Japanese Journal of Cardiovascular Surgery
Online ISSN : 1883-4108
Print ISSN : 0285-1474
ISSN-L : 0285-1474
Volume 40, Issue 1
Displaying 1-11 of 11 articles from this issue
Preface
Review (Submission)
  • Yasuko Tomizawa
    2011 Volume 40 Issue 1 Pages 1-6
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    Recently, the number of women doctors choosing a career in surgery is increasing. However, the situation of women doctors in Japan is still difficult, because most women doctors also have to take care of their homes and children, because the husbands rarely share child care or household chores in Japan. In 2008, the Committee on Women Surgeons of the Japan Surgical Society conducted a questionnaire survey among 105 academic societies, including 11 surgical societies who belong to the Japanese Association of Medical Sciences. The response rate was 96.2%. Among the 11 surgical societies, only 4 had a total of 16 women councillors, and only 1 society had a woman director. Only 1 surgical society had a woman editor, and the other 10 societies had none. The Japanese Surgical Society and the Japanese Society of Internal Medicine have never had a woman councillor since their inauguration over 100 years previously. Furthermore, the Japanese Society for Cardiovascular. Surgery also had no woman councillors. At the 38th annual meeting of the Japanese Society for Cardiovascular Surgery in 2008, no woman doctor was assigned the role of chairperson in any of the sessions. In obtaining or renewing board certification, only 38% of the academic societies recognized pregnancy, childbirth and childcare as conditions for retaining qualification. Improvements in working situations, gender equality, and support for professional commitment and child care are needed for women surgeons in Japan.
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Case Reports
  • Kenji Matsuzaki, Kou Takigami, Hiroshi Matsuura
    2011 Volume 40 Issue 1 Pages 7-9
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    A 65-year-old woman with a history of chronic atrial fibrillation was admitted for treatment of progressively worsening pain in the right forearm, which had begun several days before presentation. She did not have a palpable right brachial pulse, but her axillary pulse was palpable. We suspected acute thromboembolism of the brachial artery, and tried emergency thrombectomy via the brachial artery. However, her brachial artery was completely occluded with white organized thrombi, which was the cause of the chronic occlusion. Vasodilative drugs were administered, but her symptoms remained. Preoperative angiography showed the right brachial artery to be occluded and the ulnar artery could be partially visualized via the collateral arteries. We performed bypass grafting between the right axillary and ulnar artery, using an autologous saphenous vein graft. Her symptoms improved, and postoperative angiography revealed the bypass graft to be patent. The possibility of acutely worsening chronic ischemia should be considered, even if symptoms indicate acute thromboembolism of the extremities.
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  • Nozomi Kojima, Satoshi Ito, Arata Muraoka, Hiroaki Konishi, Yoshio Mis ...
    2011 Volume 40 Issue 1 Pages 10-13
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    Congenital anomalies of the coronary artery are rare. However, they can cause sudden death because of arrhythmia. We present a case of a 62-year-old man with severe aortic valve regurgitation associated with an anomalous origin of a narrowed right coronary artery (IB2 according to the Shirani Classification) detected on preoperative coronary three-dimensional computed tomography (CT) . The patient underwent both aortic valve replacement for aortic regurgitation, and coronary artery bypass. The postoperative course was uneventful.
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  • Takako Nishino, Toshihiko Saga, Hitoshi Kitayama, Susumu Nakamoto, Kiy ...
    2011 Volume 40 Issue 1 Pages 14-18
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    The number of operations performed for cardiovascular disease has increased since recent improvements in diagnostic and the therapeutic technology have led to a remarkable increase in the life expectancy of patients with Marfan syndrome. On the other hand, operative procedures can be difficult when patients have complications of connective tissue abnormalities such as thoracic deformities, lung diseases and ophthalmic lesions. Although recent surgical outcomes have improved, those of secondary surgery are more difficult. We describe aortic root replacement to treat perivalvular leakage after aortic valve replacement in a patient with Marfan syndrome with a severe thoracic deformity.
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  • Atsuo Maeda, Masanori Hirota
    2011 Volume 40 Issue 1 Pages 19-21
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    We surgically treated coronary artery fistula with 2 aneurysmal formations without cardiopulmonary bypass. Preoperative epicardial imaging suggested that ligation of both inflow and outflow of the coronary artery fistula was feasible. Preoperative understanding of anatomical relationships by 3D-CT imaging can be very useful in selection of surgical procedures.
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  • Yasuaki Shimada, Keisuke Tanaka, Yoshimori Araki, Yuji Narita, Atsuo M ...
    2011 Volume 40 Issue 1 Pages 22-26
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    A 64-year-old man who had chronic aortic dissecting aneurysm with true lumen obstruction of the abdominal aorta was referred to our hospital for surgery. He underwent total aortic arch replacement with the elephant trunk technique using an aortofemoral artery bypass as a first-stage operation. Reconstruction of the thoracic aortic descending aneurysm using the previous elephant trunk graft in a second-stage operation was feasible. His perioperative course was uneventful and he had no neurologic complications.
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  • Masami Shingaki, Masaaki Koide, Yoshifumi Kunii, Kazumasa Watanabe, Ta ...
    2011 Volume 40 Issue 1 Pages 27-30
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    A 50-year-old man with Marfan syndrome, was given a diagnosis of pseudoaneurysm in an anastomotic site of the left coronary artery after Bentall operation, with severe calcification. He was successfully treated with reanastomosis of a new graft to the left main trunk by the removal of a calcified intima. Coronary artery bypass grafting was not possible because his coronary arteries were covered with thickened fatty tissue due to a previous omental flap procedure for mediastinitis, and therefore we chose left main trunk coronary angioplasty. The whole calcified intima was excluded with a dissector and resected at both ostias of the left descending artery and left circumflex artery. An 8-mm woven Dacron graft was anastomosed at the left main trunk by large stitches of adhesive tissue around the adventitia, to the inside of the lumen of the left main trunk. The patency of the left main trunk was confirmed by CT and he was discharged in a good condition. Close observation is needed for long-term morbidity.
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  • Koji Akasu, Ryusuke Mori, Tomohiro Ueda, Hiroshi Tomoeda, Koichi Arina ...
    2011 Volume 40 Issue 1 Pages 31-33
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    Aggressive anticoagulation therapy is necessary when Toyobo-LVAS is used for long-term treatment of severe heart failure. However, it is necessary to regulate it carefully if there is a hemorrhagic complication due to thromboembolism, but repeated blood testing is painful. We compared simple measurement with the CoaguChek XS® with the conventional blood testing method. The correlation coefficient was 0.916, and the regression line was Y=0.8027X+0.3399. In addition, drawing blood using the CoaguChek XS® was very effective in the reported pain reduction in patients.
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  • Takehiro Kubota, Yuhki Okubo, Masatoshi Motohashi, Shigeyuki Sasaki, Y ...
    2011 Volume 40 Issue 1 Pages 34-37
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    We report the surgical correction of an incomplete atrioventricular septal defect (AVSD) associated with pulmonary stenosis in a 72-year-old woman. She was given a diagnosis of atrial septal defect at the age of 19, but at that time surgery was not indicated. She had an uneventful pregnancy at age 28. She had received medical treatment for congestive heart failure since the age of 67. Four years later, she was admitted to another hospital due to edema of the leg and retention of massive ascites. After careful and precise evaluation, AVSD was diagnosed, associated with bilateral atrioventricular (AV) valve regurgitation, pulmonary stenosis, atrial fibrillation and significant stenosis of the left anterior descending (LAD) coronary artery. She was referred to our hospital for surgery, and intracardiac repair was determined to be necessary after clinical assessment. Prior to surgery, she underwent percutaneous coronary intervention with a bare-metal stent for an LAD lesion. Under antegrade cold blood cardioplegia and mild hypothermia, we performed closure of the ostium primum atrial septal defect using a heterologous pericardial patch with expanded polytetrafluoroethylene strip, and right side atrioventricular (AV) valvuloplasty and pulmonary valvotomy. The postoperative course was uneventful. The patient has been designated NYHA class I for 2 years since surgery, and has had mild regurgitation of both AV valves, but neither have affected her quality of life. Surgical correction should be considered in elderly patients with incomplete AVSD, even in those aged 70 and over.
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  • Toshihito Yoshida, Yuji Naito
    2011 Volume 40 Issue 1 Pages 38-41
    Published: January 15, 2011
    Released on J-STAGE: June 27, 2011
    JOURNAL FREE ACCESS
    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.
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