Coronary artery bypass grafting (CABG) was performed in 16 patients with impaired left ventricular function due to ischemic heart disease (IHD) and the surgical procedures and cardiac functions before and after operation were studied. Preoperative angiogram showed three vessel disease in all patients. The ejection fraction was less than 40% in all and the mean cardiac index (CI) was 1.97l/min/m². At operation arterial graft was used in 10 patients (Group-AG) and no arterial graft but saphenous vein graft was used in 6 patients (Group-SVG). The average total cardiopulmonary bypass time, aortic cross clamping time and the number of revascularized vessels in both groups showed no significant differences. However, intraaortic balloon pumping was necessitated in one of Group-SVG and the requirement of postoperative catecholamine was in higher ratio in Group-SVG than in Group-AG. Postoperative CI improved to 3.1±0.4l/min/m² and 3.3±0.3 l/min/m² in Group-AG and Group-SVG, respectively. The postoperative New York Heart Association Functional Class improved to Class I or II in all patients and there were no significant differences of the improvement between the groups. Conclusively, it seems that the arterial grafts can be used safely and extensively in CABG for impaired left ventricular function due to IHD.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

Thirty six patients with post-infarction complications underwent operation, and the postoperative and late follow-up results were analyzed. There were post-infarction ventricular septal perforation (VSP) in 9 patients and left ventricular aneurysm formation in 27 patients. The operative indications were poor physical work capacity in 13, cardiogenic shock or severe congestive heart failure in 10, left ventricular thrombus in 7, severe ventricular arrhythmia in 6, and repeated angina in 6. Left ventricular aneurysmectomy was performed in 14 patients and VSP closure was in 8. Coronary arteries were simultaneously bypassed in 14 patients. Three patients were died of sudden postoperative arrhythmia 10 days, 55 days and four years after operation. All survivors except two patients with preoperative massive cerebral infarction or prolonged heart failure were in New York Heart Association Class I or II in their late postoperative periods. However, five patients in whom the significant coronary lesion had not been bypassed or the bypassed grafts had occluded complained of mild angina after operation. Postoperative arrhythmia was one of major factors in the late results and simultaneous coronary artery bypass grafting was important to improve the symptoms in the late postoperative periods.

Surgical results in eight octogenarians who were operated upon for abdominal aortic aneurysms were compared to those of 42 patients under 80 years of age. Seven of eight octogenarians were operated on an emergency basis, and four of them were ruptured aneurysms. The size of the ruptured aneurysms was over 6cm in all cases of both groups. Postoperative complications occurred more frequently and postoperative mortality were significantly higher in octogenarians than in patients under 80. Early surgical intervention is recommended for elderly cases with large abdominal aortic aneurysms.

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.