A marked progress has been made in cardiovascular surgery during the last one decade. A survey made by us on national hospitals and national sanatoria in our country, has revealed that more than 1, 500 patients were operated for heart disease up to June, 1968, with an yearly increase during past few years. The number of the cases undergoing cardiac sureery at Chiba National Hospital for the same period accounts for 223, with overall operative mortality of 6.3%. The most prominent works achieved by us would be investigation of the mechanism of “the homologous blcod syndrome” as well as compactation of the disc oxygenator to avoid this syndrome. In virtue of this device, intracardiac surgery has become the procedure feasible with as same ease and safety as general surgery; for example, the operative mortality of our recent series treated with this apparatus (approx. 80 cased was 4%).
Operative risks in patent ductus arteriosus have become negligible, since the posterolateral approach has been employed. Prognosis of pure mitral stenosis has now markedly been improved by means of instrumental transventricular commissurotomy. It has been confirmed by ourselves that most of cardiac anomalies with shunt should be closed at relatively early dates of life to avoid insurmountable progress of disease at late stager. Radical surgery in tetralogy of Fallot has become a procedure feasible without much difficulties, since our compact disc oxygenator has been used, There should be yet rooms to be investigated in valvular replacement, but our experience has suggested this would become a procedure to be done at relatively early stages of the disease in the near feature.
According to our survey, there were 91 cases operated for disorders of the large vessels in national hospitals and sanatoria for the same period. The results have been reported to be generally satisfactory. Our own series in surgery of this category, 8 cases in total, comprises a female, 22 years of age, with interruption of the aortic arch, reconstructed successfully. She is classified to a rare type, i. e., the absence of P. D. A., and believed to be the 4th case reported in the literature.
Replies from these hospitals to our questionnaire have focused our attention to the fact that there have been serious shortages in the staff as well as the facilities in conducting cardiovascular surgery. They have stressed enlargement of the government subsidy for children with heart disease, as an imminent problem. In conclusion, we sincerely hope that the government could undertake all possible measures to meet such requests.

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Six cases of patent ductus arteriosus were studied by Frank system VCG, after that the operation was performed on all of them, and the following results were obtained.
QRS maximum vectors were inscribed to left inferiorly and posteriorly in most of the cases and the direction was around +30° in the frontal plane projection. Only one case was inscribed to right inferiorly and posteriorly. T maximum vectors were inscribed to left inferiorly and posteriorly and directed more vertically than the maximum QRS vectors. The direction of QRS and T loop inscription was normal in the right sagittal plane and the horizontal plane projections. However, in the frontal plane projection the direction was remarkably variable-in the counterclockwise direction in four cases, in the figure of eight pattern in one case and in the clockwise direction in one case in the QRS loop, in the counterclockwise direction in two cases and in the clockwise direction in four cases in the T loop.
Vectorcardiographically two cases showed the normal pattern, two cases left ventricular hypertrophy, one case the changing pattern to left ventricular hypertrophy and one case right ventricular hypertrophy. Maximum QRS vectors with high oxygen saturation in the right ventricle were directed around 30° in the frontal plan projection and the direction was more vertical with less than 70% oxygen saturation.
Maximum QRS vectors in the frontal plane with more than 50 mmHg of the pulmonal systolic pressure were inscribed in the vertical position.
One case of right axis deviation was changed to normal 3 months after the operation.

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Electrocardiographic studies were made on 40 cases of mitral stenosis before and after mitral commissurotomy.
Auricular fibrillation was present in 28% of the total cases. Various extrasystoles were seen before and after surgery, especially immediate after surgery, Right axis deviation was present in 55% of the total cases pre-operatively. Electrical axes were moved to the left in many cases post-operatively, and right axis deviation was reduced to 28%.
Right and left auricular, and right ventricular hypertrophies were present in 20, 66 and 20% of the total cases pre-operatively, and they were reduced to 3, 7 and 8% post-operatively. Left ventricular hypertrophy was present in 33% of the cases, and it was increased to 50% post-operatively.
Transient myocardial injury was seen in all cases in the immediate post-operative period, and it was improved in several days, but negative T waves persisted for a few months in many cases. ST-T changes suggestive of myocardial disease were present in 68% of 28 cases pre-operatively, which was reduced to 36% in 6 months after mitral commissurotomy.

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A method of CO₂ flooding in the chest during open heart surgery is ccmmonly used to prevent air embolization.
Our experimental and clinical studies were carried out to develop an effective method of replacing the air in the operative field with gaseous CO₂ and to measure Pco₂, pH during extracorporeal circulation using Travenol sheet.
1) Two plastic tubes, open-end and 3/8″ in diameter, were necessary to obtain 100% CO₂ concentration in the chest when the flow of CO₂ was 4L per minute.
2) No significant signs of hypercapneic acidosis were produced by CO₂ flooding during cardiopulmonary by-pass using pure O₂ gas.

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In our clinic, 176 cases of cardiac surgery revealed direct vision of cardiac operation was 105 cases.
Artificial cardiac valves were replaced in 18 cases and 20 valves. Implantable pace makrs were inserted in 3 cases of A-V block.
As vascular surgery cases 207 cases were treated in our clinic in last 1 yr. and 6 months. A traumatic ruptured descending aorta was repaired under hypothermia and heart lung machine. Also membranous inferior vena cava obstruction was treated by finger fracture. These case reports were described.

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In June 30, 1966, the first case of transventricular ccmmissulotcmy for mitral sterosis was successfully performed. Since then 23 closed cardiac operations have keen performed (21 normothermic, 2 hypothermic). Initial 2 open heart cases were operated under hypothermia. Since February 1967, cardiopulmonary by-pass has been used for open heart surgery, and 20 cases were operated.
All but 1 case, the cardiopulmonary by-pass was performed with the use of disposable bubble oxygenator (Junken) and hemodilution method. The average lowest Ht was 28.2%, but we have never been experienced any complication due to the cardiopulmonary by-pass.
Although our experience is not so sufficient, relatively rare cases of congenital malformations have been encountered common atrium with pulmonic stenosis, aorticopulmonary fenestration, spontaneously closed common atrioventricular canal type VSD, constrictive pericarditis following cardiotomy for pulmonic stenosis, non-cyanotic infundibular stenosis with VSD (2 cases), pinc Fallot's tetralogy (2 cases).
In this paper, the former 3 cases was reported and disscussed.

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We replaced the mitral valve with a Kay-Shiley diescoid valve prostheses in 4 cases of predominant or pure mitral insufficiency. We had no mortality; all these patients are improved and alive in normal activity. The longest postoperative period is 22 months and the shortest 4 months.
The postoperative course of 3 cases were very smooth, but the patient of the second case developed severe heart block, as soon as the heart was closed. With a continuous infusion of Isoprotherenol satisfactory cardiac rate could be maintained and sinus rhythmm returned by 14 days after operation.

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The life expectancy following recovery from the attack of myocardial infarction is better than that previously been thought.
This study was undertaken to estimate the time and methods of the rehabilitation of myocardial infarction.
For this purpose, 19 patients in our hospital were examined from the point of factors which affecting the immediate and long term prognosis.
The past history, signs and symptoms on admission and laboratory findings such as W. B. C. and E. S. R. are useful in determining the time of rehabilitation and discharge.
CASE,
A 51-year-old man collapsed with acute myocardial infarction and ventricular fibrillation.
Closed chest cardiac massage and emergency ventilation were started immediately, and he regained sinus rhythm in about 20 minutes.
Two months later, his recovery was complicated by left sided heart failure which responded to diuretics and digitalis,
He has been now back to work.

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Four cases of atypical myocardial infarction, experienced recently, were reported.
Case 1; She was 71-year-old woman, who never complained of chest pain, but her EKG showed always deep QS and elevated ST in V₂-V₆ constantly through her 40 days hospitalization and never showed coronary T until her sudden death.
There was old spread anterior myocardial infarction accompanied by ventricle tumor that was confirmed by the post mortem examination.
Case 2; she was a 69-year-old woman complained of severe neuralgic pain on the left shoulder, radiated down to the left upper extremity. The acute anterior myocardial infarction connected with the shoulder-arm syndrome was diagnosed by the EKG and other tests. Sho had the severe stroke of chest pain once during the course of hospital ization. It was not the second stroke of infarction, but it was considered the variant form of angina, because of the duration of pain, slight increase of GOT, GPT and LDH, and the features of her EKG. The autopsy confirmed the diagnosis of the fresh anterior myocardial infarction based on the coronary sclerosis.
Case 3; He was a 34-year-old man, a company employee, admitted to the neurological department because of the antabus therapy. He suddenly complained of chest pain on the 6th day after taking CYANAMIDE (10ml daily), and that was captured at once by EKG as the anterior myocardial infarction. It was considered an unusual case of cyananide-alcohol reaction induced myocardial infarction because of the following maters: a) He had had the anamnesis of acute hepatitis repeatedly and the liver function test was abnormal. b) He often suffered from the chest pain when he entered to our clinic. c) He was a heavy drinker and took sake immediately before the stroke of infarction.
Case 4; He was a 43-year-old man, a day-laborer, complained of severe chest pain accompanied with temporal episode of loss of consciousness two days P. T. A. His EKG showed the posterior infarction.
He had absolute bed rest faithfully during the first one week only, but thereafter he begun to walk up and down against doctor's abvice. Slight improvement of EKG feature could be noted 7 days later, as compared with the preceding EKG. He was discharged because of the economical reason two weeks later, when the results of his EKG and Master's test showed more improvement. He had been working hard since his discharge from our clinic. He was called on and was examined 5 months later. His EKG feature showed more improvement, except for the ischemic ST-T pattern in the Master's double test.
The diagnosis, prognosis, and the rehabilitation of the myocardial infarction was discussed in addition to these 4 case reports.

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In order to research the effect of dipyridamole on the immediate and long-term prognosis of the myocardial infarction, differences of mortality rate or survival rate between the dipyridamole administrating group and the dipyridamole non-administrating group or between the dipyridamole normal dossage group (75mg daily) and the dipyridamole much dossage group (150mg daily) were examined.
As the results, in the patients with myocardial infarction both at immediate stage and after immediate stage, the administration of dipyridamole tends to hasten the disappearance of anginal pain and congestive failure, protect the occurrence of second episode and embolism, and decrease mortality rate or survival rate of this disease.
Furthermore, the dipyridamole much dossage group indicates less mortality rate or better survival rate than that of the dipyridamole normal dossage group.

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Forty seven (39 males and 8 females ranging 26-80 years in age) cases of 51 myocardial infarction which we have treated during past 11 years (1957-1968) were followed up and the prognosis was analyzed as follows.
1) Total mortality rate: 21 (44.7%) out of 47 patients died.
2) Immediate term prognosis: 9 (24.3%) out of 37 patients who have been followed from the onset died.
3) Long term prognosis: 12 out of 38 died during the long term follow up; 5 cases during the first year period, 3 cases in the second and each one case during the following 4th, 5th, 6th and 11th year period respectively. The survival rate of the patients, therefore, were 70.2%, 63.2% and 55.6% during the first, second and fifth year. The causes of the death of 12 cases; 8 cases with acute death or recurrent infarction, 2 cases with vascular disease of C. N. S. and with senility.
4) The prognosis of the patients without prior hypertension, anginal pain and biabetes mellitus were better than those with the prior episodes in the immediate and long term prognosis.
5) The long term prognosis of the patients who had the rehabilitation were better than those without.
6) The heigher the age, the worse the prognosis.
7) 66.6% of the mortality were observed during the first year and 85.6% in the second year.
8) The localization of infarction, as determined by E. K. G. affected the prognosis being the worst patients with co-existing anterior and posterior walls infarction, and the best with posterior infarction.

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1) There were 104 cases of myocardial infarction during the period from 1951 to 1967. Male patients were twice as much of female. The mortality rate of this series was ca 50% at the end of 1968. This rate was markedly high compared with the mortality rate of the same series, that is 20%, at the period of 1 year after admission.
2) Severe or unusual cases; These cases were, in order of frequency, rhythm disturbance, septal infarction, death of acute coronary insufficiency and atrial infarction. The mortality rate was high in all of them. In acute coronary insufficiency, syphilis was the cause in the half of cases, coronary sclerosis or coronary stenosis were severe and the weight of the heart were increased.
3) Complicated cases: They were, in order of frequency, infectious disease infarction of the other organs, brain disease, endocrine disorders and lung disease. The mortality rates were high in all but rheumatism and disease of digestive system. are low In the cases of combined infarctions, there were many lung infarctions, and almost of them died. Thrombo-emboli in combined infarctions were found in only two cases of liver cirrhosis and two cases of respiratory disease.
4) Complaints in myocar dial infarction: Almost half cases of myocardial infarction complained of anginal symptoms, and the half cases of them complained of only slight chest pain.
5) The accuracy of diagnosis in myocardial infarction: The diagnosis of myocardial infarction was correct in about half cases. In another half of cases, myocardial infarction was misdiagnosed as other cardiac diseases.
6) Interesting cases were as follows:
(1) Q₃ T₃ figure in a case of a combined myocardial and lung infarction.
(2) Q, ST, T variations in V_4R-V₆ followed by a heart rupture.
(3) Three cases of so-called S₁, S₂, S₃ pattern. They were a case of right atrial and ventricular infarction, a case of right ventricular infarction with cor pulmonale, and a case of septal infarction with r.b.b.b.
(4) Unordinary exercise EKG figure. The first case was a patient comlaining of squeezing sensation of the chest and pain in the right chest with r.b.b.b. and figure of posterior infarction. On exercise test after admission a negative T in V₃, V₅ turned to positive without symptom of angina. The patient died cf interior infarction after 8 months. The second case admitted to the hospital 3 days after having squeeze sensation of the chest with a coronary T in V_2-5. Exercise test after 1 month showed ST elevation in V_2-4 and disappearance of coronary T without coronary attack. The patient was diagnosed as an anteroseptal infarction with polycythemia. He has been healthy and working without anginal attack thereafter.
The third case was a rest angina with polyglobulinemia. On the exercise test, ST in V₁ elevated, ST in V_4-6 lowered reciprocally, T in V_4-5 elevated to the normal levels without symptoms of angina.
7) Relation between body movement and anginal attack. The effort angina was the majority, and the subjective symptoms were severe in general. The night angina and rest angina followed in number, and the subjective symptoms were mild.
8) Relation between EKG figure and prognosis. The changes of Q, ST, T were most frequent and the mortality rates were high. In conduction pathway disturbances, the mortality rates were high, too.
9) Relation among our 3 type classification, myocardial infarction and prognosis. I type: a steep elevation of R_V5. III type: a depression of R_V5. II type: the middle of I and III types. The greatest majority of myocardial infarction cases fell in the I type and mortality was also highest. III type and II type followed in rate.
10) Other tests and Examinations.
(1) Oxygen inhalation test. Ten minutes inhalation of oxygen results

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We experienced 344 cases of cardiovascular surgery in past 9 years up to July, 1968; 264 cases of congenital heart diseases and 80 of acquired. We operated 211 cases under open heart surgery for congenital heart diseases except 53 cases which were 40 cases of patent ductus arteriosus and 8 cases of Fallot's tetralogy received shunt operation and so on.
In 264 cases of congenital heart diseases, 24 cases died and were Fallot's tetralogy and anomalous pulmonary venous return for their most part.
In 80 cases of acquired heart diseases, we treated under open heart surgery in their 17 cases which included 7 cases received artificial valve replacement. 49 cases of them recovered and 6 died, and their operation result was worse than that of congenital, but we succeeded in 6 cases of valve replacement.

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On our inquiry of 113 patients of congenital heart disease, following facts had become plain:
1. Patients of congenital heart disease were more frequently born from October to April of next year (12 patients per month). On the other hand, less patients were born from May to September (in mean, 5.6 patients per month). Comparative ratio of the patients of congenital heart disease for the normal new-borns in all Japan showed the same tendency.
2. The frequency of the birth-rate of congenital heart disease is independent of the age of their parents.
3. Two pairs of identical twin were investigated. Each of them composed of normal new-born and anomolous one. They were of pulmonary stenosis and of ventricular septal defect.
4. Mothers, having history of abortion, were of 23% in 113 cases.
5. Mothers, treated as the prevention of abortion by steroid, were 10.1% in 113 cases.

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