Mediastinal wound infection following sternotomy is a serious post-operative complication. Therefore a median sternotomy must be avoided for the patient having a low cervical terminal tracheostomy. A 64-year-old man, who had undergone a low cervical terminal tracheostomy after total laryngectomy, complained of an anterior chest oppression. His coronary angiography revealed 75% stenosis of the left main coronary ostium. He underwent coronary artery bypass grafting through left thoracotomy. Extracorporeal circulation with femoral cannulation was performed, and the left internal thoracic artery and right saphenous vein were used as grafts under hypothermic fibrillatory arrest without aortic cross-clamping. The left thoracotomy approach is a safe and advantegeous method in selected patients.

A 49-year-old man was admitted to another hospital because of exertional dyspnea. He had run an entire 20-km race 33 days before admission. Echocardiograms, MRI and CT scans, and cineangiograms showed a right ventricular tumor arising from the tricuspid valve, which occupied the area from the right ventricular outflow tract (RVOT) to the pulmonary trunk and extended to the bilateral pulmonary arteries. MRI scans suggested that the tumor had not invaded the normal cardiac structure. The patient was transferred to our hospital for surgery. An operation was performed on the same day, since the tumor could have caused pulmonary embolisms. Under cardiopulmonary bypass, a right atriotomy, pulmonary arteriotomy and incision in the RVOT were made. The tumor had adhered to the chordae of the tricuspid valve, myocardium of the RVOT, and pulmonary valve. It was completely resected macroscopically. The postoperative course was uneventful and the patient was discharged on the 18th postoperative day. The size of the tumor was 2.0×2.0×10.0cm and the histological diagnosis was angiosarcoma. The patient died 4 months after the operation due to brain metastasis and local recurrence. This appeared to be a case of rapidly progressive cardiac angiosarcoma with an unusual noninvasive growth pattern.