Fourteen cases (ranged 4 days to 5 months old, mean=40 days old) of coarctation of thoracic aorta underwent subclavian flap aortoplasty were between Jan. 1986 and Dec. 1990. Early postoperative course in these patients was reviewed retrospectively. In 9 cases of these patients, complex intracardiac anormalies co-existed (VSD in 7, ECD in one, single ventricle with MA in one). Preoperative pressure gradients between upper and lower extremities were 40±7mmHg and the gradients were significantly reduced after the repair of coarctation (8±4mmHg). Serum creatinine phosphokinase (CPK) increased postoperatively reaching peak levels by day 3 (12, 315 ±8, 462IU/l) and then gradually decreased. Gultamic oxaloacetic transaminase (GOT), glutamicpyruvic transanmiase (GPT), serum urea nitrogen (BUN) and serum creatinine (S-Cr) also increased postoperatively. When patients were divided into two group following the maximum CPK levels (group A: >4, 000; group B: <4, 000IU/l), the duration of mechanical ventilation (A: 117±21; B: 20±9hr), max. S-Cr levels (A: 2.16±0.64; B: 0.47±0.13mg/dl) and max. GPT (A: 323±127; B: 58±24IU/l) were significantly increased in group A. There was no significant correlation between these factors and postsurgical residual pressure gradients. An increase in these factors did not depend on the operation time, age, body weight and additional surgical procedures such as pulmonary arterial banding. These data suggest that the transient unbalanced blood distribution might exist even under no pressure gradients between upper and lower extremities. This might be important in the management of postoperative patients after repair of coarctation.

There were 10 patients of left ventricular free wall rupture accompanied with acute myocardial infarction in our coronary care unit from Jan. 1987 to Jan. 1991, while 872 AMI patients in the same period. Five of 10 ruptured patients died. All these 5 patients were acute type of rupture. Elder patient, female, 1st attack of infarction and PTCA were considered to be risk factors of rupture. We managed 5 subacute and chronic type ruptured patients successfully at emergent operation with using fibringlue-oxycellulose. Fibringlue-oxycellulose method was useful especially for woozing from infarcted myocardium. The management for acute type rupture is difficult because of its clinical time course, it is considered that prevention of rupture for high risk patient is most important to reduce the mortality of AMI patients in the coronary care unit.

We report a very rare case of annuloaortic ectasia with an etiology of both aortitis syndrome and Marfan's syndrome. A 25-year-old woman showed AAE and AR. Her mother had died of SLE, but there was no Marfan's syndrome in her family. Her eyes were normal but her finger was long enough to show wrist sign and thumb sign. Urgent operation was performed because of her progressive heart failure. The ascending aorta was enlarged and Valsalva sinuses showed asymmetrical dilatation. The Cabrol operation was done with a composite graft of 23mm Medtronic Hall valve and 26mm Gelseal graft. The valve was sutured to the graft for 5mm from the end of graft to minimize the tension for annulus because of the high invidence of valve detachment and leakage in aortitis syndrome. Pathological study showed findings of both aortitis syndrome and Marfan's syndrome. Postoperative aortography showed good valvular function, and the patient is doing well now at 6 months after operation.

Between 1996 to 2000, 12 patients with arteriosclerotic thoracic aortic aneurysm underwent surgery with cardiopulmonary bypass using the right axillary artery as an arterial inflow. All patients received total arch replacement with selective cerebral perfusion and deep hypothermic circulatory arrest. One patient with occlusion of the left carotid artery died of postoperative stroke. There were no postoperative complications or deaths related to axillary artery perfusion except for cerebrovascular accidents. Perfusion through the axillary artery, providing antegrade aortic flow, is a safe and effective procedure to avoid stroke owing to retrograde arterial perfusion. We believe that the axillary artery could be an alternative to conventional femoral artery cannulation in the setting of aortic arch operations.