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Objectives: We aimed to assess the injury rate and characteristics in Japanese male professional ice hockey players. Methods: This study involved an inclusive cohort of male ice hockey players from a Japanese professional team competing in the 2010-2011 through the 2019-2020 seasons. An injury was defined as the 'time-loss and medical attention' definition of the International Ice Hockey Federation. All injuries that occurred during games and practice sessions were recorded daily on injury charts by the team athletic trainers and/or physician. Game-related injury rates were analysed using both the athlete-at-risk (AAR) and time on ice (TOI) methods. Results: Sixty players were included in the study. A total of 479 injuries were recorded, with 307 (64%) occurring during 451 games and 172 (36%) occurring during the practice sessions. The game-related injury rates obtained using the AAR and TOI methods were not statistically different (p>0.05): 115.3 (95% CI 107.1 to 123.1) and 116.8 (95% CI 109.9 to 124.7) per 1000 player-game hours, respectively. Most injuries involved the upper extremities (39.9% game-related, 32.6% practice-related), followed by the lower extremities (23.5% game-related, 32.5% practice-related). The most frequent mechanism of game-related injury was body checking (45.4%). Conclusion: We observed a higher injury rate in a Japanese male professional team compared with rates reported in other leagues. The reported injury characteristics should help to improve injury prevention strategies that should target shoulder dislocations caused by body checking, and finger or wrist fractures resulting from contact with a hockey stick or puck impact.

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We herein report a case in which we encountered complications when placing an Impella CP ventricular assist device (catheter-based ventricular assist device) in a patient with a Perceval bioprosthetic valve (sutureless valve). Specifically, the catheter-based ventricular assist device became anchored to the sutureless valve and needed to be removed under cardiopulmonary bypass. (Level of Difficulty: Advanced.).

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A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful.

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OBJECTIVES: To investigate the early and mid-term results of aortic root remodelling with external ring annuloplasty in acute type A aortic dissection. METHODS: From January 2015 to April 2019, a total of 194 patients underwent emergency or urgent operation for acute type A aortic dissection in our hospital. Of these, outcomes in 18 patients who underwent valve-sparing aortic root remodelling with external ring annuloplasty were retrospectively evaluated. RESULTS: The mean age of the 18 patients was 49 ± 14 years. Fourteen patients (78%) were men. Five patients had Marfan syndrome and 2 patients had bicuspid aortic valve. Two patients had coronary malperfusion and 1 patient had cerebral malperfusion. All 18 patients underwent aortic root remodelling with external ring annuloplasty. Cusp repair using central cusp plication was required in 9 patients. Concomitant procedures were hemiarch replacement in 8 patients, total arch replacement in 7 patients, partial arch replacement in 1 patient and coronary artery bypass grafting to the right coronary artery in 3 patients. Thirty-day mortality rate was 5.6% (1 of 18). Postoperative echocardiography showed aortic regurgitation of <1+ in all patients. During follow-up (mean 56 ± 41 months), 1 case of recurrent aortic regurgitation required aortic valve replacement. CONCLUSIONS: Aortic root remodelling with external ring annuloplasty may be an appropriate treatment in middle-aged or younger patients presenting with acute type A aortic dissection.

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With the use of the superior transseptal approach during mitral valve surgery, good exposure of the mitral valve can be achieved with simple traction sutures, which minimize the risk of deformation of the mitral valve. For this reason, we routinely perform mitral valvoplasty using the superior transseptal approach; however, we, occasionally encounter cases that develop postoperative atrial dysrhythmia. We have therefore, devised a very simple technique for preservation of the sinus node artery in the superior transseptal approach, which is effective for reducing the incidence of postoperative sinus node dysfunction. In this technique, during incision of the dome of the left atrium, the sinus node artery is carefully dissected and preserved.

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The patient was a 77-year-old man with sudden-onset chest and back pain. Computed tomography angiography (CTA) from the abdomen to the proximal thigh showed an aortic aneurysmal dissection (AAD) and a left deep femoral artery (DFA) aneurysm. The AAD was conservatively managed as there was no sign of increase. The left DFA aneurysm was surgically resected to avoid complications such as rupture, thromboembolism, and limb ischemia. On follow-up CTA obtained 3 weeks later, a spontaneous AVF in a varicose vein of the right DFA was noted. There were no symptoms associated with the AVF, and he was conservatively managed. However, the varicose vein gradually increased, and he underwent successful transarterial catheter embolization (TAE) with metal coils without any complications. After vascular repair of the aneurysm and the AVF of the right DFA, there was no sign of recurrence.

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BACKGROUND: This study was a long-term Doppler echocardiographic assessment of mitral valve repair for anterior mitral leaflet prolapse using expanded polytetrafluoroethylene sutures. METHODS: Between April 1992 and December 2003, we performed mitral valve repair using expanded polytetrafluoroethylene sutures in 204 patients (mean age, 54.6 years) with severe mitral regurgitation (MR) having anterior mitral leaflet prolapse. The cause of valve disease was degenerative in 181 patients (88.7%). Postoperative serial transthoracic echocardiographic studies were performed in all hospital survivors. Residual MR flow detected by color Doppler echocardiography was classified according to the maximum regurgitant jet area. RESULTS: The 30-day mortality of 204 patients was 1.4% (3 deaths). There were 12 late deaths and 14 reoperations in this series. Kaplan-Meier survival and freedom from reoperation at 12 years were 84.6% +/- 4.0% and 89.9% +/- 2.9%, respectively. Postoperative transthoracic echocardiographic assessment after discharge (mean follow-up, 4.2 +/- 3.0 years) showed less than mild regurgitation (maximum regurgitant jet area < 4.0 cm2) in 80.9% of the patients. Overall, freedom from severe MR (maximum regurgitant jet area > or = 7.0 cm2) estimates at 12 years were 88.1% +/- 3.1%. Freedom from severe MR at 12 years for 114 patients with no MR (maximum regurgitant jet area = 0 cm2) on intraoperative transesophageal echocardiography and 77 patients with MR was 95.3% +/- 2.1% and 82.9% +/- 5.1%, respectively (p = 0.033). CONCLUSIONS: Twelve-year echocardiographic follow-up demonstrates good long-term results of chordal replacement with expanded polytetrafluoroethylene sutures for anterior mitral leaflet prolapse. To avoid recurrence of regurgitation, a significantly high level of competence of the valve is essential in the repair of anterior mitral leaflet prolapse.

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BACKGROUND AND AIMS OF THE STUDY: Hemolysis after mitral valve repair is a rare occurrence, but is one of the complications leading to reoperation. Since 1999, mitral valve repair at the authors' institution has been performed using a prosthetic annuloplasty ring covered with autologous pericardium to prevent this complication. The study aims were to investigate the mechanism of hemolysis after mitral valve repair and to describe the surgical management of this complication. METHODS: This retrospective study comprised 204 consecutive patients who underwent mitral valve repair using an annuloplasty ring between October 1991 and April 2000 at the authors' institution. Patients were allocated to the non-covered ring group (n = 174) and the covered ring group (n = 30), and compared for the degree of mitral regurgitation (MR), serum levels of lactate dehydrogenase (LDH), and occurrence of hemolysis. The degree and flow pattern of MR, and patient prognoses were described for hemolytic patients. RESULTS: Postoperative MR and serum LDH were not significantly high in either group. A total of seven patients presented with hemolysis; postoperative echocardiography revealed MR to be mild in two patients, moderate in three and severe in two. Collision of the regurgitant jet into the artificial ring was evident in all seven patients. A beta-blocker proved effective in treating hemolysis in three patients, mitral re-repair was performed in three, and a prosthetic mitral valve was inserted in one patient. None of the patients in the covered ring group presented with hemolysis. CONCLUSION: The major cause of hemolysis after mitral repair was collision of the regurgitant jet into the artificial ring. The simple technique used herein prevented contact of the regurgitant jet with the rough surface of the ring, and may in turn have prevented hemolysis. In selected patients, hemolysis was improved by beta-blocker administration.

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We treated 93 patients who developed left ventricular free wall rupture after acute myocardial infarction. Medical management including pericardial drainage was performed in 78 patients (84%), but 67 of them died. All 11 surviving patients showed an oozing type rupture. Surgical repair was performed in 15 patients (16%). As a result, 9 patients died and 6 survived. All but 1 of the patients who died presented with a blow-out rupture. Blow-out type rupture occurred in 3 and oozing type rupture in 3 of the surviving patients. One patient with blow-out type rupture underwent implantation of a left ventricular assist device following percutaneous cardiopulmonary support (PCPS), because of low output syndrome after the operation. The device was successfully removed 7 days after implantation. In all of the 3 patients with oozing type rupture, sutureless technique was successfully performed using fibrin-glue or fibrin-glue sheet fixation. After a mean follow-up period of 7 years after operation, 5 of 6 are still alive. To improve the clinical outcome of left ventricular free wall rupture, it is important for surgeons to closely liaise with physicians, to perform surgical repair as soon as possible, and to utilize a circulatory support system after operation. Therefore, we developed a new PCPS system compatible with emergency cardiac surgery and a new left ventricular assist system draining via the left ventricle.

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BACKGROUND: The efficacy of magnesium administration in preventing the occurrence of atrial fibrillation after coronary artery bypass grafting surgery remains controversial. Optimal dose and timing of the administration also await clarification. The purpose of this study was to assess the effect of 3-day postoperative infusion of magnesium on postoperative atrial fibrillation and to find factors that can influence the efficacy of this treatment. METHODS: After institutional review board approval, a retrospective study was conducted reviewing 200 consecutive patients who underwent isolated, initial coronary artery bypass grafting operation. The first 100 patients did not receive the prophylactic treatment, whereas the next 100 patients were treated with magnesium postoperatively. Patients in the magnesium-treated group received 10 mmol (2.47 g) of magnesium sulfate (MgSO4 * 7H2O) infused daily for 3 days after surgery. RESULTS: The incidence of postoperative atrial fibrillation was 35% in the untreated group compared with 16% in the magnesium-treated group (p = 0.002). Multivariate logistic regression analysis revealed that advanced age, decreased left ventricular ejection fraction, and absence of magnesium therapy were independent predictors of postoperative atrial fibrillation. For patients receiving the magnesium therapy, advanced age and decreased ejection fraction were the independent factors that predicted the arrhythmia. CONCLUSIONS: Postoperative 3-day magnesium infusion is effective in reducing the incidence of atrial fibrillation occurring after coronary artery bypass grafting surgery. However, in older patients or in patients with reduced left ventricular function, magnesium treatment alone is insufficient for prophylaxis of postoperative atrial fibrillation.

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A 56-year-old man presented with sustained chest pain. Coronary angiography revealed total occlusion of the distal right coronary artery and left anterior descending branch. Left ventriculography depicted a mobile mass in the right sinus of Valsalva originating from the ostium of the right coronary artery. Transesophageal echocardiography (TEE) showed a mobile mass in the sinus of Valsalva and another mobile mass in the aortic arch. The mass at the right sinus of Valsalva was surgically resected, and histologic examination revealed an organized thrombus. Coagulation study showed protein S deficiency. This is the first case of acute myocardial infarction as a result of multiple coronary embolism caused by thrombosis in the right sinus of Valsalva with a second aortic arch thrombosis, contributed by protein S deficiency.

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Pseudoaneurysm is an unusual complication of coronary artery bypass grafting. Such aneurysms are caused by technical surgical failures, or inflammation of the sternum and mediastinum following sternotomy observed as an early or mid-term complication of cardiac surgery. This case was an 80-year-old man with a piece of artificial rubber pericardium used for complete closure of the pericardium. A large pseudoaneurysm developed in the body of the saphenous vein graft 15 years after surgery. The old rubber synthetic pericardium was severely degenerative, which induced inflammation and disrupted the saphenous vein graft.

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We present a case of an insertion of a left ventricular assist device for severe cardiac failure after the repair of a left ventricular free wall rupture. A 72-year-old man was admitted with chest pain and unconsciousness, and required emergency surgical repair of a left ventricular free wall rupture under percutaneous cardiopulmonary support. Severe cardiac failure occurred postoperatively, and weaning from percutaneous cardiopulmonary support was impossible. We implanted a left ventricular assist device, and this could be removed at one week after implantation. The left ventricular assist device was very useful as a "bridge to recovery".

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