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A 52-year-old man with reduced left ventricular function (ejection fraction 0.27) due to myocardial infarction, underwent coronary artery bypass grafting (CABG; LITA-LAD, free RITA-4PD) for angina pectoris. He had suffered from recurrent sustained ventricular tachycardia (VT) since 5 hours after CABG. This arrhythmia was resistant to various antiarrhythmic agents such as Lidocaine, Mexiletine, Disopyramide, Procainamide and Propafenone. He required mechanical circulatory supports (intra-aortic balloon pumping and percutaneous cardiopulmonary support) for the maintenance of hemodynamics during repeated VT that required cardioversions of a total of 441 times during 18 days. Following the administration of Amiodarone, the VT was successfully suppressed. However, he had repeated episodes of VT on exercise, thus, he underwent insertion of the implantable cardioverter-defibrillator at the 98 post-operative day, and he was successfully discharged at the 134 post-operative day after CABG. The instrument was verified to be normal in function after the VT induction test.

A 72-year-old woman with solitary plasmacytoma of the right fifth rib was surgically treated. She underwent radical resection of the bony chest wall including the right fifth rib, the ribs above and below the involved rib, the intercostal muscle, and the parietal pleura. Histological finding of the tumor was plasmacytoma of the rib. The type of monoclonal protein was IgG and lamda. She is doing well one year and eleven months after surgery without any signs of recurrence. Solitary plasmacytoma is rare as compared with multiple myeloma. Patients with solitary plasmacytoma originating in the rib have a feasibility of operative indication, and radical treatment is expected to be by adequate surgical resection. Seventeen cases of solitary chest wall plasmacytoma described in the Japanese literature are reviewed.

Aortic valve replacement with a 17 mm Björk-Shiley prosthetic valve, and the closure of left ventricular and right atrial fistulae which were connected with the aortic root were successfully performed in a 10-year-old boy. He was admitted because of high fever and severe heart failure, and diagnosed aortic regurgitation, and left ventricular and right atrial fistulae due to active infective endocarditis. The annular defect was repaired with annular enlargement by a pericardial patch and annulo-right atrial fistula was directly closed from the right atrium. The patient is doing well 1 year after surgery.

A four-year-old boy who had isolated levocardia associated with left atrial isomerism, polysplenia and tetralogy of Fallot underwent successful corrective surgery. In addition, these anomalies were complicated by interrupted inferior vena cava, azygos continuation, and total anomalous hepatic venous connection. Because of these systemic venous anomalies, cardiopulmonary bypass presented us some problems of venous cannulations. We used 4 direct venous cannulations; i.e., superior vena cava, persistent left superior vena cava through coronary sinus, azygos vein and hepatic vein. Reports of total correction in patients with isolated levocardia associated with tetralogy of Fallot are rare, and we report the case with some reviews of the related literature.

This is a report of two patients with extensive destruction of the mitral annulus due to active infective endocarditis. Patient 1 was a 66-year-old female and the patient 2 was a 59-year-old male. In both patients medical therapy had failed to control endocarditis and emergency mitral valve replacements were carried out. At the operation special surgical techniques were necessitated, since insertion of artificial valves in the annulus was impossible because of the lack of the annular tissue due to destruction and excision. On the posterior commissure side, mitral valve prosthesis were sutured to the left atrial wall just above the anatomical mitral ring. Furthermore, in patient 2, a bovine pericardium collar attached to the prosthetic valve was sutured to the left atrial wall to secure fixation of the prosthetic valve. The postoperative courses were uneventful in both patients. This technique seems to be useful in patients with mitral annular destruction.

Surgery were performed by 2 different methods of myocardial protection in 17 patients with postinfarction ventricular septal perforation (VSP) from 1982 to 1989. Ten consecutive operations were performed using hypothermic fibrillatory arrest with pulsatile perfusion (VF group). Pulsatile flow was produced by an intra-aortic balloon pumping device. Other 7 consecutive VSP operations were performed using cardioplegic arrest (CP group). In the VF group, the mean age was 67 years (range 54 to 78 years), and VSP was located in the anterior wall in 7, in the inferior wall in 2, and in the anterior and inferior walls in 1 patients. The operation was performed 2.5 days after the onset of VSP. In the CP group, the mean age was 71 years (range 50 to 78 years), and VSP was located in the anterior wall in 6 and in the inferior wall in 1 patient. The operation was performed 4.7 days after the onset of VSP. Cardiogenic shock developed after septal rupture in 50% of the patients in the VF group and 71% in the CP group (N.S.). Prior to the operation, no significant differences were found in hemodynamic status between the 2 groups. Cardiac index in the VF group was higher than that of the CP group (p less than 0.05) shortly after cardiopulmonary bypass. The operative mortality rate was 10% in the VF group and 57% in the CP group. From these clinical results, hypothermic fibrillatory arrest with pulsatile perfusion can be beneficial as a method of myocardial protection during surgery for VSP and presently this has become the method of choice in our department.

Twelve patients (age 18 to 69 years old) with surgical treatment for congenital bicuspid aortic valve and one (age 26 years old) for quadricuspid aortic valve were reported. These 13 patients occupied 12.3% of the total number of patients with aortic valve replacement during the same period. Among the patients with bicuspid aortic valve, 10 patients were male (83%) and 2 were female (17%). Seven patients exhibited aortic stenosis and 5 showed predominant aortic regurgitation. The mean age of patients with aortic stenosis was higher than that of patients with aortic regurgitation. (63.3 years vs 32.0 years old). Infective endocarditis occurred in 2 patients (17%). Three patients had pure aortic regurgitation without evidence of endocarditis. One 26-year-old female patient who had a quadricuspid aortic valve presented with aortic regurgitation associated with PDA. All patients underwent aortic valve replacement with no early and late deaths.

A surgically corrected case of tetralogy of Fallot with anomalous origin of left pulmonary artery from the ascending aorta is presented. The patient was under-developed 3-year-old girl. She weighed only 1,000 grams at birth and had a systolic heart murmur and slight cyanosis. Echocardiography demonstrated the features of tetralogy of Fallot shortly after birth. Chest roentgenogram showed right ventricular enlargement, but vascular marking of lung was almost normal. Catheterization and cineangiography demonstrated the findings of tetralogy of Fallot. Final diagnosis of anomalous origin of left pulmonary artery from ascending aorta was confirmed by aortography. Surgical correction was accomplished using cardiopulmonary bypass with surface cooling. The left pulmonary artery was detached from the aorta and anastomosed to the main pulmonary artery. Pulmonary valve stenosis and severe infundibular hypertrophy were corrected, and ventricular septal defect was closed with a patch. Postoperative recovery was uneventful. On follow up after surgery, she appears to be in very good condition.

An experimental model was developed to study the fate of prosthetic materials used for the construction of an intra-atrial baffle for the Mustard operation. Total atrial septa were replaced in sixteen puppies with autologous pericardium (n = 3), glutaraldehyde-preserved canine pericardium (n = 4), glutaraldehyde-preserved porcine pericardium (n = 3), EPTFE reinforced sheet (Gore-Tex sheet, n = 3) and EPTFE reinforced cardiovascular patch (Gore-Tex patch, n = 3). Septal replacement was performed under total circulatory arrest and surface induced deep hypothermia. All animals were sacrificed six months after the septal replacement. Pathological examination revealed that all septal grafts were well healed, completely covered by neoendothelium and had contracted to approximately 60% of their original size. There were no significant difference between groups. Histologic examination showed the good tissue adaptation of autologous pericardium and Gore-Tex patch materials. The thinnest layers of neoendothelium covered autologous pericardial baffle. Glutaraldehyde-preserved pericardium and Gore-Tex sheet did not adapt well to host atrial tissue. These materials were easily detached from their neoendothelial substrates. It was concluded that the autologous pericardium as well as a Gore-Tex patch may be superior to other prosthetic materials used for the construction of an intra-atrial baffle for the correction of transposition of the great arteries.

A rare case of complete thoracic aortic occlusion secondary to blunt trauma was reported. The patient was a 27-year-old policeman who was involved in an automobile accident while driving a patrol car. Hypertension of the upper extremities, edema of the upper body and anuria were found at emergency room examination. Emergent aortogram demonstrated traumatic occlusion of the aorta at the level of isthmus. Urgently an axillo-femoral bypass was performed, and two days later radical aortic repair was carried out. At the radical operation, disruption of the aortic intima was encountered in the area of ligamentum arteriosum. The distal torn edge was enfolded and completely occluded the aortic lumen. The lacerated intima was sutured, and the intimal defect of the aorta was restored with woven Dacron patch. Postoperative course was uneventful. On subsequent follow-up 3 years after injury, the patient was asymptomatic showing normal thoracic aortogram.