We performed a surgical correction on a 53-year-old male patient, who had suffered from Stanford type A aortic dissection. The thoracic aorta was dilated along its whole length. Under retrograde cerebral perfusion, the correction consisted of extended Cooley's hemiarch repair and the closure of the tear, which was an entry into the pseudolumen of the descending thoracic aorta. The postoperative course was uneventful except a temporary DIC due to extensive thrombosis of the pseudolumen of the descending thoracic aorta. We think that the second operation of the descending thoracic aorta is unneccesary. Although the staged operation is generally approved for broad Stanford type A aortic dissection, we succeeded in a clinically curative one-staged operation using extended Cooley's hemiarch repair only with a median sternotomy.

An 80-year-old woman who had been suffering from atrial fibrillation and recurrent cerebral infarction was admitted to our hospital. Transesophageal echocardiography revealed a giant mobile thrombus in the left atrial appendage. The patient underwent thrombectomy and left atrial appendage obliteration under cardiopulmonary bypass. Her postoperative course was uneventful. The patient showed no recurrence of the left atrial thrombus nor thromboenbolism postoperatively. Based on the present results, we recommend cardiac thrombus be investigated by transesophageal echocardiography in cases of atrial fibrillation accompanied by recurrent thromboembolism. This should be followed by thrombectomy under cardiopulmonary bypass, even in the elderly.

The surgical results of 9 patients (group II) who were treated for thoracoabdominal aneurysm using left heart bypass combined with oxygenation were compared to those of 16 patients (group I) using left heart bypass without oxygenation. The left heart bypass time in group II was longer than that in group I, and the operations performed in group II were more extensive with more intercostal and lumbar arteries being reconstructed than those in group I. Nevertheless, bleeding associated with transfusion was less in group II than in group I. Intraoperatively, hypothermia and hypoxemia developed in 44% and 31%, respectively of group I, whereas neither of these conditions occurred in group II. There were three operative deaths in group I, compared with one in group II. Paraplegia was encountered in one patient of group I, but in none of the patients in group II. There were a few patients with respiratory failure or other organ failures in both groups. Our results showed that left heart bypass combined with oxygenation offered more stable and effective respiratory as well as circulatory support for a long duration compared to conventional left heart bypass without oxygenation in the surgical treatment of thoracoabdominal aortic aneurysm.

Forty-four cases of ruptured abdominal aortic aneurysm were treated between January 1980 and December 1995. We classified the cases into three groups: Group I, 1980-1984; Group II, 1985-1989; and Group III, 1990-1995 and evaluated the surgical results, the preoperative states, the bleeding and blood transfusion volume and so on. The surgical results have improved every year and there were no surgical deaths during the past seven years. Most of the causes of previous surgical deaths were DIC (4 cases) and renal failure (3 cases). The volume of intraoperative bleeding was 7227.3±3293.4ml in Group I, 4176.0±2577.9ml in Group II and 1781.9±1877.0ml in Group III. The volume of intraoperative blood transfusion was 6975.5±2711.6ml in Group I, 4826.7±2596.6ml in Group II and 3542.4±1561.5ml in Group III. We decreased the volume of intraoperative blood transfusion significantly in Group III by using a Cell Saver. The surgical results have improved significantly due to the decrease of bleeding and blood transfusion under the rapid control of bleeding and the autotransfusion of shed blood using the Cell Saver. The technique of postoperative care also contributed to the more satisfactory results.