It is known that subaortic stenosis (SAS) occasionally progress after the repair of Co/A. And it may progress if the initial repair is incomplete. We successfully repaired a 6-year-old girl with recurrent SAS with aortic and mitral regurgitations and pulmonary hypertension (Pp/Ps=0.74) progressed after the initial repair for SAS. She had been operated at 4-year-old with transaortic resection of subaortic myocardium and the membrane. He SAS had progressed since the coarctectomy at 7 months of her age. At that procedure, right coronary cusp was lacerated and repaired. In may 1989, Konno operation with 21 St. Jude Medical aortic prosthesis and mitral valve replacement with 25 St. Jude Medical prosthesis were performed. Interventricular septum, aortic root and right ventricular outflow tract were reconstructed employing composite patch with preserved equine pericardium and Dacron velour. So mitral annulus was dilated because of the volume over loading due to aortic regurgitation, that complete repair was not able to do with mitral valvulo and annuloplasty. After the procedure severe cardiac and respiratory failure occurred and continued for over 10 days. And hemolytic anemia with homoglobiuria appeared. It continued for 14 days. In spite of those complications, the girl became well and goes to school with the administration of warfarin and dipyridamole. We recommend that Konno operation could be the first indication for the children with narrow aortic root when incomplete repair was made during the initial repair for subaortic stenosis.

We experienced three cases of triple shunts (VSD+ASD+PDA) for past ten years. All three cases admittied with cardiac failure and respiratory distress early in the infant period. Ligation of PDA, suture closure of ASD and patch closure of VSD were performed in the two cases. Another case was performed ligation of PDA because of low body weight (1, 700g). Triple shunts were correctly diagnosed in only one case. Another two cases were diagnosed VSD and PDA at operative period. The patient with low body weight was lost at 38 days after operation. Post operative course were uneventfull in the two cases of total repair. Triple shunts should be repaired in the same time. But two staged operations are consider to perform in the low body weight infant and patients with major general pediatric surgical disease.

Screening of carotid and intracranial artery diseases by magnetic resonance angiography (MRA) was performed in forty-one adult patients prior to elective cardiovascular surgery. In twenty patients (48.8%), MRA demonstrated significant cerebrovascular lesions: carotid or main cerebral artery stenosis in 7, diffuse cerebral arteriosclerotic change in 6, vertebral artery lesion in 5 and berry aneurysm in 2. Advanced age (over 70 years) and previous cerebrovascular events increased the incidence of cerebrovascular lesions on MRA. Forty patients underwent scheduled surgery under cardiopulmonary bypass, and pulsatile flow perfusion was used in patients in whom significant cerebrovascular lesions were demonstrated on MRA. One patient with aortic arch aneurysm was judged to be an unacceptable candidate for surgery in light of his marked diffuse arteriosclerotic lesions on MRA. In five patients, staged operation was performed from 10 to 30 days after cerebrovascular surgery (bypass surgery for internal carotid occlusion in 2, aneurysm clipping in 2, carotid endarterectomy in 1). Postoperative neurological complications occurred in one patient (2.5%). In conclusion, screening of carotid and intracranial artery diseases by MRA is a safe and useful method for evaluation of cerebrovascular lesions in patients with advanced age, previous cerebrovascular events and/or arteriosclerotic diseases.

Seven children aged 3 to 14 years, underwent cardiac valve replacement with a St. Jude Medical valve prosthesis. In 4, the valve was placed in the aortic position, in 2 in the mitral position and in 1 in the aortic and mitral position. Three patients underwent Konno's procedure. We followed up them from 2.3 to 9.3 years (mean follow-up 6.0 years). There were no operative or hospital deaths. One patient died after delivery by caesarean section 9.3 years after the operation. All patients recieved warfarin and antiplatelet agents for postoperative anticoagulation and no thromboembolic or bleeding complications occured. All survivors did not need reoperation and they were in New York Heart Association functional class 1 without somatic growth retardation.

Three patients with hyperosmolar hyperglycemic non-ketotic diabetic coma (HHNKDC) following open-heart surgery are presented. Because the symptoms of HHNKDC are not specific, it is difficult to recognize this unique complication in the early postoperative stage. The mortality rate of this complication is high. Thus, HHNKDC should be recognized as early as possible after open-heart surgery, since it is curable if diagnosed at an early stage.