Japanese Journal of Cardiovascular Surgery Vol.40, No.1

Preface

• Y. Sawa

Review（Submission）

• Current Status of Japanese Women Surgeons Belonging to the Japanese Society for Cardiovascular Surgery and Other Surgical and Academic Societies Y. Tomizawa……1
  Current Status of Japanese Women Surgeons Belonging to the Japanese Society for Cardiovascular Surgery and Other Surgical and Academic Societies

  （Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan）

  Yasuko Tomizawa

  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.
    Jpn. J. Cardiovasc. Surg. 40:1-6（2011）
  
  Keywords：women surgeon, support, surgery

Case Reports

• Axillary-Ulnar Artery Bypass Grafting in a Case with Chronic Critical Ischemia in an Upper Extremity K. Matsuzaki et al.……7
  Axillary-Ulnar Artery Bypass Grafting in a Case with Chronic Critical Ischemia in an Upper Extremity

  （Department of Cardiovascular Surgery, NTT Higashi Nihon Sapporo Hospital, Sapporo, Japan）

  Kenji Matsuzaki

  Kou Takigami

  Hiroshi Matsuura

  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.
    Jpn. J. Cardiovasc. Surg. 40:7-9（2011）
  
  Keywords：critical ischemia of the upper extremity, bypass surgery, autologous venous graft
• Aortic Valve Replacement in a Case of Anomalous Origin of the Right Coronary Artery N. Kojima et al.……10
  Aortic Valve Replacement in a Case of Anomalous Origin of the Right Coronary Artery

  （Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan）

  Nozomi Kojima	Satoshi Ito	Arata Muraoka
  Hiroaki Konishi	Yoshio Misawa

  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.
    Jpn. J. Cardiovasc. Surg. 40:10-13（2011）
  
  Keywords：single coronary artery, coronary artery bypass, aortic regurgitation, valve replacement
• Aortic Root Replacement for Perivalvular Leakage after Aortic Valve Replacement for Marfan Syndrome with Severe Thoracic Deformity T. Nishino et al.……14
  Aortic Root Replacement for Perivalvular Leakage after Aortic Valve Replacement for Marfan Syndrome with Severe Thoracic Deformity

  （Department of Cardiovascular Surgery, Kinki University School of Medicine, Osakasayama, Japan）

  Takako Nishino	Toshihiko Saga	Hitoshi Kitayama
  Susumu Nakamoto	Kiyoaki Takaba	Kousuke Fujii
  Shintaro Yukami

  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.
    Jpn. J. Cardiovasc. Surg. 40:14-18（2011）
  
  Keywords：Marfan syndrome, perivalvular leakage, thoracic deformities, secondary surgery
• The Importance of Preoperative Epicardial Imaging by Three-Dimensional Computed Tomography in Off-pump Cardiac Surgery for Coronary Artery Fistula with Coronary Aneurysm A. Maeda and M. Hirota……19
  The Importance of Preoperative Epicardial Imaging by Three-Dimensional Computed Tomography in Off-pump Cardiac Surgery for Coronary Artery Fistula with Coronary Aneurysm

  （Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan）

  Atsuo Maeda

  Masanori Hirota

  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.
    Jpn. J. Cardiovasc. Surg. 40:19-21（2011）
  
  Keywords：coronary artery fistula, coronary artery aneurysm, coronary angiography, 3D-CT
• Two Stage Operation for Chronic Dissecting Thoracic Aortic Aneurysm Associated with True Lumen Obstruction of the Abdominal Aorta Y. Shimada et al.……22
  Two Stage Operation for Chronic Dissecting Thoracic Aortic Aneurysm Associated with True Lumen Obstruction of the Abdominal Aorta

  （Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan, and Present addresses:Chubu Rosai Hospital*, Nagoya, Japan, Kyoto Prefectural University of Medicine**, and Japanese Red Cross Nagoya Diichi Hospital***, Nagoya, Japan）

  Yasuaki Shimada*	Keisuke Tanaka**	Yoshimori Araki
  Yuji Narita	Atsuo Maekawa***	Hideki Oshima
  Akihiko Usui	Yuichi Ueda

  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.
    Jpn. J. Cardiovasc. Surg. 40:22-26（2011）
  
  Keywords：dissecting aortic aneurysm, true lumen obstruction, collateral flow, elephant trunk, segment operation
• A Case of Pseudoaneurysm of Severely Calcified Left Coronary Artery after Bentall Operation M. Shingaki et al.……27
  A Case of Pseudoaneurysm of Severely Calcified Left Coronary Artery after Bentall Operation

  （Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan）

  Masami Shingaki	Masaaki Koide	Yoshifumi Kunii
  Kazumasa Watanabe	Tai Fuchigami

  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.
    Jpn. J. Cardiovasc. Surg. 40:27-30（2011）
  
  Keywords：post-Bentall operation, pseudoaneurysm, angioplasty
• New Anticoagulation Control for Toyobo-LVAS Using the CoaguChek XS® K. Akasu et al.……31
  New Anticoagulation Control for Toyobo-LVAS Using the CoaguChek XS®

  （Department of Surgery, Kurume University School of Medicine, Kurume, Japan）

  Koji Akasu	Ryusuke Mori	Tomohiro Ueda
  Hiroshi Tomoeda	Koichi Arinaga	Shuji Fukunaga
  Shigeaki Aoyagi

  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.
    Jpn. J. Cardiovasc. Surg. 40:31-33（2011）
  
  Keywords：CoaguChek XS®, PT-INR, Toyobo-LVAS, anticoagulation therapy, warfarin
• Successful Surgical Treatment of Incomplete Atrioventricular Septal Defect Associated with Pulmonary Stenosis in a 72-Year-Old Woman T. Kubota et al.……34
  Successful Surgical Treatment of Incomplete Atrioventricular Septal Defect Associated with Pulmonary Stenosis in a 72-Year-Old Woman

  （Department of Cardiovascular Surgery, Hakodate Chuo General Hospital, Hakodate, Japan, Division of Medical Sciences, Health Sciences University of Hokkaido*, Sapporo, Japan, and Department of Cardiovascular Surgery, Hokkaido University Hospital**, Sapporo, Japan）

  Takehiro Kubota	Yuhki Okubo	Masatoshi Motohashi
  Shigeyuki Sasaki*	Yoshiro Matsui**

  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.
    Jpn. J. Cardiovasc. Surg. 40:34-37（2011）
  
  Keywords：adult congenita cardiac surgery, iAVSD, pulmonary stenosis, CAVVR
• Four Cases of Single-Stage Surgery of Abdominal Aortic Aneurysm with MIDCAB on Revascularization T. Yoshida and Y. Naito…38
  Four Cases of Single-Stage Surgery of Abdominal Aortic Aneurysm with MIDCAB on Revascularization

  （Cardiovascular Center, Hokkaido Social Insurance Hospital, Sapporo, Japan, and Present address:Department of Cardiovascular Surgery, Hokkaido University Hospital*, Sapporo, Japan）

  Toshihito Yoshida

  Yuji Naito*

  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.
    Jpn. J. Cardiovasc. Surg. 40:38-41（2011）
  
  Keywords：abdominal aortic aneurysm, coronary artery bypass graft surgery, minimally invasive direct coronary artery bypass graft surgery, single-stage surgery