In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

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.

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.

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.

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.