left heart was 100% at one year, and 81.5% at five years and 10 years. Ten cases required reoperation for the right heart, and freedom from reoperation was 84.6% at one year, 29.7% at five years and 9.9% at 10 years. Conclusion: Durability of the pulmonary autograft was excellent. The Ross procedure can be an effective treatment strategy for severe aortic valve diseases in neonates and infants.

Anomalous origin of the coronary artery from the pulmonary artery (ACAPA) is a rare congenital heart disease. A woman in her 60s was diagnosed as ARCAPA during examination for angina. A magnetic resonance image showed myocardial ischemia in a small area of the right coronary artery (RCA) and left anterior descending artery. Reimplantation of the RCA to the ascending aorta and patch plasty of the pulmonary artery were performed. Repositioning of the RCA orientation was necessary for relief of the kinking. The postoperative course was uneventful. She is now free from angina 15 months after surgery.