A 2-day-old male baby was referred to our hospital because of a heart murmur. We diagnosed as a right cervical aortic arch, and coarctation between the right carotid and right subclavian artery. On echocardiography, the velocity at the coarctation was 1.8 m/s, the left ventricular ejection fraction (LVEF) was 53%, and he was asymptomatic during the neonatal period. A chromosome examination showed a deletion of 22q11 syndrome. At 1 month, he weighted 3.8 kg and was readmitted to our hospital for wheezing. Echocardiography showed a left ventricular dysfunction with LVEF of 24%. The coarctation velocity increased to 5.1 m/s. An urgent operation was performed because of a severely depressed cardiac function. His LVEF increased to 67%, and the velocity was less than 1 m/s postoperatively, and he was discharged on postoperative day 32. We report a rare neonatal surgical case of a right cervical arch with a coarctation.

A 1-year-old girl with patent ductus arteriosus (PDA) was admitted for cardiac catheter examination which identified a 7.8 mm Krichenko D type PDA. An Amplatzer duct occluder (ADO) was used but fluoroscopy showed the device at an oblique angle and residual shunt. The girl underwent surgical removal of the device 2 days after deployment because of progression of residual PDA shunt and left pulmonary artery encroachment, suggesting device dislodgement. Median sternotomy was performed, cardiopulmonary bypass was established and dissection was carried out around the PDA. Marked protrusion of the PDA wall made by the ADO retention disc was noted. The main pulmonary artery was incised under cardioplegic arrest. The device was incarcerated in PDA and attempts to remove the device failed. Therefore delivery cable through sheath was reconnected to the device by its microscrew, and the pulmonary end of the device was recaptured into sheath. The incarceration was dissolved and the device was removed. PDA was ligated.

We surgically treated a case of anomalous origin of the left coronary artery from the pulmonary artery with the specific route of the left coronary artery in a 17-month-old boy. He had suffered persistent cough and poor weight gain since the age of 4 months. An ultrasound cardiography, at the age of 16 months, revealed retrograde blood flow of the left coronary artery into the main pulmonary artery. Moreover, a chest computed tomography showed an anomalous left coronary artery arising from the bifurcation of the right pulmonary artery and winding in contact on the posterior aortic wall. Though the anomalous left coronary artery shared adventitia with the aortic wall we were able to separate the coronary artery from the aorta, and the patient underwent direct transplantation of the left coronary artery. The postoperative course was uneventful and recovery was rapid.

Fourteen patients (mean age 17.2 years, range 2 to 39 years) undergoing right ventricular outflow tract reconstruction for a Ross operation were studied between 1998 and 2000. Ten of 14 patients underwent Ross procedures and 4 received Ross-Konno procedures. Echocardiographic examination of the pulmonary homograf t was performed after surgery. The mean follow-up period was 23.1 months, ranging from 14 to 33 months. Mean peak velocity and peak gradient were 1.6±0.4m/s and 11.9±5.2mmHg, respectively. Three patients in whom echocardiography revealed a peak pulmonary gradient of 20mmHg or more were retrospectively analyzed with each catheterization data. All patients had no more than 10mmHg at the distal end of the homograft with no evidence of deformity or shrinkage. Only one patient had a trivial homograft valve regurgitation, however, no patient had more than mild pulmonary regurgitation. Patient age, donor age, and preservation period did not reveal any significant risk factor for homograft stenosis. Pulmonary homograft appears to be an excellent substitute for right ventricular outflow tract reconstruction during the mid-term postoperative period.

Several problems have been reported following coarctectomy, especially in cases involving long-segment coarctation (COA). Although residual COA, proximal arch kinking, and airway compression may occur after coarctectomy, avoiding the use of artificial materials provides a better chance for the subsequent growth of the aorta. We successfully performed a modified end-to-end anastomosis with subclavian flap aortoplasty for a two-month-old boy with COA. A two-month-old boy was admitted to our hospital for nocturnal tachypnea and a feeding disorder. The initial echocardiography showed a preductal long COA beyond the left subclavian artery. A perimembranous VSD, a patent foramen ovale, and a patent ductus arteriosus were also noted. The left ventricular function was mildly depressed with an ejection fraction of 59%. Enhanced CT revealed a long-segment COA with a length of 15 mm. The blood pressure gradient between the upper and lower limbs was 40 mmHg. The operation was performed at the age of 2 months. The 4th intercostal space was opened through a posterolateral left thoracotomy incision. The distal end of the isthmus was so ligated as to maintain blood perfusion to the lower body through the PDA. The arch was clamped between the left carotid and the left subclavian artery (LSCA). The LSCA and the isthmus were divided as distally as possible, and the two distal ends were longitudinally incised and sutured to each other in a side-to-side fashion using a 7-0 polypropylene continuous suture. After complete resection of the ductal tissue, a newly created distal arch was anastomosed to the descending aorta. The left ventricular ejection fraction was increased to 74% at discharge. Catheterizations 3 years after the surgery did not reveal any stenosis or deformity in the aorta at normal PA pressure. The patient has been doing well and is free of complications 7 years after the surgery. At present, end-to-end anastomosis and aortic arch advancement with or without cardiopulmonary bypass are widely used procedures for coarctectomy ; however, a modified end-to-end anastomosis is still a viable option for cases involving long-segment coarctation.

A neonate, presenting with cyanosis, received the diagnosis of persistent truncus arteriosus with truncal valve stenosis with insufficiency. Her disease was classified as persistent truncus arteriosus Van Praagh type A1, or Collett and Edwards type I. At the age of 2 months, she underwent a modified Blalock-Taussig shunt, and her operative team was waiting for adequate body weight gain before performing further surgery. At the age of 1 year, however, she began to have repeated episodes of congestive heart failure due to severe tricuspid valve regurgitation and truncal valve insufficiency. When she reached 18 months of age, she underwent a definitive operation including a truncal valve plasty, VSD patch closure, and a right ventricular outflow tract reconstruction. Postoperative echocardiography 6 months after surgery showed a good truncal valve function with minimal regurgitaion. Truncal valve surgery is a challenging operation ; we report a successfully treated case, though the patient will require extensive follow-up.

An epidemiological survey on allergic conditions of 58 male (aged 38.6±11.8yrs) and 47 female (aged 42.2 ± 9.6yrs) farmers engaged in growing chrysanthemums.
Among the subjects, 47% of males and 62% of females had complaints of at least one of inquired allergic symptoms associated with the work. The immediate type of allergic reaction on nasal and/ or upper respiratory system raised in the process of sorting flowers in the working room and delayed ype of contact dermatitis in pinching the lateral bud of chrysanthemums or spraying agricultural chemicals in the field were the main complaints of those farmers.
Incidence of positive reaction for patch testing to six kinds of chrysanthemums was 5% for males and 17% for females and that of eight kinds at agricultural chemicals was 34% and 45% for each sex. And relatively high incidence was also observed in those subjects from other immunological tests such as determination of serum immunoglobulin, prick testing and calculation of eosinophil in blood and rhinorrhoea.
There were 39 (67%) males and 36 (77%) females who had at least one of the abnormal finding of those test items above mentioned. However, not the particular kind of Chrysanthemum cultivated in that area was found to be strong causative allergen for the observed allergic conditions.
From these results, it is indicated that relatively high incidence of allergic disorders may be found in the chrysanthemum growers due to inhalation and/or contact of some kinds of allergens introduced from the process of growing to forwarding, such allergen as Chrysanthemum itself, agricultural chemicals and other elements.

A 3-year-old girl was given a diagnosis of coronary arteriovenous fistula associated with a single right coronary artery on cardiac catheterization. The left coronary artery arose from the proximal part of the right coronary artery. The dilated left coronary artery ran in front of the right ventricular outflow tract and then divided into the left anterior descending branch and the left circumflex artery. A coronary arteriovenous fistula was in the left main coronary artery and opened into the right ventricular outflow tract. Under cardiopulmonary bypass and cardiac arrest, a transverse incision was made at the right ventricular outflow tract 1cm below the dilated vessel and the 5-mm oval-shaped orifice of the fistula was identified. This fistula was closed with a pledgetted mattress suture reinforced with over-and-over suture. Catheterization 8 months after surgery demonstrated no residual shunt and she has been doing well.

Renal damage caused by hemolysis during cardiopulmonary bypass (CPB) was investigated, and the preventive effects of haptoglobin in regard to this condition was also evaluated. Nineteen patients who underwent open heart surgery were divided into two groups: a control group (n=11) and a haptoglobin group (n=8). In the control group, the level of plasma-free hemoglobin increased significantly after CPB (p<0.01), and this level was strongly correlated with renal tubular leaking enzymes: NAG (r=0.76) and γ-GTP (r=0.81), in the Intensive Care Unit or on the first day after surgery. On the contrary, in the haptoglobin group, in which 4, 000 units of haptoglobin was added in the priming solution of CPB, no increased level of plasma free hemoglobin was observed. Furthermore, leak age of renal tubular enzymes were statistically less (p<0.05). It was concluded that free hemoglobin was a cause of renal damage during CPB and the damage was preventable by the administration of haptoglobin.