A 60 year-old female underwent mitral valve replacement with a Duromedics valve. She was in good condition during weaning from cardiopulumonary bypass. However, rupture of the left ventricle was manifested by massive bleeding just after dis-contination of cardiopulmonary bypass. A large hematoma accompanied by bleeding was observed in the posterior atrio-ventricular groove. The patient was quickly put back on total cardiopulmonary bypass. A slight laceration was suspected in the membranous portion of the ventricular septum just below the mitral annulus. Re-valve replacement was performed by reinforcing the mitral annulus with a Dacron patch. This patient was removed from cardiopulmonary bypass, but died of multiple organ failure in 7 days after operation. At autopsy, the left ventricular rapture was identified just below annuls in the area of the atrioventricular groove. Furthermore, extensive hematoma was noted in the posterior atrioventricular groove.

Myxoma of the left ventricle is exceedingly rare and to the best of our knowledge not a single case of its recurrence has been reported in Japan. We have recently experienced a case in which a myxomatous tumor of the left ventricle recurred at the same site as the primary lesion 2.5 years after operation and was treated by surgical excision. The patient was a 28-year-old female who, under the diagnosis of myxoma of the left ventricle, underwent surgical removal of the tumor and mitral valve replacement at her age of 25 years. Although her postoperative course was uneventful, she was noticed, at her age of 28 years, of her inaudible prosthetic valve clicks on auscultation at the outpatient service. Echocardiography revealed a tumor mass in the left ventricle, which tended to grow with the elapse of time. Echocardiography on rehospitalization disclosed a mobile cystic tumor on the posterior wall of the left ventricle, while pulmonary arteriography also revealed a movable tumor in the left ventricle. Intraoperatively, there was noted a solid tumor, composed partly of cystic structure, on the posterior wall of the left ventricle and quick pathology led to a suspected diagnosis of myxoma. Since the tumor was found to have involved the ventricular septum and myocardial tissue of the posterior wall of the left ventricle, its complete surgical excision was impossible. The tumor, with its growth pattern and morphology, was diagnosed as a malignant clinical behavior one, although histopathological evidence indicates its benignancy.

The current technique of retrograde coronary sinus perfusion (RCSP) has been provided double cannulation of the vanae cavae and isolation of these vessels, and right atriotomy. Most aortic valve and coronary artery bypass surgery are performed with single venous cannulation. We used a new RCSP catheter, Retroplegia (Research Medical Co.), and performed Cabrol procedure safely with single venous cannulation. This catheter can be cannulated to the coronary sinus through a right atrial purse-string suture without opening the right atrium. The occlusion balloon is inflated spontaneously by infusing the cardioplegic solution and occlude the coronary sinus adequately and nicely. This catheter has double lumen, one is for infusion of the cardioplegic solution, the other is for measurement of the coronary sinus pressure. We believe that this catheter is useful for RCSP of the cardiac surgery using single venous cannulation.