A 21-year-old man with coronary sinus atrial septal defect (ASD) was treated successfully. This case had been diagnosed as an ASD without a lower margin preoperatively but we confirmed this to be a coronary sinus ASD intraoperatively, and this case was classified as partially unroofed coronary sinus without PLSVC. The diagnosis of coronary sinus ASD before operation is sometimes difficult. Therefore we should pay attention to the location of the defect and the dilated coronary sinus in echocardiography, and the course of the cardiac catheter entering into the left atrium, for a correct diagnosis. In this case, the defect was located in the vicinity of the ostium of a large coronary sinus, therefore we could close the defect between the CS and the LA using a heart-shaped patch without any damage to the AV node.

We performed coronary artery bypass operation on 258 patients from July 1974 to February 1993, of whom 10 underwent a total of 11 reoperations. These 10 patients were not significantly different from the other patients with respect to gender, coronary risk factors and number of grafts used in the first operation, aside from older age and lower LVEF. The interval between the two operations was <1 year (early) or about 10 years (late) in most instances. The most common reasons for reoperation were graft failure from technical problems in early and time-related alterations in graft and progression of original disease in late cases. The outcome of reoperation was less than satisfactory, with 2 operative deaths, IABP required in 5, reoperation for bleeding needed in 3 and severe sternal wound infection of the patent vein graft postoperatively, of which atheromatous debris released from the atherosclerotic vein graft was strongly suspected to be the cause. The old vein graft should be immediately ligated at the beginning of CPB in cases with diffuse atherosclerotic vein graft in which more than several years have passed since initial operation. In reoperation, arterial graft is preferable, especially GEA graft can be used advantageously even with a left thoracotomy approach. Bypass reoperation for occlusion of LAD or Cx should be performed by a left thoracotomy approach.

Objectives: Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infections (SSIs). However, few studies have evaluated the rate of nasal carriage of MRSA and its effect on SSIs in patients undergoing general thoracic surgery. We investigated the importance of preoperative screening for nasal carriage of MRSA in patients undergoing general thoracic surgery.Patients and Methods: We retrospectively analyzed 238 patients with thoracic diseases who underwent thoracic surgery. We reviewed the rates of nasal carriage of MRSA and SSIs.Results: Results of MRSA screening were positive in 11 of 238 patients (4.6%), and 9 of these 11 patients received nasal mupirocin. SSIs occurred in 4 patients (1.8%). All 4 patients developed pneumonia; however, MRSA pneumonia occurred in only 1 of these 4 patients. No patient developed wound infection, empyema, and/or mediastinitis. SSIs did not occur in any of the 11 patients with positive results on MRSA screening.Conclusions: The rates of nasal carriage of MRSA and SSIs were low in this case series. Surveillance is important to determine the prevalence of MRSA carriage and infection in hospitals, particularly in the intensive care unit. However, routine preoperative screening for nasal carriage of MRSA is not recommended in patients undergoing general thoracic surgery.