Five infants underwent intracardiac repair of truncus arteriosus (TrA) from June, 1993 through May, 1998. The patients weighed 2.4 to 5.71kg (mean 3.47) and their ages at operation ranged from 6 to 133 days (mean 38.2). The anatomical type of TrA was type I (Collet & Edwards classification) in all cases. We employed the Barbero-Marcial procedure for 4 infants and truncal valve replacement using a homograft for one in whom moderate truncal valve regurgitation (TrVR) and severe stenosis was detected by preoperative echocardiography. There was one operative death in an infants who presented with cardiogenic shock and moderate TrVR on admission. No patients in whom preoperative echocardiographic study showed less than mild TrVR died after surgery. Close observation after surgery is necessary because aggravation of TrVR may occur on a long-term basis.

When homo- or isograft was used as a right ventricle-pulmonary artery bypass in the Rastellitype procedure for congenital heart disease, reoperation was mandatory due to calcification and conduit stenosis after several years. However, the survival period of intimal cells or smooth muscle cells has not been clarified, nor has the question of whether the calcification is due to an immunoreaction or not. Thus, to observe the geometrical or pathological changes of the grafts, an experimental model of homograft transplantation was established using rats' aorta, where cyclosporine A (CsA) was given after the transplantation. The rats used were 8 or 9 weeks old. Male King rats were the donors, and female Lewis rats were the recipients. The descending thoracic aorta was transplanted to the infra-renal abdominal aorta. There were 2 experimental groups; one in which CsA was not given (n=35), and the other in which CsA was given (n=44). The animals were sacrificed at 1, 2, 4, 6, 8, and 12 weeks after the transplantation, and were examined by an optical microscope after slicing longitudinally. The area of the cross-section, intima and the media of the vessel were calculated by 2 ways; manually, and by computer. These data were used to calculate and analyze the percentage of intima-media area, the ratio of the intima/media area, and the percentage of intima area and media area. The effect of suppression of the percentage of intima-media area and the percentage of the intima area were revealed to be significant at an acute stage after brief high dose CsA administration. From this result, we suggest that there is a possibility of a rejective reaction participating in the intimal hyperplasia in the acute phase after homograft transplantation.

We report here a surgical case of sinus of Valsalva and right atrium fistula associated with acute infective endocarditis (AIE) without perivalvular abscess cavity or aneurysm of the sinus of Valsalva (ASV). A 51-year-old man, who had been given a diagnosis of rheumatic aortic stenosis and regurgitation (AsR) and mitral stenosis and regurgitation (MsR) and tricuspid regurgitation (TR) by echocardiography, had a high fever 2 months after removal of teeth and AIE was diagnosed. He was referred to our hospital because sinus of Valsalva and right atrium fistula were detected by echocardiography and congestive heart failure (CHF) deteriorated during medical treatment. Perivalvular abscess cavity and ASV were not detected by preoperative echocardiography. Medical treatment was continued after admission, and operation was done after amelioration of the CHF and infection were recognized. The aortic valve was removed together with vegetation, two areas of the aortic wall in which the tissue was fragile were cauterized by electrocautery, patch closure at the sinus of Valsalva was performed using a partial of e-PTFE graft and aortic valve replacement (AVR) and mitral valve replacement (MVR) were done. Though residual aortic-right atrium shunt was detected after the operation, the postoperative course was good with no CHF or signs of infection.