The effects of coronary artery bypass grafting (CABG) to conpletely obstructed coronary arteries (COCA), with angiographically demonstrable collaterals distal to the occulusion, on the lef ventricular contractility and postoperative symptoms were studied in 18 patients consisted of 10 with transmural myocardial infarction (TMMI) on ECG in the area perfused by COCA and 8 without TMMI. Of 19 CABGs including 13 to left anterior descending coronary artery (LAD), 5 to right coronary artery (RCA), 1 to left circumflex coronary (LCX), all 13 grafts to LAD and 1 to LCX were patent, whereas 2 of 5 to RCA were obstructed on the postoperative angiogram. The following evaluations were undertaken in 16 patients with patent grafts. In 8 patients with TMMI, left ventricular ejection fraction increased from 0.56±0.08 (Mean±SD) preperatively to 0.65±0.07 postoperatively (p<0.005), left ventricular segmental wall motion improved from 21.6±6.7% to 29.6±6.5%(p<0.01). Angina disappeared postoperatively in all patients but one with TMMI. All patients showed clinical symptoms of NYHA class III or IV preoperatively, which were improved to be of class I or II postoperatively. In conclusion, it was found that CABG to COCA, especially to LAD was associated with an excellent graft patency rate and with significant improvement of left ventricular contractility, even in the patients with TMMI.

Eight patients with multiple aortic aneurysms of both the thoracic and abdominal aortae treated surgically from 1991 to 1995 were evaluated clinically. The patients consisted of six men and two women, with an average age of 65.6 years ranging from 50 to 73. The incidence of multiple aortic aneurysms was about 10% of all cases of aortic aneurysms. The entire aorta should be examined in all patients with aortic aneurysms. Among the five patients who underwent a two-staged operation, the thoracic operation preceded the abdominal one in one case, and the abdominal operation preceded the other in four cases. No aneurysm rupture occurred in the two-staged cases. In conclusion we should first replace the aneurysm with the higher risk of rupture. However, when such a judgement is difficult, it is improtant to consider the possibility of a rupture of the second aneurysm or a brain infarction caused by a thrombosis moving from the abdominal aneurysm. The order of operation should be decided according to the location and the size of the thoracic aneurysm.

A 42-year-old female suffered annulo-aortic ectasia (AAE) and mitral regurgitation associated with Marfan's syndrome was successfully treated by a modified Bentall procedure combined with mitral valve replacement (MVR) under continuous warm blood cardioplegia (CWBC). With the patient under total cardiopulmonary bypass and myocardial protection with CWBC, MVR with 27 mm mechanical valve was first done, followed by the total replacement of the aortic root with a composite graft made of vascular graft and an aortic mechanical valve. Anastomosis of the composite graft to the aortic valve annulus was made to guarantee a watertight closure using numerous interrupted mattress sutures and three pieces of Teflon felt strips to the annulus. Both coronary arteries were reconstructed by means of the “Interposition Graft Method” which interposes two short grafts between the composite graft and both coronary ostia. In spite of long time aortic cross clamp (235 min), cardiac function was recovered excellenthy and a peak CK-MB value was very low (23 IU/L) in the early postoperative period. Thus, CWBC provided a satisfactory myocardial protective effect. It was suggested that the modified Bentall procedure combined with MVR using CWBC was an effective therapy for a patient with AAE and mitral regurgitation associated with Marfan's syndrome.