From the surgical stand point of view we have classified 129 patients with aortic dissections, of which anatomic variations were clearly identified. In addition to the DeBakey's nomenclature, we newly employed two groups, aortic arch type and abdominal aortic type. Futhermore, each type was divided into subgroups. This report provides practical and suitable operative approaches according to anatomic variations of the aortic dissecting aneurysms. 1. Twenty-one patients had type I dissections. Thirteen of 21 (62%) were combined with aortic valve regurgitations. 2. Ten patients had type II dissections. Eight of 10 (80%) showed aortic valve regurgitation. This type was further divided into three subgroups. 3. Eighty patients had type III dissections, consisting of 18 type III a and 62 type III b dissections. The type III a dissection included all the cases in which dissections did not involve major branches of the abdominal aorta. Retrograde dissections to the proximal ascending aorta were found in eight patients out of 80 (10%). 4. Twelve patients had aortic arch type dissections. This group was divided into two subgroups, according to the extent of the aortic dissection. 5. Six patients had abdominal aortic type dissections. This group was also subdivided into two. 6. On the basis of the types of dissections outlined above, the most suitable radical operative procedure was selectively proposed in each case.

Two hundred fourteen cases treated surgically for aortic aneurysms between Jan. 1986 and Dec. 1991 at our hospital. Among them, 15 cases (7.0%) had multiple aortic aneurysms. In 10 cases, aneurysms were resected completely: 9 simultaneously (one-stage operation) and 1 separately (two-stage operation), although in 5 cases there remained another aneurysm left even after operation. In all cases who had one-stage operation, the combination of sites of aneurysms were descending thoracic aorta and infra-renal abdominal aorta. Temporary bypass (n=4), centrifugal pump (n=4) or cardiopulmonary bypass (n=1) were employed as supportive methods during aortic cross-clamp. There were neither operative nor late death in one-stage operation group, although one patient died due to rupture residual aneurysm 1.2 years after the first operation. In these patients, vascular disease are expected to be present systemically, so that operative method should be determined carefully under consideration of poor general condition and another risk factors. We recommend, however, that simultaneous one-stage operation for multiple aortic aneurysm might be safe and fully acceptable procedure, especially in case of those whose aneurysms exist in descending thoracic and infra-renal abdominal aorta.

　　This study investigated data on cardiopulmonary exercise testing (CPX) indices in order to estimate exercise intensity and ramp load from maximum walking speed (MWS) in elderly hospitalized patients with acute coronary syndrome (ACS). Subjects were 66 male patients hospitalized with ACS (49 young-old patients and 17 old-old patients). We measured exercise intensity by CPX using a cycle ergometer and MWS over 10 m, and examined the patients’ clinical characteristics. Stepwise multiple regression analysis was performed to identify variables that most closely predicted exercise intensity. We then estimated the ramp load from the relationship between exercise load at anaerobic threshold and MWS. The results indicated that MWS was an independent predictor of exercise intensity in old-old patients (adjusted R²=0.278, p=0.037) but not in young-old patients. The regression formula predicted the proper ramp load to be 5 and 10 watts as MWS was less than 1.5m/s or more than 1.5m/s, respectively. MWS was related to exercise intensity and could be used to consider the ramp load in CPX in old-old male patients with ACS.

Purpose: To compare the effects of aging in patients with acute myocardial infarction (AMI) on their clinical background and hospitalization progress, and to examine the relationships between age and these factors.
Subject: One hundred and fifty-three patients who experienced cardiac rehabilitation after percutaneous coronary intervention (PCI) (63.8±11.1 y.o, 126 men, 27 women).
Method: The patients were divided into the middle aged group (<65 y.o, n=84), young old group (65 to 74 y.o, n=44), and old group (75 y.o≥ n=25). The differences between groups were examined in respect of 13 items about clinical backgrounds (responsibility coronary arteries, CKmax, LVEF, residual stenosis, hypertension, diabetes, hyperlipemia, smoking, and BMI) and hospitalization progress (cardiac complications, locomotorium disabilities, abnormality as 200mECG, and duration of hospitalization).
Results: Left veticular ejection fraction (LVEF) was significantly lower in the old group than in the young old group. The old group had a high rate of residual stenosis. In the coronary risk factors, all of the groups had hypertension at a high rate of 54.5% or over. The middle aged group and young old group had diabetes at about 38%. The middle aged group was prone to hyperlipemia, and had significantly a high smoking rate. Body mass index (BMI) was significantly higher in the middle aged group than in the old group. In hospitalization progress, the old group had a high rate of cardiac complications and locomotorium disability. The duration of hospitalization was significantly longer in the old group than in the other groups.
Conclusion: It would be necessary to give middle-aged persons educational guidance for the improvement of the coronary risk factors, and to provide the old persons with the suitable rehabilitation programs considering various complications.