An 80-year-old woman underwent lower and middle lobe resections of right lung in 1990 and 1998 because of lung cancers. There was no recurrence. In 2009, she presented with exertional dyspnea, and echocardiography showed grade III mitral regurgitation (MR). We diagnosed with congestive heart failure caused by MR. Her chest CT showed her mediastinum was shifted to the right and her heart was in the right thoracic cavity. We performed mitral valve plasty via right 7th intercostal thoracotomy. Post-operative respiratory condition was stable and she was extubated on the first postoperative day. Post-operative UCG showed trivial MR. She was discharged on the 14th day.

The valvular function after aortic valve replacement was examined using Doppler echocardiography and changes in serum lactate dehydrogenase (LDH) and free hemoglobin levels were assessed. Data for the ATS Medical open pivot prosthetic valve were compared with those of the St. Jude's Medical prosthetic (SJM) valve, a similar bileaflet valve. These have been used in the past 5 years. There were 23 patients with ATS valves (13 men and 10 women, with a mean age of 60.4±13.8 years) and 16 patients with SJM valves (10 men and 6 women, with a mean age of 61.4±8.7 years). The left ventricular diastolic diameter index (LVDdI), left ventricular systolic diameter index (LVDsI), % fractional shortening (%FS) and left ventricular mass index (LVMI) were determined by echocardiography. The peak pressure gradients of the aortic prosthetic valves were calculated by a simplified Bernoulli equation. Postoperative LVDdI, LVDsI and LVMI were not significantly different in the ATS group and the SJM group. However, the %FS of the ATS group was significantly higher than that of the SJM group with aortic stenosis. The pressure gradients at the aortic prosthetic valve position were not significantly different between ATS and SJM valve in the 19-mm, 21-mm and 23-mm size. Postoperative improvement or recovery of the serum LDH level was observed significantly more frequently in the ATS group than the SJM group (p<0.005). The free hemoglobin level of the ATS group was also lower than that of the SJM group (p<0.005). We demonstrated satisfactory valvular function of the ATS valve compared with the SJM valve. Postoperative improvement of hemolysis was observed significantly more frequently and more rapidly in the ATS valves.

A 77-year-old woman was given general anesthesia for an ascending aortic aneurysm operation and went into anaphylactic shock. The operation was canceled. Vecuronium, pancuronium, protamine and famotidine revealed positive prick test reactions. Ascending aortic replacement underwent under minimum dose of heparin for cardiopulmonary bypass (CPB). Heparin was injected immediately before CPB (2.5mg/kg) and nafamostat mesilate was injected continuously during CPB (2mg/kg/h). The ACT value was over 1, 400sec during CPB. However, protamine was not used after CPB. The operation time was 4h and 30min. CPB time was 1h and 26min. After the patient returned to the ICU, bleeding from the chest drainage tubes increased temporarily. The bleeding decreased gradually after administration of FFP and MAP.

Primary cardiac angiosarcoma is very rare and its prognosis was reported to be very poor (average survival period 7 months). A 46-year-old woman with angiosarcoma was admitted for recurrent symptoms of cardiac tamponade. Surgical excision of the tumor was performed 5 months after initial presentation and irradiation therapy was added. Thereafter, immunotherapy, and transcatheter arterial embolization were performed for liver metastasis. Despite this multidisciplinary therapy, she passed away 355 days after surgery. In our report, we described our multidisciplinary approach to this highly malignant tumor and the treatment strategy was discussed.

Essential thrombocythemia (ET) is an uncommon type of myeloproliferative disorder, characterized by both thrombotic and hemorrhagic diatheses. No clear guidelines exist for the pre- or post-operative management of patients with ET undergoing cardiac surgery. Here, we present a rare case of a patient with essential thrombocythemia and severe aortic stenosis, who needed an aortic valve replacement on cardiopulmonary bypass and who suffered no complications.

PA-LA communication is a rare congenital heart disease consisting of direct communication between a branch of the PA and LA through an aneurysmal structure. This disease reveals the central cyanosis with clubbed fingers and surgical repair is needed when symptoms are apparent. Computed tomography is highly recommended for definitive diagnosis. Angiographic catheterization is also recommended to support the diagnosis and decide on the treatment. PA-LA communication is categorized into 4 types. Two types do not need cardiopulmonary bypass (CPB) when treated surgically, but the others need CPB. A 16-year-old girl with clubbed fingers was found to have PA-LA communication by 3DCT. She underwent surgery and was discharged in good condition. The surgical procedure was done through median sternotomy without CPB. The anomalous aneurysmal fistula was doubly ligated. No communication was found after ligation by TEE.

A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.