We report a case of massive endobronchial hemorrhage after cardiopulmonary bypass, and its successful treatment utilizing a bronchial blocker tube without circulatory support. An 85-year-old woman underwent mitral and tricuspid valves repair for mitral stenosis and regurgitation, and tricuspid regurgitation. The repairs were performed uneventfully. The patient was weaned from cardiopulmonary bypass. After protamine infusion, massive endobronchial hemorrhage occurred through the tracheal tube. On fiberoptic bronchoscopy, prompt identification and selective occlusion of the hemorrhage source was performed by a Coopdech endobronchial blocker tube (Daiken Medical Co., Ltd, Osaka, Japan). Postoperative contrast-enhanced computed tomography revealed thrombogenic pseudoaneurysm of the right middle lobe pulmonary artery. We speculated that Swan-Ganz catheters induced endobronchial hemorrhage. The patient did not experience any further hemorrhage. She was discharged from our hospital on the 25th postoperative day in good condition.

The patient was a 25-year-old man, who had been stabbed with a weapon siarilar to long ice pick. Thirty minutes later, he was admitted to our emergency center by ambulance. Anchocardiogram on admission revealed moderate pericardial effusion with normal heart function. Contrast medium enhanced computed tomography revealed that the weapon had entered from the left anterolateral chest wall and reached the posterior wall of the aortic root, approximately 1 cm above the left coronary artery orifice, through the left lung. During examinations, he suddenly went into shock and emergency open pericardial drainage was performed immediately. Approximately 400 ml of blood with a clot was removed from the pericardial cavity. After this procedure, there was no continuous bleeding. Subsequently, pseudoaneurysm developed at the aortic root injury site. Twenty seven days later, aortic surgery was performed. The injury site was resected and sutured directly, employing 4-0 polypropylene sutures with felt pledgets. He was discharged 14 days after the operation without any complications.

Subclavian arterial aneurysms are relatively rare compared to aortic aneurysms. The common causes of subclavian arterial aneurysms are arteriosclerosis, non-specific inflammation, thoracic outlet syndrome, and trauma. A case of a subclavian arterial aneurysm is reported. The patient was a 57-year-old woman. She had no previous history of hypertension, infection and trauma. She underwent complete resection of the aneurysm and reconstruction of right subclavian artery. Exploration of the aneurysmal wall revealed circumferential ridge which caused stenosis of the right subclavian artery at the orifice of the aneurysm. It has been suggested that a subclavian arterial aneurysm developed as a result of abnormal development of the embryologic right fourth and distal sixth aortic arches.

It is commonly believed that prosthetic valve implantation in actively infected patients is to be avoided. After normalization of C-reactive protein and white blood cell counts, and sterilization of blood cultures by treatment with antibiotics, we performed valvular surgery. We performed mitral valve repair in cases where the mitral valve lesion did not involve the annulus. From July 1992 to November 1996, 13 patients (mean age, 50 years) were treated surgically for infective endocarditis (IE) at Kansai Medical University. Twelve of the patients had native valve endocarditis (NVE), and 1 had prosthetic valve endocarditis (PVE). In 6 patients, the causative organisms were determined. These included: α-Streptococcus in 4 patients, Enterococcus in 1, and methicillin-resistant Staphylococcus aureus (MRSA) in 1. The affected valves were as follows: aortic valve alone in 4 patients, mitral valve alone in 6, aortic and mitral valves in 2, and a prosthetic aortic valve in 1. The PVE was due to a MRSA infection which occurred 9 months after aortic valve replacement. All patients were treated preoperatively for heart failure and the infection. The surgical procedures performed were: aortic valve replacement in 4 patients, mitral valve replacement in 3, mitral repair in 3, double valve replacement in 2, and re-aortic valve replacement in 1. There were no deaths or recurrences of IE in hospital or during follow-up to date. In all of the mitral valve repair cases, the mitral regurgitation on follow-up echocardiograms was grade I. Our results show that surgical treatment of IE after management of preoperative conditions can be successful. Furthermore, despite the absence of laboratory findings indicative of ongoing inflammation or infection, pathologic examination revealed active inflammatory reactions and organisms in 4 cases. In 1 patient, MRSA was culthued from an annular abscess that was resected intraoperatively. We suggest that cessation of antibiotic therapy be regarded with caution and suggest that the infected site must be resected surgically.