[Surgical treatment of the patients with pulmonary atresia, ventricular septal defect associated with major aorto-pulmonary collateral arteries--a report of two cases].

Two patients undergoing corrective operation for pulmonary atresia with ventricular septal defect associated with major aortopulmonary collateral arteries (MAPCAs) were reported. Both patients underwent staged surgical repair, first stage: unifocalization, and second stage: Rastelli type operation. Case 1 was a 13-year-old female who had a confluent central pulmonary artery and 1 MAPCA, unifocalized at 10 years of age. After the corrective operation, the ratio between peak right ventricular and peak left ventricular pressure (pRV/LV) was 0.5 and she followed a satisfactory post-operative course. Case 2 was a 11-year-old female who had a severe hypoplastic central pulmonary artery (3 mm in diameter) and 3 MAPCAs, and she underwent unifocalization twice. After the corrective operation, pRV/LV was 0.65 and her postoperative course was also satisfactory.

[A case of open heart surgery associated with liver cirrhosis and pancytopenia].

A 58-year-old female was diagnosed as mitral regurgitation and tricuspid regurgitation, combined with liver cirrhosis (T. Bil 2.3 mg/dl, ICG-R 37%) and pancytopenia (Hb 9.4 g/dl, WBC 3,000, Plt 56,000). She underwent mitral and tricuspid annular plications. After extracorporeal circulation, the postoperative platelet count was maintained higher than preoperative one by transfusion of platelet-rich plasma. Administration of FOY was begun during operation. Levels of T. Bil. and BUN were highest at 15th postoperative day and decreased gradually. Postoperative pleural effusion was treated by administration of 25% albumin solution keeping the level of Alb. up 3.5 mg/dl.

[Reoperation cases long after Rastelli operation: right ventricular outflow tract reconstruction by means of a xenograft non-valved patch].

Two cases who underwent the new procedure of treatment for extracardiac conduit stenosis after Rastelli operation are reported. They had undergone Rastelli operation 11 and 12 years ago. Because of stenotic Hancock valve of the conduit, they were reoperated. A longitudinal incision was made anteriorly over the conduit and the conduit was dissected free. The sides and posterior half of the conduit bed were preserved. The roof of the new right ventricular outflow tract was formed using a xenograft pericardium patch. Their postoperative courses were smooth.

[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.

[Long-term survival with Hufnagel ball valve--a case report].

Authors report a 61-year-old female with an aortic aneurysm at the distal end of the Hufnagel ball valve which was implanted surgically for the treatment of aortic insufficiency 23 years previously. The Hufnagel ball valve has been working well for the past 23 years, but the aneurysm was found enlarging in size, therefore the replacement of aneurysm with a 20 mm dacron graft was performed following removal of the well-working Hufnagel ball valve. There were 151 cases with Hufnagel ball valve implantation in the literature and at least 7 cases of them were reported in Japan. Among them, the majority survived only several years after surgery and the cases with long-term survival were very few in number. Our case is unique, because the valve in this case has worked well for 23 years.

[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.