Non-occlusive mesenteric ischemia (NOMI) is a rare but often fatal event following cardiac surgery. Early diagnosis of NOMI is difficult because the related abdominal symptoms are not very specific. From April 1999 to September 2003, 1,040 patients underwent cardiac surgery, among whom 5 patients who underwent angiography were given a diagnosis of NOMI. A catheter was used for immediate intra-arterial infusion of 500μg prostaglandin E1 into the superior mesenteric artery over a period of 30min. Prior to angiography, all patients had cutis marmorata and elevated serum lactate levels. Three patients showed peritoneal signs and therefore underwent laparotomy. Of the 5 patients, 4 survived. In conclusion, if mesenteric ischemia is suspected, selective angiography must be performed as soon as possible for diagnosis and treatment. Additionally, the presence of other findings such as cutis marmorata and elevated serum lactate levels proved to be useful in the early diagnosis of NOMI.

Cor triatriatum is a rare congenital cardiac anomaly in which the accessory chamber is separated from the left atrium by an anomalous septum. We report a rare case of cor triatriatum with severe mitral regurgitation and atrial fibrillation in an adult. The patient was a 65-year old woman who developed congestive heart failure 3 years previously, and received medical follow-up with mitral regurgitation, atrial fibrillation and cor triatriatum since then. She developed congestive heart failure again and was referred to our hospital for operation for progressed mitral regurgitation, tricuspid regurgitation and atrial fibrillation. Mitral valve plasty (Physio ring II 28 mm, cleft closure, edge to edge repair for PMC), tricuspid annuloplasty (Physio tricuspid ring 28 mm), resection of the anomalous septum and maze procedure was performed. All of the pulmonary veins were connected to the accessory chamber. There was only one hole on the anomalous septum, and the hole was large, about 3.0 cm in diameter. The patient regained sinus rhythm without mitral and tricuspid regurgitation after the operation. Even though the duration of atrial fibrillation was long and left atrium diameter was large, complete excision of the anomalous septum and maze procedure were effective for the patient diagnosed cor triatriatum.

An 83-year-old woman with unstable angina pectoris underwent percutaneous coronary intervention (PCI) of the left circumflex artery, and her condition improved. However, on the eighth day after PCI, she went into a stated shock, and echocardiogram confirmed a large amount of pericardial effusion. Pericardiocentesis was immediately performed, and bloody pericardial effusion was drained. Cardiac rupture was suspected, although the cause was unknown. Emergency sternotomy was performed, and blow out type cardiac rupture in the center of a thumb-sized infarction was found at the area of the obtuse marginal branch. The ruptured left ventricular wall was successfully closed with 2 mattress sutures because the infarcted area was relatively small. Postoperative course was good, and she was discharged on the 25th postoperative day. In this case, the cause of cardiac rupture was thought to be a small branch of the left circumflex artery, which was occluded during PCI. This is one of the rare but important mechanisms of cardiac tamponade after PCI.