Aggressive anticoagulation therapy is necessary when Toyobo-LVAS is used for long-term treatment of severe heart failure. However, it is necessary to regulate it carefully if there is a hemorrhagic complication due to thromboembolism, but repeated blood testing is painful. We compared simple measurement with the CoaguChek XS^® with the conventional blood testing method. The correlation coefficient was 0.916, and the regression line was Y=0.8027X+0.3399. In addition, drawing blood using the CoaguChek XS^® was very effective in the reported pain reduction in patients.

A 61 year-old man was admitted with fever and chest discomfort. He had undergone aortic root replacement for annuloaortic ectasia at age 57. Computed tomography showed a pseudoaneurysm and an abscess formation around the aortic root. Prosthetic valve endocarditis was diagnosed and the underwent repeat aortic root replacement. After debridement and irrigation of the abscess cavity, the left ventricular outflow tract was reconstructed with an equine pericardium, which was rolled to form a conduit. The pericardial conduit was securely sutured to the healthy left ventricular wall and the mitral annulus. A 25 mm-Freestyle valve was then sutured to the distal end of the conduit. The previous prosthetic vascular graft was removed and Completely replaced with a new prosthesis. This method provided secure fixation of a new prosthetic valved conduit to the normal left ventricular tissue with an excellent operative visual field.

A 44-year-old man presented with syncope and complete A-V block on electrocardiogram. Echocardiography revealed vegetation attached to the aortic, mitral and tricuspid valves. He underwent surgical repair because of uncontrollable congestive heart failure. The vegetation was attached to the noncoronary cusp entirely and had developed to the anterior mitral leaflet. The noncoronary sinus of Valsalva formed a giant mycotic aneurysm toward the right atrium and the aneurysm involved the tricuspid valve. The vegetation was resected together with the aortic valve and the aneurysm. Debridement was performed extensively on the right atrial wall and the aortic root. After closure of the orifice of the aneurysm with a bovine pericardium, aortic valve replacement was performed concomitantly with aortic annular reconstruction using a Hemashield^® graft. Valvuloplasty was performed on the mitral and tricuspid valves. The technique described above enabled us to resect the infectious focus and successfully repair the defective tissues.

Shprintzen-Goldberg syndrome (SGS) is a rare disorder with many characteristics of generalized connective tissue dysplasia. SGS is characterized by Marfanoid habitus with craniosynostosis and mental retardation. Patients with SGS have cardiovascular disorders similar to Marfan syndrome (MFS) and those disorders seem to play an important role in the prognosis of SGS. To our knowledge, only 19 patients with SGS have been reported, and 7 of them had cardiovascular disorders. The major cardiovascular disorders of SGS are aortic root dilatation and mitral valve prolapse. We reported the first case of SGS successfully treated surgically for cardiovascular disorders. Since then, we performed another operation in a patient with SGS. In this paper, we report our surgical results in patients with SGS.

Between 1961 and 1994, 121 patients our hospital were treated by conservative and surgical therapy for acute (67 patients) and chronic (54 patients) type B aortic dissection. Among the acute type B aortic dissections, two patients died before operation and 4 patients underwent surgical treatment in the acute phase. The false channel was occluded due to thrombosis in 30 patients. 9 in 31 patients with patent false channels required surgical therapy in the chronic phase. 46 of 54 patients with chronic type B aortic dissection underwent surgical treatment and 9 other patients were not operated on because of the false channel was not enlarged, nearly thrombosed type and refusal to operate. The long-term survival rate appeared to be better in cases acute closing aortic dissection than in cases of aortic dissection with patent false channels. Among the 54 patients who required surgical treatment in the chronic phase, there were eight early deaths (13.3%). Among chronic phase surgical cases, the long term survival rate appeared to be similar to that in type B aortic dissections treated by conservative therapy. Therefore, we consider that type B aortic dissections with acutely thrombotic false channels should be treated by medical therapy, while type B aortic dissection with patent false channel should be treated surgical treatment in the subacute phase or early chronic phase.

A 59-year-old man was admitted for treatment of Stanford type B acute dissecting aneurysm with acute renal failure. He had begun hemodialysis one month after onset, because digital subtraction angiography (DSA) revealed that the truelumen was narrowed by a dilated false channel just above the renal artery. Initially axillo-femoral bypass was performed to treat renal failure, and the patients was easily weaned from hemodialysis. Eight months after the first operation, descending thoracic aorta replacement was performed. The patient is doing well one year after operation. In conclusion, axillo-femoral bypass yielded good results because our patient recovered from renal failure and could undergo radical operation safely. Axillo-femoral bypass allowed evaluation of the hemodynamic study before radical operation.

A 64-year-old woman with chest pain and intermittent claudication was admitted to our hospital. Unstable angina pectoris and arteriosclerosis obliterans (ASO) of both leg were diagnosed. Angiography indicated total occlusion of the right external iliac artery and severe stenosis of the left external iliac artery, in addition to significant stenoses of the three major coronary arteries. The ankle pressure index was 0.49 in her right leg, and 0.74 in the left. Because coronary stenting was unsuccessful, emergency coronary artery bypass grafting was performed prior to arterial reconstruction of the lower extremities. To prevent exacerbation of limb ischemia during cardiopulmonary bypass (CPB), selective limb perfusion was performed with a 14-gauge intravenous catheter inserted into the right superficial femoral artery. There were no complications related to limb ischemia during or after the operation. Selective limb perfusion was considered to be useful to prevent limb ischemia during CPB in patients with ASO of the legs.

There are rare reports of families with multiple members with aortic dissection in the absence of Marfan syndrome. We encountered four cases of aortic dissection in two families. The aortic dissection occurred in the mother and child of the first family and in sisters of the second family. All cases had systemic hypertension preoperatively and presented Stanford type A aortic dissection. All of them were operated successfully. None of them showed the characteristics of connective tissue disease affecting the skeletal, ocular, and cardiovascular system. However, many members of the two families had systemic hypertension and histopathological examination of the aorta showed cystic medial necrosis in all of the four cases. The present study suggests that the familial aortic dissection may be caused by weakness of the aortic wall related to heredity and systemic hypertension.