A 75-year-old man was admitted with symptoms of unstable angina pectoris. The patient was initially treated with ticlopidine and aspirin after first undergoing percutaneous coronary intervention (PCI) by means of a drug eluting stent (DES). Coronary angiography thereafter showed re-stenosis in left main trunk and two-vessel disease. As a result, emergency off-pump coronary artery bypass grafting (OPCAB) was therefore performed. However, major bleeding (3, 245ml) occurred after OPCAB. Therefore, a re-thoracotomy operation had to be performed to stop the bleeding. Based on the above findings it is important for surgeons to keep in mind that pre-operative ticlopidine administration can increase the risk of re-operation for hemostasis, while also potentially increasing and the requirements for blood and blood product transfusion both during and after OPCAB surgery.

The main objective of this study was to describe the long-term results of left internal thoracic artery grafting of the left anterior descending artery with a sternotomy or anterior minithoracotomy without using extracorporeal circulation. From March 1997 to February 2000, a median sternotomy was performed in 8 patients and a minithoracotomy in 22 patients. We compared and analyzed the findings of these groups. An emergency operation was performed in 75% of the patients in the median sternotomy group and in 27.3% of those in the minithoracotomy group (p=0.03). The operation time was 2.1h in the median sternotomy group and 3.9h in the minithoracotomy group (p<0.01). The early graft patency rate was 100% in the median sternotomy group and 90.4% in the minithoracotomy group (NS). The five-year actuarial survival rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. The five-year cardiac event free rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. In conclusion, the results for the median sternotomy group were comparatively better than for minithoracotomy group. Minithoracotomy and median sternotomy have differences in operation time, early graft patency and early outcome. The median sternotomy technique therefore remains an invaluable operative modality for the treatment of one-vessel disease.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

This paper reports the findings of off-pump coronary artery bypass grafting (OPCAB) for a 56-year-old man who had undergone a renal transplantation. Coronary angiography (CAG) revealed triple-vessel coronary disease. OPCAB was therefore performed. The patient was discharged 20 days after surgery without any subsequent rejection, infection or renal dysfunction. At two years after the operation the patient is doing well without any cardiac events. Cardiac disease, especially coronary artery disease is a common cause of death in renal transplant patients. Cardiac surgery in renal transplant patients is expected to increase. OPCAB for renal transplant patients with ischemic heart disease is therefore expected to reduce the incidence of myocardial infarction, thereby prolonging patient survival.

A 72-year-old man was admitted to a local hospital with symptoms of unstable angina pectoris. He was given Clopidogrel for acute coronary syndrome. Coronary angiography showed left main trunk and three-vessel disease. He was then admitted to our hospital due to a sudden onset of unstable angina following shock during the PCI procedure. We performed emergency off-pump coronary artery bypass grafting (OPCAB). He received 10 mg/kg/h tranexamic acid during the operation. He also received 2,000 U ascorbic acid at the start of surgery and 2,000 U after undergoing anastomoses of the coronary artery. Postoperatively, only some minor bleeding was observed. Tranexamic acid and Ascorbic acid reduce bleeding, and transfusion requirements of packed red blood cells, platelets, and the total blood units in patients on Clopidogrel who undergo emergency OPCAB.

A 58-year-old man with diabetic nephropathy had been on hemodialysis for 15 years. He had lost his left leg below the knee and whole right leg due to atherosclerotic necrosis. During the past 3 years, his cardiac function had also gradually deteriorated. For the past 2 years, echocardiography showed progressively worsening mitral valve regurgitation. Coronary angiography showed severe stenosis in the left main trunk and left descending artery. Ischemic cardiomyopathy with mitral regurgitation were diagnosed. He underwent coronary artery bypass grafting and mitral valve annuloplasty. Because of difficulty in weaning him from cardiopulmonary bypass, he required intra-aortic balloon-pump (IABP) support. An IABP was inserted through the ascending aorta via a tube graft. It was removed on the 4th postoperative day with a small skin incision, under local anesthesia. The postoperative course was uneventful. This IABP insertion technique was useful for a patient with severe arteriosclerotic disease.