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Recent good results of cardiovascular surgery have led to expansion of its indication to elderly patients and patients with serious complications. Such patients may have serious respiratory complications after cardiac surgery and need to undergo tracheostomy relatively early in the postoperative period. Although the full sternotomy approach is the standard in almost all cardiac surgeries, superficial and deep sternal infections are rather common after early tracheostomy in full sternotomy patients. The lower partial sternotomy approach is a safer and more useful procedure in patients who will need tracheostomy in the early period after cardiac surgery. We report on 2 patients who were successfully tracheostomized within a week after cardiac surgery, with a review of the literature.

Since June, 1998, modified ultrafiltration (MUF) was performed for 92 consecutive children who underwent cardiac surgery using cardiopulmonary bypass, except those with atrial septal defect. Among 92 cases, MUF could not be completed in two cases because of the accident that many air bubbles were found in the arterial line of the CPB circuit. The causes of such trouble were discussed.

Pulmonary stenosis (PS) and regurgitation (PR) are major concerns late after transannular patching for tetralogy of Fallot (TOF). In this study, we reviewed the TOF patients undergoing transannular patching to reveal whether the valvuloplasty technique (two cusp plasty) improved long-term results. We also reviewed potential for grow of the pedicled autopericardial patch.Since 1977, 151 patients underwent corrective surgery for TOF. Transannular patching was required in 58 (38.4%). PS and PR in the postoperative long-term period of these 59 cases were reviewed. 25 patients had the standard transannular patching (S-TAP), and 33 had two-cusp plasty (TCP). Pedicled autologous pericardial patch were used in 9 patients of TCP. Actuarial freedom from PS at 7 years was 70.8 +/- 9.2% in S-TAP and 79.2 +/- 8.3% in TCP, and there was no significant difference. Incidence of severe PR was significantly higher in S-TAP (7/24) than TCP (1/24) (p0.05). Actuarial freedom from PR at 7 year was 69.6 +/- 9.6% in the former and 95.8 +/- 4.2% in the later, respectively. The diameter of the pulmonary arterial annuals was augmented with the somatic growth in 6 patients with the pedicled pericardial patch.Two cusp plasty was more effective to prevent PR in the postoperative long-term period, comparing to S-TAP. As the material of the patch, pedicled autologous pericardium showed satisfactory outcome.

Patients with vascular disease has a high incidence of coexistence of coronary artery disease and patients with coronary artery disease can be associated with aortic or peripheral vascular occulusive lesions. Simultaneous coronary artery bypass grafting (CABG) and surgery for coexistent vascular lesions was performed in 13 patients from October 1991 until September 1995. Average number of graft for CABG was 3.5. For vascular lesions, fomoro-popliteal artery bypass was performed on four patients, aorto-both side iliac artery bypass using bifurcated prosthesis on there, aorto-iliac artery bypass on one, carotid endarterectomy on three and aorto-subclavian artery bypass on two patients. All patients survived without any major complications. There were no late death noted in the longest follow-up period of 42 months. Simultaneous surgical procedures for coronary arterial and other vascular lesions can be performed with acceptable risk and may offer physiological, psychological, social and echonomical advantages to avoid rehospitalization and repeated surgical interventions.

The surgical and postoperative long-term results were assessed in 55 patients undergoing correction of complete atrioventricular septal defects. The patients was divided into two groups according to mode of plasty of the atrioventricular valve: 45 patients in whom the cleft was closed in the earlier series, and 10 with trifoliated mitral valve, leaving the cleft unclosed in the later series. The early death occurred in 13 of 45 patients in the earlier series and none in the later series. During 11 years follow up period, mitral valve regurgitation of grade 3 and 4 was observed in 20% of the patients, respectively, in the earlier series. In contrast, grade 3 mitral regurgitation was detected in only one and no grade 4 regurgitation was present in the later series. Tricuspid valve regurgitation was irrelevant. In the later series, the diameter of the mitral valve was greater than the average value of Rowlatt's standard by 3.4 mm after partisioning the common atrioventricular valve into mitral and tricuspid components, and smaller than the normal by 0.2 mm, though the diameter was within the normal range after valvulo-and annuloplasty. On the other hand, the diameter of the tricuspid valve was also greater than the normal value by 1.7 mm after partisioning, however, that was smaller than the normal by 1.7 mm after valvulo-and annuloplasty, on the average. The diameter was smaller than the normal lower limit by one standard deviation in two patients. There was present neither mitral nor tricuspid stenosis in all on the post-operative hemodynamic study.(ABSTRACT TRUNCATED AT 250 WORDS)