We report a case of emergency operation for ruptured abdominal aortic aneurysm with intraoperative cardiac arrest. The patient was a 71-year-old man with a past history of CABG and total gastrectomy. A transperitoneal approach was used for operation. Intraoperatively, a large retroperitoneal hematoma and intestinal adhesion were found. This large retroperitoneal hematoma increased, followed by cardiac arrest. Immediately left thoracotomy, direct cardiac massage and digital compression to the descending aorta were performed. After aneurysmal opening, an occlusion balloon was inserted in descending aorta. The infrarenal aorta was exposed and clamped. Cardiopulmonary resuscitation was successful. The aneurysm was replaced with a bifurcated artificial vessel and distal anastomosis to the bilateral femoral arteries. There were no signs of cardiac or renal failure in the early postoperative period. The postoperative recovery was successful.

Differential diagnosis of a so-called false aneurysm of the left ventricle from the true type after a myocardial infarction is important because the risk of rupture of the false aneurysm is high. Two cases of ventricular aneurysms with false type-like shape underwent surgical repair. Preoperative left ventriculography in Case 1 (male, 77) showed an aneurysm of 40×40×35mm in size with a narrow neck at the postero-inferior wall. The aneurysm of Case 2 (male, 61) was 20×20×10mm in size with a narrow neck at the inferior wall. These ventriculographic findings suggested a false type of aneurysm, but operative findings and pathological examination revealed that these were“true”aneurysms in which wall myocardial cells were observed. Left ventriculography and echocardiography were not sufficient to differentiate false left ventricular aneurysm from true aneurysm, particularly at the posterior and inferior wall.

Between January 1981 and December 1996, we performed valve replacement in 281 patients using bileaflet prosthetic valves in mitral and/or tricuspid positions. Thrombosed valve were seen in 10 patients (7 in mitral, 3 in tricuspid positions). In 5 patients, coumadin had been stopped for several reasons (pacemaker implantation, melena, drug allergy), but in the other 5 patients, anticoagulation was within the therapeutic range at the time of presentation. For thrombolytic therapy urokinase or tissue plasminogen activator were used. The treatment was successful in 5 patients (4 mitral, 1 tricuspid), and unsuccessful in 5 patients (3 mitral, 2 tricuspid). Three of the 5 unsuccessful patients were treated surgically (3 with re-mitral valve replacement, 1 with thrombectomy). Prompt surgical treatment can be used as the first line of therapy for thrombosed valves. Thrombolytic therapy may be useful in some cases of bileaflet valve thrombosis without critical hemodynamic collapse. Doppler echocardiographic assessment of increasing peak velocity and pressure half time is useful for detecting thrombosed valves.