An 85 year-old woman underwent mitral valve replacement with Carpentier-Edwards PERIMOUNT (CEP) at the age of 72 because of rheumatic mitral stenosis. Thirteen years after its implantation, prosthetic valve dysfunction developed increasingly severe aortic valve stenosis and she underwent double valve replacement. Prolapse was found in one leaflet of the explanted CEP valve, while neither visible calcification nor tear was detected.

From October, 1960, to December, 1976, a total of 167 patients with the tetralogy of Fallot (TOF) underwent corrective repair under simple deep hypothermia at Iwate Medical University. In 59 out of 167 patients the address or telephone number were identified. Fifty-four patients, consisting of 25 males and 29 females, were investigated by written questionnaire or telephone interview. They were followed for 20-35 years. The mean (±SD) age at operation was 5.3± 4.2 years old (range 6 months to 19 years). Reoperations were successfully performed on two patients with residual shunts. Among these, 43 patients (80%) were in NYHA class I, and 11 patients (20%) were class II. None of the patients were in class III or IV. Medication was not prescribed except in one patient. Twenty-eight patients (52%) married and gave birth to 34 children, none of whom had congenital heart disease. A total of 51 (94%) patients were employed, or were housewives. In conclusion, most patients were considered to have a good quality of life long after repair of TOF under simple deep hypothermia.

We experienced 2 cases of accessory mitral valve tissue (AMVT). Case 1 : A 56-year-old man was admitted with aortic regurgitation. Transthoracic and transesophageal echocardiography revealed AMVT with no left ventricular outflow tract obstruction. The patient underwent a successful aortic valvuloplasty. AMVT was carefully excised, because we suspected AMVT might be the cause of recurrent aortic regurgitation and left ventricular outflow tract obstruction with aging. Case 2 : A 63-year-old woman was admitted with mitral regurgitation due to infective endocarditis. During medical treatment, transthoracic and transesophageal echocardiography revealed membranous structure in the left atrium uneffected by antibiotics. Mitral valvuloplasty and resection of membranous structure was performed. The membranous structure was not vegetation and had no relationship to mitral regurgitation. Pathological examination proved AMVT. To our knowledge, this is the first report of AMVT in left atrium in an adult.

Two cases who underwent emergency operation for papillary muscle rupture complicating acute myocardial infarction were presented. The first case was a 75-year-old female who had suffered myocardial infarction 26 days previously. Operation was performed on the 2nd day after onset of mitral insufficiency. The posterior papillary muscle was partially ruptured and the mitral valve was replaced with a mechanical prosthesis (SJM 25mm). The second case was a 76-year-old female who had suffered myocardial infarction 10 days previously. Emergency operation was performed on the 4th day after onset of mitral insufficiency. The posterior papillary muscle was completely ruptured. Mitral valve replacement with a mechanical prosthesis (Omnicarbon 25mm) was performed. In both cases, recovery from cardiogenic shock was not possible preoperatively even with pharmacologic and circulatory support, but the postoperative courses were uneventful in both cases. We recommend immediate surgical intervention for mitral insufficiency in patients with severe grade regurgitation and cardiogenic shock following acute myocardial infarction.