Evaluation of attitudes in resident training : / 医学教育

  We performed a comparative analysis of 98 residents trained in our hospital from April 2003 through March 2012. Assessments of residents performed with interviews and a written test at entry to the training course showed a good correlation（r＝0.4 ; p＜0.005）with the final assessments performed by instructing physicians when the 2–year training course had ended. In contrast, the directing nurses’ summative evaluations were not correlated with entry assessments（r＝0.071 ; p＝0.485）. Evaluation of the attitudes of residents by nurses differed considerably from that by physicians. The physicians seemed to have successfully performed the entry examination using good selection criteria, such that residents with superior evaluations at entry achieved excellent results at the end of training; in contrast, the evaluation by nurses was not so straightforward.<br>  The physicians tended to assess residents’ attitudes from the viewpoint of performing practices, whereas the nurses evaluated residents mainly from the standpoint of receiving practices; therefore, differences in the assessment scores between physicians and nurses were understandable. Considering this difference and the results of this study, we suggest that the residents’ attitudes in light of professionalism should be evaluated from multiple directions, from both the “giving” and “receiving” vectors.

Modified Aortic Root Remodeling Combined with Aortic Valve Repair Technique for Severe Aortic Regurgitation Resulting from Prolapse of the Right Coronary Cusp and Aortic Root Dilatation / 日本心臓血管外科学会雑誌

A 70-year-old man who had been followed up in our outpatient clinic for mild aortic regurgitation underwent curative surgery for progression of the regurgitation due to a prolapsed right coronary cusp, associated with annular dilatation and aortic root aneurysm formation. The Operation consisted of subvalvular circular annuloplasty to reduce the size of the aortic annulus, adjustable leaflet suspension for the prolapsed right coronary cusp, and modified aortic root remodeling, which replaced the Valsalva sinus of both non and right coronary cusps while sparing the Valsalva sinus of the left coronary cusp. Coronary artery bypass grafting was additionally performed for the 90% stenosis of the proximal right coronary artery segment. The postoperative course was uneventful with no need of blood transfusion. He was discharged from the hospital 10 days postoperatively. This combination of valvuloplasty with valve-sparing aortic root reconstruction procedure can be useful.

Simultaneous Axillo-Axillary Crossover Bypass Grafting and Off-Pump CABG Using Bilateral Internal Thoracic Arteries in a Patient with Severe Atherosclerosis in Both the Ascending Aorta and Proximal Left Subclavian Artery / 日本心臓血管外科学会雑誌

Combined surgery for left Subclavian artery revascularization and CABG was performed in a 74-year-old man with diabetes mellitus. The preoperative coronary angiogram showed critical stenoses in all three major branches, and arteriography revealed obstruction at the left proximal subclavian artery. Severe atherosclerotic calcification was acknowledged circumferentially in the ascending aorta and in the aortic arch. For this patient axillo-axillary crossover bypass grafting was performed first using and expanded PTFE graft, followed subsequently by off-pump CABG using all <i>in situ</i> grafts (right internal thoracic artery-left anterior descending artery (RITA-LAD), left internal thoracic artery-diagonal branch (LITA-diagonal branch), gastroepiploic artery-right coronary artery (GEA-RCA)). Postoperative recovery was smooth, with disappearance of significant pressure difference between both arms (preoperatively, 46mmHg). An angiogram on the 7th postoperative day showed a widely patent axillo-axillary bypass graft along with good flow of all three coronary grafts, in which LITA was visualized well through the axillo-axillary bypass graft. For complex atherosclerotic disease of the proximal aorta and incipient portion of neck vessels associated with severe coronary sclerosis, this technique is a suitable option.

Minimally Invasive Coronary Artery Bypass Grafting with Mini-sternotomy and Cardiopulmonary Bypass / 日本心臓血管外科学会雑誌

To assess the indications and clinical outcome of minimally invasive coronary artery bypass grafting with mini-sternotomy and cardiopulmonary bypass (MICS-CABG) for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases, we examined results in 17 patients (mean age 62.5 years) who underwent MICS-CABG. The average number of distal anastomoses was 2.2 anastomoses/patient. The category of the coronary lesions was the left main trunk in 6 patients, triple vessel disease in 7, double vessel disease in 3, and left anterior descending artery stenosis with aortic regurgitation in 1 patient. Each operative procedure through the mini-sternotomy was easily and completely performed in all patients. By means of postoperative coronary angiography, full patency without stenosis in all grafts was recognized in 95.0%. Immediately after the MICS-CABG, all patients showed quick recovery of respiration, and postoperative admission duration significantly decreased compared with standard CABG with full sternotomy. The above results suggest that MICS-CABG is one of the procedures of choice for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases.

Late Aortic Dissection after Aortic Valve Replacement for Aortic Regurgitation with Slight Aortic Dilatation Successfully Repaired by the Bentall Procedure / 日本心臓血管外科学会雑誌

We report a 57-year-old male who suffered from ascending aortic aneurysmal dilatation complicated with acute localized dissection. He had received aortic valve replacement with a prosthesis for severe aortic regurgitation resulting from valve degeneration and annular dilatation 4 years previously at which time the maximal ascending aortic diameter had been 45mm so that a procedure for the aorta itself was not done. On the present occasion an aortogram showed a maximal aortic diameter of 90mm and localized dissection from above the right coronary ostium to near the connection to the brachiocephalic artery. A successful composite valve-graft replacement of the ascending aorta (Bentall procedure with Piehler's modification) was carried out on a semi-emergency basis. This experience with this case implies that certain intervention for associated moderate aortic dilatation should be considered when an aortic valve replacement is performed.