A 51-year-old male, who had undergone aortic valve replacement (BS27A) 13 years ago, was admitted with a sudden onset of cerebral stroke and SVC syndrome. Computed tomography and aortography revealed aneurysmal dilatation and dissection of the ascending thoracic aorta with occlusion of the superior vena cava and the right pulmonary artery. A modified Collins procedure was performed and the postoperative course was uneventful.

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.