[Patent foramen ovale presented hypoxemia with cardiac sarcoidosis].

A 53-year-old woman with a double, double, double (DDD) pacemaker due to complete atrioventricular block was admitted to our hospital with a diagnosis of congestive heart failure. At the time of admission, she was in a hypoxic state with cyanosis and clubbed finger. The ultrasonic cardiogram showed a severe degree of tricuspid valve regurgitation and a thin left ventricular septal wall. Transesophageal echocardiography revealed a patent foramen ovale (PFO) with continuous right to left shunt flow. She was diagnosed with cardiac sarcoidosis with hypoxemia caused by PFO. PFO closure and tricuspid valve annuloplasty (DeVega method) were performed. Following surgery, the patient's hypoxemia improved and the cyanosis disappeared. The patient was discharged 37 days after the operation.

[Postoperative right ventricular function after repair of tetralogy of Fallot with respect to the method of right ventricular outflow tract reconstruction].

We evaluated postoperative right ventricular function in the sixty-four consecutive patients with tetralogy of Fallot underwent total correction. The patients were divided to three groups according to the method of right ventricular outflow tract reconstruction: transannular patching (TA group; n = 31); right ventricular outflow patching with preservation of pulmonary valve ring (RV group; n = 12) and transatrial-transpulmonary approach without right ventriculotomy (no-RV group; n = 21). The early results of postoperative cardiac catheterization and echocardiography were compared among the three groups. Degree of pulmonary regurgitation was significantly low in the RV group and no-RV group compared with TA group (p < 0.005). Right ventricular ejection fraction was the highest in the no-RV group (p < 0.002). The repair without right ventriculotomy for tetralogy of Fallot can provide the best results with respect to postoperative right ventricular function.

Life-threatening reperfusion injury in skeletal muscle: a simple technique to control critical hyperkalemia.

A 55-year-old male suffering from acute abdominal aortic occlusion due to iatrogenic aortic dissection was urgently admitted to hospital. An axillo-bifemoral bypass was constructed 6 hours from the onset of dissection. Before and after revascularization, blood samples were repeatedly obtained from a systemic artery and femoral vein. The arterial potassium concentration gradually increased, reaching 7.3 mM/L. Oliguria and arrhythmias occurred, and the left lower limb became rigid 3 hours after reperfusion. The femoral artery and vein were clamped and within 30 minutes, the arterial potassium concentration fell to 4.8 mM/L. The urine output increased. The left lower limb was amputated, and the patient survived. Immediately following revascularization, hyperkalemia may occur. Clamping of the afferent and efferent vessels is recommended as a simple and practical technique to quickly control life-threatening hyperkalemia.

[A case of radical operation for right-sided infective endocarditis due to Pseudomonas aeruginosa concurrent with VSD in the elderly person].

The case is a 60-year-old male. He was seen at this department because of a slight fever of less than 37.5 degrees C from half a year earlier. Echocardiography revealed vegetations under the tricuspid valve and pulmonary valve, and on scintigraphy of the pulmonary blood flow he was diagnosed with multiple pulmonary infarction. Causative bacteria were not identified by blood culture on admission. As the intraoperative findings, vegetations were seen attached to the area from the septal cusp to the anterior cusp in the tricuspid valve. With the pulmonary valve, a part of the valvular cusp was perforated. After closing VSD with a patch, the vegetations attached to the valvular cusps were excised and the tricuspid valve was reconstructed. As for the pulmonary valve, valve replacement was performed because of the destructive degeneration of the valvular cusp. Pseudomonas aeruginosa was detected on culture of the tissue of the valvular cusp resected during operation. Post operative course was uneventful. The patient was discharged on the 21st postoperative day.

["Separate hypothermia" retrograde cerebral perfusion for repair of aortic arch].

We have developed a new technique of retrograde cerebral perfusion. To avoid the disadvantages by deep hypothermia, and to protect the brain for longer time, we perfused from SVC cannula with blood cooled at 10-15 degrees C, at the same time from femoral artery with blood cooled at 20-26 degrees C. From October 1991 to December 1992, 8 patients underwent surgical repair using this method. By this method, the cases of which cerebral perfusion time were 147, 134, 125, 119, 110 minutes, did not have neurological deficits.