Intra-aortic-aneurysmal thrombi sometimes cause severe complications, such as distal arterial thromboembolism and consumption coaguropathy, significantly affecting the prognosis. Such thrombi can be easily detected by CT-scan, Ultrasound and MRI, but these imaging techniques cannot indicate thombotic activity. The radioactivity of ¹¹¹In labeled platelet scintigraphy (platelet scintigraphy) can reflect thrombotic activity. We performed platelet scintigraphy in 13 true aortic aneurysms (TA), 17 dissecting aortic aneurysms (DA) and 11 postoperative cases of dissecting aortic aneurysms (PO) and the results were compared with the values of fibrino-petide-A (FPA) and FDP-E in blood. In cases of the TA, the result of platelet scintigraphy showed the radioactivity of abdominal aortic aneurysms (AAA) is stronger than that of thoracic aortic aneurysms (TAA). In the cases of DA, the group of thrombotic dissection showed no RI deposit. Acute cases showed strong RI deposit with gradual reduction. Two cases of PO, in which anti-coagulant therapy had been performed showed no RI deposit. Concerning the results of FPA and FDP-E, the values for AAA were higher than those of TAA, and in cases of DA, acute cases showed a high value, with gradual reduction, while two PO cases with anti-coagulant therapy showed low values. No significant correlation was found between the value of FPA and FDP-E. On the other hand, the values of FPA and FDP-E significantly correlated to radioactivity of platelet scintigraphy. The higher was the value of FPA and FDP-E, the stronger was the radioactivity. The values of FPA and FDP-E of the strong radioactivity group were significantly higher than these of the weak radioactivity group. Platelet scintigraphy and measurement the value of FPA and FDP-E are effective to estimate intra-aortic-aneurysmal thrombotic activity, and useful to anticipate complications and evaluate prognosis.

Isolated cleft of the anterior mitral leaflet in the presence of an intact atrioventricular septum is a rare cause of mitral regurgitation. We report a surgical case with cleft of the anterior mitral leaflet and abnormality of papillary muscles. A 53-year-old man was admitted to our hospital because of congestive heart failure. Echocardiography showed severe mitral regurgitation, severe tricuspid regurgitation, abnormal direct connection of the anterolateral papillary muscle and the anterior mitral leaflet and adhesion of the base of papillary muscles. At the posterior portion of the anterior leaflet, a 1-cm cleft was found during surgery. The top of the anterolateral papillary muscle adhered to the anterior leaflet, but rheumatic changes were not noted. The cleft was sutured directly, and annuloplasty was performed with a 31-mm Duran flexible ring. Tricuspid annuloplasty was also performed with the DeVega method. His postoperative course was not eventful. Mitral regurgitation caused by mitral cleft associated with abnormal connection of papillary muscles and the mitral leaflet have not been previously reported.

We describe an unusual case of a chronic pulmonary thromboembolism with right atrial thrombus. A 56-year-old man suffering from chronic pulmonary thromboembolism for 5 years complained of increasing dyspnea. Computed tomography revealed massive emboli in bilateral pulmonary arteries and a thrombus in the right atrium. Massive tricuspid regurgitation and atrial fibrillation were also recognized. We performed pulmonary thromboendarterectomy using a Jamieson rigid long miniature sucker with a rounded tip and our original flexible sucker under deep hypothermic circulatory arrest. Right atrial thrombectomy, tricuspid annuloplasty and a Maze procedure were also performed during the cooling, recirculating, and warming period. His postoperative cause was uneventful, and he was able to return to an ordinary lifestyle without acquiring oxygen inhalation. Tricuspid annuloplasty and Maze operation during pulmonary thromboendarterectomy contributed to the maintenance of stable homodynamics during and after surgery.

Postoperative quantitative evaluation of left internal thoracic artery (LITA) grafts is usually performed by angiography, scintigraphy and Doppler flowire. However it is difficult to observe the characteristics of the intima of the LITA graft. The purpose of this study was to evaluate the characteristics and quantity of plaque of intima of LITA grafts in 6 cases after coronary artery bypass surgery using an intra-vascular ultrasound device (IVUS). There was no stenosis or calcification of LITA grafts on angiography. However we found atherosclerotic plaque in all LITA grafts by IVUS. Characteristics of plaque were eccentric in all cases, and soft, hard and mixed plaque were found. The average minimal lumen diameter of LITA grafts was 2.6±0.2mm. The average lumen area of LITA grafts was 5.4±0.7mm². The rate of plaque area was 37.1±5.9%. The eccentric arteriosclerotic plaques were seen in all cases, contradicting the established theory that LITA do not form arteriosclerosis easily. We suggest that IVUS is an effective follow-up device for evaluating the morphological findings and quantitative evaluation of LITA graft in a timely manner.

Twenty-nine patients with bronchial asthma received spa therapy at Okayama University Medical School, Misasa Branch Hospital. Twenty out of 29 cases were steroid-dependent intractable asthma.
Spa therapy was markedly effective in 8 cases (27.6%), moderately effective in 14 cases (48.3%), slightly effective in 5 cases (17.2%) and not effective in 2 cases out of 29 cases.
Spa therapy was more effective in the cases with age over 40 years than in the cases under 40 years. Non-atopic type asthma was more successfully treated with spa therapy compared to atopic type asthma. Regarding pathophysiological classification, spa therapy was greatly effective in the cases with bronchiolar obstruction and with hypersecretion.

Adequate exposure is crucial for successful mitral valve surgery. We report simple techniques for optimizing mitral valve exposure via conventional left atriotomy. The right side of the pericardium is sutured to the chest wall after medial sternotomy and pericardiotomy. We mobilize both the superior and inferior vena cava by dissecting the pericardium on their right side. Tourniquets are placed around both venae cavae and hitched up to the left after bicaval cannulation. Then the right side of the left atrium is lifted up and exposed. A longitudinal incision of the left atrium allows excellent exposure of the mitral valve using a single retractor. We adopted these procedures for 38 consecutive patients for mitral valve plasty, and additional incisions were not required. Simple mitral plasty procedure in 18 cases required 212±32 min for operation, 120±22 min for extracorporeal circulation and 88±18 min for aortic cross clamp. We conclude that this method is simple and does not lengthen the procedure.

Massive thrombi are sometimes present in aortic aneurysms, which cause severe complication such as distal arterial thromboembolism, and greatly influence the prognosis. Such thrombi can be easily detected by CT scan and ultrasound. However these imaging techniques can only demonstrate the presence of thrombi, and are not able to indicate these activity. We performed ¹¹¹In-labeled-platelet scintigraphy (platelet scinti.) in 27 cases of aortic aneurysms (13 true aneurysms and 14 dissecting aneurysms) and 13 postoperative cases of dissecting aneurysms, and compared the findings of CT scan. In some cases, the findings of platelet scinti. were markedly different from the findings CT scan. And our results suggested that the radioisotope deposit revealed by platelet scinti. was reflected thrombotic activity. In one case of dissecting aneurysm, marked RI deposit was revealed by platelet scinti., and subsequently the false lumen was occluded. One postoperative case of dissecting aneurysm showed marked RI deposit and, distal arterial thromboembolism developed. ¹¹¹In-labeled-platelet scintigraphy is thought to be useful to estimate thrombotic activity in aortic aneurysm, and to predict complications and the prognosis.

An internal felt-reinforced patch-plasty was performed in 11 patients with dissecting aortic aneurysm (DeBakey type I: 4 cases, type II: 1 case, type III: 5 cases, aortic arch dissection: 1 case). The aortic cross-clamp time was 84±19 min on the average. The initial tear of the aortic intima was closed on 10 patients. Minor leakage through a felt inserted in the false lumen was observed in one patient of type I. There was no operation-related death except one patient of type III who died from arrythmia encountered following termination of centrifugal pump bypass. Thrombotic occlusion of the false lumen developed in the ascending aorta in type I and II cases, and in the desceding aorta in type III one month after operation. The false lumen localized in the aortic arch was completely occluded by thromi. Postoperative course was excellent in all patients after 16 months on the average. Internal felt-reinforced patch-plasty is a simple and reliable procedure for closing the intial tear of dissecting aortic aneurysms.