Twenty patients undergoing primary elective coronary artery bypass grafting were randomly divided into two groups to evaluate the hemostatic effect of aprotinin. Low dose aprotinin (1×10⁶KIU) was used during cardiopulmonary bypass in one group (11 patients), and the others were not given any. There was no need for reoperation due to bleeding and no difference of graft patency in the two groups. Changes in platelet, fibrinogen, thromboxane B₂ and antiplasmin values were similar in both groups. Postoperative blood loss was significantly lower in the aprotinin treated patiens (p<0.05) and postoperative blood use was also significantly lower (p<0.01). We conclude that low-dose aprotinin had a beneficial effect for reducing postoperative blood loss and blood use, though we did not find any changes in the results of laboratory tests.

Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for bladder cancer is accepted as an effective treatment, and infectious complications are rare. We present a case report on a patient with a common iliac pseudoaneurysm and a recurrent mycotic thoracoabdominal aortic aneurysm, who had a history of previous BCG therapy for bladder cancer. A 64-year-old man underwent emergency graft interposition of the right common iliac artery due to a ruptured pseudoaneurysm. Nine months after initial surgery, a biopsy of the pelvic retroperitoneal collection revealed epithelioid granuloma with caseous necrosis. Ziehl-Neelsen stain and mycobacterial culture were positive for acid-fast bacilli, which was identified as BCG (Tokyo 172). Diagnosis of BCG infection was delayed because of lack of clear clinical evidence of persistent infection. After 6 months of antituberculous chemotherapy the patient underwent resection of the mycotic thoracoabdominal aortic aneurysm and in situ reconstruction with a branched Dacron graft soaked in rifampicin because of its rapid growth. The pathological diagnosis was infectious aneurysm with sclerosis and epithelioid granuloma, however, acid-fast stain and culture were negative. Nine months later CT showed no recurrence of infectious aneurysm. Because the clinical presentation of BCG mycotic aneurysm is different from bacterial or fungal mycotic aneurysm, diagnosis by means of medical history checking and clinical presentation, in addition to surgical and medical combined treatment are important for its management.

A 75-year-old man with a heart murmur and fatigability was referred to our hospital. We diagnosed unruptured giant right sinus of Valsalva aneurysm that obstructed the right ventricular outflow tract by echocardiography (UCG), computed tomography (CT) and magnetic resonance imaging (MRI). The right ventricle was dilated and its ejection fraction was decreased to 9.3% by MRI. Successful surgical repair involved the right sinus of Valsalva plasty using a bovine pericardial patch and resection of the aneurysm through only a right ventricular outflow incision. His postoperative course was uneventful.