We report a rare case of primary cardiac undifferentiated pleomorphic sarcoma with invasion to the posterior mediastinum, for which partial resection of the tumor in the left atrium had already been carried out twice. After remission for about three years, recurrence in the atrial wall involving the mitral valve posterior leaflet required a third surgical resection following mitral valve replacement.

Eight patients with multiple aortic aneurysms of both the thoracic and abdominal aortae treated surgically from 1991 to 1995 were evaluated clinically. The patients consisted of six men and two women, with an average age of 65.6 years ranging from 50 to 73. The incidence of multiple aortic aneurysms was about 10% of all cases of aortic aneurysms. The entire aorta should be examined in all patients with aortic aneurysms. Among the five patients who underwent a two-staged operation, the thoracic operation preceded the abdominal one in one case, and the abdominal operation preceded the other in four cases. No aneurysm rupture occurred in the two-staged cases. In conclusion we should first replace the aneurysm with the higher risk of rupture. However, when such a judgement is difficult, it is improtant to consider the possibility of a rupture of the second aneurysm or a brain infarction caused by a thrombosis moving from the abdominal aneurysm. The order of operation should be decided according to the location and the size of the thoracic aneurysm.

A 42-year-old female suffered annulo-aortic ectasia (AAE) and mitral regurgitation associated with Marfan's syndrome was successfully treated by a modified Bentall procedure combined with mitral valve replacement (MVR) under continuous warm blood cardioplegia (CWBC). With the patient under total cardiopulmonary bypass and myocardial protection with CWBC, MVR with 27 mm mechanical valve was first done, followed by the total replacement of the aortic root with a composite graft made of vascular graft and an aortic mechanical valve. Anastomosis of the composite graft to the aortic valve annulus was made to guarantee a watertight closure using numerous interrupted mattress sutures and three pieces of Teflon felt strips to the annulus. Both coronary arteries were reconstructed by means of the “Interposition Graft Method” which interposes two short grafts between the composite graft and both coronary ostia. In spite of long time aortic cross clamp (235 min), cardiac function was recovered excellenthy and a peak CK-MB value was very low (23 IU/L) in the early postoperative period. Thus, CWBC provided a satisfactory myocardial protective effect. It was suggested that the modified Bentall procedure combined with MVR using CWBC was an effective therapy for a patient with AAE and mitral regurgitation associated with Marfan's syndrome.

A 50-year-old man was admitted to our hospital due to chest pain. He had a history of chronic pancreatitis associated with a pancreatic pseudocyst. Coronary angiography revealed stenotic lesions in left main trunk and right coronary artery coronary artery bypass grafting (RITA-LAD, LITA-OM, SVG-#4PD) were performed. The postoperative course was uneventful without any complications, and he was discharged on the 9th day after surgery. A week later, fatigue and dyspnea appeared. Echocardiography showed a large mount of pericardial fluid and echo-guided pericardiocentesis was performed. One week after the procedure the pericardial fluid reaccumulated. Pericardial drainage resulted in continuous drainage of pericardial fluid. A 7 French plastic stent was placed in the pancreatic pseudocyst, which decompressed the pancreatic pseudocyst, which led to the disappearance of pericardial effusion accumulation. The possible relation between a recurrent pericardial fluid accumulation and a pancreatic pseudocyst was suspected.