A 37-year-old woman with Noonan's syndrome underwent surgery for patent ductus arteriosus (PDA) and ventricular septal defect (VSD) with cardiomyopathy. Preoperative examination showed a small left-to-right shunt ratio (L→R) and mild pulmonary hypertension. However she had severe heart failure and repeated upper respiratory infections. The cardiomyopathy of this patient was the dilated type rather than the hypertrophic obstructive type which is usually seen in Noonan's syndrome. Postoperative cardiac functions did not improve significantly. This report discussed the operative technique, indications, and cardiac function aspects associated with Noonan's syndrome.

In the past 9 years, 37 patients with infective endocarditis underwent valve replacement. The aortic valve was involved in 17 patients, the mitral valve in 10, and both valves in 10, respectively. 35 patients had native valve and 2 had prosthetic valve endocarditis. Bacterial findings were Streptococcus in 20 patients (54%), Staphylococcus in 5 (13.5%), gram-negative in 3 (8%), and undetected in 10 (27%). 10 patients developed aortic annular abscess. After aggressive debridement of all apparently infected tissue of annular abscess, the defects left in the left ventricular outflow tract were repaired by interrupted mattress sutures with pledgets in 4 patients, by autologous pericardial patch in 4, and by valved conduit in 2 PVE patients, respectively. Retrograde cardioplegic infusion from the coronary sinus not only facilitated operative manipulation but also provided superior myocardial protection in such patients. Operative mortality was 11% (4/37). Reoperation was necessary in 2 patients; one for periprosthetic leak, and the other for newly developed severe left coronary ostial stenosis after the first operation, but both died eventually. Late mortality was 8% (3/37). Mean follow-up of 31 months was achieved in all 30 survivors, in whom there was no recurrence of infection and clinical improvement was excellent.