Many patients with abdominal aortic aneurysm have coexisting coronary artery disease. There is no evidence regarding the safety or efficacy of surgery, or whether surgery should be done in 1 session or in more than 1 session. Single-stage surgery is generally more invasive. We performed single-stage surgery using minimally invasive direct coronary artery bypass graft surgery (MIDCAB) for revascularization in 4 patients with abdominal aortic aneurysm and coronary artery disease. The average operation time was 399 min. The average number of bypassed grafts was 1.75 per patient. All patients were extubated within 24 h after surgery. The average discharge time was 29.3 postoperative days. No patients died during surgery or during hospitalization. Multidetector-row CT scan showed all bypassed grafts to be patent. MIDCAB surgery is safe and effective for revascularization in performing single-stage surgery in patients with abdominal aortic aneurysm and coronary artery disease.

A 63-year-old woman with annuloaortic ectasia and severe aortic regurgitation was referred to our hospital. Preoperative coronary angiography revealed 50% stenosis of the orifice of the left main trunk. She underwent aortic root replacement, but we were unable to insert a 12-gauge cannula into the orifice of the left coronary artery because of cardioplegia. Therefore, we decided to perform patch plasty of the left main trunk by a saphenous vein patch. Her postoperative course was uneventful, and postoperative computed tomography (CT) showed good expansion of the left main trunk without any evidence of aneurysm formation.

Background : Perioperative care in congenital heart surgery has evolved in recent years, and it was considered a contributive factor to improve surgical outcome and prognosis. Objective : To extract perioperative clinical protocols that have been applied in our hospital, then assess their usefulness for better clinical outcome. Methods : We retrospectively reviewed our patients' records to analyze representative perioperative protocols that might have contributed to surgical outcome, such as intraoperative transesophageal echocardiography (ITEE), extubation in the operating room on patients of atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), Glenn procedure and Fontan procedure. We also assessed clinical pathway of ASD and VSD, and each protocol was individually explored to calculate achievement ratio in order to show its adequacy. Results : This study included 482 of on-pump surgery patients and 146 of off-pump surgery patients from June 2007 to June 2014. ITEE was performed in 474 of on-pump surgery patients and 102 of off-pump surgery patients. No case had a residual lesion immediately after operation. Extubation in the operating room was performed in cases without severe pulmonary hypertension (PH). The extubation ratio was 94.7% (ASD repair), 60.0% (VSD repair), 50.0% (TOF repair), 42.5% (Glenn procedure), and 45.2% (Fontan procedure), respectively. Clinical pathways of ASD and VSD included patients without severe PH. Achievement ratio of the clinical pathway was 98.2% in ASD and 94.2% in VSD patients, respectively. Four patients were excluded because of high c-reactive protein (CRP), and one patient because of familial circumstance. Conclusion : ITEE was useful in evaluation of cardiac function, residual issue and residual air at weaning of cardiopulmonary bypass. Reintubation did not occur in any clinical course of extubation in the operating room, but the extubation rate was not high because of safety concerns. Achievement ratio of the clinical pathways of both ASD and VSD was more than 90%, therefore, application of the clinical pathway was considered appropriate.

A 9-year-old boy with multisaccular thoracic aortic aneurysm associated with coarctation of the aorta underwent definitive repair under partial cardiopulmonary bypass. The operation consisted of resection of the aneurysm and reconstruction of the descending aorta. Aortic reconstruction was done without an artificial graft, and extended end-to-end anastomosis was performed successfully. He has been doing well and there was no significant restenosis at the repair site 5 years after the operation. Some authors reported that untreated coarctation of the aorta frequently developed aneerysm, which usually has multisaccular lesions. Surgical strategy of aortic reconstruction for coarctation of the aorta in boyhood should be decided prudently to avoid postoperative complications.

We performed a double switch operation for the patients with corrected congenital transposition of the great arteries concomitant with intra-cardiac abnormalities including dextrocardia, non-confluent pulmonary artery and Ebstein's malformation between April 2003 and August 2006. The mean age and weight at the time of surgery were 38 months (range 2-89 months) and 10.7kg (range 4.6-16.1kg), respectively. Before the double switch operation, one patient had received a right modified BT shunt as a neonate and another had received bilateral modified BT shunts at the age of one month and 2 months respectively, followed by a central pulmonary artery angioplasty with installation of a right ventricle to a pulmonary artery shunt at the age of 5 years. For definitive repair, the Senning+Rastelli procedure was performed in two patients and Senning+Jatene procedure was performed in one patient. Mitral valve-and tricuspid valve plasties were performed, the atrialized right ventricle was plicated in the patient with Ebstein's malformation during the double switch operation. A Senning procedure was performed in patients with apicocaval juxtapositions. We reconstructed the systemic venous chamber with a dog-ear-like structure made from suture line pouches at the site of upper and lower portions of the atrial free wall, and the pulmonary venous chamber was completed, without augmentation with additional material. The mean surgery, cardiopulmonary bypass-and aortic cross clamp times were 606, 318 and 151 min, respectively. Postoperative CT scans showed smooth systemic venous returns and no pulmonary vein obstruction. No arrhythmias of any kind were detected after the double switch operation. These results suggest the suture line pouch technique in the atrial switch operation is useful in the double switch operation.

Objective: We previously reported the immune-enhancing behavior of fucoidan, a sulfated polysaccharide extracted from Gagome kombu (GKF), both in vitro and in animal studies. In the present study, we evaluated the immune efficacy and safety of GKF in healthy Japanese adults.Methods: In this randomized, double blind, placebo-controlled study, 30 subjects who ingested GKF (200 mg/day) or placebo for 4 weeks were enrolled. For evaluation of efficacy, phytohemagglutinin-stimulated cytokine production in whole blood cells was measured. For evaluation of safety, blood chemistry analysis, hematological analysis, and urinalysis were conducted.Results: Almost all cytokine production decreased in samples from the placebo group during the test period. Ingestion of GKF for 4 weeks significantly suppressed the decrease in production of the T helper 1 (Th1)-type cytokines interferon-γ and interleukin-12 as well as the Th1:Th2 ratio. There were no adverse clinical changes in blood analysis and urinary analysis, and no serious symptom was observed.Conclusion: These results indicate that GKF is a useful and safe food ingredient to support immune function.

Introduction : Although there are various diagnostic tools like computed tomography, magnetic resonance imaging, and positron emission tomography, it is sometimes difficult to precisely diagnose cardiac tumors. Early pathological diagnosis is crucial for possible chemotherapy and/or radiation therapy in cardiac malignant lymphoma. Objectives : To assess the diagnostic value of pericardial excisional biopsy and cytology of pericardial effusion for the pathological diagnosis of cardiac lymphoma. Methods : Five patients had a clinical diagnosis of cardiac tumor with no pathological diagnosis. The pericardial biopsy and pericardial effusion were obtained without sternotomy through the subxyphoid by a small incision under local anesthesia. Results : All procedures were completed without complications. In 3 cases, the cytology of pericardial effusion yielded a diagnosis of malignant lymphoma. One patient who had a negative cytology result in whom surgical resection was performed for definitive diagnosis and tumor volume reduction was found to have malignant lymphoma. The remaining patient underwent tumor biopsy via a cardiac catheter and benign lymphoma was diagnosed. There were no specific findings in the pericardial excisional biopsy in 3 cases. Conclusion : The analysis of cytology of pericardial effusion obtained through the subxyphoid may be useful for the diagnosis of cardiac malignant lymphoma. Pericardial excisional biopsy may not be necessary for the diagnosis of cardiac malignant lymphoma.

We encountered a case of pseudoaneurysm of the ascending aorta, aortic stenosis and regurgitation, and infected popliteal aneurysm discovered 24 years after cardiac operation. A 34-year-old male who had undergone radical operation for subaortic stenosis at age 10 had infectious endocarditis. Pseudoaneurysm of the ascending aorta and aortic stenosis and regurgitation were noticed after diagnosis of a popliteal aneuyrsm, and operation was performed in two stages. Resection of the popliteal aneurysm, direct suturing of the entry as well as resection of the pseudoaneurysm of the ascending aorta, patch plasty of the defect and replacement of aortic valve were performed with satisfactory results.

We reviewed 223 cases of surgical treatment for abdominal aortic aneurysm in octogenarians in this hospital between 1981 and 2000, and investigated the characteristic features, complications, and indications of the operation. The cases were divided into two age groups. Group O included 23 cases of octogenarians, and Group Y included 200 cases of patients under 80 years old. The average age was 68.6 years old in group Y (33-79 years old), and 83 years old in group O (80-93 years old). The hospital mortality rate was 0% in elective operation cases. In emergency operation case, Group O had a hospital mortality rate of 57.1%, significantly higher than the 6.1% for group Y. The hospital mortality rate was 17% in group O and 0.5% in group Y. The rate of emergency operation case was significantly higher in group O (30.4%) compared to group Y (16.5%). As for the preoperative complications, group O had more cases of renal dysfunction, COPD and gastrointestinal complication. As for the coronary artery disease and other cardiovascular complications, there were no significant differences between the groups. In the postoperative complication, group O had more cases of ileus, pneumonia, and cardiovascular disease. These complications were fatal in group O. These results suggest that surgical treatment for abdominal aortic aneurysm was performed safely in both groups for elective operations. Because the results of emergency operations are poor, early diagnosis and treatment seem to be important for the improvement of operative results.

Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD). Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing. Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids. Conclusions Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.