A 26-year-old woman at 40 weeks of gestation attended our emergency department due to sudden onset of chest and back pain, although she had experienced no previous abnormalities. The patient was very tall, had spider fingers and scoliosis, all of which indicated Marfan's syndrome. Enhanced computed tomography and cardiac ultrasonography revealed acute aortic dissection and annulo-aortic ectasia with aortic regurgitation. Thereafter, a baby weighing 3,070g was delivered by emergency Caesarean section and then a Bentall-type operation was performed consecutively. An intraoperative injection of heparin resulted in minimal uterine bleeding. Surgery at the 40th week of gestation was successful for both the mother and the neonate.

We investigated the effects of milrinone administered during cardiopulmonary bypass (CPB) for open heart surgery. Ten patients (group M) received milrinone after aortic declamping during CPB. Ten other patients served as controls with no administration (group C). Soon after the bolus infusion of milrinone, the perfusion pressure dropped significantly in the M group, however, after CPB and at the end of operation, aortic pressure showed no difference between the two groups. There were no differences in heart rate, pulmonary artery pressure and pulmonary capillary wedge pressure. After CPB, cardiac index was high and systemic vascular resistance index was low in the M group. The need for cathecholamine and time for rewarming showed also no significant differences. No adverse reaction was recognized. During CPB, a single administration of milrinone was useful for peri- and post-operative management of patients undergoing open heart surgery.

Objective:We wanted to design an adequate method with which to cryopreserve rat aorta.Methods:Rat aorta were cryopreserved at 0.7℃/min,and kept frozen for 3 months.After being thawed,arteries were examined for contraction and vasodilation.Results:The mean contractions to KCL,PE,ET-1 and the relaxant ratio of SNP were better preserved in Group B than in Group C(P0.05).Conclusion:A modified cryopreservation technique can better preserves endothelial contractile function and endothelium independent vasodilation of the rat aorta than the conventional method,but the endothelium dependent vasodilation is badly preserved after the cryopreservation.

The left IMA graft to the LAD showed a string sign with no antegrade flow in an asymptomatic 67-year-old man 3 years after the operation. The LAD lesion had regressed from 95% stenosis to less than 50% during this period. Exercise electrocardiographic and thallium 201 myocardial scintigraphic examinations revealed no ischemia in the LAD region. When the LAD was temporarily occluded by a PICA balloon, the anterograde flow from the IMA to the LAD could be demonstrated by angiography. The IMA graft in no flow situation has maintained anatomical patency for 3 years after the operation.

A case of coronary subclavian steal following coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA) in the presence of the stenosis of the left subclavian artery (SCA) is reported. The patient was a 70-year-old woman who developed recurrent angina about one year and three months after CABG with an ITA to LAD, and then underwent postoperative coronary arteriography. Angiograms revealed retrograde flow through the ITA to the left SCA and severe stenosis of the origin of the left SCA. Restoration of antegrade flow througn a left ITA graft to the coronary artery was achieved by balloon angioplasty to the stenosis of SCA. This procedure resulted in resolution of symptoms. The coronary subclavian steal is an infrequent, but very important complication after CABG with an ITA, and should be kept in mind in this mode of CABG.

Aortitis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Surgical treatment for obstructive lesions due to aortitis syndrome therefore is difficult in many cases. The patient was a 23-year-old female who at the age of 19 had been diagnosed as aortitis syndrome with cerebral vessel involvement, and she subsequently received steroids. She increasingly experienced syncopal attacks, and was indicated for surgical treatment. Angiography revealed obstruction of the left common carotid and left subclavian arteries, and severe stenosis of the right common carotid and right vertebral arteries. She underwent bilateral ascending aorta-carotid artery bypass operation with 7mm ring-supported EPTFE grafts. After the operation she developed clinical signs of temporary brain damage due to hyperperfusion syndrome, but she now completely recovered and maintains a good clinical condition.

We report a case with successful surgical resection for a leiomyoma with an extension into the right atrium from the pelvic vein. The patient was a 54-year-old woman who presented with syncope in 1989. She had had a history of resection of a uterine leiomyoma 10 years previously. Preoperative angiograms showed a long tumor with an extension into the right atrium through the inferior vena cava originating from the right internal iliac vein. The diagnosis of intravenous leiomyomatosis was made. The operation was performed through a median sterno-laparotomy using cardiopulmonary bypass with successful results. Histologic sections showed a benign leiomyoma. To our knowledge, 20 cases of resection of intravenous leiomyomatosis with the use of extracorporeal circulation have been reported in the literature. This rare condition was discussed with the review of the literature.

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (p=0.0031) and hyperlipidemia (p=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

Using the DDG-2001 pulse dye densitometer, cardiac output (CO) and circulating blood volume (BV) were determined before and after the operation, and its accuracy and the significance of postoperative management were studied. Referring to 14 cases undergoing open heart surgery, CO and BV were determined using the DDG-2001 before application of the cardiopulmonary bypass and immediately, 4h and 12h after the operation. The level of CO was compared with that determined by the thermodilution method, and the level of BV with that calculated from hemoglobin levels determined before and after the cardiopulmonary bypass application and the priming volume in the circuit. Further, body fluid balance after the operation was calculated, and its relation to BV was studied. As to the correlation coefficient and inclination of the regression line, they were 0.77 and 0.849 with CO, and 0.821 and 0.844 with BV, respectively. Upon completion of the operation BV decreased, but increased again 4h and 12h later, although the body fluid balance was negative. CO and BV determined by the pulse dye densitometry favorably correlated with those determined by other methods. Immediately after the operation BV decreased, but then increased in the course of time, although the body fluid balance was negative.