A 2.5 year old male infant who had a ventricular septal defect and mild pulmonary stenosis was admitted for evaluation of fever and anemic complexion in February 1995. After admission, echo cardiography revealed massive vegetations from the outflow of the right ventricle to the right pulmonary artery through the pulmonary valve, and serial blood cultures were found to be positive for streptococcus mitis. Antibiotics did not relieve the high fever or decrease the volume of vegetation in the patient. At surgery, performed 2 weeks after the admission, the pulmonary valve was entirely destroyed and it was resected without prosthetic replacement after the excision of the vegetation and a Teflon patch was used for VSD closure. The post-operative course produced no noticeable complications. In the follow-up echocardiographic study, no vegetation was observed.

Acute type A aortic dissection presents a surgical emergency because conservative therapy is not effective in the majority of instances. Enhanced CT-scan of the chest is commonly available and is considered to be an optimal diagnostic method for this disease. The operative strategy is to resect the primary tear to close the entry site of the aortic dissection and replace it with a tubular Dacron graft. Therefore, the existence of the entry site is important in determining the operative procedure. Based on the numerical value of the enhanced CT-scan inspection, the present study seeks to preoperatively identify the location of the presumed entry site in aortic dissection. From May 1996 to June 1999, 21 consecutive patients (Marfan's syndrome excluded) with acute type A aortic dissection underwent surgical treatment. Nineteen patients were preoperatively examined by enhanced CT-scan: 11 men and 8 women, with a mean age of 61 years. CT-scan slices used for early diagnosis were of the ascending aorta, aortic arch, descending aorta, and thoracoabdominal aorta. The largest diameters of the whole and true lumen were measured from cross-sectional aortic images with a personal computer, and the areas of the whole and true lumen were obtained by the manual tracing method. The true ratio was calculated for the largest diameter and area of the whole lumen. The nineteen patients were divided into two groups according to the location of the entry site based on the operating views. Seven patients with the entry site in the ascending aorta were classified as group A, and twelve patients with the entry site further in the aortic arch and descending aorta were classified as group B. Comparisons were performed by non-parametric analysis. Moreover, a discriminant analysis was applied to evaluate the classification between the two groups. The ratio of the largest diameter of the true lumen in group A at the level of the ascending and descending aorta was significantly greater than that in group B (75.0±11.3 vs. 59.7±14.0%, 82.7±8.6 vs. 70.1±11.4%). Linear discriminant analysis resulted in the correct classification rate of 68.2%, and 77.3%, respectively. The ratio of the area of the true lumen in group A at the level of the aortic arch was also significantly greater than in group B (65.4±17.3 vs. 45.7±15.8%) and linear discriminant analysis resulted in the correct classification rate of 55.1%, When the entry site was located in the aortic arch, the diameter of the true lumen was seen to be smaller in the ascending and descending aorta, and the dissecting lumen appeared enlarged. When the entry site is located in the ascending aorta, the ratio of the area of the true lumen in the aortic arch was significantly higher (55.1%). Detailed examination of enhanced CT-scans is useful to determine the location of the entry site and the treatment strategy for this disease.

We reported a case of left atrial myxoma with renal infarction as an initial clinical symptom. A 65-year-old man had severe right lumbago. A chest CT demonstrated right renal artery embolism. On emergency operation a right renal embolus was removed. Preoperative echocardiography and transesophageal echo showed a tumor in his left atrium which was close to the mitral valve. The tumor was resected one week after the first operation. Embolectomy of the right renal artery could not restore renal function. To the best of our knowledge, this type of cardiac myxoma with renal infarction as an initial clinical symptom is rare.