Nine patients underwent surgical repair of ventricular septal defect (VSP) following acute myocardial infarction in our hospital during the past 5 years. Sites of perforation were apex ventricular septum (A-VSP) in five, high anterior ventricular septum (H-VSP) in one and posterior ventricular septum (P-VSP) in three. A-VSPs were closed by single patch on the left ventricular side of the septum. H-VSP was closed by double patch and ventriculotomy was closed directly. For P-VSPs, three different operative procedures were performed. Patch closure of VSP and reconstruction of free ventricular wall was done in one, while in other two VSP was closed by single patch on the left or right side of the septum. There were two operative deaths, one A-VSP and one P-VSP. We think that patch closure through right ventriculotomy is useful in cases of small P-VSP.

When performing surgery of the thoracic aorta, several supporting methods must be easily available to facilitate various grafting procedures which are selected as the most suitable method for each case. We report on a practical cardiopulmonary bypass (CPB) circuit which can be used in the surgical treatment of any thoracic aortic disease: aortic dissection, true aneurysm involving the aortic arch, descending aortic aneurysm or thoraco-abdominal aortic aneurysm. The circuit design is based on a percutaneous cardiopulmonary support system. We added some modifications to the system for managing CPB simply. The improved bypass circuit was applied in operations on 26 patients and yielded excellent clinical results. The advantages of the circuit are listed as follows: 1) If massive bleeding occurs during closed-circuit CPB, the blood can be sucked into a built-in hard shell reservoir on the venous side of the bypass, and can immediately be returned back into the bypass circuit. 2) Using clamping forceps it is possible to easily switch between closed-circuit CPB and conventional CPB using gravitational venous return. 3) Selective cerebral or other organ perfusion can be done by a built-in roller pump distal to the oxygenator. The perfusion line using the roller pump diverges from the main line using the centrifugal pump kept in a spinning state. If the hypothermic method is used, the lower body is perfused via a femoral arterial cannulation by the centrifugal pump, and the upper body by the roller pump with right subclavian arterial cannulation. When the cardiac rhythm changes to ventricular fibrillation in cooling the patient, the flow ratio of the lower body to the upper body must be 1:1, since retrograde perfusion from the femoral artery may cause cerebral infarction due to embolism of dislodged debris or thrombi from the aneurysm.

There were 10 patients of left ventricular free wall rupture accompanied with acute myocardial infarction in our coronary care unit from Jan. 1987 to Jan. 1991, while 872 AMI patients in the same period. Five of 10 ruptured patients died. All these 5 patients were acute type of rupture. Elder patient, female, 1st attack of infarction and PTCA were considered to be risk factors of rupture. We managed 5 subacute and chronic type ruptured patients successfully at emergent operation with using fibringlue-oxycellulose. Fibringlue-oxycellulose method was useful especially for woozing from infarcted myocardium. The management for acute type rupture is difficult because of its clinical time course, it is considered that prevention of rupture for high risk patient is most important to reduce the mortality of AMI patients in the coronary care unit.