[Experience of double internal thoracic artery grafts in coronary artery revascularization].

We have started employing two internal thoracic artery grafts in coronary artery revascularization since February 1988. We have carried out seven such operative procedures in a 15 month period since then. Ages ranged from 55 to 67 years with a mean of 60.6. Six patients were male and one patient was female. One patient was in Canadian Cardiovascular Society angina Class I, one in Class II, four in Class III, and one in Class IV, preoperatively. There were no operative deaths. Postoperatively, six patients were in CCS Class I and one was in Class II. All of the internal thoracic artery grafts were patent at hospital discharge in six angiographically examined patients. We feel that use of double internal thoracic artery grafts in coronary revascularization carries minimal additional risk, when performed in selected case.

[A case of mitral stenosis with free floating ball thrombus].

A free floating thrombus in the left atrium is a rare complication of the mitral valvular disease. A 56-year-old woman with mitral stenosis was admitted for cerebral infarction and abdominal pain. A free floating ball thrombus was detected in the left atrium by echocardiography. We performed the emergent open heart surgery for removal of ball thrombus and mitral commissurotomy successfully. The size of thrombus was 4 x 3 x 2 cm. Postoperative course was uneventful.

[A case of infective endocarditis with the mycotic aortic valve aneurysm].

A 49-year old man was admitted with a complaint of syncopal attack. Transient A.V block was detected and permanent pacemaker (DDD) was implanted. Five months later he was re-admitted because of dyspnea and palpitation. Infective endocarditis with aortic regurgitation and mycotic aortic valve aneurysm was diagnosed by echocardiography and cineangiography. The aortic valve and valve aneurysm were resected and AVR was performed using Björk-Shiley disc valve (23A) in the usual manner. But 6 months later he suffered from acute cardiac failure due to perivalvular leakage. He died in spite of re-AVR with translocation method.

[A case report of atypical coarctation of the aortic arch with thoracic aortic aneurysm].

A 30-year-old woman was admitted to our hospital because of the abnormal shadow on chest X ray film and paralysis of right fingers. The preoperative aortogram and DSA showed atypical coarctation of the aortic arch with thoracic aortic aneurysm. We successfully performed extra-anatomical bypass with a 14 mm Cooley low porosity Ducron graft between ascending aorta and discending aorta. Her postoperative course was uneventful and discharged one month after the operation.

The left ventricular eccentricity as a predictor of postoperative cardiac performance in valvular heart diseases.

A clear correlation expressed by the following equation was observed between the preoperative left ventricular end-systolic eccentricity (epsilon s) and the percentage change of the left ventricular dimension (% delta D) in chronic valvular heart diseases: % delta D = 88.37 epsilon s - 48.16 (r = 0.66, p less than 0.001). Therefore, epsilon s may function as an index for predicting the postoperative cardiac performance independent of the affected valvular locations and the morphology of the lesions.