A 62-year-old woman, who received implantation of a prosthetic graft for treatment of a descending aortic aneurysm 15 months previously, was admitted with hemoptysis. An aortogram demonstrated communication from the distal anastomosis to S⁶ of the left lung. After removal of the aorta across the distal anastomosis concomitantly with left lower lobectomy, we replaced a short segment of the graft. Culture of the pus obtained from the anastomotic site was positive for MRSA. Postoperatively, although the left pleural cavity was irrigated continuously with 1% popidone iodine solution, massive bleeding from the distal anastomosis appeared again 2 weeks later. This time, to remove the infected graft as much as possible, two extraanatomical bypasses were created between the right axillary and right femoral arteries, and the ascending and abdominal aorta. The closed prosthetic and aortic stumps were covered by a viable omental flap. Four months later, bleeding occurred again at the site of the proximal anastomosis. The last radical surgery was performed extrapleurally through a trapdoor thoractomy made in the left infraclavicular region. There was a 1.5cm long laceration of the aorta just proximal to the oldest graft-aortic anastomosis. The aorta was divided and closed between the left common carotid and subclavian arteries. The left subclavian artery was ligated at its origin. The pleural cavity was continuously irrigated with popidone iodine to clean up the microorganisms. She was discharged from the hospital on the 258 POD and has been doing well since then.

The UBE woven 150cc WYK graft is a non-sealed graft that became available commercially in January 2005, and does not need to be preclotted before implantation. Subjects in this study comprised 50 patients with abdominal aortic aneurysms or common iliac arterial aneurysms, who received prosthetic Y grafts in our institution. Subjects were divided into 2 groups: the U group (n=26), with implantation of the UBE graft, and the I group (n=24) who received implantation of an INTERGARD^TM woven Y graft. Intraoperative bleeding, inflammatory response and duration of postoperative hospitalization were evaluated in each group. Significant differences were noted between C-reactive protein levels, frequency of recurrence of fever and duration of postoperative hospitalization. No differences were noted between intraoperative bleeding and time. The UBE woven 150cc WYK graft, compared with the INTERGARD^TM woven Y graft, required no extra time for implantation and appeared to offer advantages such reduced immunoreaction after surgery. However, follow-up for sufficient late-phase evaluation of the grafts is required.

We report two emergency mitral valve replacements performed successfully on 16-week and 29-week pregnant women for infective endocarditis in the active phase. The first patient was in severe acute heart failure on admission, and the fetus was already dead. Induced abortion was performed uneventfully 6 days after mitral valve replacement. The second patient presented with several episodes of systemic embolization. An echocardiography revealed giant movable vegetation on the mitral valve. The patient had emergency mitral valve replacement just after the Caesarian section. Both the patient and her baby weighting 1, 374g had an uneventful good courses with no complication. We concluded that in emergency operations in pregnancy, saving the mother's life should have priority over all else, but we should find the way to rescue the fetus life if at all possible. Therefore, depending on the situation, we should not hesitate about doing a simultaneous operation, Caesarian section and heart surgery, for that purpose.

Between January 1981 and December 1996, we performed valve replacement in 281 patients using bileaflet prosthetic valves in mitral and/or tricuspid positions. Thrombosed valve were seen in 10 patients (7 in mitral, 3 in tricuspid positions). In 5 patients, coumadin had been stopped for several reasons (pacemaker implantation, melena, drug allergy), but in the other 5 patients, anticoagulation was within the therapeutic range at the time of presentation. For thrombolytic therapy urokinase or tissue plasminogen activator were used. The treatment was successful in 5 patients (4 mitral, 1 tricuspid), and unsuccessful in 5 patients (3 mitral, 2 tricuspid). Three of the 5 unsuccessful patients were treated surgically (3 with re-mitral valve replacement, 1 with thrombectomy). Prompt surgical treatment can be used as the first line of therapy for thrombosed valves. Thrombolytic therapy may be useful in some cases of bileaflet valve thrombosis without critical hemodynamic collapse. Doppler echocardiographic assessment of increasing peak velocity and pressure half time is useful for detecting thrombosed valves.