A 22-year-old woman without any serious distincted symptoms was found to have hypertension on a health examination. On further examinations, involving echocardiography and chest enhanced CT, showed dilatation of the ascending aorta, aortic coarctation, well-developed intercostal arteries and other collateral arteries. She was only 137 cm tall and weighed 52 kg. Besides, she had not had menstruation for the past two years. Chromosomal studies revealed Turner syndrome. Left lateral thoracotomy was thought to have the risk of heavy bleeding from collateral arteries, therefore we chose ascending-to-descending aorta bypass grafting through median sternotomy. She had an uncomplicated postoperative course. Here we report about operation in a adult case of coarctation of the aorta and discuss the usefulness of extraanatomical bypass grafting.

Ionescu-Shiley pericardial xenografts implanted in the mitral position between April 1980 and October 1984 were studied. In some cases the cusp was torn in a relatively early postoperative phase, thus requiring an emergency operation. Functional disorders, such as caused by the calcification of the cusp, advance at a relatively moderate pace, and the prognosis of a second operation in cases with valve dysfunction and a chronic course was favorable. The actuarial probability of freedom from reoperation was 88.5±8.7% at 5 years and 55.7±14.5% at 10 years. The structural deterioration of the pericardial valve increased about 5 years after replacement. This tendency was the same as in other bioprostheses. At 10 years the overall actuarial survival rate was 67.2±12.1%. Freedom at 10 years from thromboembolism was 84.6±9.8%. For cases whose the course is under observation at present, the strategy is to recommend an additional operation as far as possible, while continuously observing the function of the valve.

We report a successfully treated case of infectious endocarditis with ventricular septal defect (VSD) and double-chambered right ventricle. A 41-year-old man complained of dyspnea. Echocardiography showed his tricuspid valve, aortic valve, and pulmonary valve had vegetation and severe regurgitation. He received treatment with antibiotics but it was not effective. He underwent TVR, AVR, pulmonary valve resection, VSD patch closure and RV abnormal muscle resection. Pathological findings of resected valves showed infectious endocarditis. He recovered uneventfully and resumed his original social activities.

An 83-year-old female was referred to our hospital because of a swelling and pain of the left lower extremity. An endoaneurysmorrhaphy and bypass surgery between the left common iliac artery and the external iliac artery were performed under the diagnosis of deep vein thrombosis associated with a left isolated internal iliac aneurysm. Forty patients with isolated internal iliac aneurysm were reported in Japan and deep vein thrombosis occurred only in our patient. The external growth of the aneurysm behind the external iliac artery might cause compression, congestion and phlebitis of the common iliac vein, resulting in deep vein thrombosis.

We used the Fogarty 2Fr IMAG Kit^® on 14 patients who underwent aorto-coronary bypass grafting. The free flow of the left internal thoracic artery (LITA) after dilatation using Fogarty balloon catheter was 7.4 times greater than before dilatation. There was no statistical differences in catecholamines used postoperatively and postoperative cardiac output in the groups of cases with and without dilatation. String sign was appeared in 4 patients with dilatation of LITA. Fogarty balloon catheter save effective dilatation of LITA in certain selected cases.

A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction (AMI) was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation (VSP) ; therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia (HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager^® and ProduXion Manager^® from the Aries Systems Corporation activated clotting time (ACT) ; thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI ; however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.

We performed coronary artery bypass operation on 258 patients from July 1974 to February 1993, of whom 10 underwent a total of 11 reoperations. These 10 patients were not significantly different from the other patients with respect to gender, coronary risk factors and number of grafts used in the first operation, aside from older age and lower LVEF. The interval between the two operations was <1 year (early) or about 10 years (late) in most instances. The most common reasons for reoperation were graft failure from technical problems in early and time-related alterations in graft and progression of original disease in late cases. The outcome of reoperation was less than satisfactory, with 2 operative deaths, IABP required in 5, reoperation for bleeding needed in 3 and severe sternal wound infection of the patent vein graft postoperatively, of which atheromatous debris released from the atherosclerotic vein graft was strongly suspected to be the cause. The old vein graft should be immediately ligated at the beginning of CPB in cases with diffuse atherosclerotic vein graft in which more than several years have passed since initial operation. In reoperation, arterial graft is preferable, especially GEA graft can be used advantageously even with a left thoracotomy approach. Bypass reoperation for occlusion of LAD or Cx should be performed by a left thoracotomy approach.

The case was a 27-year-old woman with a history of Turner syndrome. The patient underwent ascending-descending aorta bypass for aortic coarctation 6 years previously and underwent subsequent follow-up on an outpatient basis. She consulted our department because of fever, chest pain and headache as the main complaints. Age-indeterminate type A aortic dissection was found on computed tomography, and she was admitted to the hospital on the same day. Echocardiography also revealed an enlarged aortic root and bicuspid aortic valve. Aortic root replacement and total arch replacement were performed, and her postoperative course was favorable. It is reported that in cases of Turner syndrome with aortic coarctation, aortic aneurysm and aortic dissection are likely to occur due to the vulnerability of the aortic wall. We encountered a patient with Turner syndrome who underwent ascending-descending aorta bypass for adult aortic coarctation and subsequently developed type A aortic dissection, underwent aortic root and total arch replacement, and rehabilitated after surgery, as well as provide bibliographic considerations.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years:n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V:n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.