Postoperative quantitative evaluation of left internal thoracic artery (LITA) grafts is usually performed by angiography, scintigraphy and Doppler flowire. However it is difficult to observe the characteristics of the intima of the LITA graft. The purpose of this study was to evaluate the characteristics and quantity of plaque of intima of LITA grafts in 6 cases after coronary artery bypass surgery using an intra-vascular ultrasound device (IVUS). There was no stenosis or calcification of LITA grafts on angiography. However we found atherosclerotic plaque in all LITA grafts by IVUS. Characteristics of plaque were eccentric in all cases, and soft, hard and mixed plaque were found. The average minimal lumen diameter of LITA grafts was 2.6±0.2mm. The average lumen area of LITA grafts was 5.4±0.7mm². The rate of plaque area was 37.1±5.9%. The eccentric arteriosclerotic plaques were seen in all cases, contradicting the established theory that LITA do not form arteriosclerosis easily. We suggest that IVUS is an effective follow-up device for evaluating the morphological findings and quantitative evaluation of LITA graft in a timely manner.

We perfomed an aortic valve replacement and intraoperative plasma exchange with Cell Saver 4^® made by Haemonetics for removal of bilirubin. Diluted blood after cardiopulmonary bypass and suctioned blood (total volume 11, 300ml) was washed, concentrated and transfused. Plasma bilirubin level was decreased to 5.4mg/dl from 9.9mg/dl during operation. It was concluded that intraoperative plasma excange with Cell Saver 4^® was safe and effective technique for removal of bilirubin during open heart surgery.

An internal felt-reinforced patch-plasty was performed in 11 patients with dissecting aortic aneurysm (DeBakey type I: 4 cases, type II: 1 case, type III: 5 cases, aortic arch dissection: 1 case). The aortic cross-clamp time was 84±19 min on the average. The initial tear of the aortic intima was closed on 10 patients. Minor leakage through a felt inserted in the false lumen was observed in one patient of type I. There was no operation-related death except one patient of type III who died from arrythmia encountered following termination of centrifugal pump bypass. Thrombotic occlusion of the false lumen developed in the ascending aorta in type I and II cases, and in the desceding aorta in type III one month after operation. The false lumen localized in the aortic arch was completely occluded by thromi. Postoperative course was excellent in all patients after 16 months on the average. Internal felt-reinforced patch-plasty is a simple and reliable procedure for closing the intial tear of dissecting aortic aneurysms.