Various types of surgical techniques have been reported for the closure of complicated PDA, since Morrow first described an innovatory operative method. At our institute, extracorporeal circulation has been frequently used as a support measure for these operations to ensure the safety of the operation. Ten patients with complicated PDA were operated under extracorporeal circulation. All patients but one were adults. The reason for use of extracorporeal circulation included age, presence of atherosclerosis or calcification of the ductus, short neck ductus, ductal aneurysms, right sided descending aorta and recanalization after previous ligation. The ductus was approached through the left lateral thoracotomy in 8 patients and median sternotomy in 2. The Morrow procedure was performed in 2 patients. No hospital death occurred, although the mean duration of the hospital stay after the operation was longer in these cases than in cases with simple PDA. We conclude that the use of extracorporeal circulation is safe and effective for the closure of complicated PDA.

A 60-year-old woman underwent surgical treatment of postinfarction ventricular septal perforation (VSP) in the early phase after receiving total cardiopulmonary bypass without aortic occlusion. VSP developed four days after anterior myocardial infarction. On admission, inraaortic balloon pumping was used to obtain hemodynamic stabilization. On the day of admission, emergency total cardiopulmonary bypass was performed. VSP was closed with a Dacron felt patch positioned on the left side of the septum. The anterior wall of the left ventricle was closed with Dacron felt strips and reinforced using a Gore-Tex sheet. Postoperative hemodynamics improved significantly. Although the operation while the heart was beating was difficult technically, the total cardiopulmonary bypass time of this method was not longer than that of operations under cardioplegic arrest. Further more, the area of infarction was easily distinguished by color and bleeding. The surgery during normothermic heart beat was effective in preventing further ischemia of the myocardium. The surgical treatment of VSP in the early phase during normothermic heart beat under total cardiopulmonary bypass was considered to be more effective and safer than operations under cardioplegic arrest.

This study was designed to assess the correlation of brain natriuretic peptide (BNP) levels with cardiac function and to determine the usefulness of BNP as a prognostic marker in patients undergoing cardiac valvular surgery. We measured plasma levels of BNP in 53 patients who had undergone aortic valve replacement (AVR) or aortic and mitral valve replacement (DVR) more than 1 year earlier. These cases were divided into the aortic stenosis (AS) group and an aortic regurgitation (AR) group. Fifty-two patients were in NYHA class I, and 43 (82.7%) of them had plasma levels of BNP above the normal range. There were significant correlations between the plasma levels of BNP and ejection fraction (EF) in both the AS and AR groups (r=-0.460, p<0.05; r=-0.529, p<0.01). In the AR group, BNP showed significant correlations with LVMI and LVDd (r=-0.469, p<0.05; r=0.680, p<0.0001), whereas, in the AS group, BNP showed no significant correlation with these factors. The most remarkable finding was the development of heart failure in 3 patients whose plasma levels of BNP were over 80pg/ml, despite remaining in NYHA I during follow-up. We concluded that plasma levels of BNP in a late phase after AVR or DVR can be an excellent biochemical marker for predicting of heart failure and overall prognosis.

A 51-year-old man developed a high fever with congestive heart failure after treatment for his dental caries and was admitted to our hospital. Transesophageal echocardiogram showed severe aortic regurgitation with a bicuspid aortic valve where vegetation and perforation was identified on its leaflets. Infective endocarditis caused by Streptococcus constellatus was diagnosed by blood culture. A computed tomography scan of the chest showed enlargement of his ascending aorta with a maximum diameter of 5.0cm. After treatment with antibiotics and diuretics for 60 days, he underwent surgical treatment for his aortic valve and ascending aorta. After excising the diseased aortic leaflets with vegetation, a mechanical prosthetic valve (Carbomedicus 23mm) was implanted. His ascending aorta was also replaced separately with a woven Dacron tube graft. There was an anomalous origin of the right coronary artery which was detached from the ascending aortic wall as a button and was implanted on the tube graft. Histologically the aortic wall showed disappearance of elastic fibers with myxomatous degeneration in the media. Immunohistochemical staining also revealed that matrix metalloproteinase-2 (MMP-2) was strongly expressed in the aortic media. The postoperative course was uneventful and he was discharged on the 37th postoperative day.

The patient was a 56-year-old male with an 8-year history of Behcet's syndrome, who presented with chest pain. A saccular aneurysm (4×4cm) of the descending aorta was disclosed by X-ray and CT. Impending rupture of the aneurysm was suspected and emergency surgery was performed under cardiopulmonary bypass. The aneurysm consisted of a large thrombus, and a punched-out lesion on the aorta (φ10mm) was found beneath the thrombus. Closure with a Dacron patch was carried out successfully. Pathologic examination revealed the patient to have vasculo-Behcet's syndrome. Generally this desease has a poor prognosis, especially if an aneurysm is present, since sudden rupture can occur. Thus, prompt surgical treatment of the aneurysm should be considered. The patient was free of recurrence at the time of writing this report.