Blow-out type free wall rupture is a severe complication after acute myocardial infarction and its prognosis is poor. A 68-year-old man was admitted to our hospital for extensive anterior acute myocardial infarction with cardiogenic shock. Echocardiogram and CT strongly indicated the presence of intrapericardial fluid, and we had to perform an emergency operation. Before median sternotomy, we cannulated the femoral artery and vein, and cardiopulmonary bypass was started. We resected the ruptured and necrotic left ventricular myocardium and employed the feltstrip sandwich method. Postoperative recovery of cardiac function and consciousness was satisfactory and he was discharged from hospital on the 37th postoperative day. PCPS or femoro-femoral bypass and consecutive surgical therapy can be a useful method for the treatment of left ventricular free wall blow-out rupture.

A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.