We herein describe the findings of a 32-year-old female was known to have had an electrocardiogram abnormalities and had avoided excessive exercise since her high school student days. She suddenly lost consciousness due to ventricular fibrillation (Vf) in July 2007. As a result she was taken to our hospital by ambulance. Emergency coronary angiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome). She therefore underwent surgery. During the operation, the main pulmonary artery (PA) was transected while on the cardiopulmonary bypass and the left main coronary trunk (LMT) ostium was detected. Antegrade cold blood cardioplegia was induced, and retrograde continuous cold blood cardioplegia was subsequently applied to the coronary sinus, thus obtaining a complete cardiac standstill. The LMT ostium was excised with a cuff of the main PA wall as a button. During further dissection of the LMT distally to the bifurcation, the LMT wall was injured, thus resulting in the need to repair it under deep hypothermic circulatory arrest (DHCA) in order to obtain a bloodless surgical field. During core cooling, the LMT was anastomosed to the left posterolateral wall of the ascending aorta, then the LMT was repaired with a patch consisting of a non-treated autologous saphenous vein (SV) under DHCA. Several surgical techniques for BWG syndrome have been reported. Among these techniques, the direct implantation of the left coronary artery to the ascending aorta is the most physiological and therefore is considered to be the best technique. In this case, direct implantation was accomplished, however, the LMT also had to be repaired.

Coronary artery bypass grafting (CABG) was performed in 16 patients with impaired left ventricular function due to ischemic heart disease (IHD) and the surgical procedures and cardiac functions before and after operation were studied. Preoperative angiogram showed three vessel disease in all patients. The ejection fraction was less than 40% in all and the mean cardiac index (CI) was 1.97l/min/m². At operation arterial graft was used in 10 patients (Group-AG) and no arterial graft but saphenous vein graft was used in 6 patients (Group-SVG). The average total cardiopulmonary bypass time, aortic cross clamping time and the number of revascularized vessels in both groups showed no significant differences. However, intraaortic balloon pumping was necessitated in one of Group-SVG and the requirement of postoperative catecholamine was in higher ratio in Group-SVG than in Group-AG. Postoperative CI improved to 3.1±0.4l/min/m² and 3.3±0.3 l/min/m² in Group-AG and Group-SVG, respectively. The postoperative New York Heart Association Functional Class improved to Class I or II in all patients and there were no significant differences of the improvement between the groups. Conclusively, it seems that the arterial grafts can be used safely and extensively in CABG for impaired left ventricular function due to IHD.

Thirty six patients with post-infarction complications underwent operation, and the postoperative and late follow-up results were analyzed. There were post-infarction ventricular septal perforation (VSP) in 9 patients and left ventricular aneurysm formation in 27 patients. The operative indications were poor physical work capacity in 13, cardiogenic shock or severe congestive heart failure in 10, left ventricular thrombus in 7, severe ventricular arrhythmia in 6, and repeated angina in 6. Left ventricular aneurysmectomy was performed in 14 patients and VSP closure was in 8. Coronary arteries were simultaneously bypassed in 14 patients. Three patients were died of sudden postoperative arrhythmia 10 days, 55 days and four years after operation. All survivors except two patients with preoperative massive cerebral infarction or prolonged heart failure were in New York Heart Association Class I or II in their late postoperative periods. However, five patients in whom the significant coronary lesion had not been bypassed or the bypassed grafts had occluded complained of mild angina after operation. Postoperative arrhythmia was one of major factors in the late results and simultaneous coronary artery bypass grafting was important to improve the symptoms in the late postoperative periods.

A case of 41-year-old man with large candidal vegetation on the tricuspid valve was reported. He was presented with high fever and newly developed heart murmur. Four months before admission, he had suffered from head trauma which required intravenous hyperalimentation and injection of multiple antibiotics through catheter indwelling the superior vena cava. On admission, echocardiogram showed large vegetation on the tricuspid valve, although blood cultures were sterile. At operation, tricuspid valve was replaced with St. Jude Medical prosthesis because large vegetation developed from the anterior tricuspid leaflet was confirmed. Candida albicans was detected by microscopic examination of the vegetation. The total of 1500mg of Amphotericine-B were administered intravenously after operation. His postoperative course was uneventful. We discussed about the availability of echocardiogram for diagnosis and the effectiveness of a combination of chemotherapy and valve replacement for treament of fungal endocarditis.

A 53 year-old male with mitral valve aneurysm was presented. This patient, who had no episodes of rheumatic fever, was admitted with complaints of general fatigue, dyspnea and continuing high fever. Echocardiographic examination showed an abnormal echo behind the anterior leaflet of mitral valve, protruding into the left atrium during systole. Angiogram showed the same abnormal change of mitral valve and mitral regurgitation (MR) and aortic regurgitation (AR). We diagnosed as mitral valve aneurysm with MR and AR due to infective endocarditis. At operation, it was revealed that the aortic valve was destroyed, resulting in severe AR, and the anterior leaflet of mitral valve was a large aneurysm itself. Both valves were replaced with St. Jude Medical valve prosthesis. Postoperative course was good and with no complications. In Japan, 21 cases of mitral valve aneurysm were reported. We discussed the clinical course and the operative procedure for mitral valve aneurysm in this report.

Maximal oxygen uptake (Vo₂max) and lactate threshold were measured during an incremental bicycle ergometer test in 40 healthy middle-aged and older runners between 43 and 79 years of age. Although the 10-km run time slowed with increasing age, there were no significant differences in recent training habits or relative amount of body fat between four age groups. However, our cross-sectional data revealed an annual decrement of -0.74 ml/kg/ min/yr, which was significantly greater than that reported in previous studies. Vo₂max values for the runners were greater than those for sedentary men of similar ages by about 50% in each age group. Significant correlations were found between the age at the onset of running training and Vo₂max (r=-0.600, p<0.05) . Vo₂@LT declined significantly but less rapidly with age (r=0.686, p<0.05) than Vo₂max. Both the mean maximal heart rate (HRmax) and HR@LT also declined with age. No significant differences in HRmax were observed between the runners and sedentary men of the respective age groups. Significant correlations were also found between the estimated HRmax and directly measured HRmax (r=0.600) . Neither systolic blood pressure nor diastolic blood pressure during submaximal-maximal exercise were found to increase with age. We suggest that maintenance of a higher lactate threshold in older runners when expressed as a percentage of Vo₂max is attributable to a greater age-dependent decline in Vo₂max with a smaller change in Vo₂@LT.