We report an alternative way to preserve autologous blood with the aid of erythropoietin for a patient with anemia combined with irregular antibody who need the CABG operation. A 62-year-old woman was given a diagnosis of angina pectoris due to three-vessel coronary artery disease. All blood reserved for the coronary operation was incompatible on the crossmatch test and an irregular antibody was suspected. Antibody screening tests revealed anti-drug antibody and anti-P1 antibody. The operation was postponed because she had anemia. After 800ml of autologous blood was collected with administration of erythropoietin and iron for a month, the operation was performed. Two saphenous vein grafts were anastomosed to the left anterior descending artery and circumflex branch respectively. Total blood loss was 580g. Her postoperative course was uneventful and hemoglobin level was ranged from 7 to 10g/dl without any homologous blood transfusion.

A 70-year-old man with a diagnosis of unstable angina pectoris (UAP) and arteriosclerosis obliterans (ASO) was admitted to our hospital with chest pain and intermittent claudication of both lower extremities. Coronary artery bypass grafting (CABG) was performed prior to peripheral arterial reconstruction due to UAP. He was in good condition after CABG, but he had sharp pain in both lower extremities suddenly on the 2nd postoperative day and the creatinine phosphokinase level increased to 17, 560IU/l. On the 3rd postoperative day axillo-bifemoral bypass was performed. However 5 hours after the revascularization, respiratory arrest and ventricular fibrillation occurred and he died in spite of attempted cardiopulmonary resuscitation.

We report a 69-year-old woman with transient mitral valve regurgitation and hemolysis following mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis. She had a history of congestive heart failure caused by mitral valve regurgitation so we performed mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis (Model 6900). Three days after surgery, a systolic murmur became clearly audible and the serum LDH level reached a maximum of 2, 018IU/l on postoperative day 10. Echocardiography showed regurgitant flow through the center of the bioprosthetic valve. It was thought that stent distortion of the implanted pericardial bioprosthesis had occurred and re-operation would be necessary, but the regurgitant flow disappeared suddenly on postoperative day 12. If mitral valve regurgitation occurs following mitral valve replacement with a pericardial bioprosthesis, stent distortion should be taken into consideration.

From 1985 through 1994, 12 consecutive patients with Taussig-Bing anomaly underwent an arterial switch. Age at operation varied from 8 to 42 months (mean 21 months). Coarctation of the aorta was present in 6 patients (including 4 with hypoplasia of the aortic arch), interruption of the aortic arch in one, straddling mitral valve in one and subaortic stenosis in two. The relationship of the great arteries was D-transposition in 11 patients (oblique in 6 and anteroposterior in 5) and side-by-side in one. Eleven patients had previous palliative surgery. Pulmonary artery banding was done in 11 patients, Blalock-Hanlon in 3, carotid flap aortoplasty in 3, subclavian flap aortoplasty in 2, extended aortic arch anastomosis in 2 and ligation of PDA in 1. The Lecompte maneuver was adopted in all but one patient with side-by-side great vessels. Intraventricular reconstruction was done through the right ventricle in 11 patients and through the right atrium in one who underwent one-stage repair. There was one early death, which was related to thrombosis of the superior mesenteric artery. One patient with side-by-side great vessels died at home 6 months after the arterial switch operation. The suspected cause of death was myocardial infarction due to compression of the left coronary artery by the pulmonary artery. In the follow-up of 10 patients ranging from 1.8 to 9.4 years (average 6.3 years), one required reoperation for pulmonary stenosis. We conclude that two-staged arterial switch operation of Taussig-Bing anomaly with D-transposition can be performed with low mortality, but there seems to be some risk of the compression of the left coronary artery in the original Jatene method for Taussig-Bing anomaly with side-by-side great vessels.

Case 1 was a 2-year-old girl who underwent mitral valve replacement with a St. Jude Medical valve for severe mitral regurgitation 14 days following common atrioventricular canal defect correction. The postoperative course was uneventful, but an unilateral thrombosed leaflet of a St. Jude Medical valve was observed 3 times by echocardiography and fluoroscopy. Thrombolytic therapy with urokinase was done each time and the thrombus was successfully dissolved. Case 2 was a 1-year-old girl who underwent closure of ventricular septal defect and mitral valve replacement with a St. Jude Medical valve for ventricular septal defect, severe mitral regurgitation and pulmonary hypertension. Unilateral thrombosed leaflet of the St. Jude Medical valve and poor left ventricular function were found by echocardiography 11 days after the operation. Thrombolytic therapy with urokinase was successfully performed without any complications. Thrombolytic therapy with urokinase was considered to be effective treatment for unilateral thrombosed leaflet of a mechanical bileaflet valve prosthesis in a child. Poor left ventricular function might be one of the causative factors of unilateral thrombosed leaflet of a mechanical bileaflet valve prosthesis.

With the progressive aging of the Japanese population, cardiac surgeons are increasingly faced with elderly patients. We have studied 29 consecutive patients, 80 years of age or older, who underwent aortic valve replacement at our institution between January 2000 and December 2003. Mortality, morbidity and late follow-up results were compared to those in 36 patients aged from 64 to 75 years old undergoing the same procedure over the same time period. The older patient group had a significantly higher incidence of calcified aortic stenosis and emergency operations and a higher score of NYHA functional class. Hospital mortality was 2 of 29 (6.9%) in the older patient group and 2 of 36 (5.6%) in the control group (ns). Postoperative renal failure and respiratory failure which needed prolonged ventilator support occured significantly more often in the older patient group. However, there was no significant difference between the 2 groups in terms of hospital stay. Almost all octogenarians showed improved NYHA functional class to class I or II after the operations. The actuarial survival rate was 89% in the older patient group and 78% in the control group at 3 years. The late survival rate and cardiac event-free rate were not significantly different between these 2 groups. Following aortic valve replacement, octogenarians, despite more compromised pre-operative status had good relief of symptoms, a favorable quality of life and a similar late survival to the younger patient groups. These findings support the recommendation that valve replacement should be performed in octogenarians with symptomatic aortic valvular disease.