There are few reports of successful CABG for coronary lesions due to collagen disease. In particular, there is no report of CABG in progressive systemic sclerosis (PSS). A 60-year-old female with PSS underwent successful coronary artery grafting for angina pectoris. She had a history of PSS and had been on predonisolon for the previous 2 years. Three months prior to admission, she began to complain of angina on mild exersion. Selective coronary angiogram revealed 90% stenosis in the midportion of the right coronary artery and 90% stenosis in the proximal portion of the left anterior descending artery. Based on these findings she underwent saphenous vein grafting to the left anterior descending branch and the posterior descending branch of the RCA. Despite the history of PSS, the patient's postoperative course was uneventful and she is now doing well with no attack of angina. Postoperative angiography showed both vein grafts were patent, but there was a slight stenotic lesion in the midportion of the graft to the right coronary artery. From our experience, careful consideration of the bypass conduit is important in patients requiring steroids.

Three surgical cases of postinfarction left ventricular free wall rupture (LVFWR) are described. Patient 1, a 76-year-old woman, developed LVFWR of the posterior wall after acute myocardial infarction (AMI). Coronary arteriography (CAG) revealed total occlusion of left circumflex artery (Cx) (#11). Direct closure of the myocardial tear was performed using cardiopulmonary bypass (CPB) and cardiac arrest. Patient 2, a 67-year-old man, developed LVFWR of the anterior wall after AMI. CAG revealed total occlusion of left anterior descending artery (LAD) (#7). He was placed on a percutaneous cardiopulmonary support system (POPS) prior to the operation and direct closure of the myocardial tear was performed with the heart beating. Patient 3, a 57-year-old man, developed LVFWR of the posterior wall after AMI. CAG revealed total occlusion of Cx (#13). He was placed on PCPS prior to the operation and direct closure of the myocardial tear was performed using CPB and cardiac arrest. Patients 2 and 3 who were placed on PCPS prior to the operation successfully underwent emergency operations. In all cases, 2-0 Prolene horizontal mattress sutures with Teflon felt strips were used through the infarcted area in order to close the myocardial tear.

A 72-year-old woman had undergone a right upper lobectomy and thoracoplasty in 1954 and an aortic valve replacement in December 2001. She suffered from dysphagia in June 2002. X-ray film and CT-scan revealed a sternal partial nonunion. The treatment was resection of the clavicle, because of the adhesion behind the sternum and the sternal partial nonunion. The postoperative course was uneventful and she was discharged. However, she was transferred to our hospital because of hematoma and bleeding at the right clavicle 1 month after the operation. Emergency operation was performed because of injury of the ramus of artery subscapularis. We ligated the ruptured portion and additionally resected the clavicle. Her postoperative course was good. Resection of the clavicle is one choice for sternal partial nonunion after open heart surgery. However, when we resect the clavicle, we should consider preservation of the ligament, reconstruction of the ligament, and the clavicular excision range.