A 72-year-old man suffering from postinfarction angina and atrial septal defect (ASD) underwent a combined operation of four bypass graftings and direct closure of ASD. The great saphenous vein was harvested with the use of a bipolar Nd-YAG laser dissector without scissors or threads. Nd-YAG laser (wavelength: 1.064um) was irradiated to the branches of the saphenous vein through the ceramic tips of the dissector. After about five minutes exposure, the branch was dissected and bleeding from the dissected edge was not seen. Postoperative angiogram six months after grafting showed all grafts were patent, and morphological abnormalities such as reginoal shrinkage, diffuse narrowing and aneurysmal dilation were not observed. We conclude that laser graft harvesting using the bipolar dissector is safe and effective in saving time.

Since arteriosclerosis is a general progressive disease, an aneurysm of the thoracic aorta is not infrequently complicated by ischemic heart disease. Therefore, assessment of indications of surgical treatment and selection of the surgical procedure and auxiliary procedures on the basis of accurate preoperative evaluation of ischemic heart disease are considered to be very important for improving the results of operations for thoracic aortic aneurysm. Recently. we successfully operated on a 64-year-old patient with a left ventricular aneurysm and a descending aortic aneurysm. One-stage operation was performed by a left thoracotomy approach and partial left heart bypass by draining the pulmonary artery into the femoral artery with mild hypothermia. The approach and the auxiliary procedures employed in this patient are considered to be a useful combination applicable also to one-stage operation for descending aortic aneurysm and coronary artery bypass grafting.

A 60-year-old woman underwent surgical treatment of postinfarction ventricular septal perforation (VSP) in the early phase after receiving total cardiopulmonary bypass without aortic occlusion. VSP developed four days after anterior myocardial infarction. On admission, inraaortic balloon pumping was used to obtain hemodynamic stabilization. On the day of admission, emergency total cardiopulmonary bypass was performed. VSP was closed with a Dacron felt patch positioned on the left side of the septum. The anterior wall of the left ventricle was closed with Dacron felt strips and reinforced using a Gore-Tex sheet. Postoperative hemodynamics improved significantly. Although the operation while the heart was beating was difficult technically, the total cardiopulmonary bypass time of this method was not longer than that of operations under cardioplegic arrest. Further more, the area of infarction was easily distinguished by color and bleeding. The surgery during normothermic heart beat was effective in preventing further ischemia of the myocardium. The surgical treatment of VSP in the early phase during normothermic heart beat under total cardiopulmonary bypass was considered to be more effective and safer than operations under cardioplegic arrest.