We reported a successfully operated case of ruptured coronary artery aneurysm which resulted from a coronary artery fistula. A 70-year-old woman who had been treated for hypertension developed syncope and profound shock. Echocardiography and chest CT-scan suggested the presence of cardiac tamponade. An emergency operation was done. An aneurysm was seen at the left side of the right heart outflow and pulmonary artery, on the proximal left anterior descending coronary artery. Closure of the orifice of the inflow and the outflow vessels of the aneurysm, and aneurysmorraphy was performed under cardiopulmonary bypass. Serpentine small arteries were found around the aneurysm and were simply ligated by mattress sutures. The postoperative course was uneventful, and coronary angiographic study demonstrated normal coronary distribution.

We encountered an instructive case of anterolateral papillary muscle rupture after acute myocardial infarction. A 73-year-old woman with rapidly progressive dyspnea came to our emergency room. Her symptoms associated with acute heart failure rapidly worsened. We diagnosed anterolateral papillary muscle rupture after acute myocardial infarction due to occlusion of the first diagonal branch, based on transesophageal echocardiogram and coronary angiography. We immediately performed mitral valve replacement and coronary artery bypass grafting (CABG) to the diagonal branch. Although she required postoperative intraaortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS), she eventually recovered. Mitral papillary muscle rupture causes rapidly deteriorating hemodynamics and requires surgical treatment. Because of a serious complication of myocardial infarction, this case emphasizes that early diagnosis and aggressive treatment are required for mitral papillary muscle rupture.

We report a case of mitral regurgitation due to an atypical variant of Fabry disease. A 60-year-old man was admitted to our hospital. He had a history of myocardial infarction and heart failure, and was repeatedly admitted for worsening heart failure (NYHA class II to III). A follow-up echocardiogram revealed deteriorating dilated cardiomyopathy and mitral regurgitation. We performed valvuloplasty for mitral regurgitation. Cardiomyopathy was suspected during the operation and myocardial biopsy was performed. We diagnosed Fabry disease by histopathological findings. After the operation, his heart failure temporarily improved. Heart failure worsened 4 months later. He died of heart failure a year later from the operation. Fabry disease (α-galactosidase-A deficiency) is an inherited metabolic disease. In Fabry disease, angina, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, and mitral regurgitation are common cardiac manifestations. Recently, an atypical variant of Fabry disease, with manifestations limited to the heart, has been increasingly reported. This case suggested that we might encounter Fabry disease with only cardiac manifestations such as cardiomyopathy and valvular disease in routine clinical work.

A 33-year-old man presented with respiratory distress and lower leg edema in April 2006. Atrial septal defect (ASD), complicated with moderate mitral regurgitation (MR), advanced tricuspid regurgitation (TR) and pulmonary hypertension (95/32mmHg), was diagnosed. Qp/Qs was 6.3 and L-R shunt ratio was 84.4%. An “edge-to-edge” mitral valve plasty for MR complication as well as closure of the septal defect and tricuspid annuloplasty was performed, and a good result was obtained. It is known that ASD has a tendency to be accompanied by MR, and the strategy for treatment course for MR is debatable. The mitral lesions of MR complicating ASD are often seen in the posteromedial side of the anterior mitral leaflet, and usually many of the tendinous cords and valve leaflets are in the normal range in length. There have been reports on the mid-term results of edge-to-edge repair of mitral regurgitation due to degenerative lesions but the mid- and long-term results for MR complicating ASD, such as this case are unknown. We need to carefully observe the time course of this case.

The patient was a 58-year-old woman with untreated diabetes. She consulted a local doctor in May 2006 complaining of constipation that had persisted for 2 weeks, under gradually worsening abdominal pain. She was transferred to our hospital with a diagnosis of aortic aneurysm. Blood tests indicated high inflammatory response, and CT showed hematoma around the aorta from directly under the diaphragm to the level of superior mesenteric artery and influx of contrast medium into the hematoma. Control of the infection was first attempted with antibiotics, but eventually surgery was performed because the hematoma increased. The hematoma and aortic wall were completely excised from the local of the diaphragm to the level beneath the renal artery, with partial cardiopulmonary bypass and selective perfusion to abdominal branches, and anatomic reconstruction was performed with a synthetic graft and omental implantation. The hematoma was fetid and Citrobacter koseri was detected in culture. The patient was discharged after 4 weeks of antibiotic treatment, without complications and with satisfactory progress. At present, there has been no recurrence of infection in the 22 months since her discharge.

A 78-year-old woman who had had chest pain since 3 days previously, was given a diagnosis of acute myocardial infarction. Emergency coronary angiography revealed mid-left anterior descending artery and proximal right coronary artery lesions. Percutaneous coronary intervention was performed, and re-perfusion was successful. Cardiac tamponade was then diagnosed. Despite pericardial drainage, she remained in shock. After an intra-aortic balloon pump was established, an emergency operation was performed. On the operating table, her pulse disappeared. When thoracotomy was performed, a viscous hematoma was found in the pericardium. We found 3 ruptures in the left ventricular free wall, and hemorrhage. The diagnosis was a blow-out type left ventricular free wall rupture of the heart (LVFWR). We have used the patches-and-glue sutureless technique without cardiopulmonary support. This treatment for blow-type of LVFWR is rare.

A 66-year-old man was given a diagnosis of urinary-tract infection and hospitalized for 2 weeks in another hospital in late August 2009. In late October of that year he was transferred to our hospital by ambulance because he was unable to ingest anything orally. Echocardiography showed that a vegetation of about 10 mm in maximum dimension was attached to the aortic valve, causing severe aortic stenosis and regurgitation. The patient's general condition was poor, and sepsis and disseminated intravascular coagulation syndrome developed. The next day, an urgent operation was performed, and an abscess was observed occupying one-third of the aortic valve annulus. The abscess was completely excised and the abscess cavity was covered with an equine pericardium patch. We then performed aortic valve replacement using a bioprosthetic valve followed by tricuspid valve annuloplasty. Peptostreptococcus spp. was detected in a culture of the abscess. Infective endocarditis due to Peptostreptococcus spp. is rare. There has been no recurrence of infection for 7 months postoperatively.

A 52-year-old man with a 10-year history of severe diabetes was referred to our hospital with hemorrhage from a methicillin-resistant Staphylococcus aureus-infected femoral artery following the use of an arterial closure device (Prostar XL: Perclosure, Co., Ltd., Redwood, CA, USA). At surgery, the common femoral artery showed a circular area of disintegration, 9mm in diameter, due to massive infection. One month after femoral angioplasty with a saphenous vein patch, re-hemorrhage occurred as a result of uncontrollable infection. Next, an obturator foramen (OF) bypass was performed and the infected femoral artery was removed. Two months after OF bypass, the wound healed and the patient was well. We conclude that OF bypass is a satisfactory method of treatment for compromised patients with an infected femoral artery.

Left heart bypass was performed with Bio Medicus Co.-made Bio-pump, a representative centrifugal pump. A vinyl chloride tube for the usual cardio-pulmonary bypass not treated with antithrombogenic material. was used in the bypass circuit. In the experiment, the mongreal adult dogs were divided into the systemic heparinized group and non-heparinized group and the bypass was performed for 6 hours. As a result, coagulation and fibrinolysis were more activated in the non-heparinized group than the other group. So, when this method is used clinically, a small quantity of heparin should be administered. Clinically, this approach was used as an adjunct in operation for 7 cases of thoracic aortic aneurysm. During left heart bypass, a small quantity of heparin (0.5-1.0mg/kg) was administered. A rise in FPA and FDP considered attributable to autotransfusion during the operation was noted. Distal perfusion could be performed fully and the amount of bleeding during and after operation was small, but 1 case each of acute renal failure and paraplegia as postoperative complication was encountered. Neither was considered due to left heart bypass; and, changes in respiratory system and hepato-renal function were considered within the tolerable range. These results have led us to believe that left heart bypass using Bio-pump is safe and useful as an adjunct in operation for thoracic aortic aneurysm and should be used positively in the future.

A 24-year-old woman had been injured in an automobile accident. The chest X-ray showed widening of the mediastinum and computed tomography showed mediastinal hematoma around the aortic arch. Aortic rupture was suspected, so we performed aortography, which revealed pseudoaneurysm of the descending aorta. Moreover, she also had splenic rupture and pelvic fracture. She underwent an emergency operation 4 hours after the accident. Medial tear of the descending aorta was replaced with a graft under temporary bypass without heparin. Simultaneously, splenectomy was performed. Her postoperative course was uneventful. We consider that temporary bypass without heparin is a useful method during repair of the descending aortic rupture due to trauma.