We report a case of metastasis to the right ventricle from uterine stromal sarcoma. A 61-year-old woman was admitted to our hospital because of abdominal pain due to gallbladder stones. Preoperative transthoracic echocardiography showed a tumor in the right ventricle and tricuspid regurgitation. The tumor was multilocular and had grown in the right atrium over the tricuspid valve. We performed tumor resection and tricuspid valve plasty. Postoperative transthoracic echocardiography showed the tricuspid regurgitation had resolved.

A 62-year-old woman who had suffered from malignant articular rheumatism since 2000 felt fatigue, exertional dyspnea and edema was admitted in May 2009. Cardiac catheterization demonstrated a dip-and-plateau pattern of the pressure curve of RV. Therefore we diagnosed constrictive pericarditis. She decided to have surgery as soon as possible. As she had also been troubled with constrictive pulmonary damage, chronic renal failure, and was taking an inotropic agent, we concluded that the use of extracorporeal circulation was risky. After median sternotomy, we recognized diastolic insufficiency of the heart due to hypertrophy of the epicardium. Using an ultrasonic scalpel and electrotome, we incised the thickened epicardium with a waffle procedure. The dip-and-plateau disappeared and as a result the cardiac index was improved immediately (1.9 l/min/m²→2.6 l/min/m²). She was discharged on postoperative day 25. In this way waffle procedure for constrictive pericarditis can an effective surgical procedure for a high risk patient.

A 25-year-old woman with a history of atopic dermatitis was admitted to hospital with shortness of breath, high fever, cough, and bloody sputum. Chest X-ray showed a diffuse infiltrative shadow. We diagnosed pneumonia, and antibacterial therapy was started ; however, the treatment was ineffective. Echocardiography showed tricuspid endocarditis, and she was thus transferred to our hospital. We selected medical treatment because the case was complicated with severe lung abscesses and pulmonary failure. As a result of appropriate antibacterial medication for 4 weeks, her symptoms and lung abscesses were improved ; however, tricuspid regurgitation and right heart failure continued to worsen. Therefore, the patient underwent vegetectomy and tricuspid valve plasty. No perioperative pulmonary complication was observed. She continued to receive the same antibacterial treatment after 2 weeks. In preceding antibacterial treatment before surgical treatment, it is effective for tricuspid endocarditis complicated with severe lung abscess.

We studied 90 consecutive cases undergoing open heart surgery with preoperative collection of autologous blood and ultrafiltration during extracorporeal circulation. Among the 58 out of 90 patients (64.4%), open heart surgeries were achieved without homologous blood. We evaluated 13 factors (age, height, weight, body surface area, cardiopulmonary bypass time, aortic cross clamping time, dilutional rate, Hct before predonation, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, term of autologous blood predonation, amount of bleeding during surgery, amount of bleeding after surgery) in connection with open heart surgery without homologous blood. Among these factors, age, body surface area, cardiopulmonary bypass time, aortic cross clamping time, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, amount of bleeding during surgery and amount of bleeding after surgery demonstrated differed significantly between the only autologous blood transfusion group and the homologous blood transfusion group. According to the evaluation by multivariate regression analysis of these factors, the amount of bleeding after surgery was the most contributor to open heart surgery without homologous blood, followed by amount of bleeding during surgery and body surface area. We concluded that open heart surgery without homologous blood may be achieved in more patients by understanding these factors. Autologous blood predonation by the “leapfrog” method, control of the dilution rate by ultrafiltration during extracorporeal circulation and fresh autologous blood transfusion after extracorporeal circulation were effective to achieve open heart surgery without homologous blood.

A cervical aortic arch is a very rare congenital malformation of aortic arch. A case is reported of a 42-year-old woman with an extensive circular aneurysm of a left-sided cervical aortic arch. The arch aneurysm was successfully removed surgically and replaced with woven Dacron graft. Histologic examination of the aneurysm revealed atherosclerosis and intimal defect.

In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.

A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.

To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α₂ plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.