For aortic root replacement in annuloaortic ectasia (AAE), an artificial prosthesis is commonly sutured to the aortic annuls (hemodynamic ventriculoaortic junction). In this case report, suturing was conducted using the anatomic ventriculoaortic junction along with full-thickness-suturing. The first case was a 28-year-old man and the second, his 31-year-old brother. The former showed AAE (maximum diameter, 120mm) with 4°AR and the latter, AAE (maximum diameter, 54mm) without AR. The present method is simple due to the flat suture line and is quite reliable owing to full-thickness-suturing.

A 65-year-old woman presented with coughing and dyspnea. Giant left atrial myxoma was found by echocardiography. The tumor size was 7×5×4cm and its weight was 70g. The biatrial approach was chosen over left atriotomy or the transseptal approach. However, it may not be possible to decide on the correct incision line in cases of giant tumor. Intraoperative trans-esophageal echocardiogaphy was useful for evaluation of the mitral valve.

The patient was an 83-year-old man. He had pyloric stenosis due to Borrmann type III gastric cancer. He also had an abdominal aortic aneurysm 7cm in length. We performed gastrectomy and Y graft replacement simultaneously. His postoperative course was good. We discussed the operative indications and operative method, especially with regard to simultaneous operation.

Preoperative and postoperative evaluation was conducted on 25 patients (33 lesions) with arteriosclerosis obliterans (ASO) by three-dimensional CT angiography (3D-CTA) and intraarterial digital subtraction angiography (IA-DSA). The usefulness and problems of 3D-CTA for diagnosis of ASO were studied. Both methods had equal ability to detect lesions in the area of the iliac artery and the femoral artery. Totally occlusive lesions were accurately diagnosed by 3D-CTA, but diagnosis of stenotic lesions was much less accurate. To confirm blood flow following vascular reconstruction 3D-CTA was useful and IA-DSA was not required. 3D-CTA images can be obtained from desired directions and clearly detect calcification and blood clots with little health risk involved. They are useful for the diagnosis of ASO.

Conventional CT and three-dimensional CT angiography (3D-CTA) were conducted after peripheral arterial bypass surgery on 17 patients (26 grafts) from October, 1994 to April, 1996. Seventeen grafts were patent. The following objectives were satisfied in these cases: 1. Prosthetic graft or saphenous vein was depicted by 3D-CTA, 2. The distal portion of the native artery was depicted by 3D-CTA, and 3. Opacification of the graft interior was recognized by transverse section of CT. Nine grafts were occluded but prosthetic grafts were depicted in 5 cases, and prosthetic grafts and the distal portions of native arteries in 3 cases. Opacification of the graft interior was not seen in any case. Achievement of the above three objectives was considered necessary to determine graft patency.

A comparison was made of the three-dimensional CT angiography (3D-CTA) images of four grafts (IMPRA, Bionit, GELSOFT, and saphenous vein). All patent grafts were visualized by 3D-CTA, and opacification of the graft interior was noted in all cases on transverse sections of CT. Occluded GELSOFT and saphenous vein grafts could not be visualized by 3D-CTA. In spite of occlusion, IMPRA and Bionit were visualized by 3D-CTA. However, opacification of the graft interior could not be noted on transverse sections of CT. Confirmation should be made of the following: 1. distal portion of native artery shown on 3D-CTA, 2. recognition of opacification (high density) of graft interior on transverse sections of CT. When the CT threshold changed, occluded IMPRA and Bionit showed spotty images. This phenomenon should facilitate accurate diagnosis.

A 62-year-old man was diagnosed as having atrial septal defect (ASD) and atrial fibrillation (Af) upon admission to our hospital with acute myocardial infarction. He was placed on medication for 3 years but surgery was considered necessary because of the further complication of angina pectoris. Coronary arterial bypass grafting, ASD closure and right atrial separation procedure which was a modification of the right-sided maze operation, were performed simultaneously. Although chronic Af disappeared immediately after surgery, it reappeared on the 8th postoperative day, and medicinal and electrical defibrillation had no effect. We considered that the main cause of Af accompanied by ASD had existed in the right atrium before surgery. Also, as the right atrial separation procedure was less invasive than the Cox/maze procedure for such complications in patients with ischemic heart disease, we chose this method. In our patient, postoperative left ventricular loading was considered to have been the cause of Af recurrence. Therefore the indications for this procedure should be decided carefully in patients with preoperative left ventricular hypofunction or left atrial dilatation.

The patient was a 71-year-old man with intermittent claudication. Angiography indicated severe stenosis of the right common iliac artery. The right femoral artery was anastomosed to an artificial graft by conventional hand-sewn suturing and the left femoral artery by the Vascular Closure Staples (VCS). Postoperatively, the patient had an uneventful recovery and was discharged. This new procedure minimizes trauma to the vascular intima since the arcuate legged clip is non-penetrating. Suturing with VCS is more extensive than by the conventional method. VCS has been applied by the authors to treat arteriosclerosis obliterans lesions.

The present study was performed to investigate heart rate responses and occurrence of arrhythmias caused by various diving maneuvers and swimming in infants. Forty four healthy infants (mean age 2.5±1.1, mean ±SD) served on this study. Condition of telemetry electrocardiograph recording was 1) rest on the land and in the water, 2) diving, 3) swimming and 4) “pass in water (PW) ”. Moreover, diving styles was classified for five patterns by presence of body movement or expiration (Apneic not move diving, Expiratory not move diving, Apneic kick diving. Expiratory kick diving and Underwater swimming) . “Diving bradycardia” was observed during diving and PW, and the magnitude of heart rate reduction was grater in diving without body movement than diving combined with body movement. Presence of expiration did not influence on the level of bradycardia during diving. Any kinds of arrythmias was observed 13 out of 44 subjects. In premature contractions, supraventricular premature contraction (SVPC, 7 subjects) was observed more often than ventricu-lar premature contraction (PVC, 3 subjects) . Another arrhythmias observed was atrioventricular junctional rhythm (AVJR, 1 subject), atrioventricular junctional escaped beat (AVJEB, 3 subjects) and wandering pacemaker (1 subject) . The danger arrhythmias which is necessary to restrict on exercise or swimming was not observed in this study.

In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.