[Thoracic Aortic Aneurysm due to Giant Cell Arteritis;Report of a Case].

A 70-year-old man with an ascending aortic aneurysm was referred to our hospital. He had not shown any head symptoms and blood tests did not indicate any inflammation. Ascending aortic replacement was performed under cardiopulmonary bypass. Pathologic examination of the aneurysm wall was diagnosed for giant cell arteritis( GCA). Aortic aneurysm due to GCA without no symptom was extremely rare.

Epicardial electrical isolation of the right atrial appendage on the beating heart with an infrared coagulator.

To determine the clinical efficacy of application of infrared energy to the beating heart as a means of creating electrical blocks, an original infrared coagulator (KIRC-119; Phomec Inc, Tokyo, Japan) was applied to the atrium of a patient with atrial fibrillation. A postoperative electrophysiologic study was performed to confirm its efficacy. The coagulator was applied epicardially to the beating heart concomitant with an on-pump beating heart coronary artery bypass graft procedure. Sinus rhythm was restored during the operation, and the electrophysiologic study revealed that a bidirectional block had been created on the right atrial appendage. The infrared coagulator may facilitate performance of the epicardial Maze procedure on the beating heart.

The stiffness of normal and abnormal mitral valves.

BACKGROUND: Although it is well known that valvular lesions show changes in stiffness, this fact has not been studied objectively or quantitatively. METHODS: Using a tactile sensor, stiffness of the mitral valve was measured at 11 autopsies and 19 surgically excised specimens. The relationships between stiffness and histological state were investigated in 394 points of resected specimens. RESULTS: In normal mitral valves, the anterior leaflet was significantly stiffer than the posterior leaflet in all zones. The rough zone had the least stiffness in both leaflets. Mitral stenotic valves were significantly stiffer than normal in all zones, the rough zone had the greatest stiffness. The grade of fibrosis (r=0.862), hyalinosis (r=0.783), and calcification (r=0.464) had positive correlation with the stiffness, respectively. An S score that was composed of these three factors had strong positive correlation (r=0.935). The regression equation was: stiffness=2.882+2.304xS score (r(2)=0.88). With cut-off values of 8 g/cm for severe fibrosis, 10 for focal hyalinosis, 13 for diffuse hyalinosis, 15 for mild calcification and 18 for massive calcification, these changes were accurately (>90%) detected. The grade of myxoid change had mild negative correlation with the stiffness (r=-0.507). CONCLUSION: The actual value of stiffness of normal and abnormal mitral valves and the relationships between stiffness and histological changes were obtained. A tactile sensor promptly and accurately shows stiffness of the heart valve indicating its histological state. It can be a useful device for cardiovascular surgery.

[International communications and exchanges in cardiothoracic surgery].

The importance of international communications and mutual exchanges have become more vital than ever in every field including our specialty of cardiothoracic surgery. The communications should be not only on individual or institutional bases but also at the level of academic Societies. The Asian Society for Cardiovascular Surgery has played a critical role as the key Society on the third pole of the globe to communicate with the organizations in other continents, such as the European Association for Cardiothoracic Surgery, the American Association for Thoracic Surgery, the Society of Thoracic Surgeons as well as Cardiothoracic Surgery Network (CTSNet). In order for the Japanese cardiothoracic surgeons to continue to be respected and hold the leadership in Asian community of our specialty, it is mandatory to promptly improve the domestic problems concerning the postgraduate training of cardiothoracic surgeons.

Dawn of cardiac surgery in Japan.

Because of World War II, the development of closed heart surgery in Japan was delayed for several years. As far as open heart surgery was concerned, the tireless Japanese investigators in the early 1950s worked extremely hard to quickly catch up with the North Americans and Europeans. Looking back at the dawn of Japan's open heart surgery, we are impressed at how the investigators precisely reported their experiences as cited in this editorial, how many times they repeated their experiments prior to clinical application, and most importantly how cooperatively they worked as a group even in the very competitive environment.

Epicardial maze procedure on the beating heart with an infrared coagulator.

PURPOSE: Maze surgery is widely used to treat atrial fibrillation (AF) but requires cardiopulmonary bypass and longer aortic cross-clamping time. Percutaneous transcatheter pulmonary vein (PV) isolation is time consuming and relies on fluoroscopy and contrast media, and PV obstruction and cardiac tamponade are still major problems. To overcome these drawbacks, we developed an epicardial maze procedure with an infrared coagulator on the beating heart, and the aim of this study was to confirm electrophysiologically the efficacy of this method. DESCRIPTION: Light from a lamp in the infrared coagulator is focused into a quartz rod, and the distal exit-plane of the rod is connected to a sapphire tip that allows 10 mm of linear photocoagulation. In an experiment in 5 dogs with AF, instead of making all of the incisions usually required for maze surgery, the infrared coagulator was applied epicardially to create a continuously overlapping linear lesion that was the same as the incision line in the maze III procedure except for the intraatrial incision. After the procedure, 11 electrodes were attached to both atria, and an electrophysiologic study was performed. EVALUATION: The electrophysiologic study confirmed electrophysiologic isolation of both atrial appendages and within the PV encircling lesion. Sustained atrial fibrillation could no longer be induced. CONCLUSIONS: The epicardial maze procedure was successfully performed on a beating heart with the infrared coagulator.

Effect of pravastatin on progression of coronary atherosclerosis in patients after coronary artery bypass surgery.

BACKGROUND: Although the anti-atherosclerotic effects of HMG-CoA reductase inhibitors are well known, their specific effect on saphenous vein grafts after coronary artery bypass graft (CABG) operation is not well documented and has not been studied in Japan, so the aim of the present prospective randomized controlled study involving 27 Japanese institutions was to investigate the effects of pravastatin on the progression of atherosclerosis in such grafts and native coronary arteries after CABG. METHODS AND RESULTS: A total of 303 patients who had undergone CABG were randomly assigned to either the pravastatin group (n =168) or the control group (n = 167). Paired coronary angiograms were obtained at baseline and at the end of 5-year follow-up in 182 (60%) patients. The low-density lipoprotein cholesterol concentration significantly decreased in the pravastatin group from 141.4 mg/dl to 113.7 mg/dl (-19.6%), compared with 141.1 mg/dl to 133.7 mg/dl (-5.2%) in the control group (p < 0.001). Although there was no significant difference in the quantitative coronary angiography measurements between the 2 groups, the global change score indicated a significant pravastatin-mediated reduction in plaque progression (p < 0.01). CONCLUSIONS: Pravastatin can potentially reduce atherosclerotic progression in both the bypass graft and native coronary arteries of patients after CABG.

[The surgical subspecialty board in Japan].

This article deals with a 7-year endeavor to reform the board certification system of surgical specialty and subspecialty, outlining of 29 meetings of the surgical subspecialty board in Japan. The surgical societies are responsible to constantly improve the quality of the surgical training programs and qualification systems so that the board certified surgeons are accepted and treated as true surgical specialists in this country.

[The relationship between surgical and its subspecialty boards in Japan].

This article deals with a 7-year endeavor to reform the board certification system of the surgical specialty and its subspecialties. The most important lesson learned is that the societies running the board must work not for the societies but for trainees and patients. The new postgraduate surgical training program is an overlapping system composed of a general surgery program of 5 years and optional subspecialty program of 7 years. There are four types of subspecialty program: cardiovascular; respiratory; gastroenterological; and pediatric surgery. The written examination for general surgery is taken 4 years after the start of training. Those who pass it and experience 350 general surgery cases within 5 years are eligible for oral examination by the surgery board. Those who pass the written examination for general surgery and experience a certain number of subspecialty surgeries within 7 years after the start of training are eligible for the oral and/or written examinations for the subspecialty board. The surgical societies are responsible for constantly improving the quality of the surgical training programs and qualification systems so that board-certified surgeons are accepted and treated as true surgical specialists in this country.

[Patient safety management in surgery].

This article deals with practical guidelines for informed consent to surgery and strategies to avoid adverse events during the operative and postoperative periods. It also describes what to do in the event of accidents and what should or should not be done to avoid medical litigation.