A regular check-up in a 69-year-old man showed normal blood chemistry values, except for elevated value of liver enzymes and inflammatory reactions. A computed tomography scan (CT) of the abdomen revealed a normal appearance of the liver, pancreas and spleen, but incidentally showed a tumor in the right atrium. The tumor (a blood cyst which contained white thrombus) was successfully excised. Blood cysts of the heart are extremely rare in adults. These tumors are incidently found at autopsy on cardiac valves in approximately 50% of infants under 2 months of age. The blood cyst in this case arose from the right atrial wall, which is also quite rare.

A 48-year-old man complained of hemoptysis. Chest CT scan showed a large cardiac tumor invading the atrial septum and both atria, as well as multiple small nodules in bilateral lung fields. They were diagnosed as a malignant cardiac tumor and its lung metastases. As the tumor in the left atrium was extremely massive, operation was performed to prevent sudden death due to occlusion and to make a pathological diagnosis. The cardiac tumor invaded the atrial septum from the right atrium and occupied the left atrium. After the cardiac tumor was completely removed, the bilateral atria, the atrial septum, SVC, IVC and the right lower pulmonary vein were reconstructed with prosthetic pericardial patches. The tumor was angiosarcoma. During the postoperative period, Interleukin-2 was used as the treatment for angiosarcoma. Unfortunately the patient died of lung failure on the 107th postoperative day. Though IL-2 could not stop the development of lung metastasis in this case, the effectiveness of radiotherapy or IL-2 for angiosarcoma has recently been reported. In such cases where complete resection of the primary cardiac lesion is possible, postoperative radiotherapy or IL-2 administration seems to be effective for cardiac sarcoma.

Spinal cord injury after successful operation of the thoraco-abdominal aorta is an unpredictable complication which negatively affects the patient's quality of life. The main cause of spinal cord injury has been reported to be peroxidation of lipids. Edaravone, a free radical scavenger, has been used in the acute phase of cerebral infarction to ameliorate the brain damage. The aim of the present study was to evaluate the protective effect of edaravone on the neurological and histological outcome, and to examine the method of its administration so as to obtain the better effect, using animal models with ischemic spinal cord. Three groups of rabbits underwent surgical exposure of the abdominal aorta that was clamped for 20min to achieve spinal cord ischemia. Group A (n=6, control group) was given no medication. In group B (n=6), edaravone (3mg/ml saline/kg body weight) was administered intravenously 30min after reperfusion. In group C (n=6), the same dose of edaravone was administered at 30min, 24h and 48h after reperfusion. Neurological status was clinically assessed, using Tarlov's score, at 24h, 48h and 1week after reperfusion. Somatosensory evoked potential was measured preoperatively, at 20min after ischemia, at 30min after reperfusion, and at 24h, 48h and 1week after operation. Spinal cord sections were examined histologically to determine the degree of neuronal damage given by ischemic-reperfusion. Group A presented paraplegia with marked neuronal necrosis. Groups B and C maintained better neurogical function than Group A (p<0.001), and Group C was much better than Group B (p<0.05). In the model rabbits with 20min of ischemia-reperfusion, systemic repetitious administration of edaravone was found to have a more protective effect than a single administration on the spinal cord neurons and glia cells both neurologically and histologically.

Edaravone is an agent developed as a free radical scavenger, and is useful in functional recovery of the brain after cerebral infarction. However, to the best of our knowledge no experimental studies have been made regarding the effect of edaravone on cerebral protection during aortic arch surgery. We investigated the pharmacological effect of edaravone experimentally, through selective cerebral perfusion under deep hypothermia. Twelve adult dogs (body weight 14.8±2.0 kg) were used, and selective cerebral perfusion was performed under hypothermic circulatory arrest of 20°C for 120 min at 5 mg/kg/min, which was half the usual flow volume of cerebral perfusion. Group E (n=6) received 3 mg/kg edaravone for 30 min at the start of both selective cerebral perfusion and rewarming of the body, while Group C (n=6) received no drugs. Somatosensory evoked potential (SEP) was measured, and so were blood pressure, body temperature, pH level, oxygen partial pressure, and blood flow in the cerebral tissue. Histopathological investigations were also performed. In Group E, complete SEP recovery was observed in all dogs, while in Group C, complete SEP recovery was observed in only 2 dogs (33%) (p=0.014). A statistically significant difference was also observed in cerebral tissue pressure (p=0.014), but not in pH level, oxygen partial pressure, or cerebral tissue blood flow. On histopathological investigation, Group C demonstrated reduced staining of Nissl granules in neurons of the cerebral cortex, and many of them presented the appearance of acute circulatory impairment while Group E demonstrated no reduction in staining of Nissl granules. In the present experimental study of selective cerebral perfusion under deep hypothermia below the safety threshold flow, edaravone was effective in cerebral protection.

A Successful surgical repair of a ruptured ventricular septum concomitant with a left ventricular free wall rupture secondary to myocardial infarction was performed on a 81-year-old woman. Anterior myocardial infarction was accompanied with a ventricular septal rupture, 7mm in size, and hemorrhagic dissection type left ventricular free wall rupture. Acute ventricular aneurysm formation of the left ventricle was also noticed. A review of the literature reveals that in surgical cases, the hemorrhagic dissection type ventricular rupture in left ventricle was usually concomitant with ventricular septal rupture.

The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; n=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; n=35), and those who were 60 years or younger and received rHuEPO (group III; n=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (p<0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (p<0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.

This study was designed to assess the role of macrophages in saphenous vein graft disease after coronary artery bypass grafting (CABG). Three newly harvested saphenous vein grafts (SVGs) and 6 SVGs removed from patients 8 to 15 years after CABG (3 were occluded soon after the operation and 3 became diseased after a long period) were immunostained for macrophages and investigated microscopically. No macrophages were detected in the newly harvested SVGs. In the grafts with early occlusion, macrophages were detected only in the superficial layer of the intima. In the grafts that became diseased after a long period, macrophage accumulation was detected at the site of atherosclerotic lesions. In the pathogenesis of arterial atherosclerotic lesions, vascular endothelial cell damage and subsequent subendothelial migration of monocytes/macrophages in the early phase are thought to be very important. This study revealed that macrophage migration into the intima of SVGs occurs soon after surgery and suggested it could be the basis of saphenous vein graft disease occurring long after CABG.

Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic Fowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.

Ruptured type B acute aortic dissection (AAD) is a life-threatening condition, in which surgical treatment most often yields unsatisfactory results. We report a case of a ruptured type B AAD in a 67-year-old man detected on computed tomography that required a partial aortic arch replacement with reconstruction of the left subclavian artery with adjunct deep hypothermic circulatory arrest (DHCA). Although the patient had a postoperative stroke, he recovered markedly with rehabilitation. DHCA and open proximal anastomosis are useful for the surgical treatment of type B AAD, however, an elaborate strategy to prevent an intraoperative cerebral embolism is especially important.