Aortic valve preservation is indicated in cases of aortic regurgitation caused by sinotubular junction (STJ) dilatation with ascending aortic aneurysm. We performed aortic remodeling using a tailored Dacron graft for the rupture of a large ascending aortic aneurysm. The patient was a 68-year-old woman. She was admitted in shock with cardiac tamponade. Chest CT showed a large ascending aortic aneurysm, 11cm in maximum diameter. Echocardiography demonstrated moderate cardiac effusion and massive aortic regurgitation. The ascending aorta was dilated from the STJ to the innominate artery, but the aortic valve appeared normal. We decided to preserve the native aortic valve. We performed aortic root remodeling using a 26mm Dacron graft (Yacoub's procedure). An intraoperative endoscopic study revealed the disappearance of aortic regurgitation (AR). The coronary arteries were reconstructed by the Carrel patch technique. Postoperative aortography revealed trivial AR, and the patient was discharged two weeks after the operation. We conclude that this technique avoids the complications associated with mechanical valve implantation and necessary lifetime anticoagulation.

To clarify the mechanism responsible for the increase in stroke volume (SV) due to training, we investigated the effects of interval training on the left ventricle using M-mode echocardiography. Six healthy male subjects volunteered to undergo 48 training sessions for 12 weeks (4 sessions· week^-1) One session consisted of five periods of exercise of 3-min duration on a cycle ergometer at a power output of 100% maximal O₂ uptake (Vo₂max), interspersed with 2-min recovery cycling at 50%Vo₂max. The echocardiograms at rest and during mild exercise (100W) were recorded before and after the training. The interval training significantly increased Vo₂max. Although there was no significant difference in SV at rest before and after the training, the training increased SV significantly during exercise. Before the training, there was a significant difference in left ventricular enddiastolic dimension (LVEDD) and left ventricular end-diastolic volume (LVEDV) at rest and during exercise. However, after the training, LVEDD and LVEDV during exercise were significantly larger than those at rest. These results suggest that interval training for 12 weeks increases diastolic filling (elasticity) of the left ventricle during exercise in healthy young men, partly contributing to the increase in SV due to the training.

We reported an operative case of bilateral coronary arteries to pulmonary artery fistula with giant saccular aneurysm. This 68 year-old female was admitted for evaluation of chest oppression and heart murmur. On coronary angiography, the diagnosis was made as a coronary artery fistula originating from right coronary artery and left anterior descending artery, and draining into the main pulmonary artery. The operation was indicated by giant saccular aneurysm, high shunt ratio, and positive finding of ischemic change on exercise electrocardiogram. The closure of coronary fistula and aneurysmorrhaphy were performed under cardiopulmonary bypass. The aneurysm was 25×30mm diamater, and not found arteriosclerotic change in operative finding. The fistula was completely disappeared by postopertive coronary angiography. We concluded that curative operation for coronary artery fistula with giant aneurysm can be done with minimal risk under cardiopulmonary bypass.

We report a case of a solitary iliac aneurysm-fistula of the sigmoid colon. A 68-year-old male was diagnosed as having diverticulum of the sigmoid colon by barium enema at a near-by hospital with a major complaint of melena. He continued to have massive melena although he received sigmoid colectomy. His condition eventually deteriorated into shock and he was transferred to our department. Angiographic findings showed a left common iliac aneurysm. Under the diagnosis of a rupture of a sigmoid colon, emergency operation was performed including aneurysmectomy and bypass formation between the femoral and femoral artery as an extraanatomical bypass. The patient developed multipul organ failure following the sepsis and died 8 days postoperatively. An aneurysm-intestinal fistula is a complication of an aneurysm. The problem of this disease is the difficulty in making a definite diagnosis with high mortality rate. We should consider the possibility of an aneurysm-intestinal fistula for the patient with gastrointestinal bleeding of the unknown origin.

This clinical study was peformed to clarify the postoperative cardiac functions after coronary artery bypass graft surgery in the cases associated with decreased left ventricular ejection fraction (EF) or increased end-diastolic volume index (EDVI). The patients were divided into two groups by preoperative EF. The EF of Group I ranged from 31 to 39% in 42 cases, and the EF of Group II was below 30% in 27 cases. Several parameters of cardiac function such as EF, peak ejection rate (PER), peak filling rate (PFR) or early diastolic peak filling rate were evaluated with radionuclide ventriculography. Postoperative mean values of these parameters significantly improved in both Group I and Group II compared to preoperative values. Although these parameters and left ventricular wall motion did not improve in the 7 cases with an EDVI over 140ml/m² in Group II, the clinical results of these 7 cases were good during the follow-up period except one case which preoperatively had frequent ventricular arrythmia. The clinical condition improved remarkably in the 3 patients who had preoperative angina pectoris among these 7 cases. Surgical indications must be carefully determined in cases with increased EDVI and frequent ventricular arrythmia.

Concomitant occurrence of acute aortic dissection and atherosclerotic aneurysm is rare. In such a circumstance, rupture of the existing aneurysm is the more likely scenario. In general, atherosclerotic plaque frequently serves to terminate the dissection process. A 65-year-old man with an abdominal aortic aneurysm was admitted due to severe back pain. Emergency CT showed acute aortic dissection (Stanford B) with a partially thrombosed pseudo-lumen and fusiform abdominal aortic aneurysm. Hemolysis occurred due to compression of the true lumen by the thrombosed pseudo-lumen. Emergency abdominal aortic graft replacement was performed successfully.

The survival rate of patients with cardiac rupture due to a blunt trauma is low, therefore it is necessary to have a well-defined diagnostic and treatment plan in order to improve the survival rate. In 8 such patients transthoracic echocardiograms at the time of arrival at our hospital showed pericardial effusion with cardiac tamponade in all patients. The mean time between suffering the injury and arriving at the hospital was 186±185min, and the mean time between arrival and being brought to the operating room was 82±49min. Preoperative pericardial drainage was performed in 2 patients, and percutaneous cardiopulmonary support system was used in 2 patients. The rupture site was in the right atrium in 3 patients, the right atrium-inferior vena cava in 1 patient, the right ventricle in 2 patients, the left atrium in 1 patient, and the left ventricle in 1 patient. Extracorporeal circulation was used in 4 patients, and the injured site was repaired. We were thus able to save the lives of 6 of the 8 patients (survival rate 75%). Transthoracic echocardiography was easy to perform and effective for making an accurate diagnosis. Many such patients tend to have multiple traumas, but, if the patient is in a state of shock due to cardiac tamponade, the patient should be moved immediately to the operating room. It is important to provide circulatory maintenance until surgery, and pericardial drainage and PCPS are also effective additional treatment modalities.

A 72-year-old woman suffered sudden back pain 42 days after ascending aortic replacement for retrograde acute type A aortic dissection. Computed tomography (CT) revealed type B aortic dissection and a stenotic true lumen at the abdominal aorta. The celiac artery and the superior mesenteric artery (SMA) branched from the true lumen, but bilateral renal arteries were not found by DSA. Infrarenal abdominal aortic fenestration was performed at 6th day from onset, because of progressive renal dysfunction. Intestinal ischemia was not confirmed by laparotomy. After the Infrarenal aorta was clamped and transected, the proximal intima was resected in a U-shape. The proximal stump which was reinforced with teflon felt was anastomosed to an 18mm woven graft. Distal anastomosis was carried to the true lumen was carried out with closure of the false lumen. Regaining flow into the collapsed true lumen was observed by epiaortic echography. Postoperatively, continuous hemofiltration was required for several days until renal dysfunction was improved. CT showed reasonable expansion of the true lumen, and no findings of visceral ischemia except for partial infarction of the left kidney. DSA revealed that bilateral renal arteries were perfused from the true lumen through the fenestration. Neither aortic dilatation nor new ischemia have been recognized, but further close observation is necessary.

A 24-year-old man was transferred to our hospital because of traumatic rupture of the thoracic aorta suffered in a traffic accident. On admission, he had recovered from shock and was alert. Chest CT showed massive hematoma around the total extent of the descending aora and the intimal flap at the diatal descending aorta. We performed an emergency operation. Through left thoracotomy, we found dilatation of the descending aorta. Epiaortic echo revealed that the aortic intima was completely transecred between Th 10 and Th 11. The pseudoaneurysm was replaced with a Hemashield vascular graft under partial cardiopulmonary bypass. The intercostal artery was preserved. His postoperative course was uneventful and paraplegia was not seen. We reported a rare case of traumatic rupture of the distal descending thoracic aorta above the diaphragm followed by successful surgical treatment.

Rare complications-1) Sarcoidosis, 2) Amyloidosis, 3) Phycomycosis-following surgical therapy for aortitis syndrome are reported. Sarcoidosis occurred in 39 y.o. female following Bentall operation for AAE and AR was diagnosed by biopsy and was controlled with drug completely 1 year after the onset. Amyloidosis found in 56 y. o. male after AVR and AAo plication for AAE and AR started with severe diarrhea and the diagnosis was made by autopsy. Phycomycosis was diagnosed by necropsy in 49 y. o. female after CABG and thoraco-abdominal bypass operation. Poor control of inflammation and administration of gluco-corticoid are the common problems for the 3 cases. Aortitis syndrome is autoimmune disease and some immunological factor has a role for the cause of the three complications. We must be very strict about the administration of the gludo-corticoid and the control of the inflammation.