The total correction of tetralogy of Fallot (TOF) after the right ventricular outflow tract construction without ventricular septal defect closure which is called central palliation is rarely reported. A case of TOF had been undergone the central palliation because of left ventricular hypoplasia in a 30 year-old woman, 19 years after Blalock-Taussig's shunt. She was performed successfuly on the total correction of TOF and pulmonary valve replacement at 35 years old, 5 years after the central palliation.

The severity of mitral regurgitation (MR) and tricuspid regurgitation (TR) was evaluated semiquantitatively by Doppler color flow imaging. The maximum MR area/body surface area (MRA/BSA) correlated significantly to the severity of angiographyic changes (tau=0.897). The maximum TR area/body surface area (TRA/BSA) also correlated significantly to the severity in angiography (tau=0.874). The cutoff values were 0.5, 2, 4, and 8cm²/m² for MRA/BSA and 1, 2.5, 5, and 10cm²/m² for TRA/BSA. Fourteen children (mean age 4.2 years) underwent repair of partial atrioventricular septal defects (P-AVSD) from 1985 to 1992. The cleft in the anterior leaflet was closed in the mitral valve; other procedures such as annuloplasty were not performed. They have been followed for periods from 7 months to 7 years and 5 months (mean 4 years); they were examined by echo cardiography and the Holter electrical cardiogram at the end of the period. MR had reduced to grade 0-II in all cases. No patients were given any medication, and all remained in NYHA Functional Class I. Paroxysmal supraventricular tachycardia developed in only one patient. We concluded that no annuloplasty in mitral valve is needed in children suffering from P-AVSD.

We reported a rare case of myxoma originating from the anterior leaflet of the mitral valve. A 65-year-old woman was admitted with sympotomes of easily fatigability and palpitation. On auscultation, a grade II/IV systolic murmur was audible at the apex. Echocardiography demonstrated a dense mass arising from the anterior mitral leaflet. The tumor (16×13×10mm in size) was resected from the anterior leaflet of the mitral valve. There was no definite evidence of a tumor stalk on the mitral valve nor valve regurgitation after the operation. Microscopically, polyhedral cells were recognized, indicating myxoma. The postoperative course was uneventful and no recurrence has been noticed during the past 6 years.

Fifty-three patients who had received aortic valve replacement (AVR) using tilting disc valve prostheses (Lillehei-Kaster valve, Omniscience valve, Omnicarbon valve), underwent replacement of their aortic valve prostheses over the past 13 years. The indications for reoperation were non-structural opening failure in 35 patients, thrombosed valves, including 2 stuck valves in 8, prosthetic valve endocarditis (PVE) in 7 and perivalvular leakage (PVL) in 3. The interval periods until reoperation for opening failure and thrombosed valve were 112 and 118 months respectively, and for PVE and PVL were 21 and 25 months. There were 7 hospital deaths (13.2%). Surgical results in cases of active PVE with root abscess and stuck valve required emergency operation were significantly worse than these for nonstructural opening failure. Opening failures, which accounted for two-thirds of the indications for reoperation was found to be due to subvalvular pannus formation on minor orifices which hindered the disc from opening properly. It was suggested that reoperation for these types of prosthetic valve should be done before they develop into emergency cases, taking account of these valve-related complications.

Between March 1985 and May 1988 we performed valve replacement to 86 cases using 92 Duromedics prosthetic valves in the atrioventricular position. Long term results were obtained, we examined the problem (especially thrombosed valve). The cumulative follow-up was 313.6 patients-year (p-y). The 6-year actuarial survival rate including early mortality was 83.4±4.1%. The valve-related complications were as follows; peripheral embolism 3 cases (1.0%/p-y), thrombosed valve 7 cases (2.2%/p-y), hemorrhage and paravalvular leakage each 1 case (0.3%/p-y). All valve-related complications were 12 cases (3.8%/p-y). Reoperation for valve-related complications were 5 cases (1.6%/p-y), it was all to thrombosed prosthetic valve. Thrombosed valve were seen 7 cases (4 cases in mitral, 3 cases in tricuspid position). The event free rate of thrombosed valve was 89.1±4.0%. It was high incidence in tricuspid position. We concluded that it was necessary to be done early reoperation the time of fixed with one leaflet alone.