We report an adult case of double chambered right ventricle (DCRV), in which right ventricular outflow tract stenosis is thought to have progressed after interruption of follow-up of ventricular septal defect (VSD). A 35-year-old female was diagnosed with VSD immediately after birth and had been hospitalized twice for infective endocarditis in infancy and childhood. More than 10 years after the interruption of regular follow-up, she visited her family doctor with a chief complaint of shortness of breath on exertion and chest pain, and was referred to our hospital for evaluation of VSD. Echocardiography showed VSD and DCRV. VSD was as small as 5×4 mm, but the maximum flow velocity at the DCRV stenosis was 4.87 m/s, which was judged to be an indication for surgical treatment. The patient underwent right ventricular stenosis release through the right atrium. Postoperative right ventricular stenosis was resolved. Since adult cases of DCRV are rare, and there is a lack of awareness of the disease concept and the nonspecific symptoms, it is difficult to diagnose DCRV in adults; so it is therefore important to treat patients with this disease concept in mind. In addition, it might be necessary to maintain follow-up with patients even with small VSD.

Pulmonary blastoma is rare and its prognosis very poor. A 6-year-old boy was referred to our hospital with chest pain. Computed tomography demonstrated that the left pleural cavity was filled with a tumor. Cardiac echocardiography demonstrated that the tumor had invaded through the pulmonary vein into the left atrium and that the tumor extended into the left ventricle. Part of the tumor was adhered to the anterior leaflet of the mitral valve. To increase operative radicality, an autotransplantation technique was performed concomitantly with resection of the original lesion. Through a median sternotomy, a moderate hypothermic cardiopulmonary bypass was established to obtain cardiac arrest. First, longitudinal incision of right-sided of the left atrium was made. The tumor invaded into the left atrium through the left superior pulmonary orifice. The ascending aorta, the main pulmonary artery, and both caval veins were transected. The left atrium was incised along the pulmonary venous orifices. The heart was completely removed from the mediastinum and transferred to another table. Resection of the intracardiac metastatic lesion and mitral valve replacement was accomplished. During this time, thoracic surgeons performed a left pneunectomy. The left atrial wall around the left pulmonary venous orifices was resected in combination with the left lung. After the deficit of the left atrial wall was repaired with a Gore-Tex patch, the heart was replaced and we reconstructed the great arteries and caval veins. The autotransplantation technique is a useful procedure for combined lesions of the heart and lung.