A 76-year-old man was admitted complaining of sudden right lower limb pain. Echocardiography showed occlusion of the right femoral artery. He underwent thrombectomy and regained his lower limb circulation. Two days after the operation, the patient suffered cardiopulmonary arrest. He was resuscitated and immediately after the resuscitation, echocardiography revealed a left ventricular mass that almost fell into the left ventricular out-flow tract. Emergency surgery was performed to remove the mass. Pathological testing showed that the mass was a metastatic transitional carcinoma. Fourteen days after the open-heart surgery, the patient suddenly developed left lower limb pain. We performed an emergency thrombectomy so that limb perfusion could recover quickly. The pathological diagnosis was embolism from a tumor of the left ventricle. His postoperative progress was rapid and he died 23 days after the open-heart surgery.

Percutaneous subclavian vein catheter hemodialysis has been accepted as a convienient method in acute need of hemodialysis, but recently, as a serious complication, not a few cases of venous obliterations were reported. Patients on hemodialysis with a functioning arteriovenous fistula become symptomatic with venous hypertension and painful edema. As fistula ligation renders the arm unsuitable for future blood access, venous reconstruction should be considered. In our series, two patients with right subclavian vein obstruction and innominate vein stenosis were treated by polytetrafluoroethylene bypass graft and by angioplasty, respectively. Their symptoms disappeared, and fistulas were preserved for 6 and 25 months.

A 59-year-old man has had a heart murmur for a long time. Four years previously coronary artery-pulmonary artery fistula was diagnosed as the cause of arrhythmia, by coronary angiogram. Despite two coil embolizations some fistulae recanalized and dilated. The coronary artery connected with the main pulmonary trunk and a part of plexiform angioma on the right ventricule outflow tract. Under heart beating, we ligated the origin of each fistulae with direct closure of the ostia from inside pulmonary artery. His symptoms finally improved.

A 45-year-old man presented with cough and dyspnea. He had undergone reconstruction of the ascending aorta for acute aortic dissection (DeBakey type I) 5 months previously, at which time we used the gelatin-resorcin-formalin glue (GRF glue) for reconstruction of the wall layer. Preoperative transesophageal echocardiography and aortography revealed aortic regurgitation due to redissection of the aortic root. Intraoperatively, dehiscence was noted between the right coronary sinus including the coronary ostia and the non-coronary sinus. These intraoperative findings suggested that the pathology leading to the redissection was related to the previous use of GRF glue. The redissected segment appeared to be necrotic on macroscopic examination intraoperatively, however histological examination revealed only degenerative changes, and there was no evidence of the glue. He was treated by the modified Bentall method and had a good postoperative course after discharge. In this case, it is also conceivable that tissue necrosis resulted from the use of too much formalin.

We performed a modified Bentall operation and aortic arch replacement simultaneously in three cases of chronic type A aortic dissection with connective tissue disease. Two of the subjects were men. Ages ranged from 37 to 48 years. There were two cases of Marfan's syndrome, and one case of cystic medial necrosis. All patients had annuloaortic ectasia (AAE), severe aortic regurgitation (AR) and marked dilatation at the base and arch of the aorta with extensive dissecting lesions. Widespread, progressive vascular lesions are often seen, especially among cases of dissecting aneurysm of the aorta with connective tissue disease, and there is a high probability that new vascular lesions and valvular diseases will result after surgery. Therefore, cases must be followed, keeping in mind the possibility of early extended aortic operation and secondary surgery.

We report a successful conversion of atriopulmonary anastomosis to total cavopulmonary connection using an autologous atrial flap. A 28-year-old man after atriopulmonary anastomosis with a valve conduit performed under a diagnosis of double inlet left ventricle (DILV), d-TGA, was admitted with moderate cyanosis and atrial fibliration which he had suffered since age 25. Cardiac catheterization and ultrasonic cardiography revealed regurgitation at the site of tricuspid patch closure, and atrial dilatation. We excised the regurgitated patch, closed tricuspid valve leaflets, and made an atrial lateral tunnel using an autologous atrial flap. In particular we took care of crista terminalis, sinus node arteries, and sinus node at the operation. He recovered his sinus rhythm on the first operative day, but secondary atrial fibrillation developed. Four months later, catheterization showed good hemodynamics with low central venous pressure, and no obstruction of the atrial tunnel.