We report a case of nonpenetrating cardiac trauma successfully managed by an emergency operation. An 82-year-old woman, who was involved in a traffic accident, was transferred to our institution from a remote island in a critical condition accompanied with left hemothorax, loss of consciousness, subarachnoid hemorrhage and right humerus fracture. She was transported rapidly to the operation room, and immediate left thoracotomy revealed a small cardiac rupture on the free wall of right ventricular outflow tract with concomitant rupture of the pericardium. The wound was controlled by digital compression, and was closed with interrupted pledgeted sutures without cardiopulmonary bypass. She regained consciousness gradually although tracheotomy was needed, and was moved to another local hospital in a stable condition.

Systemic lupus erythematosus (SLE) is a chronic systemic inflammatory disease associated with the production of various autoantibodies and involvement of multiple organs. We report that steroid therapy for the SLE might play a major role in accelerating atherosclerosis and the patient suffered an aortic dissection. A 53-year-old woman had been receiving steroid therapy for 10 years due to SLE. The patient had thoracoabdominal aortic dissection. Conservative therapy was commenced, but the diameter of the dissecting aneurysm was enlarged. Therefore, grafting for the thoracic descending aorta and the abdominal aorta was performed. The patient experienced no significant postoperative complications.

The valvular function after aortic valve replacement was examined using Doppler echocardiography and changes in serum lactate dehydrogenase (LDH) and free hemoglobin levels were assessed. Data for the ATS Medical open pivot prosthetic valve were compared with those of the St. Jude's Medical prosthetic (SJM) valve, a similar bileaflet valve. These have been used in the past 5 years. There were 23 patients with ATS valves (13 men and 10 women, with a mean age of 60.4±13.8 years) and 16 patients with SJM valves (10 men and 6 women, with a mean age of 61.4±8.7 years). The left ventricular diastolic diameter index (LVDdI), left ventricular systolic diameter index (LVDsI), % fractional shortening (%FS) and left ventricular mass index (LVMI) were determined by echocardiography. The peak pressure gradients of the aortic prosthetic valves were calculated by a simplified Bernoulli equation. Postoperative LVDdI, LVDsI and LVMI were not significantly different in the ATS group and the SJM group. However, the %FS of the ATS group was significantly higher than that of the SJM group with aortic stenosis. The pressure gradients at the aortic prosthetic valve position were not significantly different between ATS and SJM valve in the 19-mm, 21-mm and 23-mm size. Postoperative improvement or recovery of the serum LDH level was observed significantly more frequently in the ATS group than the SJM group (p<0.005). The free hemoglobin level of the ATS group was also lower than that of the SJM group (p<0.005). We demonstrated satisfactory valvular function of the ATS valve compared with the SJM valve. Postoperative improvement of hemolysis was observed significantly more frequently and more rapidly in the ATS valves.

A 77-year-old woman was given general anesthesia for an ascending aortic aneurysm operation and went into anaphylactic shock. The operation was canceled. Vecuronium, pancuronium, protamine and famotidine revealed positive prick test reactions. Ascending aortic replacement underwent under minimum dose of heparin for cardiopulmonary bypass (CPB). Heparin was injected immediately before CPB (2.5mg/kg) and nafamostat mesilate was injected continuously during CPB (2mg/kg/h). The ACT value was over 1, 400sec during CPB. However, protamine was not used after CPB. The operation time was 4h and 30min. CPB time was 1h and 26min. After the patient returned to the ICU, bleeding from the chest drainage tubes increased temporarily. The bleeding decreased gradually after administration of FFP and MAP.

A 65-year-old woman was referred to our department for further examination and treatment of an abdominal aortic aneurysm. Preoperative abdominal 3-D CT revealed a horseshoe kidney with 2 aberrant renal arteries, arising from bilateral common iliac arteries and supplying blood to the renal lower poles. At operation, the abdomen was explored via a long midline incision. The abdominal aortic aneurysm was replaced with a knitted Dacron bifurcation graft without symphysiotomy, and the 2 aberrant renal arteries were preserved. Postoperative 3-D CT showed no sign of renal infarction or dysfunction. Abdominal 3-D CT was useful to reveal aberrant renal arteries of the horseshoe kidney.

A 31-year-old woman had an aneurysm of the brachiocephalic artery and aortic regurgitation due to aortitis syndrome. As C-reactive protein (CRP) levels were high (27.5mg/dl), steroid therapy was initiated. After CRP became negative, the brachiocephalic aneurysm was repaired using a GELWEAVE^® Y-graft, and the aortic valve was replaced with an ATS^® mechanical valve. Regional cerebral oxygenation (rSO₂) was monitored during the operative period. The level of rSO₂ did not change during the period when the brachiocephalic artery was clamped, resulting in no cerebral damage after the operation. Homer's syndrome appeared after the operation but the symptoms gradually improved spontaneously. A mechanical valve was chosen because the patient did not want to undergo a reoperation. No cerebrovascular event occurred after the operation and the patient was discharged on the 28th postoperative day.

We report mitral valve replacement (MVR) in a patient who had undergone left pneumonectomy for thoracic empyema 8 years previously. A 75-year-old man had heart failure due to mitral valve regurgitation and medication therapy was initiated. Although the heart had shifted to the right side, MVR was performed using a SJM valve with primary median sternotomy. The tracheal intubation tube was removed 17h after the operation, and the patient was discharged on the 43rd postoperative day. Careful preoperative assessment, preoperative control of heart failure, and careful attention to perioperative fluid management are important components of successful clinical management.

The operation for constrictive pericarditis after coronary artery bypass grafting (CABG) needs complete pericardiectomy without injury to the bypass graft. A 60-year-old man had pleural effusion a month after CABG. Right atrial pressure (RAP), right ventricular pressure (RVP), and pulmonary capillary wedge pressure (PCWP) were elevated and RVP showed a dip and plateau sign on cardiac catheterization. We diagnosed heart failure due to constrictive pericarditis following CABG. Pericardiectomy was performed using a cardiopulmonary bypass through a median sternotomy. The Harmonic Scalpel was useful for dissecting the pericardium. After the operation, it took a month for the patient to improve. RAP, RVP and PCWP were decreasing, and the dip and plateau sign of RVP was improved. The pleural effusion disappeared and the patient was discharged on the 73rd postoperative day.