Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery.

Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

Objective: In Japan, only a few reports of the Ross procedure in neonates and infants have been published. The objective of this study was to evaluate the outcome of patients undergoing a Ross procedure before the age of one year, and to review the validity of opting for this procedure at this age. Methods: The records of 13 infants (including three neonates) undergoing a Ross procedure between December 1996 and June 2017 were reviewed. Major outcomes studied included graft-associated morbidity, autograft function, and the need for reoperation. Results: The median age at the time of Ross procedure was 166 days, and median weight was 5.7 kg. Primary diagnoses were aortic stenosis in 10 cases and aortic insufficiency in three. Nine cases required emergent Ross procedure due to left ventricular dysfunction refractory to medication, requirement of mechanical ventilation or intravenous inotropic drugs. Concomitant procedures included three aortic coarctation repairs, two annular enlargement procedures with a Konno incision and one each of aortic and mitral annuloplasty. The mean cross-clamp time was 131 min and the mean extracorporeal circulation time was 178 min. Two cases required extracorporeal membrane oxygenation. Seven underwent delayed sternal closure and four required postoperative peritoneal dialysis. The median duration of mechanical ventilation was five days and the median length of intensive care unit stay was seven days. Survival was 100% at a median follow-up of 9.9 years. The diameter of the aortic annulus mostly stayed within normal limits, although sinus of Valsalva's enlargement beyond normal value was noted in some cases. Trans-aortic valve pressure gradient was less than 20 mmHg and aortic insufficiency was less than mild in all cases, thus requiring no reintervention for the valve. Two cases required coronary arterial bypass and release of the subaortic stenosis. Freedom from reoperation for the left heart was 100% at one year, and 81.5% at five years and 10 years. Ten cases required reoperation for the right heart, and freedom from reoperation was 84.6% at one year, 29.7% at five years and 9.9% at 10 years. Conclusion: Durability of the pulmonary autograft was excellent. The Ross procedure can be an effective treatment strategy for severe aortic valve diseases in neonates and infants.

A 47-year-old female was admitted to our hospital for management of dyspnea. She had undergone surgery for an atrial septal defect (ASD) at the age of 17. Computed tomography revealed left isomerism, inferior vena cava interruption with azygos continuation and a residual ASD. Intra-operative findings showed that the residual ASD was positioned across the orifice of the hepatic vein. The previous suture line could be identified in the partially-closed atrial septum above the residual defect. Re-closure was performed without difficulties, and the patient's condition was good at discharge. Closure of ASD is a simple and basic procedure in cardiac surgery but care must be taken not to leave a shunt at the lower part of the defect, especially in cases with ASD defects in the lower margin.

We report a case of minimally invasive surgery (MICS) for left ventricular aneurysm with a large mobile thrombus, which appeared after chemotherapy for malignant lymphoma. A 42-year-old man with a postinfarction left ventricular aneurysm was admitted to our hospital to receive chemotherapy for malignant lymphoma. Eight days after the first administration of anticancer drugs, echocardiography revealed a large mobile thrombus in the left ventricular aneurysm that was absent on admission. The patient was referred to our department, and left ventricular endoplasty was performed through a small left thoracotomy. He recovered rapidly, and chemotherapy was resumed a month after surgery. This suggests MICS to be a valuable option for left ventricular aneurysm repair.

A 73-year-old woman presented with epigastric discomfort and lightheadedness. She was admitted to another hospital with congestive heart failure due to severe aortic and mitral regurgitation. However, her heart failure was refractory to medical treatment, necessitating transfer to our hospital for surgical treatment. Emergency surgery was performed for worsening heart failure after admission to our hospital. Intraoperative findings showed aneurysms of the ascending aorta and aortic root and avulsion of the aortic valve commissure between the right coronary and non-coronary cusps. Replacement of the ascending aorta and aortic root replacement using the Florida sleeve method as well as double valve replacement (mitral and aortic) were performed with a favorable outcome. Histopathological examination showed myxomatous degeneration, which suggested that it could have contributed to avulsion of the aortic valve commissure.

A 34-year-old man was referred to our hospital for primary tricuspid regurgitation. An echocardiogram showed severe tricuspid regurgitation caused by the prolapse of the anterior leaflet due to chordal rupture and enlargement of the tricuspid annulus. A large cleft on the anterior leaflet and a divided leaflet near the septal leaflet with a ruptured chorda were observed during surgery. We attached an artificial chorda from the anterior papillary muscle of the right ventricle to the prolapsed leaflet. We then repaired the large cleft with interrupted 6-0 polypropylene sutures and performed tricuspid annuloplasty. The prolapse of the anterior leaflet disappeared, and an intraoperative transesophageal echocardiogram revealed improvement of tricuspid regurgitation. The technique of mitral valve repair can be used even for a complex pathology of congenital cleft, chordal rupture, and annular enlargement of the tricuspid valve.

This patient is a 72-year-old-man who had undergone aortic valve replacement using a Starr-Edwards Ball Valve to treat aortic valve stenosis when he was 28 years old. In April 2015, he was admitted with cardiac failure of NYHA III. Echocardiography showed a remarkable increase of aortic valve pressure gradient and progressive change in mitral valve stenosis and tricuspid valve regurgitation. The Starr-Edwards Ball Valve was replaced using a CEP MAGNA EASE prosthesis, the mitral valve was replaced using a CEP MAGNA MITRAL EASE prosthesis with tricuspid annuloplasty using the MC3 ring. Cloth wear of the Starr-Edwards Ball Valve cage and all-round pannus formation under the valve seat was found at the operation, and the cause of the higher pressure gradient may have been the pannus. The postoperative period of this case following the initial aortic valve implantation of the Starr-Edwards Ball Valve is the longest known in Japan as far as we could discover.

A 73-year-old man diagnosed with severe aortic regurgitation by transthoracic echocardiography was referred to our hospital. Quadricuspid aortic valve was diagnosed on preoperative transesophageal echocardiography. We performed aortic valve replacement with a bioprosthetic valve. In the operation, the accessory cusp was found to be located between the right coronary and noncoronary cusps, and the cusps had multiple fenestrations near the commissures.

We describe a case of Takotsubo cardiomyopathy in an 88-year-old woman who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm. The patient developed cardiac arrest shortly after the surgery. Following immediate resuscitation, her electrocardiogram showed extensive ST segment elevation in leads V2-V6, and echocardiography revealed apical akinesis with basal hyperkinesis. Emergency coronary angiography confirmed the absence of coronary lesions, and she was diagnosed with Takotsubo cardiomyopathy. Her cardiac function improved within a few days following the administration of catecholamines. Although EVAR is a less invasive surgical procedure, it may trigger Takotsubo cardiomyopathy. Prompt diagnosis and appropriate management of Takotsubo cardiomyopathy are essential to treat critical conditions in the acute phase.

Retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) is a lethal complication. A 54-year-old woman with bovine aortic arch presented with dilatation of the descending aorta due to chronic type B aortic dissection. She underwent TEVAR in zone 2 for closure of the entry site just below the origin of the left subclavian artery. On the day after TEAVR, she showed right hemiparesis, and was diagnosed with cerebral infarction on MRI and RTAD on CT. She underwent an emergent operation. The entry was at the proximal end of the bovine trunk, where the edge of the bare stent stuck out. We performed partial arch replacement with entry resection. Her postoperative course was uneventful. She was transferred to another hospital for rehabilitation 37 days after the surgery.

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.

Patient: A 74-year-old man. Previous history: Total arch replacement for thoracic aortic aneurysm at 72 years old. History of current condition: The patient presented at a local otolaryngology clinic complaining of hoarseness of the voice. Left vocal cord paralysis was present, and as he had previously undergone thoracic vascular graft replacement, he was referred to our department. Further investigation with computed tomography (CT) revealed air in the mediastinum, and he was admitted for treatment of mediastinitis. Post-admission course: Upper gastrointestinal endoscopy revealed esophageal ulceration. After antibiotic treatment, thoracic subtotal esophagectomy via right thoracotomy, esophagostomy, and gastrostomy were performed on admission day 39. Vascular graft infection was also suspected, and antibiotic treatment was therefore continued. As some improvement in inflammatory response was evident, antibiotic treatment was discontinued and the patient's condition was monitored, but fever developed on day 107, and CT again revealed air in the mediastinum. Bronchoscopy revealed a broncho-mediastinal fistula in the left main bronchus. On day 110, repeated total arch replacement using a vascular graft, omentoplasty, and left main bronchus repair were performed via left thoracotomy. Esophageal reconstruction was left for later surgery, but follow-up CT on day 160 again revealed air in the mediastinum. Bronchoscopy was performed the same day and revealed a broncho-mediastinal fistula in the left main bronchus, located on distally from the previous fistula. This fistula was surgically closed on day 173. The subsequent course was favorable, and antethoracic esophageal reconstruction by jejunal elevation was performed on day 233. The patient was able to start eating on day 244, and was discharged in an improved condition on day 250.

A 77-year-old woman was admitted to our hospital with a decreased level of consciousness and left hemiplegia. Contrast-enhanced CT showed acute type A aortic dissection and right common carotid artery occlusion. Electrocardiogram findings showed ST segment elevation in the anterolateral wall. The results suggested that the aortic dissection had extended to the left main trunk and caused acute myocardial infarction. Percutaneous coronary intervention (PCI) was performed preoperatively to improve myocardial ischemia reperfusion. After a successful PCI, the patient underwent ascending aorta replacement immediately. In cases of acute aortic dissection involving the left main artery, preoperative PCI prevents extensive myocardial damage and serves as a bridge to surgery.

We experienced a hybrid repair for Kommerell diverticulum and right aortic arch. A 62-year-old man with dyspnea and dysphagia was referred to our hospital. He underwent atrium septum defect closure when he was 15 years old and was found to have ventricular septal defect and severe aortic regurgitation at the referring hospital. Preoperative computed tomography incidentally showed right aortic arch and Kommerell diverticulum with aberrant left subclavian artery. First, we performed ventricular septal defect closure and aortic valve replacement. Three months later, we performed one-stage hybrid repair of Kommerell diverticulum that included left common carotid-subclavian artery bypass, left subclavian artery plug occlusion and descending aortic replacement via a right thoracotomy. This hybrid strategy did not require in-situ reconstruction of the aberrant subclavian artery and minimized the risk of bleeding, injuries of esophagus and recurrent laryngeal nerve. The postoperative course was uneventful. This hybrid repair is a safe and effective procedure for Kommerell diverticulum with aberrant subclavian artery.

A 49-year-old man presented with subclavian steal phenomenon and severe stenosis of LMT. His SSP was composed of severe stenosis of the innominate artery, and the greater part of the blood supply to the right subclavian artery was through the collateral circuit of the vertebral arteries and the internal thoracic arteries. We performed replacement of the innominate artery with a prosthetic graft and coronary artery bypass using LITA in one-stage surgery.