The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate.

A 68-year-old woman with a history of bipolar disorder was admitted to another hospital with a gastric ulcer. On admission, Takotsubo cardiomyopathy was suspected because her electrocardiogram was abnormal and the characteristic left ventricular wall motion was apparent. On hospital day 11, echocardiography revealed a thrombus in the apex of the left ventricle. She was transferred to our hospital and heparin treatment was commenced. On follow-up echocardiography, the left ventricular wall motion had normalized but thrombus mobility had increased. Thrombectomy was performed via a transmitral approach with endoscopic assistance. Endoscopy allowed excellent visualization of the intracardiac structure.

A mobile plaque in the ascending and transverse aorta increases the risk of cerebral infarction during treatment of an arch aneurysm. A previous report described an isolation technique for replacing the ascending and transverse aorta with a mobile atheroma by selective hypothermic antegrade cerebral perfusion (Shiiya et al., Ann Thorac Surg 72:1401-1402, 2001). Here, we present an improved isolation technique for more severe conditions, such as shaggy aorta and shaggy brachiocephalic artery, in two patients. First, we anastomosed both axillae arteries with grafts and placed drainage cannulae in the superior and inferior venae cavae prior to filling the cardio-pulmonary bypass system with blood. Next, we cannulated the right common carotid artery and selective cerebral perfusion was started prior to cannulation and perfusion of the left common carotid artery. Systemic perfusion was then initiated through the axillae grafts. Both patients who underwent this procedure recovered without neurologic complications.

Unroofed coronary sinus syndrome (URCS) is a rare congenital cardiac anomaly. Recently, cardiac surgery using a minimally invasive approach has become the preferred treatment, affording better cosmetic results and a more rapid post-operative recovery than the traditional method. We report the case of a 54-year-old male in whom partial URCS was treated via a totally endoscopic repair technique featuring right mini-thoracotomy.

The short-term results of our strategy for posterior leaflet repair appear promising.

Mitral valve plasty has superseded valve replacement as the standard technique for treating degenerative mitral valve prolapse. Quadrangular resection is considered the gold standard for posterior leaflet prolapse. Chordal replacement was first developed to treat the anterior leaflet and subsequently became widely used for the posterior leaflet, after which a new version of posterior leaflet resection was developed that did not involve local annular plication. In the era of the mini-thoracotomy, the premeasured loop technique is simple to adopt and is as durable as quadrangular resection. However, there is controversy surrounding whether resection or chordal replacement is the optimal technique. The resection technique is curative because it removes the main pathologic lesion. The disadvantage of the resection is that it can be complicated and often requires advanced surgical skills. In contrast, chordal replacement is not pathologically curative because it leaves behind a redundant leaflet. However, the long-term results appear to be equivalent in many reports. Functionally, chordal replacement retains greater posterior leaflet motion with a lower trans-mitral pressure gradient than quadrangular resection. Moreover, chordal replacement is simple and yields uniform results. The optimal technique depends on whether the anterior leaflet or posterior leaflet is involved, the Barlow or non-Barlow disease state, and whether a mini-thoracotomy or standard sternotomy approach is used. For mitral valve repair, the most superior and reliable technique for the posterior leaflet is resection using the newer resection technique with a sternotomy approach, which requires a skilled surgeon.

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