Preoperative blood donation is well known as one approach to reducing complications caused by homologous blood transfusion. The purpose of this study is to evaluate whether preoperative blood donation prior to coronary artery bypass grafting (CABG) reduces homologous blood transfusion. The subjects were selected from 151 consecutive patients who underwent CABG between October 1996 and October 1998. Of the 151 patients, 76 made preoperative blood donations (group A). Results in this group were compared with those obtained in the control group consisting of the subjects who received CABG without preoperative blood donation (group B, n=75). Both groups were matched for age, sex, preoperative hematocrit, cardiopulmonary bypass time, blood transfusion index (BTI; body weight×preoperative hematocrit). There were no significant differences between the two groups in terms of age and mean bypass duration. Homologous blood requirements were significantly lower in group A (78.9%) compared to group B (61.0%). BTI in group A (2, 224±447) however, was higher than that in group B (2, 129±515). In our study, preoperative blood donation was very effective to reduce homologous blood transfusion in coronary artery bypass grafting.

Aneurysms of the inferior left ventricular wall comprise only a small fraction of all aneurysms that have been reported in surgical series. Pseudo-false ventricular aneurysm is very rare and communicates with the left ventricule through a small orifice, and its wall contains myocardial tissue, unlike false ventricular aneurysm. A 53-year-old man was admitted to our hospital with chest pain. Echocardiography revealed left ventricular aneurysm, and the coronary arteriography subsequently revealed a complete occlusion of right coronary #2 and 75% and 90% stenosis of left anterior descending artery #7 and #8, respectively. Left ventriculography revealed an aneurysm of the inferior left ventricular wall, which communicated with the left ventricle through a small orifice and exhibited contraction. Surgical repair was indicated. Endoventricular circular patch repair (Dor operation) of the aneurysm of the inferior left ventricular wall and coronary artery bypass grafting to the left anterior descending artery and the right coronary artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The postoperative course was uneventful and the patient was discharged on the 22th day after surgery. Pseudo-false ventricular aneurysm of the inferior left ventricular wall was diagnosed by pathologic examination.

A 73-year-old woman was referred to our hospital for angina pectoris due to triple-vessel-disease. She underwent off-pump coronary artery bypass grafting ×3 (RITA-LAD, LITA-OM, SV-PDA). Her vital signs were stable during the operation and the postoperative status was steady in the ICU. However, on the next day, she suddenly had severe back pain with markedly elevated blood pressure. Urine output immediately shut down and respiratory failure progressed with time. An enhanced CT scan revealed aortic dissection (DeBakey type I and Stanford type A). An emergency operation was performed via re-sternotomy. Cardiopulmonary bypass was initiated and the body was cooled down to 20°C. Under circulatory arrest with isolated cerebral perfusion, the ascending aorta was replaced using a one-branched Hemashield graft (26mm in diameter). The entry of the dissection was located at the proximal anastomosis site of the vein graft. The postoperative course was uneventful and she was discharged on the 24th postoperative day.

A 68-year-old man was referred to our hospital with an abnormal shadow on chest X-ray film. Enhanced chest CT scan revealed intrathoracic left subclavian artery aneurysm (maximum diameter 4cm) just above the aortic arch. Surgery was indicated considering the risks of aneurysm rupture and distal embolism, although he was asymptomatic. Under left 4th posterolateral thoracotomy, the aneurysm was exposed. Cardiopulmonary bypass was initiated with cannulation of the left femoral artery and vein (to the right atrium). Circulatory arrest and isolated cerebral perfusion were achieved at 25°C core-temperature. The distal arch was replaced using a 26mm Hemashield graft and the left subclavian artery was reconstructed interposing an 8mm graft. The postoperative course was uneventful: he was extubated at 8h and was sent to the ward the next day. He was given an ambulatory discharge on the 13th postoperative day.

A 50-year-old man who had coronary artery bypass grafting (LITA-LAD, RA-RCA, SVG-OM-PL) 6 years previously was admitted with acute dissection of the aorta (DeBakey type I). Preoperative computed tomography showed that all coronary bypass grafts were patent. We replaced the graft of the ascending aorta and reconstructed the coronary artery bypass by re-sternotomy, circulatory arrest (rectal temperature: 23.6°C), retrograde cerebral perfusion, and intermittent retrograde cardioplegia. Because a radial artery (RA) graft and a saphenous vein graft (SVG) each had intact orifices, we detached them together and attached the grafts back to the aortic graft wall. He was weaned successfully from cardiopulmonary bypass without difficulty and postoperative transthoracic echocardiography (TTE) showed good left ventricle (LV) function. Postoperative multidetector-row computed tomography (MDCT) showed that the RA graft and SVG were patent. By performing circulatory arrest and intermittent retrograde cardioplegia, we successfully protected the myocardial function of a patient with acute aorta dissection after a CABG and we reconstructed the graft without needing further coronary anastomosis.

A 92-year-old woman was referred to our hospital with lower abdominal pain and lumbago. Her vital signs were stable at an emergency outpatient-clinic. An enhanced CT scan showed a sealed rupture of a right internal iliac artery aneurysm (85×73mm in diameter). An emergency operation was performed via median laparotomy. As predicted pre-operatively, a large hematoma was found in the retroperitoneal space and mesenterium surrounding the right internal iliac artery aneurysm (sealed rupture). Y-grafting was performed using a 16×8mm Intergard: proximal and distal ends of the graft were the abdominal aorta and bilateral femoral arteries, respectively. Left common iliac artery, right external iliac artery and right internal arterial aneurysm were suture-closed. The postoperative course was uneventful and she was discharged on the 13th postoperative day on foot.

A 73-year-old woman was referred to our hospital with a feeling of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronarypulmonary artery fistula originating at the left anterior descending artery. Also another fistula was shown between the right coronary artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysm rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligation of the fistulae were carried out with success. Transesophageal echocardiography was useful to confirm disappearance of the abnormal shunts after the operative procedures. The postoperative course was uneventful. Postoperative coronary angiography showed no aneurysm or fistula. She was discharged on the 11th postoperative day on foot.

A 61-year-old woman who presented with symptoms of dysphagia was hospitalized after right subclavian artery aneurysm was diagnosed. A selective right subclavian arteriogram revealed the presence of two large subclavian arterial aneurysms. The operative procedure consisted of aneurysmectomy through a right supuraclavian incision followed by the reconstruction of the blood vessel by end-to-end anastomosis of the right subclavian artery. The postoperative course was uneventful. Multiple subclavian artery aneurysms are rare among peripheral aneurysms. This case was found by the symptoms of dysphagia caused by compression of the esophagus. The etiology of this case is unclear, but most likely was due to trauma.

Primary cardiac tumors are comparatively rare. Primary cardiac angiosarcoma is the most common cardiac malignant tumor and the most common site of this tumor is in the right atrium. It is usually difficult to diagnose and treat this condition before death. The present case of primary cardiac angiosarcoma was located in the left atrium, which is very rare. A cardiac malignant tumor was suspected in this 56-year-old man based on chest MRI examination. The operation was performed successfully but its outcome was very poor.

A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoraco-abdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60mm, 55mm and 55mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1, 200ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not required for blood pooling and reduction of priming volume in the cardiopulmonary bypass system.