Chylothorax is a serious complication that can jeopardize the outcome of thoracic surgery and prolong hospitalization. We report a 66-year-old man who underwent graft replacement for a distal arch aneurysm, in whom a persistent postoperative chylothorax developed. It was necessary to perform continuous drainage and conservative management. Administration of octreotide sharply decreased the drainage volume and the chylothorax disappeared within 2 weeks. Early administration of octreotide for postoperative chylothorax may shorten the therapeutic period.

A 60-year-old man with constrictive tuberculous pericarditis rapidly progressing after his hospitalization underwent partial pericardiectomy, anterior to the bilateral phrenic nerves through a midline sternotomy without a cardiopulmonary bypass. The results of right cardiac examination a month postoperatively showed the cardiac diastolic dysfunction remained unchanged. However, the results after 6 months and also 3 years postoperatively showed the cardiac function recovered from the constrictive pericarditis. He is free from tuberculosis and heart failure. We should be aware of a sign of heart failure due to constrictive tuberculous pericarditis and take the surgical treatment into consideration. We regard the partial pericardiectomy without cardiopulmonary bypass as one of the effective treatments for constrictive tuberculous pericarditis.

HIV infection is an extremely serious problem, and the number of HIV-infected patients is increasing in the world. The introduction of highly active antiretroviral therapy (HAART) and protease inhibitors (PI) allows maintenance of the inhibition of viral replication and partial reinstating the immune system in most patients. As HIV has changed from a progressive fatal illness to a chronic condition, many infected patients increasingly require diverse health services including cardiac surgery. We report a case of a 68-year-old man with HIV infection who underwent successful coronary artery bypass grafting using a cardiopulmonary bypass. The operative indication were determined according to the CD 4 count and the amount of HIV-RNA. Standard precautions were taken in the same way as for hepatitis B and hepatitis C cases. There was no percutaneous exposure to HIV infected blood. The postoperative course was uneventful, and the patient was discharged with no complications of HIV. The patient has been quite well without any therapy for HIV over one year.

Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.

A 75-year-old woman suffered from chest compression on effort. Detailed examinations showed aortic valve stenosis and unusual separation of the left coronary artery from the aorta. Surgical exposure revealed that the aortic valve was composed of 3 cusps. Two of 3 cusps were calcified, and another small cusp had fused to the aortic wall. Fusion of the cusp produced a cyst with a hole that was 1.5mm in diameter. Excision of the cyst disclosed the normal orifice of the left coronary artery. The aortic valve was resected and replaced with an artificial valve. Her postoperative course was uneventful, without any angina pectoris.

We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.

Mycobacterial infection after open-heart surgery is a rare complication. We report 2 cases of cutaneous infection caused by Mycobacterium fortuitum (M. fortuitum). Case 1: A 56-year-old man had wound infection from the 10th postoperative day (POD). The growth of M. fortuitum was detected on the 38th POD. Combination of multiple antibiotic therapy was performed. He was cured after several recurrences of cutaneous ulcer and abscess following 15 months. Case 2: A 26-year-old man had wound infection from the 28th POD. Deep sternal infection with mediastinitis developed. Bacteriological examination revealed the growth of M. fortuitum on the 61st POD. Omentopexy was performed on the 67th POD. Wound infection completely healed, and the patient was discharged from our hospital on the 137th POD. Mycobacterial infection should be considered when the wound infection is resistant to ordina antibiotics.

We describe two cases of a 9-day-old male and a 5-year-10-month-old female who had congestive heart failure due to severe mitral regurgitation. Preoperative echocardiogram revealed severe mitral regurgitation due to dysplasia of the leaflet, chordae and papillary muscle. Because the leaflet area was not enough for the valve orifice, we performed double orifice repair by suturing the free edge to the corresponding edge of the opposite leaflet. The mitral regurgitation was found to be significantly reduced on postoperative echocardiogram. Double orifice repair is simple and can be performed rapidly. However, although this technique has been performed in adults, it has not been commonly performed in infants. Our results suggest that this procedure can be useful for the congenital mitral regurgitation. Long-term follow-up is needed to confirm the result.