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A 30 year old male developed sudden chest pain while driving his car and was subsequently admitted to our hospital. Cardiac catheterization and arteriography revealed multiple embolism in the right coronary artery, the right renal artery and the both popliteal arteries. Thrombus was also suspected in the left atrium by echocardiography. Emergent surgery was performed to prevent recurrence of embolism, IA type cor triatriatum (according to the Lucus-Schmidt classification) and 3 x 1 cm thrombus in the accessory chamber was found. The thrombus was extracted and the abnormal septum was satisfactorily resected. The postoperative course was favourable and the patient returned to the community after discharge. Cases of cor triatriatum complicated by multiple arterial embolism are very rare and have not been reported in Japan yet. For this reason we present this case with additional discussion from literature.

A 20 year-old man was admitted to our hospital suffering from fever and cough due to bronchiectasis. He had been injured in automobile accident 18 years before. The subsequent bronchography revealed a marked stricture of the right intermediate bronchus with post-stenotic bronchiectasis. Right middle and lower lobectomy was performed. Postoperatively, pneumonia improved, and pulmonary function was preserved. There is no agreement on criteria indicating the need for bronchial reconstruction in cases like this, because evaluation is difficult whether inflammatory changes in the lobes intending to the reimplant may be reversible. In our case, we considered that recurrent pneumonia and bronchiectatic changes of the right lower lobe were contra-indications to bronchial reconstruction.

Left ventricular fistulas arising from the left coronary artery are rare, and only 3 cases have been reported Japan. Surgical closure of a left coronary artery-left ventricular fistula in a 14-year old male was reported. The fistula was identified by coronary arteriography after the patient had been admitted to hospital complaining of recurrent chest pain. Ligation of the fistula involving the left anterior descending coronary artery was performed with cardiopulmonary bypass, chemical arrest and hypothermia. The blood flow through the LAD decreased from 370 ml/min to 100 ml/min after the fistula was ligated, and there was uneventful postoperative recovery. Furthermore chest pain of the patient was shown to diminish and movement of the left ventricular septum was improved, compared with the preoperative cineangiography. However, trivial residual flow fo the circumflex coronary artery to the left ventricle remained on postoperative coronary arteriography. The principal aim of the procedure for surgical correction should be effective closure of the fistula without compromising the distal blood supply of the coronary artery involved, cardiopulmonary bypass is considered necessary to appropriate closure of the fistula.