A 61-year-old woman underwent a regular echocardiography in October 2008 in which a mass of 1 cm in diameter was pointed out in the left ventricle apex. It did not dcrease, in spite of anticoagulation therapy, and therefore we performed surgery. The tumor was confirmed on the septal side of the cardiac apex by intraoperative cholangioscopy, and it was excised through the mitral valve. It was diagnosed as myxoma on immediate intraoperative pathological examination, and we confirmed that there was no tumor remnants on the resected stump histologically. The patient was discharged on the 13th day after the operation and 2 years later she was alive without recurrence of the tumor. This is the 25th case of left ventricular myxoma in Japan. In these reports, an initial resection of the tumor in the left ventricle was performed in 23 cases and the approach methods were described in 20 cases. The evaluation of the resected stump, regardless of remaining tumor, was described in only 3 cases. There were no reports of relapse after the operation. There are many reports which emphasize the usefulness of echocardiography, which is very helpful not only in the diagnosis, but also in periodic evaluations after the operation.

Four patients with multiple dissecting aortic aneurysms treated surgically from 1960 to 1996 were evaluated clinically. The incidence of multiple dissecting aortic aneurysms was 3.2% of all surgically treated cases of aortic dissection. Only one case suffered from Marfan's syndrome. Morphologically, all cases showed chronic DeBakey II+III type dissection. Case 1 was treated by Bentall's operation for DeBakey II type dissection and the residual aortic aneurysm was not treated surgically. Case 2 underwent a two-staged operation: Bentall's operation first, followed by entry closure with plication of the DeBakey III type aneurysm. Case 3 underwent a two-staged operation: graft replacement of the ascending aorta combined with coronary artery bypass grafting in the first operation and graft replacement of descending and abdominal aorta in the second. Case 4 was treated by graft replacement of the hemiarch, resuspension of the aortic valve and entry closure of the DeBakey III type dissection. Among them, two cases (Cases 1 and 2) whose aneurysms were treated incompletely showed a rapid growth and rupture of residual DeBakey III type aneurysm. In conclusion, one-staged aggressive and complete operation should be done for the patients with multiple dissecting aortic aneurysms. When a two-staged operation is selected, more intensive follow-up of the residual aortic aneurysm is needed.

A 76-year-old-woman, who had undergone endoscopic resection of a gastric polyp 2 years previously, had a cardiac tumor incidentaly pointed out on an abdominal ultrasonographic image. Echocardiography showed a solid round mass (34×25 mm in diameter), attached by a short stalk and which was floating on the right ventricular outflow tract and prolapsing over the pulmonary valve during systole. We suspected right ventricular myxoma. Urgent surgery was performed under cardiopulmonary bypass. After aortic clamping, the trunk of the pulmonary artery was opened near the right ventricule. The tumor was found under the pulmonary valve, attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was completely excised with a piece of the papillary muscle and chordae. After right atriotomy, mild tricuspid regurgitation was seen on a water test. After we performed tricuspid annuloplasty and chordplasty with artificial chordae, a second water test did not show any tricuspid regurgitation. The postoperative course was uneventful, and she was discharged on the 13th postoperative day.

We have experienced 3 successful repair surgeries for insufficient bicuspid aortic valve. The operative procedure consisted of combinations of suture placation, raphe triangular resection, commisural annuloplasty, and patch closure of perforation due to infectious endocarditis. The postoperative course was uneventful and postoperative echocardiography showed residual regurgitation as only trivial or mild. Retrospective study done on 19 previous cases with insufficient bicuspid aortic valve demonstrated that this operative procedure could have been applied in 15 (79%) of the cases. These results showed that repair surgery for insufficient bicuspid aortic valve is useful and has a wide application.