A 70-year-old woman was admitted with precordial pain. Two-dimensional echocardiography revealed a right atrial tumor. CT scan also showed a high density tumor in the right atrium. Right atriography demonstrated a mobile tumor with a stalk arising from the vicinity of the Eustachian valve. On open heart surgery the stalk of the tumor seen to be attached to the Eustachian valve. The tumor was very hard because of massive calcification. Removal of the tumor was accomplished in the standard fashion, excising the Eustachian valve together with surrounding endocardium to prevent recurrence. The weight of the tumor was 20g and the size was 6×3×2cm. Histologic examination of the tumor revealed myxoma. Thirty five cases of right atrial myxoma have been reported in Japan. There was only one previous report which reported a case originating from an Eustachian valve.

A 40-year-old woman presented with Salmonella enteritidis endocarditis involving the mitral valve. A severe degree of congestive heart failure developed despite appropriate medical and antibiotic treatment, and resulted in urgent surgical intervention in the active phase of the infection. She underwent successful mitral valve replacement with a mechanical valve, followed by additional antibiotic infusion with adequate distribution to the biliary system to prevent late reactivation of the organism. Although antibiotic therapy is fairly effective for patients with Salmonella enteritidis, early rather than procrastinated surgical treatment is recommended to minimize damage to the valve and surrounding structures.

A 74-year-old man undergone mitral valve plasty. After cessation of cardiopulmonary bypass, bleeding persisted from the cardioplegia injection site and dilatation of the ascending aorta with discoloration was observed. The diagnosis of type A aortic dissection extending to the descending aorta was made by transesophageal echocardiogram. Replacement of the ascending aorta was performed under deep hypothermic circulatory arrest. The postoperative course was uneventful. The false lumen of the aortic arch and descending aorta was thrombosed completely on postoperative computed tomography. Intraoperative aortic dissection is a rare but fatal complication of cardiopulmonary bypass. Prompt recognition and appropriate surgical management are of prime importance.

Partial atrio-ventricular canal is usually symptomatic and treated surgically in a childhood. In the literature, only eight cases have been operated on over fifty years of age. We experienced two cases of partial atrio-ventricular canal; one was 63-year-old female and the other was 67-year-old male. The female patient showed rapid increase of the pulmonary pressure during the last three years. The male patient had moderate mitral regurgitation with mild pulmonary hypertention. Although the repair of the mitral valve was successful in the female patient, it was difficult in the male patient because of massive calcification along the edges of the mitral cleft. Blood biochemistry data revealed the liver cirrhosis due to congestion in the male patient. Because of poor tolerance of the viscera in aged patients, it is quite important not to raise the central venous pressure more than 15cmH₂O at the cessation of the cardio-pulmonary bypass. Over-hydration may cause congestive heart failure easily, and take into vicious cycle. Of course early operation is better, these two cases, however, had uneventful course and resumed active life early in their postoperative days. Results of them encouraged us to treat aged patient of partial atrio-ventricular canal surgically.

Surface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO₂ up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO₂ and VO₂ changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O₂/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.

From 1978 through 1992, 103 patients (mean age: 69 years) underwent elective repair of abdominal aortic aneurysm (eAAA) at our institute. One or more postoperative complications occurred in 30 patients (29%), with mortality rate of 1.9%. Factors significantly associated with postoperative complications by univariate analysis included male sex (p=0.0082), operation time (p=0.0006), size of aneurysm (p=0.0045), blood loss during operation (p=0.0037), decreased pulmonary function (p=0.0155), and the number of platelet counts (p=0.0468). Simple linear regression analysis showed that there was a significant correlation among AAA size, operation time and blood loss. Age at operation, however, did not have any influence on morbidity and mortality. Complete survival information was obtained in 96 (follow up rate of 95%) patients, and the influence of preoperative risk factors on late survival was also examined by the Kaplan-Meier method. Factors influencing long-term survival were renal dysfunction and age at time of operation.

Elective resection of abdominal aortic aneurysms is now a safe operation, though mortality related to ruptured abdominal aortic aneurysm (rAAA) remains high. To evaluate factors affecting survival after rAAA, 26 consecutive cases were studied. The operative mortality was 58% (15/26) compared with 1.8% for 110 elective AAA patients. Factors associated with poor prognosis were blood pressure of less than 90mmHg and profound acidosis of the arterial blood on admission, size of the aneurysm, and massive transfusion. The high mortality and morbidity rate for the rAAA patient emphasize the need for early and aggressive treatment of AAA in elective cases at high risk. In a follow-up study, however, the survival rate of rAAA, excluding hospital mortality, was 71% at five years and there was no significant difference in quality of life as compared with those patients who had elective AAA resection during the same time interval.

Clinical evaluation of perioperative IABP use in valvular heart surgery was studied. There were 4 preoperative, 18 intraoperative and 20 postoperative applications of IABP. The indications of IABP were LOS in 19 patients, failed weaning from bypass in 11, life threatening arrhythmia in 11, and congestive heart failure in 1. Sixteen out of 26 patients with successful weaning from IABP support could be discharged. Ten died after removal of IABP. Longer duration of cardiopulmonary bypass and aortic clamp, lower value of cardiac index 24 hours after introduction of IABP support were implicated in unsuccessful IABP support. The causes of death were due to LOS in 8 patients, MOF in 12, GVHD in 2, others in 3. The outcome of IABP for patients with valvular heart surgery was not satisfactory. However, the results of IABP support in valvular surgery will be improved by reducing the incidence of postoperative complications, especially LOS, followed by MOF.

Total aortic arch repair was performed simultaneously with the aortic root replacement using Cabrol's method in a 61-year-old man with recurrent aortic dissection. Two months prior to admission the patient had undergone a separate replacement of the aortic valve and ascending aorta for acute type A dissection with aortic regurgitation due to a bicuspid valve. He developed a suture line disruption caused by recurrent dissection in the aortic root which had been reinforced with GRF glue on the first operation. During the second operative procedure the dilated aortic arch with the remnant false lumen was found to be extensively injured. Therefore total arch replacement was required in addition to aortic root reconstruction preserving the previously placed mechanical valve.