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The optimal timing of acute myocardial infarction-associated ventricular septal rupture surgery is controversial. Therefore, we examined the appropriateness of our ventricular septal rupture surgical strategy for early surgery in absence of organ failure and delayed surgery after organ failure recovery. We retrospectively included 22 patients who underwent surgery for ventricular septal rupture between January 2012 and February 2021. After diagnosis, patients without organ failure underwent early surgery; those with organ failure underwent delayed surgery after organ failure recovery. In the early- (n = 17) and delayed-surgery (n = 5) groups, the mean ± standard deviation time from diagnosis to surgery was 0.3 ± 0.7 (0-2) and 5.2 ± 2.3 (3-8) days, respectively. The early-surgery group was treated with preoperative mechanical circulatory support using an intra-aortic balloon pump. The delayed-surgery group was treated with an Impella (n = 1), intra-aortic balloon pump combined with venous artery extracorporeal membrane oxygenation (n = 1), and Impella combined with venous artery extracorporeal membrane oxygenation (ECpella) (n = 3). The hospital and mid-term (52.1 ± 42.9 months) mortality rates were 9.1% (early-surgery group, 11.8%; delayed-surgery group, 0%) and 18.2% (early-surgery group, 23.5%; delayed-surgery group, 0%), respectively. Further, 70.6% and 82.4% patients without organ failure had cardiogenic shock and an anterior rupture location, respectively. In the early-surgery group, combined treatment with an intra-aortic balloon pump and medical therapy yielded hemodynamic stability until surgery. However, in patients with organ failure requiring long-term management, ECpella therapy was preferable, depending on the rupture size. Our treatment strategy was reasonable. Further research is warranted to determine the optimal support duration, especially for patients requiring long-term management.

A 78-years-old woman was referred to our institution for the treatment of right subclavian artery (SCA) aneurysm. She previously underwent total arch replacement via median sternotomy approach. Preoperative computed tomography revealed a 55 mm sized SCA aneurysm. Stent graft was inserted from brachiocephalic artery to right common carotid artery via the graft anastomosed. The orifice of the right SCA was covered with stent graft inserted into the right common carotid artery-brachiocephalic artery and the right SCA was occluded with coils distal to the aneurysm, carotid-SCA bypass was performed with 8 mm ePTFE graft. Postoperative examination confirmed complete exclusion of the aneurysm and patency of the bypass graft. We thought that hybrid treatment for this patient was a less invasive alternative to conventional surgical procedure.

Purpose To compare the characteristics of reimplantation (RI) using grafts with sinuses and remodeling (RM) with/without external suture annuloplasty using a pulsatile flow simulator. Methods Porcine aortic roots were obtained from an abattoir, and six models of RM and RI with sinuses were prepared. External suture annuloplasty (ESA) was performed in the RM models to decrease the root diameter to 22 mm (RM-AP22) and 18 mm (RM-AP18). Valve models were tested at mean pulsatile flow and aortic pressure of 5.0 L/min and 120/80 (100) mmHg, respectively, at 70 beats/min. The forward flow, regurgitation, leakage, backflow rates, valve-closing time, and mean and peak pressure gradient (p-PG) were evaluated. Root configurations were examined using micro-computed tomography (micro-CT). Results The backflow rate was larger in the RM models than in the RI models (RI: 8.56% ± 0.38% vs. RM: 12.64% ± 0.79%; p p p Conclusions RM with ESA and RI with neo-sinuses showed comparable hemodynamics. ESA to RM reduced regurgitation.

A 76-year-old man with thoracic aortic aneurysm was admitted to our hospital. Aortic arch replacement was performed uneventfully. He suffered from abdominal pain 17 days after the operation. Computed tomography (CT) scan revealed a strangulated bowel obstruction, and we performed emergent open abdominal surgery. During the operation, we found an adhesion between the greater omentum and the retroperitoneum. The small intestine was intussuscepted into this site, and strangulated with necrosis of a 35-cm length. We performed a partial resection of the small intestine. We encountered rare strangulated bowel obstruction after open heart surgery due to adhesion of the great omentum in a patient without a history of abdominal surgery.

The prevalence of concomitant abdominal aortic aneurysm（AAA）and colorectal cancer（CRC）is increasing. Management of patients with AAA and CRC is controversial, particularly when both diseases require urgent surgical treatment. In this report, a 66-year-old man with a large AAA and concomitant advanced sigmoid colon cancer is described. The patient underwent synchronous endovascular aneurysm repair（EVAR）for AAA and laparoscopic sigmoidectomy for sigmoid colon cancer. The patient was discharged on postoperative day 13 without complications. We conclude that one-stage management with minimally invasive synchronous EVAR and laparoscopic sigmoidectomy may provide an alternative treatment method for patients with large AAA and advanced colon cancer.

A 84-year-old man was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Two days after the PMI, chest X-ray revealed left pneumothorax, and a chest tube was inserted. The pneumothorax did not improve, and computed tomography revealed left lung injury by the right ventricular lead. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured right ventricle and left lung were repaired. Ten days after the surgical procedure, intravenous implantation of new right ventricular lead was performed. He was discharged 38 days after the surgical procedure.

A 73-year-old woman suffered from premature ventricular contraction( PVC) which could not be controlled by medications. Holter 24-hour continuous recording electrocardiogram (Holter ECG) revealed 22,706 PVC beats/day. Upon further examination, she was found to have severe aortic stenosis and mild insufficiency. Preoperative electro-physiological study and standard 12-lead electrocardiogram revealed that the PVC originated from myocardium under the left coronary cusp. Aortic valve replacement and intraoperative cryoablation were performed. Her postoperative course was uneventful, Holter ECG revealed 638 PVC beats/day. Clinical symptons of PVC disappeared immediately after surgery. She was discharged 19 days after the operation.

The differences in aortic root geometry associated with various valve-sparing root replacement (VSRR) techniques have not fully been understood. We evaluated the root configuration of current VSRR techniques by developing in vitro test apparatus. Six fresh porcine hearts were used for each model. The aortic root remodeling control group involved replacement of the ascending aorta with diameter reduction of sino-tubular junction (STJ) (C1). The aortic valve reimplantation control group involved replacement of the ascending aorta alone (C2). VSRR included remodeling without (RM) or with annuloplasty (RM + A) and reimplantation with a tube (RI) or a handmade neo-Valsalva graft (RI + V). The root geometry of each model in response to closing hydraulic pressures of 80 and 120 mmHg was investigated using echocardiography. Among the VSRR models, RM yielded the largest aorto-ventricular junction (AVJ), which was similar to those in non-VSRR models [mean AVJ diameter (mm) at 80 mmHg; RM = 25.1 ± 1.5, RM + A = 20.9 ± 0.7, RI = 20.7 ± 0.9, RI + V = 20.8 ± 0.4]. RI + V yielded the largest Valsalva size and largest ratio of Valsalva/AVJ, which was similar to the control group [mean Valsalva diameter (mm) at 80 mmHg; RM = 28.4 ± 1.4, RM + A = 25.8 ± 1.3, RI = 23.6 ± 1.0, RI + V = 30.5 ± 0.8, ratio of Valsalva/AVJ at 80 mmHg; RM = 1.14 ± 0.06, RM + A = 1.24 ± 0.06, RI = 1.15 ± 0.06, RI + V = 1.47 ± 0.05]. The STJ diameter at 80 mmHg was numerically smaller with RM + A (22.4 ± 1.2 mm) than with RM (24.8 ± 2.3 mm, p = 0.11). There were no significant differences in AVJ, Valsalva, or STJ distensibility or ellipticity between procedures. Current modifications, including annuloplasty for remodeling or reimplantation in the setting of neo-Valsalva graft, yield near-physiological root geometries.

A 36-year-old woman with severe aortic valve stenosis was admitted to our hospital. She had been diagnosed with antiphospholipid syndrome complicated with systemic lupus erythematosus (SLE) and had been taking prednisolone( 10 mg/day) for 22 years. As SLE patients with prolonged steroid use are known to be at risk of an aortic dissection and aneurysm, femoral artery was chosen for arterial perfusion to reduce a risk of aortic dissection. Aortic valve replacement was performed uneventfully, because the aorta was treated carefully during the operation. Negative microbial culture and pathological examination of the resected aortic valve demonstrated an atypical vegetation, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was discharged without complications 23 days after the operation.

An 85-year-old man received simultaneous coronary artery bypass grafting (CABG) and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index (ABI) improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography( CT) demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.

A 58-year-old man with Marfan syndrome visited our clinic for a routine examination. He had undergone a modified Bentall procedure with Carrel patch technique for annuloaortic ectasia 15 years previously. Computed tomography revealed an aneurysm of 43×57 mm in diameter at the right coronary ostium. He underwent resection of the aneurysm and coronary reconstruction using Piehler technique. He was discharged on the 37th postoperative day when his renal function recovered. Although the modified Bentall procedure may improve the surgical outcome, long-term follow-up is important because of various postoperative anastomotic complications in patients with Marfan syndrome.

Purpose Preoperative pulmonary dysfunction has been associated with increased operative mortality and morbidity after cardiac surgery. This study aimed to determine whether values for the diffusing capacity of the lung for carbon monoxide (DLCO) could predict postoperative complications after cardiac surgery. Methods This study included 408 consecutive patients who underwent cardiac surgery between June 2008 and December 2015. DLCO was routinely determined in all patients. A reduced DLCO was clinically defined as %DLCO CO was calculated as DLCO divided by the predicted DLCO. The association between %DLCO and in-hospital mortality was assessed, and independent predictors of complications were identified by a logistic regression analysis. Results Among the 408 patients, 338 and 70 had %DLCO values of ≥ 70% and P CO (P = 0.275). A multivariate logistic regression analysis with propensity score matching identified reduced DLCO as an independent predictor of complications (OR, 3.270; 95%CI, 1.356–7.882; P = 0.008). Conclusions %DLCO is a powerful predictor of postoperative complications. The preoperative DLCO values might provide information that can be used to accurately predict the prognosis after cardiac surgery. Clinical trial registration number UMIN000029985.

Coronary sinus aneurysm is a rare heart anomaly. Herein, we report a rare case with giant coronary sinus aneurysm misdiagnosed as an extracardiac mediastinal tumor. The preoperative diagnostic imaging failed to diagnose the correct location of the tumor and a simple resection was planned. It turned out to be coronary sinus aneurysm intraoperatively and required cardiopulmonary bypass support for the resection.

Although aortic valve-sparing operations are performed throughout Japan, the indications, specific repair techniques, and outcomes have not been reported in full. Thus, we conducted the first nationwide survey of aortic valve-sparing surgery. We mailed a questionnaire to 508 institutions across Japan to obtain information on elective aortic valve and aortic root surgeries performed in 2014. Included in the mailing was a secondary questionnaire that sought further information from institutions reporting aortic valve-sparing surgeries. Two hundred and fifty (49%) institutions responded and reported a total of 7859 aortic valve operations and 771 aortic root operations. Aortic valve operations performed strictly for aortic regurgitation totaled 2080, 156 (8%) of which were aortic valve repairs. Of the 699 aortic root surgeries performed for aortic regurgitation, 236 (34%) were valve-sparing root replacement surgeries. The valve-sparing root replacement surgeries comprised aortic valve reimplantation (n = 173, 73%) and aortic root remodeling (n = 63, 27%). Five of 57 (9%) institutions were responsible for 42% (99/233) of the total aortic valve-sparing surgeries performed. Detailed information that was obtained for 233 patients who underwent aortic valve repair or valve-sparing root replacement showed 30-day mortality and reoperation for regurgitation after aortic valve repair (n = 97), aortic root remodeling (n = 37), and aortic valve reimplantation (n = 99) to be 1, 0, and 1% and 3, 3, and 1%, respectively. To date, aortic valve-sparing operations have been performed for limited patients at limited institution in Japan, but the early outcomes have been excellent.

Objective To quantify stability in cranial cruciate ligament (CrCL) deficient canine stifles with hamstring grafts affixed at 3 femoral locations. Study Design Canine stifle motion study using a multi-cohort, repeated measures design. Sample Population 27 canine cadaver stifles. Methods Hamstring grafts (HG) were affixed at the gracilis-semitendinosus insertion and on the lateral femur (1) proximal trochlear ridge (TR), (2) craniodistal to fabella (F), or (3) condyle center (CC). Total, cranial, and caudal tibial translation and total, medial, and lateral angular displacement, with and without translational load, were quantified with the CrCL intact, transected, and reconstructed. Angular displacement was quantified from points on the distal femur and proximal tibia. Graft strain was calculated from tissue displacement measured at joint angles of 30°, 60°, 90°, and 120°. Results Tibial translation was lowest in F constructs, which also achieved the least difference in tibial translation from intact stifles. Tibial translation was lower in intact stifles than in CrCL transected or reconstructed stifles. Less angular displacement of the proximal tibia was detected in the medial than in the lateral direction, and tibial displacement was lower in the cranial than the caudal direction. Angular displacement was lowest in the F treatment group. F constructs had the lowest graft strain at joint angles greater than 30°. Conclusions Femoral fixation of a canine hamstring graft craniodistal to the lateral fabella conferred the best joint stability and lowest graft strain in vitro. No fixation method restored joint stability of the intact CrCL.

Sarcopenia was assessed as a prognostic factor for patients undergoing cardiac surgery by evaluating the quantity and quality of skeletal muscle. Sarcopenia was assessed by perioperative abdominal computed tomography using the total psoas muscle index (TPI) and intra-muscular adipose tissue content (IMAC). Patients were classified into high- (HT, n = 143) and low- (LT, n = 63) TPI groups and low- (LI, n = 122) and high- (HI, n = 84) IMAC groups. There were significantly more complications in the LT and HI groups than in the HT and LI groups. (HT 15.4% vs. LT 30.2%, P = 0.014) (LI 11.5% vs. HI 31.1%, P

Objectives: The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk. We investigated the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery. Methods: In total, 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by ELISA. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria. Results: AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels, perioperative data (urine output), ICU stay period, and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. In multivariable logistic regression analysis, the preoperative ET-1 level and CPB time were the independent determinants of AKI, even adjusted by age, sex, and BMI. The preoperative GDF-15 level, CPB time, and RCC transfusion were independent determinants of 30-day mortality plus morbidity. Conclusion: Preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risks for patients undergoing cardiovascular surgery.

We elucidated the efficacy of the slit skirt technique to prevent bleeding from the proximal anastomosis between the graft and aortic annulus. Between September 2008 and September 2014, 15 patients underwent a modified Bentall operation with the slit skirt technique at our institution. No patients had bleeding from the proximal anastomosis. No re-thoracotomy for bleeding was required. During midterm follow-up (median period, 21 months), no patient had pseudoaneurysms at the proximal suture line. We conclude that the slit skirt technique is useful to prevent bleeding from the proximal anastomosis after the Bentall operation.

We evaluated an air-assisted strip seeder, developed by the Hokuriku research center, in farmers’ fields for four years. Plantings using the seeder had more panicles and a higher yield than those using a shooting hill-seeder. The early growth of planting using the air-assisted strip seeder was promoted by increasing the rate of seedling establishment because the seeding depth of plantings using the air-assisted strip seeder was shallower than that of plantings using the shooting hill-seeder. Tillering in this planting was also promoted, which boosted the yield, while simultaneous seeding with fertilizer application using the air-assisted strip seeder was also compared with conventional practice over two years in a field at the Hokuriku research center. During simultaneous seeding with fertilizer application, the rate of seedling establishment was equivalent to that in conventional practice. After seedling establishment, growth and yields in the simultaneous seeding with fertilizer application were equivalent to or exceeded those in conventional practice. Discipline: Crop production Additional key words: rice, seeding depth, seedling establishment, simultaneous seeding with fertilizer application, yield *Corresponding author: e-mail furuhata@ affrc.go.jp Received 26 February 2014; accepted 3 September 2014. Introduction The Hokuriku research center has developed an air-assisted strip seeder (Chosa et al. 2009b, Fig. 1.) The seeding base width of the seeder is 10 m (base width of one side is 5 m.) The blower of the seeder conveys seeds to the injection ports; powered by the PTO of the tractor and can deposit seeds in rows with interval spacing of 30 cm. The effective field capacity is 2 ha/h, assuming a base speed of 0.8 m s-1 and field efficiency of 70%. Because the seeder allows planting of large fields, its technology may promote labor-saving and low-cost technologies for direct seeding culture in the near future. In the mechanical transplanting method, a labor-saving technology for rice planting, involving the application of fertilizer or pesticide has already been developed, while in direct seeding culture, systematized techniques, such as seeding with fertilization or pesticide application, have also been introduced. In cultures using a shooting hill-seeder (Togashi et al. 2001a) and coated urea, technology simultaneously seeded with fertilizer application has been reported (Yoshinaga et al. 1997, Morita et al. 2005, Furuhata et al. 2006) In this technology, a decreased seedling emergence rate and delay in early growth was observed, compared with fertilizer incorporation into the plow layer (Furuhata et al. 2006) Furthermore, the runoff of nitrogen from the soil surface following basal dressing containing quick-acting Base width (one side 5m) Injection port Interrow space (0.3m) Spray pipe Electric motor cylinder Blower Feed roll Hopper 1980mm PTO transmission system Fig. 1. Schematic diagram of air-assisted strip seeder

We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings. UAV is very rare congenital aortic valve disease which is rarely diagnosed preoperatively.

重粘な排水不良田におけるダイズ作の湿害軽減対策として開発された耕うん同時畝立て播種技術のオオムギへの汎用利用の可能性を検討することを目的として，収穫年で2008～2010年の3カ年において耕うん同時畝立て播種技術がオオムギの生育および収量に及ぼす影響を，畝立てを行わない慣行の表面散播と比較した．播種量は耕うん同時畝立て播種技術，表面散播がそれぞれ8，12 gm-2とした．その結果，RGRはNARを高く維持することにより播種後170日以降に，地上部乾物重は播種後200日以降に畝立て区が散播区より有意に高くなり，播種技術の違いによってオオムギの収量に有意差が認められた．また，耕うん同時畝立て播種技術は，稔実率が高く一穂整粒数が増加することと，越冬後の茎数の減少が抑えられて散播と同程度の穂数を確保することによって増収した．耕うん同時畝立て播種技術では，成畝によって地下水位面から畝上端までの距離が畝立てをしない場合よりも平均して4.8 cm高いため，積雪期間以降の土壌の粗間隙率が高く維持され，好気的であることが示唆された．従って，耕うん同時畝立て播種技術は，主に積雪期間以降の湿害発生を軽減することにより，越冬後の地上部生育量を確保し，また稔実率を高めることで増収していることが明らかとなった．