Current Status of Surgical Technique Training Such as Off the Job Training / 日本心臓血管外科学会雑誌

Young cardiovascular surgeons work on various trainings such as OFFJT to improve surgical techniques. In this paper, we conducted a questionnaire survey of U-40 members to find out what they are doing to acquire standard surgical techniques.

1.How Can We Promote Work Style Reforms of Cardiovascular Surgeons ? / 日本心臓血管外科学会雑誌

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.

A Calcified Amorphous Tumor Causing Mitral Valve Perforation and Ruptured Chordae Tendineae / 日本心臓血管外科学会雑誌

Calcified amorphous tumor (CAT) is a non-neoplastic mass characterized by calcified nodules that was first reported in 1997. It is often associated with dialysis or mitral annular calcification (MAC). CAT is considered a risk factor for systemic embolism, but there has been no report of CAT damaging the native valve tissue and leading to valvular disease. An 81-year-old woman had shortness of breath on exertion starting 1 year previously, and was referred to our hospital with cardiac murmur detected on physical examination. Echocardiography showed evidence of severe mitral valve regurgitation with ruptured chordae tendineae of the posterior leaflet and a poorly mobile club-shaped structure protruding into the left ventricle and appearing to be continuous with MAC. She underwent elective mitral valve repair. A club-shaped calcification originating from MAC was found under the P2 segment, with ruptured P2 chordae tendineae immediately above it and mitral perforation in the contralateral A2 segment, which were likely to have resulted from direct damage by the hard structure. Mitral valve repair was successful with mass resection, triangular resection of the posterior leaflet P2 segment, and closure of the perforation. Histopathological findings of the mass were consistent with CAT, with no evidence of infection or malignancy. CAT may not only cause embolism but also grow while damaging the native valve tissue. It is important to closely follow-up and perform surgery in proper timing.

A Case of Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysm due to Takayasu Arteritis / 日本心臓血管外科学会雑誌

A girl was given a diagnosis of Takayasu arteritis (TA) with thoracic aortic aneurysm (TAA) at 11 years old, and began receiving medical treatment using steroids. At age 19, her biological inflammation markers were within normal limit ; however, contrast-enhanced CT showed the enlargement of the TAA to 60 mm in diameter. The risks and benefits of traditional revascularization vs endovascular procedures were carefully considered. The presence of suitable anatomical conditions, including adequate 20-mm-long landing zones, led us to select an endovascular approach. We exposed the right common iliac artery via a retroperitoneal approach, then, original stent grafts, using Z stents covered with thin-wall polytetrafluoroethylene, were positioned in the descending aorta from the level of the left subclavian artery to the level of the celiac artery. Intraoperative arteriography showed a patent stent graft without endoleaks or enlargement of the TAA. The postoperative course was uneventful, and follow-up CT scan performed 4 years after the repair showed shrinkage of the aneurysm diameter, and no evidence of any endoleaks. We concluded that endovascular treatment for TA-related aneurysm can be useful and safe, but further follow-up is needed in this case.