A 15-year-old boy who had been treated for TOF (tetralogy of Fallot) at 3 years of age was admitted with dysphagia due to esophageal stenosis. He also suffered from malrotation of the intestine. The esophageal stenosis was caused by recurrent cyclic vomiting and subsequent esophagitis. Three years earlier, he had received an implantation of a totally implantable central venous access device via the right cephalic vein. Echocardiography revealed a floating mass in his right atrium, which was assumed to be a thrombus at the catheter tip of the central venous access device. We suspected that the cause of atrial thrombus in this case was complicated by the long-term (3 years) use of the venous central port. He was suspected to have a pulmonary embolism. A perfusion lung scan (99mTc-MAA) revealed multiple diminished uptake in both lungs. The thrombus was removed successfully under partial cardiopulmonary bypass. The postoperative course was uneventful.

The internal thoracic artery is a useful conduit for coronary artery bypass grafting (CABG). Recently we have developed a method for increasing blood flow by directly injecting a phosphodiesterase III (PDE III) inhibitor into the left internal thoracic artery (LITA) to inflate the artery and prevent its contraction. In the present study we compared the reactivity of the LITA to three drugs: PDE III inhibitor, papaverine hydrochloride and isosorbide dinitrate (ISDN). Forty-two patients with a mean age of 66.8±11.5 years old who were undergoing primary CABG were enrolled in this study and were randomly separated into one of three groups based on the vasodilating drug administered. Each drug was used in 14 cases. Graft free flow (GFF) and systemic blood pressure were measured before and one minute after drug administration to calculate blood vessel resistance (R). All the drugs significantly increased GFF, and reduced both R and blood pressure. A comparison of the change rate of blood pressure did not differ significantly among the three drug groups. The PDE III inhibitor significantly increased change rates of both GFF and R, compared with the other drugs. These results indicate that PDE III inhibitor is most effective for increasing the blood flow of LITA grafts for CABG.

A 53-year-old woman was admitted because of cardiac failure caused by mitral valve stenosis and regurgitation. She had been treated by an aortic valve replacement with a Björk-Shiley convexo-concave valve (21mm) 22 years previously in our institute. Her clinical symptoms and the histological findings of the lung specimen from the operation led to a diagnosis of Swyer-James syndrome. The diagnosis was confirmed by pulmonary blood flow scintigraphy on the present admission. With her informed consent, we treated her cardiac disease by mitral valve replacement and a second aortic valve replacement was carried out because of the structural brittleness of the Björk-Shiley convexo-concave valve. She was discharged from our institute after the operation without any complications.

Multisite pacing has recently been available as a new treatment for patients with congestive heart failure. This study was intended to evaluate the effects of atrioventricular myocardial pacing on left or biventricular sites. Eleven patients (4 men, 7 women) who had undergone atrioventricular myocardial pacing between January 2000 and April 2002 were selected for this study. They ranged in age from 24 to 74 years (mean age 58.5 years). The diagnosis was dilated cardiomyopathy in 3 patients, ischemic cardiomyopathy in 4, complete atrioventricular heart block in 2, sick sinus syndrome in 1, and atrial fibrillation with bradycardia in 1. The method of pacemaker implantation was atrioventricular myocardial pacing on left or biventricular sites by means of mini-thoracotomy under general anesthesia. A DDD-R pacemaker was used. When biventricular pacing was employed, the ventricular pacing lead was cut, connected with a Y adapter, and implantation was made biventricularly. We analyzed pre- and postoperative hemodynamic states by means of a Swan-Ganz catheter, and clinical course (NYHA class). There was a significant difference between pre- and postoperative clinical course and hemodynamic state. The atrioventricular myocardial pacing on left or biventricular sites was a useful method of improving the clinical course and hemodynamic state. It is concluded that this method is available as a new therapeutic option in patients with congestive heart failure.