Femoropopliteal bypass (FP bypass) with woven Dacron grafts was performed in 159 legs of 122 patients from November 1980 to June 1993. The operative mortality rate was 0.8%. Actuarial analysis at 10 years for overall patency of FP bypass was 75.1% (mean follow-up 45.1 months). Both univariate and multivariate analysis revealed three risk factors affecting long-term patency; poor run off, difficulty in anticoagulation therapy and high serum cholesterol. The 5-year patency rate with these factors were 55.8% (p<0.01), 61.7% (p<0.01) and 63.9% (p<0.05), relatively. Therefore we recommend early surgical treatment, and strict control of anticoagulation and adequate treatment of hyperlipidemia are of great importance.

We treated 162 patients by isolated CABG with a left internal thoracic artery (LITA) anastomosed to the left anterior descending artery and a radial artery anastomosed to the circumflex artery between August 1996 and December 2002. Late angiograms were performed 6 to 65 months (21.7±15.8) after the operation. The purpose of this study was to compare midterm results of radial arteries anastomosed to the side wall of LITA (group Y) with those anastomosed to the aorta (group AC). There were no operative deaths in either group and no difference in the postoperative complication rate including cerebral infarction. The early patency of group Y was lower than that of group AC (group AC: 97.8%, group Y: 87.1%, p=0.017), and also the late patency of group Y was significantly lower than that of group AC (group AC: 90.9%, group Y: 36.4%, p=0.0008). All of the early patent radial artery grafts in group AC were patent on late angiograms, but 3 of the 25 anastomoses in group Y which were clearly patent on early angiograms later showed a string sign later. When using a radial artery graft in circumflex artery territory, we recommend an aorto-coronary bypass graft rather than Y-graft.

An 82-year-old man was referred to our hospital because of fever and disequilibrium. Brain magnetic resonance imaging showed acute multiple cerebral infarctions with multiple small intracerebral hemorrhages. The laboratory tests revealed an elevated inflammatory response, and two separate sets of blood cultures were positive for Streptococcus oralis. Transesophageal echocardiography revealed a single site of vegetation (13×11 mm) of the mitral anterior annulus. The vegetation apparently did not involve the intervalvular fibrous body. Moderate mitral regurgitation and mild to moderate aortic regurgitation were detected. Early surgical intervention was considered, but there was a high risk of operative mortality. We thus initially performed only medical treatment. Transesophageal echocardiography was again performed 12 days after his admission and revealed vegetation of the mitral anterior annulus progressing to the aortic annulus via the intervalvular fibrous body. It seemed to be difficult to control this progressive infective endocarditis with medical treatment. We therefore performed a semi-urgent operation. With an incision into the right-side left atrium, we identified the vegetation of the center of the mitral anterior leaflet progressing to the mitral anterior annulus. Subsequently, we added an aortotomy with Manouguian’s incision. We were able to remove all vegetation that was present in the aortic annulus, intervalvular fibrous body, and mitral annulus with a Commando operation. Finally, we performed double valve replacement with reconstruction of the intervalvular fibrous body and other lost cardiac structures using one boat-shaped bovine pericardial patch. He was discharged to home 34 days after surgery with no neurological complications and no recurrence of infective endocarditis. He also had no recurrence of infective endocarditis and no paravalvular leakage on either prosthetic valve at one year after the surgery.