This paper reports the findings of off-pump coronary artery bypass grafting (OPCAB) for a 56-year-old man who had undergone a renal transplantation. Coronary angiography (CAG) revealed triple-vessel coronary disease. OPCAB was therefore performed. The patient was discharged 20 days after surgery without any subsequent rejection, infection or renal dysfunction. At two years after the operation the patient is doing well without any cardiac events. Cardiac disease, especially coronary artery disease is a common cause of death in renal transplant patients. Cardiac surgery in renal transplant patients is expected to increase. OPCAB for renal transplant patients with ischemic heart disease is therefore expected to reduce the incidence of myocardial infarction, thereby prolonging patient survival.

A 72-year-old man was admitted to a local hospital with symptoms of unstable angina pectoris. He was given Clopidogrel for acute coronary syndrome. Coronary angiography showed left main trunk and three-vessel disease. He was then admitted to our hospital due to a sudden onset of unstable angina following shock during the PCI procedure. We performed emergency off-pump coronary artery bypass grafting (OPCAB). He received 10 mg/kg/h tranexamic acid during the operation. He also received 2,000 U ascorbic acid at the start of surgery and 2,000 U after undergoing anastomoses of the coronary artery. Postoperatively, only some minor bleeding was observed. Tranexamic acid and Ascorbic acid reduce bleeding, and transfusion requirements of packed red blood cells, platelets, and the total blood units in patients on Clopidogrel who undergo emergency OPCAB.

A 58-year-old man with diabetic nephropathy had been on hemodialysis for 15 years. He had lost his left leg below the knee and whole right leg due to atherosclerotic necrosis. During the past 3 years, his cardiac function had also gradually deteriorated. For the past 2 years, echocardiography showed progressively worsening mitral valve regurgitation. Coronary angiography showed severe stenosis in the left main trunk and left descending artery. Ischemic cardiomyopathy with mitral regurgitation were diagnosed. He underwent coronary artery bypass grafting and mitral valve annuloplasty. Because of difficulty in weaning him from cardiopulmonary bypass, he required intra-aortic balloon-pump (IABP) support. An IABP was inserted through the ascending aorta via a tube graft. It was removed on the 4th postoperative day with a small skin incision, under local anesthesia. The postoperative course was uneventful. This IABP insertion technique was useful for a patient with severe arteriosclerotic disease.

A 76-year-old woman with a sudden onset of chest and back pain was admitted to our hospital. Computed tomography (CT) showed a giant thoracoabdominal aortic aneurysm. Therefore, the patient underwent emergency operation. Under a left anterolateral thoracotomy and pararectal laparotomy with left heart bypass, we performed graft replacement of the thoracoabdominal aorta and reconstruction of the celiac artery, superior mesenteric artery and renal arteries. The left lung was tightly adhered to the aneurysm because of the contained rupture. Copious pulmonary bleeding and air leakage occurred due to thrombectomy of the aneurysm. During the operation, critical air leakage was repaired using the remaining aneurysmal wall. The postoperative course was uneventful. The patient was discharged 16 days after surgery. Copious air leakage due to lung injury was a potentially life-threating condition in the postoperative course of this case of thoracoabdominal aortic aneurysm. Surgical treatment of critical air leakage due to lung injury is very important in thoracic surgery.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

The patient was a 4-year-old boy, with no indication of heart disease at birth. When he was 4 years and 3 months old, he underwent surgery for cryptorchidism, and persistent changes after crying, consisting of ST-segment depression, were noted on the ECG. Therefore, it was decided that a detailed examination would be carried out. Aortography revealed that a small left coronary cusp had formed a pouch and that there was a delayed washout of the contrast material in the left coronary artery compared with the right coronary artery. Right coronary angiography showed retrograde flow to the left coronary artery. There was no significant aortic regurgitation, and no stenosis in the left coronary artery. Intraoperative findings demonstrated that the hypoplastic left coronary cusp had adhered to the aortic wall and covered the left sinus of Valsalva. Enlargement of the Valsalva was performed by placing a patch from the aortic transection site to an area directly above the coronary artery ostium. Postoperatively, the patient recovered satisfactorily and was discharged on the eleventh postoperative day. Cardiac catheterization performed 6 months after surgery showed no aortic regurgitation, no significant stenosis in the left coronary artery, and no retrograde flow from the right coronary artery. We report our experience with the rare case described above.

The patient was an 8-years- and 4-months old girl. At the age of one, she visited a previous doctor with hepatomegaly and liver dysfunction. As a result of the examination, she was diagnosed with geleophysic dysplasia. Other than the heart, she was followed in genetics, ophthalmology, orthopedics, endocrinology, and otolaryngology. At 3 years and 5 months, she was first examined by the cardiology department and was found to have mild mitral regurgitation and aortic valve stenosis, and was followed up once a year. The patient was referred to our hospital at 7 years and 11 months, and the cardiac catheterization performed at 8 years and 2 months showed mild mitral valve regurgitation, but the mean pressure gradient was 16 mmHg and the mitral valve area was 0.60 cm2 (MVAi 0.97 cm2/m2), and mitral valve stenosis was observed. The left atrial pressure was as high as 25 mmHg and the average pulmonary artery pressure was as high as 36 mmHg, and pulmonary hypertension was also observed. Intraoperative findings demonstrated that the mitral valve had a marked thickening of the leaflet, the papillary muscles and chordae were also thickened, and the effective valve opening area was narrowed. The leaflet and subvalvular tissue were resected as much as possible and mechanical valve replacement was performed. Postoperatively, the patient recovered satisfactorily and was discharged on the 16th postoperative day. Pathological findings showed no major disturbance in the layered structure of the papillary muscle or the leaflet itself, but it was highly thickened due to mucous degeneration of the leaflet. We report our experience with the rare case described above.

This study reports the case of a 0-day-old girl who was transferred to our hospital for suspected total anomalous pulmonary venous return due to her postnatal cyanosis. After she was presented at our hospital, pulmonary vein stenosis was diagnosed and emergency surgery was planned. Preoperative computed tomography showed abnormal perfusion of the pulmonary veins into the left and right superior vena cava separately on the left and right sides. Given that the persistent left superior vena cava was refluxing into the coronary sinus, the coronary sinus was enlarged greatly, and the left atrial volume was small. In the neonatal period, the right pulmonary vein was anastomosed to the right atrium, and the left pulmonary vein was anastomosed to the unroofed coronary sinus. Thereafter, at 4 months of age, the patient underwent two-stage intracardiac repair with re-routing of the right pulmonary vein and extracardiac ligation of the left vena cava. The postoperative course was good. Intracardiac repair via a two-stage surgery was effective for total anomalous pulmonary venous return (Ib+Ib) with a persistent left superior vena cava and an enlarged coronary sinus.