A 39-year-old woman was found to have a heart murmur by a medical examination at age 37. During a checkup at our hospital, echocardiography revealed mild aortic valve regurgitation (AR) and mild mitral valve regurgitation (MR). When she was 39 years old, echocardiography revealed severe MR and moderate AR. Based on preoperative examinations, antiphospholipid syndrome (APS) was diagnosed. Therefore, she received high-dose prednisolone therapy and underwent plasma exchange before the surgery. We performed double valve replacement using a bioprosthetic valve. On the first postoperative day (POD 1), the number of platelets suddenly decreased. We diagnosed catastrophic APS, and treated her with high-dose prednisolone, high-dose immunoglobulin and plasma exchange. Her blood platelet gradually increased on POD 3. Although she needed time for rehabilitation, she was discharged from our hospital on POD 88. APS can cause a catastrophic event triggered by an operation. Therefore, stringent pre- and postoperative management is necessary in patients with APS.

The patient was a 70-year-old woman with severe aortic stenosis and familial hyperlipidemia which was diagnosed in 1994. The patient was admitted as an emergency case due to syncope in 2002. According to ultrasound cardiography (UCG), the pressure gradient of the aortic valve was 120.7mmHg, and the diameter of the aortic valve annulus was 16.7mm. Computed tomography showed porcelain aorta from the annulus of aortic valve to the ascending aorta. On cardiac catheterization, the pressure gradient was 96mmHg, AVA was 0.4cm², and the ejection fraction was 38.7%. Since these findings suggested that conventional AVR was difficult, thoracotomy was performed at the left 5th intercostal level, and apicoaortic valved conduit (valved graft: SJM19HP, Intergard 22mm+Medtronic apical LV connector) was implanted. Postoperative cine MRI showed that most of the cardiac output (87%, 3.29l/min) flowed through the conduit, with the flow via the aortic valve accounting for 13%, 0.51l/min. This surgical procedure can be an effective alternative when conventional AVR is difficult.

Habitual smoking adversely affects the functions of the respiratory system. A Survey was conducted on 100 patients with respiratory diseases in the authors' institute regarding individuals' smoking habit and the following results were obtained.
1) Some respondents say they have difficulty abstaining from smoking though they perceive its unfavorable effects on their health. However, they feel a persuasive “recommendation to give up smoking” by the attending physicians a great help, and 2) earnest instruction and education for the patients are very important as many patients feel good after giving up smoking.
The relationship between habitual smoking and carbon monoxide (CO) concentration in the expired air was determined in 67 healthy volunteers with an ambulatory CO analyzer and the following results were obtained.
1) There was a significant difference in the CO concentrations in the expired air between non-smokers and smokers, 2) there were positive relationships between the CO concentrations in the expired air and daily numbers of cigarettes smoked and smoking index, 3) problems relating to passive smoking became evident, and 4) the ambulatory CO analyzer for the determination of the concentration of CO in the expired air is considered useful for the anti-smoking guidance and instructions.