The non-invasive cardiac output (NICO) monitor is a new device in order to measure cardiac output (CO). A rebreathing circuit is built in the NICO monitor and CO is calculated using the Fick CO₂ equation. We compared this technique with the standard thermodilution (TDCO) technique in patients with thoracic and abdominal surgery. Thirty-two paired data were obtained in 17 patients. Correlation between the two methods in patients with controlled mechanical ventilation (CMV) was fair, with a correlation coefficient of 0.85. However, the correlation coefficient of the two methods was 0.60 in spontaneous breathing patients. Bland-Altman analysis showed a bias of 0.24±0.68 (mean±2SD) in CMV patients and 1.44±1.28 in spontaneous breathing patients. The NICO value was inversely proportional to an end-tidal CO₂ difference (ΔETCO₂) between pre-rebreathing and post-rebreathing. The large bias in spontaneously breathing patients might be due to a small ΔETCO₂ in spontaneously breathing patients. The NICO monitor has a tendency to measure higher CO values in spontaneously breathing patients.

A 77-year-old woman underwent percutaneous coronary intervention (PCI) for chronic total occlusion of the left anterior descending artery using a drug-eluting stent (DES). Re-stenosis, stent fracture, and aneurysm were found on follow-up coronary angiography (CAG), and thus implantation of multiple DESs was required. Surgery was indicated because CAG 48 months after first DES implantation revealed enlargement of the aneurysm with other new lesions. She successfully underwent off-pump coronary artery bypass grafting and resection of the aneurysm.

A 62-year-old woman was referred to our hospital for treatment of hemolytic anemia 10 years after total arch replacement for acute aortic dissection. The cause of hemolysis was confirmed to be mechanical damage of red blood cells at the kinked graft. Because aortic valve regurgitation and occlusion of the left subclavian artery were also found, resection of the kinked graft, aortic valve replacement and reconstruction of the left subclavian artery were carried out concomitantly at reoperation. Her postoperative course was uneventful, and hemolysis resolved soon after the operation.

A 51-year-old man with osteogenesis imperfecta and who had aortic regurgitation was admitted to our hospital for aortic valve replacement. His height was 146cm and his weight was 49kg. The patient had suffered from bone fractures several times since childhood. Bone deformity, blue sclera and his status were clinically indicative of osteogenesis imperfecta. Aortic valve replacement with a 25mm SJM^® prosthetic valve was successfully performed for aortic valve insufficiency and slight annulo-aortic ectasia. Soft tissues and the sternum were fragile. Pathological examination (Elastica-Masson stain) of the aortic valve and left ventricular wall revealed a loss of fibrous tissues and remarkable thickening due to elastic fibers. The patient was discharged 31 days after surgery. Osteogenesis imperfecta is one of the collagen diseases caused by gene abnormality, in which fragile bones are easily fractured. Cardiovascular disease is rarely associated with it and the surgery-related mortality rate is reported to be approximately 30%, due to bleeding.

Out of 104 patients with perimembranous or infundibular-isolated ventricular septal defect (VSD), causative factors of Prol and AR, and the operative indication were studied in 17 with prolapse of the aortic cusp (Prol) and 10 with aortic valve regurgitation (AR). The left to right shunt ratio and the size of VSD were smaller in patients with Prol or AR than in those with the normal aortic cusp, suggesting that hemodynamics might take part in the cause of Prol or AR. Twenty-two patients underwent VSD closure only, four valvuloplasty and one aortic valve replacement. Residual AR was occurred in three out of ten patients. After surgery, AR was disappeared in six out of seven patients with the first grade preoperative AR, but AR remained in all two patients with the second grade preoperative AR. Careful preoperative observation and early operation before the appearance of AR are the important factors for avoiding residual regurgitation after aortic valvuloplasty.

An 83-year-old female was referred to our hospital because of a swelling and pain of the left lower extremity. An endoaneurysmorrhaphy and bypass surgery between the left common iliac artery and the external iliac artery were performed under the diagnosis of deep vein thrombosis associated with a left isolated internal iliac aneurysm. Forty patients with isolated internal iliac aneurysm were reported in Japan and deep vein thrombosis occurred only in our patient. The external growth of the aneurysm behind the external iliac artery might cause compression, congestion and phlebitis of the common iliac vein, resulting in deep vein thrombosis.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

In order to elucidate risk factors in arteriosclerosis obliterans (ASO), histories and physical and laboratory findings were reviewed in 163 patients with ASO, and the results were compared with ischemic heart disease (IHD) patients. Patients with ASO were much older and smoked more than patients with IHD. Such complications as hypertension, cerebrovascular disease were significantly more frequent in ASO patients than in IHD patients. On the other hand, the levels of serum total cholesterol, triglycerides, Apo A-II and Apo B were significantly lower in ASO patients than in IHD patients, although lipoprotein(a) tended to be higher in ASO. In ASO, remnant-like particles cholesterol tended to be higher when other presumable atherosclerotic risk factors were absent. The present results indicate that male gender, aging, smoking habit, hypertension and cerebrovascular disease are major risk factors in ASO patients. Although abnormal lipid metabolism may contribute to the development of ASO, we postulate that it plays a less significant role in IHD.

A 68-year-old woman complained of hemoptic shock and recovered with conservative treatment. Ruptured descending aorta into the left lung was diagnosed. Graft replacement of the descending aorta was successfully performed. We speculated that spontaneous rupture of the descending aorta into the left lung might have occurred due to high blood pressure affecting the weak aortic wall with sclerotic change, causing hemoptysis. The ruptured descending aorta was successfully replaced without dissection between the ruptured aorta and the left lung. The postoperative course was uneventful with neither pulmonary nor infectious complications.