Intermittent cold blood cardioplegia with retrograde coronary perfusion was demonstrated in 11 CABG cases and the effects of myocardial protections were compared with 11 cases of antegrade perfusion. We evaluated the effects from the assistant perfusion time after aortic declamping, the incidence of occurrence of spontaneous beating, the dose of catecholamin required after CPB, and the changes in myocardial enzyme values. The two groups were similar in age, ejection fractions, and the extent of coronary artery disease. There were no cases of death and no PMI in all 22 cases, and the mean number of grafts and aortic clamping time were similar in the two groups. Concerning the effects of myocardial protections, there were no significant differences in any items in the two groups. We conclude that intermittent cold blood cardioplegia with retrograde coronary perfusion provides the same myocardial protective effects as the antegrade perfusion in CABG cases.

A 56-year-old man with uncontrolled diabetis mellitus was admitted with general fatigue and high fever. Abdominal CT and aortography showed a saccular aneurysm in the left common illiac artery. Salmonella choleraesuis infection was diagnosed on the basis of blood culture. We performed a two-staged operation because of the tight inflammatory adhesions and the abcess formation around the aneurysm. First we performed surgical treatment of the aneurysm and extra-anatomical bypass grafting (F-F crossover bypass). Then the in situ graft replacement was performed, 4 weeks later. After the second surgery, antibiotics were administered for 6 more weeks. The patient remains asymptomatic for 6 months after the record operation.

A 21-year-old man with coronary sinus atrial septal defect (ASD) was treated successfully. This case had been diagnosed as an ASD without a lower margin preoperatively but we confirmed this to be a coronary sinus ASD intraoperatively, and this case was classified as partially unroofed coronary sinus without PLSVC. The diagnosis of coronary sinus ASD before operation is sometimes difficult. Therefore we should pay attention to the location of the defect and the dilated coronary sinus in echocardiography, and the course of the cardiac catheter entering into the left atrium, for a correct diagnosis. In this case, the defect was located in the vicinity of the ostium of a large coronary sinus, therefore we could close the defect between the CS and the LA using a heart-shaped patch without any damage to the AV node.

A 52-year-old man with annulo-aortic ectasia and DeBakey's type IIIb dissecting aortic aneurysm was successfully treated. Aortography showed moderate to severe aortic regurgitation and enlargement of the ascending aorta, and CT showed a huge type IIIb dissecting aortic aneurysm. We scheduled a two-staged operation because dissection occurred 6 months previously and ECG showed severe LVH and ST-T change. The aortic root replacement using Bentall's procedure was performed, which was followed by arch replacement with an elephant trunk prosthesis on distal aorta. The entry in the distal aortic arch was covered by an elephant trunk prosthesis and postoperative diagnostic images showed thrombo-occlusion of the false lumen in the descending aorta. This operation was safe and might be a useful method for annulo-aortic ectasia with type IIIb dissecting aortic aneurysm.

A 51-year-old female inserted a needle through the chest wall in a suicide attempt. Chest roentgenogram showed the needle located in the cardiac shadow and chest CT showed the needle penetrating into the ventricular wall. We removed the needle through median sternotomy. The needle had penetrated the right ventricular myocardium 2mm from the LAD. The tip of the needle reached the diaphragm and the surface of the diaphragm had been injured by the needle. The needle was removed without any difficulty and she was discharged 14 days after the operation.