We report a rare case of intravascular migration of a cutter knife blade after penetrating chest trauma. A 40-year-old man presented with lower abdominal pain 3 months after an unreported occupational injury to the left anterior chest wall. Computed tomography scan revealed a plate-like foreign body embedded in the distal abdominal aorta and a localized hematoma adjacent to the cardiac apex. The blade was successfully removed during semi-emergent abdominal aortic replacement. This case highlights the potential for delayed migration of sharp intravascular foreign bodies and the importance of whole body imaging in patients with atypical symptoms after penetrating trauma.

Background: Reoperation significantly improves outcomes in tetralogy of Fallot (TOF) patients. However, it is challenging to determine the timing for surgery, especially with complex indications, such as pulmonary regurgitation (PR) with right ventricular outflow tract stenosis or tricuspid regurgitation. Methods: This retrospective study analysed adult TOF patients who underwent reoperation at specialised centres between 2000 and 2015. Exclusions included pulmonary atresia with ventricular septal defect repaired by an extracardiac conduit, double-outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis and pulmonary atresia. Surgeons determined the primary reoperation indication. Results: Of 154 patients (59.1% male, mean age 35.2 ± 12.0 years), from 10 hospitals, eight deaths (5.2%) occurred over 5.7 years (range 2.5–8.0 years) post-reoperation. The main indications for reoperation were PR, right ventricular outflow tract stenosis, and tricuspid regurgitation (62.3%, 24.0% and 18.2%, respectively). Patients with PR showed more variability in preoperative right ventricular end-diastolic volume index values, particularly without concurrent indications. Conclusion: This study sheds light on reoperation outcomes in Japanese TOF patients before percutaneous treatment availability. Surgical decisions, especially with concurrent indications, need adaptable approaches. Despite the absence of a consensus on preoperative evaluation and thresholds for reoperation, our findings may support current surgical decision-making.

A 42-year-old man was referred to our hospital with heart failure and unoperated tricuspid atresia with pulmonary valve stenosis. His condition was initially managed with medical therapy; however, he required repeat hospitalisations for congestive heart failure. We diagnosed the chief cause of his heart failure as aortic valve regurgitation secondary to aortic root dilatation. Aortic root replacement was performed and then his heart failure was controlled.

The authors report a 71-year-old male with descending thoracic aortic aneurysm and multiple risk factors (aortoiliac occlusive disease, obesity, ascending aorta dilatation, and history of left ventriculoperitoneal shunt for hydrocephalus) who was treated with thoracic endovascular aortic repair (TEVAR) via left common carotid artery (LCCA) access and left axillary-carotid artery (Ax-CA) bypass; this approach shortened the LCCA clamp time during the procedure. The patient was discharged without any complications. TEVAR via LCCA access with left Ax-CA bypass is a useful and safe procedure for patients in whom conventional femoral artery access is not feasible.

81-year-old CABG for angina pectoris. The grafts were all patent in postoperative coronary angiography and he was discharged on postoperative day 24. Pericardial and pleural effusion appeared in 1 month after surgery. After pericardial and pleural effusion drainage, we started steroid therapy. However, his symptoms did not improve. We performed pericardiectomy under the diagnosis of constrictive pericarditis. Diastolic dysfunction improved after the surgery, and he was discharged on postoperative day 117. Jpn. J. Cardiovasc. Surg. 48 : 263 - 266 （ 2019 ）

Background: Pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is a risk factor of right ventricular (RV) dysfunction and arrhythmia.The aim of this study was to evaluate the mid-term outcome of pulmonary valve replacement (PVR) using bioprosthetic valves in adult patients with PR after a TOF repair.Method: A total of 32 patients with repaired TOF, who underwent PVR in our hospital between April 2003 and March 2017, were retrospectively examined.The mean follow-up duration after the PVR was 5.4±4.2years.Decision regarding the surgery was made on the basis of clinical symptoms, electrocardiography results, chest radiography, echocardiography findings, magnetic resonance imaging results, and cardiac catheter examination findings.Results: There was no perioperative mortality or the need for re-intervention after PVR.A patient underwent Bentall operation 3 years after PVR.RV end-diastolic volume index (RVEDVI) was significantly reduced (176.3±57.2mL/m 2 before to 108.1±19.4mL/m 2 after PVR, p＜0.05).There was no difference in the RV ejection fraction (42.7％±8.49％before and 42.4％±7.94％after PVR, p＞0.05).The left ventricular (LV) ejection fraction of RVEDVI group was ＜160 mL/m 2 , which showed an improvement; however, there was no significant statistical difference (55.3％±8.03％before and 58.5％±4.95％after PVR, p＝0.12).It was significantly higher in postoperative left ventricular end-diastolic pressure (LVEDP) (15.2±2.78 mmHg) of RVEDVI ≥160 mL/m 2 group than postoperative LVEDP (11.2±2.81 mmHg) of RVEDVI ＜160 mL/m 2 group (p＜0.05).Conclusion: PVR after TOF repair in adult patients with PR is effective and involves a low risk of mortality.It is suggested that 160 mL/m 2 of RVEDVI would be valid for determining whether surgery is indicated for the maintenance of RV and LV functions.

Improvement of surgical results and medical management for Congenital Heart Diseases (CHD) led emerging population of the adult patients. However, corrective surgery for complex CHD does not always mean complete cure. Increasing number of adult patients with CHD (ACHD) will visit the cardiology facilities because of secondary or residual lesions. Conduit malfunction, valvular insufficiency, association of arrhythmias and so forth are common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe and beneficial treatment, however tailored procedures for the individual patient are essential to obtain the optimal quality.

The number of the adult patients with congenital heart diseases (ACHD) continues to grow owing to improvement of surgical results and medical management. Corrective surgery for complex CHD does not always mean complete cure. It is not rare that the patients will visit the cardiology institutes because of secondary lesions due to residua or sequela in adults. Some patients with CHD remain unrepairable with different degree of heart failure and pulmonary arterial hypertension. Association of arrhythmias is common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe, beneficial and low-risk treatment; however, tailored procedures for the individual patient are essential to obtain the optimal quality. A comprehensive multidisciplinary approach is required to fulfill this goal.

A Case of Endovascular Aortic Repair with a Vascular Embolic Device and Stent-Graft for the Anastomotic Pseudoaneurysm in the Ascending Aorta Soichi Asano, Naoki Hayashida, Masanao Ohba, Kozo Matsuo, Hiroyuki Kito, Nobuyuki Hirose, Takuto Maruyama, Masashi Kabasawa, Hideomi Hasegawa and Hirokazu Murayama (Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan) We report a case of a 72-year-old woman, who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular aortic repair with vascular embolic devise and stent-graft. It seemed to be high risk to achieve conventional surgery with extracorporeal circulation, therefore we selected endovascular treatment because she had a bleeding tendency which derived from disseminated intravascular coagulation. Then, we adopted stent-grafting with a vascular embolic device, because the distal side of pseudoaneurysm had too short a landing zone to cover the stent-graft only. The patient well tolerated this procedure and her postoperative course was uneventful. The pseudoaneurysm shrank at 6th months after operation. Jpn. J. Cardiovasc. Surg. 45 : 238-241(2016)

Ostial atresia of the left main coronary artery (LMCA) in children without any primary disease is extremely rare. We present here a case of occlusion of the LMCA in a 9-year-old girl. Myocardial scintigraphy showed poor perfusion in both domains of the left anterior descending artery (LAD) and left circumflex artery (LCx). Coronary artery graphy (CAG) showed complete ostial atresia of the LMCA and retrograde perfusion from the thin collateral arteries into the LAD. We performed angioplasty using an autologous pericardium onlay patch. Her postoperative course was unremarkable. Postoperative CAG showed vanishing collateral arteries, confirming anterograde flow through the LAD and LCx, and myocardial scintigraphy showed improvement in perfusion.

Masakazu Abe Hideo Adachi Junetsu Akasaka Nobuyuki Akasaka Hidetoshi Akashi Tadashi Akiba Toshiaki Akita Atsushi Amano Jun Amano Keiju Aokage Mitsuru Aoki Shigeyuki Aomi Hirokuni Arai Tohru Asai Toshihide Asou Nobuyoshi Azuma Ko Bando Toru Bando Ryuzo Bessho Fengshi Chen Masayuki Chida Koji Chihara Hiroshi Date Yoshinori Doki Yuichiro Doki Kiyoyuki Eishi Shunsuke Endo Shozo Fujino Keiichi Fujiwara Hirotsugu Fukuda Ikuo Fukuda Toshihiro Fukui Kazuhito Funai Kinya Furukawa Kimikazu Hamano Masayuki Haniuda Michiya Hanyu Seiki Hasegawa Makio Hayama Tetsuya Higami Masahiko Higashiyama Takeshi Hiramatsu Yuji Hiramatsu Masafumi Hiratsuka Hirohisa Horinouchi Hirotoshi Horio Hajime Ichikawa Toshihiko Iizasa Akio Ikai Norihiko Ikeda Tadashi Ikeda Kazuhito Imanaka Kiyotaka Imoto Yutaka Imoto Hajime Imura Masayoshi Inoue Yosuke Ishii Shigemi Ishikawa Susumu Isoda Tadashi Isomura Hiroyuki Ito Toshiaki Ito Akinori Iwasaki Hisashi Iwata Takekazu Iwata Akira Iyoda Hironori Izutani Mitsutaka Kadokura Kichizo Kaga Naohiro Kajiwara Yuji Kanaoka Keiichi Kanda Yukihiro Kaneko Ryuzo Kanno Hiroyuki Kato Masaaki Kato Takahiro Katsumata Nobuyoshi Kawaharada Koji Kawahito Tatsuyuki Kawano Hiroaki Kawata Kohei Kawazoe Masahiro Kitada Tetsuya Kitagawa Michihiko Kitamura Hitoshi Kitayama Junjiro Kobayashi Tadasu Kohno Kiyoshi Koizumi Masashi Komeda Tatsuhiko Komiya Haruhiko Kondo Kazuya Kondo Hiroshi Kubota Masahiko Kuinose Toru Kuratani Masatoshi Kurihara Yoshihiko Kurimoto Masahiro Mae Masanobu Maeda Yoshimasa Maniwa Munetaka Masuda Hitoshi Matsuda Yoshiro Matsui Goro Matsumiya Yuji Matsumura Kozo Matsuo Hirofumi Midorikawa Takahiro Mimae Takeshi Mimura Kenji Minakata Masato Minami Yuko Minami Yoshihiro Minamiya Naoki Minato Kenji Minatoya Yoshio Misawa Akira Mishima Tetsuya Mitsudomi Takeshi Miyairi Kagami Miyaji Shinji Miyamoto Yuji Miyamoto Yoshihiro Miyata Kentaroh Miyoshi Teruaki Mizobuchi Akira Mogi Kiyofumi Morishita Kiyozo Morita Shigeki Morita Tetsuro Morota Noboru Motomura Satoru Motoyama Nobuhiko Mukohara Masato Mutsuga Takeshi Nagayasu Jun Nakajima Takahiro Nakajima Haruhiko Nakamura Hiroshige Nakamura

We describe here an initial successful case of valve-sparing surgery using reimplantation technique in a 24-year-old male with aortic root dilatation with truncal valve insufficiency after common arterial trunk repair. Concomitant right ventricular outflow tract reconstruction with expanded polytetrafluoroethylene was also successfully performed. He was discharged home on postoperative day 10 without stenosis or regurgitation of repaired valves. He is in New York Heart Association class I condition without any anticoagulant agents 6 months after operation. Of course, careful follow-up will be needed though our early result is acceptable. (C) 2014 by The Society of Thoracic Surgeons

SUMMARYThe assessment of cardiovascular function is becoming increasingly important for the care of patients with single‐ventricle defects. However, most measurement methods available in the clinical setting cannot provide a separate measure of cardiac function and loading conditions. In the present study, a numerical method has been proposed to compensate for the limitations of clinical measurements. The main idea was to estimate the parameters of a cardiovascular model by fitting model simulations to patient‐specific clinical data via parameter optimization. Several strategies have been taken to establish a well‐posed parameter optimization problem, including clinical data‐matched model development, parameter selection based on an extensive sensitivity analysis, and proper choice of parameter optimization algorithm. The numerical experiments confirmed the ability of the proposed parameter optimization method to uniquely determine the model parameters given an arbitrary set of clinical data. The method was further tested in four patients undergoing the Fontan operation. Obtained results revealed a prevalence of ventricular abnormalities in the patient cohort and at the same time demonstrated the presence of marked inter‐patient differences and preoperative to postoperative changes in cardiovascular function. Because the method allows a quick assessment and makes use of clinical data available in clinical practice, its clinical application is promising. Copyright © 2014 John Wiley & Sons, Ltd.

背景：異所性心房頻拍（ectopic atrial tachycardia：EAT）は，小児期上室頻拍の10〜15％を占めると言われている．その臨床像は多岐にわたり，適切な治療方法も異なる．基礎心疾患を持たない小児期EATの臨床的特徴を明らかにし，治療方針の決定方法について考察することを目的とした．方法：1998年4月より2013年3月までの間に当院において診療した基礎心疾患を持たない小児期EAT22例を，6歳までに頻拍が自然消失したA群と頻拍が残存したB群に分類し，B群をさらに頻拍出現様式が持続性ないし頻発性のB1群と発作性のB2群に分類し，後方視的に比較検討した．結果：A群は7例（男児3例，女児4例），B1群は10例（男児5例，女児5例），B2群は5例（男児2例，女児3例）であった．発症年齢は，A群中央値0.3 歳（0〜1.8 歳），B1群中央値10.4 歳（0.9〜15.4 歳），B2群中央値10.4 歳（4.4〜13.5 歳）であり，頻拍出現様式に関係なく，B群において有意に発症年齢が高かった（p = 0.002）．A群は全例抗不整脈薬にて頻拍の管理が可能であった．B1群ではしばしば薬物治療不応例を認めた．B2群は全例抗不整脈薬にて頻拍の管理が可能であった．B群に対して全例高周波カテーテルアブレーション（radiofrequency catheter ablation：RFCA）を行い，15例中14例で通電中に頻拍が停止した．起源は，15例中9例（60％）が心耳であり，成人と異なり，心耳に多い傾向を認めた．結論：胎児期から乳児期に発症する基礎心疾患を有さないEATは自然消失が期待でき，薬物治療が第一選択として望ましい．頻拍が残存する症例の中でも，頻拍の出現様式により，異なる臨床像を呈する可能性が示唆され，さらなる症例の集積が必要と考えた．RFCAの急性期効果は高く，頻拍が残存する症例においては，頻拍誘発性心筋症（tachycardia-induced cardiomyopathy：TIC）を合併することがないよう，RFCAの適応を含め慎重な経過観察が必要である．

BACKGROUND:Although the survival rate for repaired Tetralogy of Fallot (TOF) is dramatically improving, anatomical and functional residua and sequelae followed by arrhythmias and sudden death are still challenging issues to be resolved. Reoperation can reduce the incidence of arrhythmias and sudden death, but there is no consensus on the indications of reoperation for patients with TOF, especially in Japan.METHODS AND RESULTS:A cross-sectional questionnaire survey of reoperation indications in patients with TOF was performed through a Japanese multicenter study. The questionnaire, which focused on the number of repaired TOF patients aged >15 years old, reoperation indications and management, was sent to the institutions belonging to Japanese Society for Adult Congenital Heart Disease. In total, 41.5% (78/188) of the institutions replied. The total number of repaired TOF patients was 4,010, and sudden cardiac death was observed in 45.236/4,010 (5.9%) experienced reoperation. Pulmonary stenosis (32%) and pulmonary regurgitation (29%) were the most common reasons for reoperation. There were only 2 implantable cardioverter defibrillator or resynchronization therapy defibrillator implantations. The physiological/anatomical indications of reoperation differed among the hospitals.CONCLUSIONS:Approximately 1.1% of patients suffered sudden death and 6% of repaired TOF patients had reoperation. The indications of reoperation, however, varied among the institutions. Therefore, detailed information for each case of sudden death or reoperation should be collected and analyzed in order to establish guidelines for reoperation.