A 54-year-old man developed cardiogenic shock after acute myocardial infarction. Urgent coronary angiogram revealed complete occlusion at proximal portion of the right coronary artery and severe stenosis at just proximal site of the left anterior descending branch. Following thrombolytic therapy was not successful and he was sent to the operating room for coronary artery bypass surgery under external cardiac massage after 6hr from the onset. Three aorto-coronary bypasses were made to left anterior descending branch, first diagonal branch and right coronary artery using saphenous vein grafts by aortic cross-clamping of 67min. He fell into severe low cardiac output syndrome and could not be weaned from the cardiopulmonary bypass even by catecholamine infusions and IABP support. Veno-arterial bypass consisted of centrifugal pump and membranous artificial oxygenator was instituted. Venous blood was drained from the right atrium using percutaneous cannula via the right femoral vein and oxygenated blood was returned to the right subclavian artery. Hemodynamics recovered dramatically and after 71hr of this assisted circulation he was weaned from veno-arterial bypass. Activated coagulation time was maintained within 180-200sec. During this period, the centrifugal pump and oxygenator was not necessary to change and no clot was seen in the bypass system. He discharged from our hospital after 2 mo, postoperatively and now he is doing well as NYHA class-II 8 mo. postoperatively.

A 37-year-old female was admitted to our hospital because of haemoptysis. She had undergone descending thoracic aorta-abdominal aorta bypass grafting 11 years previously. Then the diagnosis was atypical coarctation due to aortitis syndrome. No follow up had been continued. Angiogram and CTscan disclosed a false aneurysm at the anastomotic site of the descending thoracic aorta, which was ruptured into the left lung. An emergency operation was performed. A new extra-anatomical ascending aorta abdominal aorta bypass was constructed using 16mm Dacron prosthesis, and three permanent clamps were employed for thromboexclusion of the descending aorta, previous bypass graft and the ruptured aneurysm. At present, three years after the operation, she is leading normal life with medication of hypotensive drugs. Pathogenesis, surgical approach and long-term postoperative care were discussed.