A 73-year-old man who underwent redo aortic valve replacement due to dysfunction of tissue heart valve developed hypoxemia with bilateral infiltrates on frontal chest radiograph and hypotension shortly after his operation. Due to the presence of progressive hypotension and hypoxemia, we inserted an intra-aortic balloon pump and, furthermore, provided percutaneous cardiopulmonary support. We ruled out cardiogenic pulmonary edema based on information from various examinations, including echocardiography, and subsequently diagnosed possible transfusion-related acute lung injury (possible TRALI). The patient was treated by mechanical ventilation and circulatory support under close supervision, showing a trend of improvement from postoperative day 2 and discontinuing mechanical ventilation on postoperative day 11. The patient made an uneventful recovery and was discharged on postoperative day 50. Cardiac surgery patients are at particular risk for TRALI, so physicians should consider TRALI whenever a patient develops hypoxemia during or shortly after transfusion. Rapid diagnosis and appropriate treatment of TRALI are especially important in cardiac surgery patients.

We present the case of a 53-year-old man who developed delayed-onset paraplegia after type A dissection repair. He was referred to our hospital with a diagnosis of type A dissection, for which we performed total arch replacement. Although the patient started walking on postoperative day 4, on postoperative day 5, he developed lower limb paraplegia without any precipitating episodes. Computed tomography showed that the false lumen was thrombosed in the upper descending thoracic aorta and hypoperfused in the lower descending thoracic aorta. The cerebrospinal fluid was immediately drained to maintain the spinal pressure at 14 cm H₂O for four days. Although the patient began to move his legs immediately after treatment, he remained paraparetic, and was transferred to another rehabilitation hospital on postoperative day 40.

For A 38-year-old male diagnosed a congenital complete atrioventricular block in the neonatal period, epicardial lead and pacemaker was implanted through left thoracotomy. Although we tried to implant a pacemaker through the subclavian vein as an adult, it was unsuccessful because of obstruction of the bilateral subclavian vein. For this reason, we performed a pacemaker implantation with transatrial-endocardial lead through the right thoracotomy due to save the generator electric power. This is one of the useful techniques for cases with obstruction of the upper extremity vein.

Infectious endocarditis associated with Streptococcus bovis, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the S. bovis-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. S. bovis was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

There are few reports on the long term efficacy of surgery for endocardial cushion defect (ECD) in elderly patients. We report a case with a successful course after ECD operation. A 70-year-old man was admitted with incomplete ECD, grade III mitral and tricuspid regurgitation, pulmonary hypertension and atrial fibrillation. The operative procedures included direct closure of the mitral cleft, pericardial patch closure for the ostium primum defect, direct closure of the tricuspid cleft and tricuspid annuloplasty. Pulmonary hypertension was improved after the operation, and he was discharged on the 41st day after the operation. Now, 3 years and 6 months after the operation, he has maintained an improved quality of life (QOL) with an uneventful postoperative course. The present report may suggest one solution for the long term effective treatment by operation for elderly patients who suffer from ECD, especially to achieve better QOL.

Infectious endocarditis associated with Streptococcus bovis, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the S. bovis-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. S. bovis was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

Twenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB₂ (stable metabolite of thromboxane A₂), and 6-keto-PGF₁ (stable metabolite of PGI₂) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB₂ level, and TXB₂/6-keto-PGF₁ ratio showed a tendensy to decrease (p<0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB₂ level, and TXB₂/6-keto-PGF₁ ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.

A 58-year-old man underwent renal transplantation 26 years previously and had been treated with immunosuppressive drugs. He presented at the local hospital with backache symptoms during the waiting period prior to repair of an abdominal aortic aneurysm. Computed tomography revealed a retroperitoneal hematoma around the abdominal aortic aneurysm. He was admitted to our hospital and emergency straight graft replacement was performed. After clamping of the aorta, we performed axillo-common iliac perfusion to protect the transplanted kidney. The patient recovered without transplanted kidney dysfunction.