Redo of off-pump coronary artery bypass grafting (CABG) through a left thoracotomy with a patent left internal thoracic artery graft was very effective. A 62-year-old man was admitted because of unstable angina for whom CABG had been performed 6 years earlier (LITA-LAD, Ao-SVG-OM1), the saphenous vein graft soon become occluded. Coronary angiography revealed total occlusion of the right coronary artery (RCA)#1. For vasoconstruction of the left circumflex artery (LCx) and RCA, off-pump coronary artery bypass (OPCAB) was performed through a left thoracotomy. During normal cardiac contraction, a radial artery graft (RAG) was anastomosed sequentially from the descending aorta to the obtuse margin (OM) 1, OM2, RCA#4PL (postero-lateral branch). The postoperative course was uneventful and he was discharged on the 26th post-operative day. In patients with patent grafts, re-median sternotomy has a high risk of injury to already patent grafts and adhesions make the dissection difficult. Alternatively, as in this case, off-pump coronary artery bypass through a left thoracotomy can be very effective. Total arterial vasoconstruction was performed and postoperatively there was no early graft occlusion.

When coronary artery bypass grafting (CABG) is to be done, we use the internal thoracic artery (ITA) as a graft conduit in order to obtain longer patency. When the ITA acts as a good collateral to the lower extremities, blood flow to the extremities may decrease after CABG with ITA. Simultaneous open heart surgery and laparotomy may cause pulmonary complication. We made an algorithm of treatment for patients with coronary artery disease (CAD) and aortoiliac occlusive disease including these problems. From July 1991 to March 1992, 6 patients were operated and reviewed. Four patients were operated on for CAD and AIOD simultaneously. Two patients were operated on for CAD or AIOD at first and for the other secondarily. All 6 cases were discharged without any complications and are now free from angina and intermittent claudication. When the therapeutic plan for the patients with CAD and AIOD is made, it is very important that coronary revascularization is planned at first with careful evaluation of the blood flow to the lower extremities in cases with AIOD.

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.