Purpose : Recently, the Japanese government has promoted reform of working practices. The working environment of medical professionals was no exception. In the present study, we investigated the current working environment and issues of cardiovascular surgeons, who are supposed to be working in one of the most demanding circumstances in Japan. Methods : In December 2018, the Japanese Society for Cardiovascular Surgery (JSCVS) sent a questionnaire to all JSCVS members via the internet to obtain basic data on the working environment including working hours, working items, income, and the issues to be solved for cardiovascular surgeons in Japan. Results : The JSCVS received responses from 634 cardiovascular surgeons (response rate 17%, 589 males/38 females). Respondents were primarily mid-career surgeons in their age of 40 s and 50 s. Four hundred seventy-three respondents (75.5%) and 176 respondents (28.2%) answered that they worked an average of 60 and 80 h a week, respectively. In addition, 249 respondents (40.4%) reported receiving no allowance for on-call work during off hours, after midnight, or on a holiday, while 345 respondents (56.6%) reported receiving no allowance for emergency surgery during off hours, after midnight, or on a holiday. Conclusion : Over 75% of cardiovascular surgeons reported being overworked without receiving an appropriate amount of income. Along with the reform of working style being made for the Japanese people, improving the working environment of cardiovascular surgeons is also an urgent matter to maintain healthcare for cardiovascular disease. Facilitating understanding of the issue by the Japanese people is of the utmost importance for the JSCVS.

A 70-year-old woman who was bedridden because of right hemiplegia attributable to a history of cerebral hemorrhage underwent surgical thrombectomy for pulmonary embolism four years previously. Symptoms of heart failure appeared one year previously, and she was diagnosed with constrictive pericarditis and had been treated with medication by a previous doctor. In the current situation, she visited the previous doctor with the chief complaint of fever, and pericardial effusion was observed on echocardiography. Cardiac tamponade was suspected and she was transferred to our hospital. She was then diagnosed with purulent pericarditis because purulent fluid was observed during pericardiocentesis drainage. Bacteroides fragilis was isolated from the culture of the abscess. The abscess was resistant to conservative antibiotic therapy ; therefore, we performed a pericardiotomy with a left small thoracotomy. The pleural effusion was found to be negative for culture and the patient exhibited a good postoperative course. Purulent pericarditis is refractory with poor prognosis. An appropriate surgical procedure must be chosen considering the patient's activities of daily living. Here, we report a surgical case wherein we chose the left thoracotomy approach and achieved positive results.

We report the case of a 62-year-old man who was admitted for acute cerebral infarction linked to a cardiac calcified amorphous tumor (CAT). The patient, who had been on hemodialysis for about 10 years, was referred to our hospital with dysarthria, and left hemiplegia. Brain magnetic resonance imaging (MRI) showed acute cerebral infarction in right parietal lobe of the cortex, and transthoracic echocardiography revealed moderate aortic valve stenosis and a mobile mass measuring 8 mm×5 mm in diameter attached to the aortic valve. The mobile structure was thought to be related to the cerebral infarction. Aortic valve replacement was performed. On the basis of the pathological examination, a cardiac calcified amorphous tumor was diagnosed. The patient was discharged from our hospital without any complication.

We report a surgical case of severe tricuspid regurgitation with hemodynamic features mimicking constrictive pericarditis. A catheterization study showed a dip and plateau pattern of right and left ventricular pressure. Intraoperative finding : the pericardium was not adherent to the epicardial wall. The tricuspid regurgitation was successfully repaired by cleft suture and tricuspid annuloplasty. After surgery, the echocardiographic features mimicking constrictive pericarditis were normalized.

A 71-year-old man presented to our hospital with sudden-onset epigastric pain. He reported a history of undergoing the following operations : aortic valve replacement for aortic regurgitation 11 years earlier and graft replacement of the ascending aorta for acute type A aortic dissection, 1 year earlier. His systolic blood pressure was 70 mmHg, and computed tomography revealed a pseudoaneurysm of the distal anastomosis of the ascending aorta with a connection to the right pulmonary artery. Cardiopulmonary bypass was established with cannulation of the right axillary artery and the right femoral vein, and systemic cooling was initiated before sternotomy. We identified an area showing 3 cm dehiscence at the distal aortic anastomosis after hypothermic circulatory arrest and selective cerebral perfusion. The ascending aorta was replaced as hemiarch replacement, and the defect in the right pulmonary artery was closed with bovine pericardium. The patient's postoperative course was uneventful, and he was transferred to a rehabilitation hospital on the 22nd postoperative day.

An 82-year-old woman was transferred to our hospital due to an abrupt back pain. She exhibited a cardiac tamponade and her CT angiography revealed Stanford type-A acute aortic dissection without abdominal extension. Emergent surgery for partial arch replacement was performed. After a few days of stable postoperative course, she suffered 38 degrees fever with an elevated inflammatory response and complained of a slight abdominal pain. Her CT scan revealed an intra-abdominal abscess with a small intestine necrosis. Emergent surgery for partial small intestine resection was performed. Her postoperative course was stable and she was discharged to a rehabilitation hospital 52 days after the first operation.

A 77-year-old man was transferred to our hospital with a complaint of a sudden abdominal pain after receiving a hard blow to the abdomen. Contrast-enhanced CT revealed rupture of the abdominal aortic aneurysm with a massive retroperitoneal hematoma. Because of severe hemorrhagic shock, he underwent graft replacement with a woven bifurcated graft through a median laparotomy on an emergent basis. His postoperative course was uneventful and now he is doing well 3 years after surgery. Most blunt abdominal aortic injuries are caused by high-energy trauma, such as motor vehicle collisions and fall injuries. Although body blow is considered as a low-energy trauma, abdominal aortic injury could be caused in patients with an abdominal aortic aneurysm.

The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.