Chylothorax is a rare but serious complication of thoracic surgery, with a poor prognosis, unless treated properly. We report the case of a 73-year-old man who developed massive chylothorax after thoracic aortic replacement. The patient was initially treated conservatively and during this period, we applied CART (Cell-free and Concentrated Ascites Reinfusion Therapy) method which performed thoracic drainage fluid to keep the patient's condition well. Administration of octreotide was not effective in this case. Thoracic duct ligation was eventually performed after the thoracic duct laceration was confirmed by lymphangiography. The patient recovered well and was discharged with no sign of recurrence.

Differential diagnosis of a so-called false aneurysm of the left ventricle from the true type after a myocardial infarction is important because the risk of rupture of the false aneurysm is high. Two cases of ventricular aneurysms with false type-like shape underwent surgical repair. Preoperative left ventriculography in Case 1 (male, 77) showed an aneurysm of 40×40×35mm in size with a narrow neck at the postero-inferior wall. The aneurysm of Case 2 (male, 61) was 20×20×10mm in size with a narrow neck at the inferior wall. These ventriculographic findings suggested a false type of aneurysm, but operative findings and pathological examination revealed that these were“true”aneurysms in which wall myocardial cells were observed. Left ventriculography and echocardiography were not sufficient to differentiate false left ventricular aneurysm from true aneurysm, particularly at the posterior and inferior wall.

A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative Staphylococcus aureus (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.

A 69-year-old woman underwent aortic valve replacement (AVR) for prosthetic valve (Freestyle^TM stentless valve) endocarditis (PVE) in April 2001. The patient was admitted to our hospital with diarrhea and tarry stools in January 2002 and was treated with intravenous hyperalimentation. She had fever and inflammatory findings at 1 week after admission, and was given intravenous antibiotics. Symptoms and laboratory findings improved gradually, but transesophageal echocardiography revealed a mobile mass in the ascending aorta near the noncoronary sinus of Valsalva. The serum β_-D glucan level was elevated and blood culture was positive for Candida parapsilosis. These findings suggested fungal endocarditis of the ascending aorta, so the patient underwent surgery. Vegetation was attached to the aortic wall near the noncoronary sinus of Valsalva. It was removed with part of the ascending aorta, followed by reconstruction with a gusset xenograft. In addition, aortic valve replacement was performed with a mechanical valve. The resected tissue grew C. parapsilosis, so parenteral anti-fungal drugs were administered intravenously for 8 weeks after surgery. Although cerebral infarction occurred, she was discharged on the 133rd postoperative day. There was no recurrence of infection and she remained on oral anti-fungal medication for 24 months postoperatively.

We report two emergency mitral valve replacements performed successfully on 16-week and 29-week pregnant women for infective endocarditis in the active phase. The first patient was in severe acute heart failure on admission, and the fetus was already dead. Induced abortion was performed uneventfully 6 days after mitral valve replacement. The second patient presented with several episodes of systemic embolization. An echocardiography revealed giant movable vegetation on the mitral valve. The patient had emergency mitral valve replacement just after the Caesarian section. Both the patient and her baby weighting 1, 374g had an uneventful good courses with no complication. We concluded that in emergency operations in pregnancy, saving the mother's life should have priority over all else, but we should find the way to rescue the fetus life if at all possible. Therefore, depending on the situation, we should not hesitate about doing a simultaneous operation, Caesarian section and heart surgery, for that purpose.