Leuprorelin was not effective in this small long-term treatment trial in SBMA. The possibility that earlier treatment might be beneficial may deserve further study.

Although some patients with fulminant myocarditis can be rescued owing to the improvements in mechanical circulatory support therapy, there are few reports providing evidence of cardiac rehabilitation during mechanical circulatory supports, particularly among pediatric patients. We treated two pediatric patients who underwent aggressive cardiac rehabilitation during mechanical support. Five days after the initiation of extracorporeal membrane oxygenation therapy aggressive cardiac rehabilitation was started in a 10-year-old girl with fulminant myocarditis. After explantation of the device, she was discharged on postoperative day 23. A 6-year-old girl with fulminant myocarditis started receiving cardiac rehabilitation two days after the initiation of an extracorporeal left ventricular assist device, despite having hemiplegia due to a recent broad stroke. She achieved an exercise capacity of supported walking for 280 meters after 127 days of cardiac rehabilitation and then went abroad to undergo heart transplantation when she was in the best physical condition possible. Early initiation of cardiac rehabilitation may be safe and effective for successful pediatric mechanical circulatory support therapy; this acts as a bridge to explantation or heart transplantation.

SummaryAdvanced heart failure (HF) is sometimes complicated with brain impairment because of a microthrombosis caused by decreased left ventricular contraction or reduced brain circulation. Some patients may recover after left ventricular assist device (LVAD) implantation. However, little is known about the perioperative therapeutic strategy in patients suffering from such complications, particularly from a cardiac rehabilitation viewpoint. We report on a 58-year-old male patient with a previous history of poliomyelitis and a light paralysis in the left upper extremity, who suffered left hemiplegia with no evidence of stroke after hemodynamic deterioration. The combination therapy of perioperative cardiac rehabilitation and LVAD therapy improved his left hemiplegia as well as activities of daily living, and the patient was discharged on foot on postoperative day 72 after briefing the family on LVAD home management. Early initiation of cardiac rehabilitation before LVAD implantation may be a key for the smooth discharge and resocialization of patients suffering from brain impairment complicated with advanced HF. (Int Heart J 2016; 57: 766-768) Key words: Cardiomyopathy, Stage D, Mechanical circulatory support A s one of the end-organ dysfunctions, the complication of cognitive dysfunction is sometimes seen in patients with advanced heart failure (HF) because of a microembolism caused by decreased left ventricular contraction or reduced brain circulation.1-5) Improvement of such brain impairment is strongly expected after left ventricular assist device (LVAD) implantation because resocialization is encouraged in such LVAD patients. 6) However, little is known about the perioperative therapeutic strategy for brain impairment, particularly from the viewpoint of cardiac rehabilitation.Here we report a patient who suffered left hemiplegia after hemodynamic deterioration despite no evidence of stroke and received early cardiac rehabilitation before LVAD implantation. Case ReportPatient presentation: A 58-year-old male patient (height 173 cm, weight 64 kg) with stage D HF due to dilated cardiomyopathy was admitted to our hospital to consider a heart transplant (HTx) listing and LVAD treatment. His HF had progressed gradually, and he had experienced repeated admissions because of a recurrence of HF despite guideline-directed medical therapy along with implantable cardioversion therapy.7) On admission, his New York Heart Association class was IV, and his plasma B-type natriuretic peptide level was 630 pg/mL. Transthoracic echocardiography showed that the left ventricular diastolic diameter was 74 mm, the left ventricular ejection fraction was 18%, and there was severe mitral regurgitation and moderate tricuspid regurgitation. After hospitalization, cardiac low output syndrome progressed despite continuous intravenous inotrope infusion. He eventually underwent LVAD implantation (HeartMate II, Thoratec, Pleasanton, CA) on day 33, 9 days after preoperative intra-aortic balloon pumping (IABP) support. After the initiation ...

A female neonate with a complex form of epigastric heteropagus and with three legs was referred to us. The left leg appeared normal, the central one was hypoplastic and resected 1 month after birth, and the right one projected in the cranial direction with knee flexion contracture. Three bones of the parasite were sandwiched between the right ilium and the ischiopubic bones of the autosite. At the age of 4, we performed the subtrochanteric femoral osteotomy with 90 degrees of varization and rotation, along with knee disarticulation. Ambulation was successfully achieved with the prosthesis with a multiaxis knee unit.

A survey of the factors that cause the handling mistakes of implantable ventricular assist devices-What should be done for reducing patient's mistakes in the handling of implantable ventricular assist devices?-Koichi Kashiwa 1) ，Hideo Kurosawa 1) ，Mai Takahashi 1) ，Sayaka Koga 1) ，Haruka Asakura 1) ，Yugo Nagae 1) Katsushi Tanita 1) ，Hitoshi Kubo 1) ，Yukie Kagami 2) ，Mariko Nemoto 2) ，Miyoko Endo 2) ，Rie Amao 3) Osamu Kinoshita 4) ，Mitsutoshi Kimura 4) ，Kan Nawata 4, 5) ，Susumu Nakajima 1) ，Minoru Ono 4