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In treating aortic root diseases, the Bentall procedure offers reliable and stable results. However, it requires a prosthetic valved conduit, which presents inherent challenges due to the need for anticoagulation. The Ozaki procedure, which uses pericardium for aortic valve neocuspidization, is an alternative to prosthetic valves and does not need anticoagulation. We developed a surgical technique combining the Bentall and Ozaki procedures to treat patients with aortic root disease, which we describe in this article. Because the risk of bleeding due to anticoagulation after prosthetic valve replacement was a concern, we combined the Bentall and Ozaki procedures with a graft conduit using bovine pericardial patch neocuspidization. Postoperative echocardiography showed a competent aortic valve with no regurgitation. We believe that this novel procedure provides hope for a more adaptable and patient-friendly option.

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BACKGROUND: Perigraft seroma is a persistent and sterile fluid confined within a fibrous pseudomembrane surrounding a graft that develops after graft replacement. Development of perigraft seroma is an uncommon complication that occurs after the surgical repair of the thoracic aorta using woven polyester grafts. mechanism underlying perigraft seroma formation remains unclear. CASE PRESENTATION: Herein, we describe the case of 77-year-old man who underwent repeat sternotomy for the treatment of large perigraft seroma 1 year after ascending aorta replacement for acute type A dissection. After removing a cloudy yellow fluid, we covered the prosthetic graft with fibrin glue and wrapped it with a new graft. Bacterial culture and laboratory examination of the fluid confirmed the final diagnosis of perigraft seroma, and there was no evidence of recurrence. The area in which fluid accumulated around the graft shrunk 1 year after surgery. CONCLUSIONS: The cause of a expanding perigraft after repair of the thoracic aorta remains unknown. Physicians should be aware that chronic expanding mediastinal seroma with Dacron grafts is one of the rare postoperative complications of thoracic aortic surgery. Applying fibrin glue to the graft surface might effectively prevent the recurrence of perigraft seroma.

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Mitral annular calcification (MAC) is a common finding, especially among the elderly. Caseous calcification of the mitral annulus (CCMA) is a rare variant of MAC. Calcified amorphous tumor (CAT) is an extremely rare non-neoplastic cardiac tumor accompanied by calcification and is often associated with MAC. We encountered two patients with end-stage renal failure in whom a cardiac CAT developed on the mitral annulus. In both patients, preoperative examination showed MAC of the posterior mitral annulus and a mobile mass attached to the MAC. CAT and CCMA were considered, and surgical resection was performed because of a high risk of systemic embolization. Intraoperatively, the mobile mass was associated with the CCMA. The CCMA with the mass was entirely removed, and the diagnosis of CAT was histologically confirmed. We herein report these two cases of CAT arising from CCMA in patients undergoing hemodialysis and propose the characteristic imaging features and operative findings.

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A 44-year-old man was admitted to our hospital with chest pain. We diagnosed him with pericardial effusion collection because of a spontaneous ruptured coronary aneurysm of 1.5 cm with coronary pulmonary arterial fistula (CPAF) by enhanced computed tomography and angiography. We completely resected the ruptured aneurysm and safely closed the CPAF. Rupture of coronary aneurysms with CPAF is rare, especially tiny aneurysms. In previous reports, most cases were older women and the diameter of the ruptured aneurysms was greater than 3.0 cm. We report a case of a middle-aged man with a tiny ruptured coronary aneurysm with CPAF.

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Papillary muscle rupture is a rare complication after myocardial infarction. Almost all cases occur in the papillary muscle of the mitral valve. The development of tricuspid regurgitation after right ventricular myocardial infarction caused by papillary muscle rupture is extremely rare. We present a 70-year-old man with massive tricuspid regurgitation caused by papillary muscle rupture after percutaneous coronary intervention to the right coronary artery involving a stent. We performed tricuspid valve repair with a reimplanted papillary muscle in situ using neither artificial chordae nor a prosthetic valve. Previous case reports on this surgical repair technique are not available.

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Supramolecular self-assembly and the resulting chiral transfer from the molecular level to the nanoscale is a major topic in modern supramolecular chemistry. We synthesized a galactose-bearing calix[4]arene surfactant (chiral) and mixed it with a primary amine-bearing analogue (achiral). The mixture showed strong induced circular dichroism (ICD) at an almost 3:2 molar ratio of the two surfactants, and exothermic heat was observed upon mixing. The magnitude of ΔH was comparable to that of van der Waals interactions. This phenomenon indicated that the ICD can be ascribed to the formation of a new supramolecular assembly in which the stoichiometric interaction between the two molecules leads to complexation and the resultant complex has chiral morphology. Transmission electron microscopy and small-angle X-ray scattering showed that the galactose-bearing surfactant forms vesicles, and the mixing induces a transition from the vesicles to threadlike cylinders with a diameter of ∼3.0 nm. We presume that these cylinder are twisted because of chiral transfer from the chiral galactose moiety and show ICD.

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We carried out synchrotron X-ray scattering experiments from four DNA supermolecules designed to form tetrapod shapes; these supermolecules had different sequences but identical numbers of total base pairs, and each contained an immunostimulatory CpG motif. We confirmed that the supermolecules did indeed form the expected tetrapod shape. The sample that had the largest radius of gyration (Rg) induced the most cytokine secretion from cultured immune cells. Structural analysis in combination with a rigid tetrapod model and an atomic scale DNA model revealed that the larger Rg can be ascribed to dissociation of the DNA double strands in the central connecting portion of the DNA tetrapod. This finding suggests that the biological activity is related to the ease with which single DNA strands can be formed.

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