With the official launch of the new Japanese board of cardiovascular surgery, there are various changes compared to the old system, such as the choice of training period. We conducted a questionnaire survey to find out how U-40 members perceive and understand the new system. Based on the results of the survey, we discussed and presented the current situation and prospects of the new system at the 52nd Annual Meeting of the Japanese Society for Cardiovascular Surgery.

PURPOSE: It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. MATERIALS AND METHODS: Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. RESULTS: In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. CONCLUSION: In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.
Anal Canal/*anatomy & histology/embryology ; Female ; Fetus/anatomy & histology ; Humans ; Male ; Muscle, Smooth/*anatomy & histology/embryology ; Pelvic Floor/anatomy & histology ; Sex Characteristics ; Vagina/*anatomy & histology/embryology

PURPOSE: We recently demonstrated the morphology of the anococcygeal ligament. As the anococcygeal ligament and raphe are often confused, the concept of the anococcygeal raphe needs to be re-examined from the perspective of fetal development, as well as in terms of adult morphology. MATERIALS AND METHODS: We examined the horizontal sections of 15 fetuses as well as adult histology. From cadavers, we obtained an almost cubic tissue mass containing the dorsal wall of the anorectum, the coccyx and the covering skin. Most sections were stained with hematoxylin and eosin or Masson-trichrome solution. RESULTS: The adult ligament contained both smooth and striated muscle fibers. A similar band-like structure was seen in fetuses, containing: 1) smooth muscle fibers originating from the longitudinal muscle coat of the anal canal and 2) striated muscle fibers from the external anal sphincter (EAS). However, in fetuses, the levator ani muscle did not attach to either the band or the coccyx. Along and around the anococcygeal ligament, we did not find any aponeurotic tissue with transversely oriented fibers connecting bilateral levator ani slings. Instead, in adults, a fibrous tissue mass was located at a gap between bilateral levator ani slings; this site corresponded to the dorsal side of the ligament and the EAS in the immediately deep side of the natal skin cleft. CONCLUSION: We hypothesize that a classically described raphe corresponds to the specific subcutaneous tissue on the superficial or dorsal side of the anococcygeal ligament.
Aged, 80 and over ; Anal Canal/*anatomy & histology/embryology ; *Cadaver ; Female ; *Fetus ; Humans ; Male ; Muscle, Smooth/*anatomy & histology/embryology ; Rectum/*anatomy & histology/embryology

The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.

The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.

Calcified amorphous tumor (CAT) is a non-neoplastic mass characterized by calcified nodules that was first reported in 1997. It is often associated with dialysis or mitral annular calcification (MAC). CAT is considered a risk factor for systemic embolism, but there has been no report of CAT damaging the native valve tissue and leading to valvular disease. An 81-year-old woman had shortness of breath on exertion starting 1 year previously, and was referred to our hospital with cardiac murmur detected on physical examination. Echocardiography showed evidence of severe mitral valve regurgitation with ruptured chordae tendineae of the posterior leaflet and a poorly mobile club-shaped structure protruding into the left ventricle and appearing to be continuous with MAC. She underwent elective mitral valve repair. A club-shaped calcification originating from MAC was found under the P2 segment, with ruptured P2 chordae tendineae immediately above it and mitral perforation in the contralateral A2 segment, which were likely to have resulted from direct damage by the hard structure. Mitral valve repair was successful with mass resection, triangular resection of the posterior leaflet P2 segment, and closure of the perforation. Histopathological findings of the mass were consistent with CAT, with no evidence of infection or malignancy. CAT may not only cause embolism but also grow while damaging the native valve tissue. It is important to closely follow-up and perform surgery in proper timing.

Here, we report a rare case in which the inlet pressure of the oxygenator increased three times in two operations, even though two different types of oxygenators were used. A 45-year-old man underwent mitral valve repair owing to posterior cusp (P2) prolapse. Immediately after median sternotomy, the patient went into anaphylactic shock. We immediately started cardio-pulmonary bypass. The inlet pressure in company A's oxygenator increased, and the oxygenator was immediately replaced with the same type of oxygenator. However, the same occurred, and the oxygenator was exchanged for one made by company B. Thereafter, the operation was completed without further oxygenator problems.Fifty-five days after the initial surgery, a second operation was performed to repair a pseudoaneurysm at the root vent cannulation site. After induction of general anesthesia, the patient went into anaphylactic shock, as before, but circulation was maintained. Cardio-pulmonary bypass was started using company B's oxygenator, as it gave no problems at the previous surgery. However, it had to be exchanged owing to inlet pressure elevation. Thereafter, cardio-pulmonary bypass was maintained without pressure elevation, and the operation was completed. The reasons for the inlet pressure elevations are unclear.

Young cardiovascular surgeons work on various trainings such as OFFJT to improve surgical techniques. In this paper, we conducted a questionnaire survey of U-40 members to find out what they are doing to acquire standard surgical techniques.