Right-sided infective endocarditis (RSIE) localized to the right ventricular free wall is rare, and surgical excision of vegetations in such cases has seldom been reported. We describe a case of RSIE with the vegetations on the right ventricular free wall associated with ventricular septal defect (VSD) that was successfully treated with surgical intervention at an appropriate timing. The patient was a 30-year-old woman who had been diagnosed with a VSD shortly after birth. No surgical treatment had been performed and she had been followed conservatively. She was emergently transported to our hospital with disturbed consciousness caused by water intoxication due to psychogenic polydipsia. On admission, she presented with severe hyponatremia and elevated inflammatory markers. CT was performed, showing multiple bilateral pulmonary infiltrates, which were initially suspected to be pneumonia. After admission, blood cultures yielded Streptococcus mitis, and echocardiography showed two mobile vegetations on the right ventricular free wall, corresponding to a jet lesion caused by the VSD, leading to the diagnosis of RSIE. Subsequent contrast-enhanced CT showed filling defects in both pulmonary arteries, and septic pulmonary embolism (SPE) was diagnosed. Although antibiotic therapy improved inflammatory findings, the patient had a history of IE, which itself was an indication for VSD closure. In addition, we observed newly emerging, albeit minor, infiltrates in the lung fields. Therefore, we decided to proceed with elective surgery at that point. The vegetations on the right ventricular free wall was excised, the VSD was closed with an expanded polytetrafluoroethylene (ePTFE) patch, and the atrial septal defect incidentally found during surgery was also closed with direct sutures. Pathological examination of the excised specimen confirmed the infective vegetations. Including the period of postoperative oral antibiotic therapy, the total duration of antibiotic treatment was eight weeks. Her postoperative course was uneventful, and no recurrence was observed at 3 months after surgery.

The U-40 generation of cardiovascular surgeons is receiving training as cardiovascular surgeons, including daily surgeries, ward responsibilities and other important tasks, young surgeons are on their way to becoming skilled cardiovascular specialists. However, it is said that it takes a long time to become a full-fledged surgeon, and in particular, the way to becoming a full-fledged cardiovascular surgeon varies greatly among individuals and is not standardized. Therefore, the U-40 generation is always concerned and worried about their future career development. At the 54th Annual Meeting of the Japanese Society for Cardiovascular Surgery, we will discuss what the U-40 generation needs to become full-fledged surgeons, what they are worried about, and how their seniors who are actually active as independent cardiovascular surgeons think and what their career paths have been like. I had an opportunity to reflect on the gap between the two. This time, we conducted a questionnaire survey to visualize the conditions and future prospects for becoming an independent surgeon as considered by the U-40 generation.

As part of U-40 activities, chapters have traditionally held sessions of lectures and hands-on as the Basic Lecture Course (BLC) to improve the basic skills and knowledge of young cardiovascular surgeons. Because of the COVID-19 epidemic, we have shifted our activities from onsite to online. This column focuses on “management of postoperative delirium and pain” in the lecture of “Postoperative Management in Cardiovascular Surgery” given by the Chubu Chapter in 2020. We summarize the lecture and report the results of a questionnaire survey of the U-40 members.