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To control intraoperative hyperglycemia in patients who underwent aortic surgery using STG-55® artificial endocrine pancreas and clarify the effectiveness of this device. Blood glucose control using the STG-55® was performed in 18 patients (15 men and 3 women; age, 66 ± 10 years) who required hypothermic circulatory arrest (STG-55® group). Seventeen patients (10 men and 7 women; age, 71 ± 8 years) whose blood glucose was controlled using the conventional method were included in the control group. Glucose concentration was controlled with the aim of maintaining it at 150 mg/dl. In both groups, the blood glucose concentrations did not significantly change during the interruption of systemic perfusion; however, a sharp increase was noted immediately after reperfusion. Although the hyperglycemic status persisted after reperfusion in the control group, it was effectively suppressed in the STG-55® group (STG® vs. control group at 50 min after reperfusion: 180 ± 35 vs. 212 ± 47 mg/dl, p = 0.026) and blood glucose concentration reached the target value of 150 mg/dl at 100 min after reperfusion (STG® vs. control group: 153 ± 29 vs. 215 ± 43 mg/dl, p = 0.0008). The total administered insulin dose was 175 ± 81 U and 5 ± 3 U in the STG® and control groups, respectively (p

Right‐sided infected endocarditis (IE) is very rare, especially PVIE accounts for 1.6%‐2.7% % of all IE cases. We successfully treated a IE of pulmonary valve patient with bioprosthetic valve and annulus enlargement with pericardial patch.

Key Clinical Message A 65‐year‐old man had histories of retroperitoneal fibrosis, membranous nephropathy, and acute coronary syndrome. Chest computed tomography showed an enlarged ascending aorta and type B aortic dissection, and he underwent ascending aorta and arch replacement. A pathological examination of the resected aorta showed immunoglobulin G4‐positive plasma cell infiltration.

Vacuum-assisted closure(VAC) therapy is mainly used for tissue defects. VAC therapy can remove exudate that could impair the healing process. We applied VAC therapy in patients considered at high risk of surgical site infection who underwent cardiovascular surgery via standard median sternotomy. Risk factors included advanced heart failure, obesity, diabetes mellitus, steroid administration, immunosuppressant administration, and chronic renal failure, etc. VAC therapy was used in 134 patients. Only 3 of these patients (2.2%) developed surgical site infection caused by Staphylococcus epidermidis;2 patients fully recovered after prolonged VAC therapy for 2 weeks, and the other required an additional sternal fixation after the sternal wires were removed for wound infection control. No patient developed infective mediastinitis. Prophylactic VAC therapy can reduce postoperative wound infection in high risk patients undergoing open heart surgery via full sternotomy.

A sinus of Valsalva aneurysm is an uncommon cardiac anomaly. The aneurysm usually ruptures into the cardiac cavity, and rupture into the pericardial cavity is unusual. A 69-year-old man was admitted to our hospital after collapse due to cardiac tamponade. Computed tomography revealed a ruptured right sinus of Valsalva aneurysm (5 cm) with massive pericardial effusion. The right coronary artery arose from the aneurysm. Severe aortic regurgitation due to the lack of coaptation of the valves was detected by echocardiography. Emergency patch closure of the aneurysm orifice, aortic valve replacement, and coronary artery bypass grafting to the right coronary artery were performed. The postoperative course was uneventful and the patient was discharged on postoperative day 28 in good health.

Immunoglobulin G subclass 4-related disease (IgG4-RD) is a recently recognized systemic inflammatory disease characterized by an elevated serum IgG4 level and an IgG4-positive lymphocyte infiltrate mainly in exocrine tissues. Previous reports documented IgG4-RD in several cardiovascular disorders. We present a case of type A aortic dissection associated with IgG4-RD. A 52-year-old man diagnosed with a type A aortic dissection was referred for surgical treatment. He underwent emergency hemiarch reconstruction with a prosthetic graft. His postoperative recovery was uncomplicated. Histopathologic examination of his aortic tissue showed marked adventitial thickening with fibrosis and an IgG4-positive plasma cell infiltrate. He was diagnosed with type A aortic dissection incidentally complicated by IgG4-RD. The relationship between IgG4-RD and the pathogenesis of aortic dissection remains unknown and requires further investigation.