We encountered 12 patients with 18 anastomotic aneurysms (AA) between November 1976 and October 1989. Ten of them were arteriosclerosis obliterans (ASO) and 2 were Behcet disease. The interval from initial. operation to reoperation was 65.1±24.0 months in ASO and 7.5±3.0 months in Behcet disease. In ASO, there were no abnormal findings in the prostheses and sutures, whereas the host artery at the anastomotic site widened and weakened. Because the incidence of AA after aortofemoral bypass was much higher in the case with poor run-off at the anastomotic site, it seems to be reasonable to add a distal bypass in the case with poor run-off. In Behcet disease, since AA frequently occurred within the short interval in which anti-inflammatory drugs were given, the arterial reconstruction should be carefully indicated.

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Sixteen patients with congenitally corrected transposition of the great arteries (CTGA) underwent operative closure of ventricular septal defects (VSD). Ages of the patients ranged from 10 months to 25 years. Three different approaches were employed to access to the defect: through right ventriculotomy 3, through left ventriculotomy 5, and de Leval's maneuver 8. Here, right or left ventricle refers to its anatomic morphology. Early postoperative death occurred in a patient who concomitantly underwent extracardiac couduit repair between left ventricle and pulmonary trunk. Late death occourred in 5 (left ventriculotomy in 1 and righ ventriculotomy in 4), among whom 2 expired suddenly of unknown cause (one in each of the right and left ventriculotomy), and 1 expired of pneumonia. Two other deaths were related to their reoperations for replacement of the incompetent left atrioventricular (AV) valve. Another patient who had been repaired by de Leval's maneuver also underwent replacement of the left AV valve and survived. Two patients who had undergone left ventriculotomy developed com-plete heart block leading to implantation of permanent pacemaker. Postoperative complete heart block was temporarily noted in a patient who had been repaired by de Leval's maneuver but returned to sinus rhythm on the 10th postoperative day. Late postoperative function of the systemic ventricle was assessed in 8 by gated radionuclide ventriculography. Calculated ejection fractions in each of the methods were the followings. Left ventriculotomy: 0.38, 0.47. Right ventriculotomy: 0.13. de Leval's maneuver: 0.29, 0.54, 0.66, 0.47, 0.36. These results draw us to the following conclusions that either ventriculotomy holds its drawbacks, that is, left ventriculotomy is apt to develop complete heart block and right ventriculotomy can predispose incompetent left AV valve ultimately leading to the fatal congestive heart failure. de Leval's maneuver, however, is rare to be complicated by the above morbidity and is considered to be the best operative method currently available.

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Laser thermal angioplasty with a metal hot tip probe for atherosclerosis obliterans of iliac, femoral and popliteal artery lesions was used instead of conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 24 of 28 (85.7%) vessels. The 1-year cumulative patency rate was 82.6 % of 19 vessels with clinical success in 23 vessels (one of 24 clinical success cases died due AMI at 14 days after operation). In the 8 iliac and 15 femoro-popliteal arteries, the cumulative success rates were 100% and 73.3%, respectively. Complications were observed in 25% of vessels (7 of 28 vessels). One of them necessitated emergency bypass surgery but not the others. In the 24 laser thermal angioplasty, other revascularization methods were performed on 12 cases (50%) at the same time. Although many problems remain to be solved laser thermal angioplasty can be effective for atherosclerotic disease.

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Intra-aortic-aneurysmal thrombi sometimes cause severe complications, such as distal arterial thromboembolism and consumption coaguropathy, significantly affecting the prognosis. Such thrombi can be easily detected by CT-scan, Ultrasound and MRI, but these imaging techniques cannot indicate thombotic activity. The radioactivity of ¹¹¹In labeled platelet scintigraphy (platelet scintigraphy) can reflect thrombotic activity. We performed platelet scintigraphy in 13 true aortic aneurysms (TA), 17 dissecting aortic aneurysms (DA) and 11 postoperative cases of dissecting aortic aneurysms (PO) and the results were compared with the values of fibrino-petide-A (FPA) and FDP-E in blood. In cases of the TA, the result of platelet scintigraphy showed the radioactivity of abdominal aortic aneurysms (AAA) is stronger than that of thoracic aortic aneurysms (TAA). In the cases of DA, the group of thrombotic dissection showed no RI deposit. Acute cases showed strong RI deposit with gradual reduction. Two cases of PO, in which anti-coagulant therapy had been performed showed no RI deposit. Concerning the results of FPA and FDP-E, the values for AAA were higher than those of TAA, and in cases of DA, acute cases showed a high value, with gradual reduction, while two PO cases with anti-coagulant therapy showed low values. No significant correlation was found between the value of FPA and FDP-E. On the other hand, the values of FPA and FDP-E significantly correlated to radioactivity of platelet scintigraphy. The higher was the value of FPA and FDP-E, the stronger was the radioactivity. The values of FPA and FDP-E of the strong radioactivity group were significantly higher than these of the weak radioactivity group. Platelet scintigraphy and measurement the value of FPA and FDP-E are effective to estimate intra-aortic-aneurysmal thrombotic activity, and useful to anticipate complications and evaluate prognosis.

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Transluminal angioplasty during vascular reconstructive procedures was performed to 18 lesions in 13 patients. Ages ranged from 57 to 81 years with a mean of 72.7 years, and all patients were men. Transluminal angioplasty during the thromboendarterectomy or bypass grafting was performed to 3 patients for inflow dilatation, 3 patients for outflow dilatation and 1 patient for renal artery dilatation. Transluminal angioplasty with thrombectomy for the anastomotic stenoses of EPTFE grafts was performed 11 times for 7 patients. The results of this method for arteriosclerotic lesions were as follows; patency was 100% at 1 year and 80% at 3 year. Four patients died during the follow-up periods and the dilated lesions were all patent at the time of death. The results of this method for anastomotic stenoses were as follows; patency was 34.6% at 6 month and 0% at 10 months. Graft infection occurred in 1 of 4 patients to whom transluminal angioplasty was performed 2 times. The patency of transluminal angioplasty during vascular reconstructive procedures for arteriosclerotic lesions was good. Transluminal angioplasty for anastomotic stenoses was noninvasive and easily performed with the thrombectomy, but the patency was not so good and there was the risk of graft infection by repeated operations.

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To evaluate the renal function after cardiopulmonary bypass (CPB) and the effect of Urinastatin on renal function, the tubular and glomerular damage were studied in patients underwent cardiac operations, dividing following two groups; Group U with Urinastain and Group C without Urinastatin. Of indexes of glomerular function, changes in serum creatinine and urine nitrogen, and creatinine clearance did not show remarkably after CPB. Serum β₂-microglobulin indicating glomerular function after CPB demonstrated significantly higher levels than that before operation in Group C, but did not in Group U. N-acetyl-β3-D-glucosaminidase and γ-glutamyl-transpeptidase in urine as markers of tubular function rose significantly after CPB in both groups, but they showed significantly lower level in Group U than in Group C. After CPB, even in patients without clinical renal failure, glomerular and tubular dysfunction were placed. Urinastatin was considered to be effective in protection of glomerular and tubular function.

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We have treated 12 popliteal aneurysms in ten patients from 1965 to 1989. There were seven men and three women, aged 34 to 78 years (mean, 61.5 years). Two patients had bilateral aneurysms. The chief complaint was pain at rest, claudication, coldness, etc. in eight patients, a mass or induration at the popliteus in two patients, peroneal nerve or vein compression in one patient each. Angiography showed thrombotic obstruction in six legs and distal occlusion in one leg. Ten of aneurysms of eight patients were treated surgically. In two patients, the operation was done on emergency basis. Amputation was not necessary in any case. The operative method was usually excision of the aneurysm. Reconstruction was made with artificial vessels in the first patient who underwent bilateral aneurysm surgery. Auto-saphenous vein were used in other seven patients. All vein grafts were patent at follow-up (mean follow-up period, 4 years and 3 months). Arteriosclerotic changes were histologically observed in all aneurysms. Complications such as thrombotic obstruction and distal occulsion are frequent and leg amputation is necessary in some cases. Arterial reconstruction with an auto-saphenous vein is necessary for popliteal aneurysm.

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A case of Budd-Chiari syndrome in which direct surgical intervention was successfully performed is reported. A 43-year-old female who had had a history of hepatic coma was pointed out complete obstruction of inferior vena cava (IVC) between the right atrium and diaphragma, associated with hepatic dysfunction and esophageal varices. At operation, the IVC lesion was visualized directly by thoracotomy through midsternal incision and by laparotomy through right hypochondrial oblique incision, with the liver retracted. Under partial extracorporeal circulation with suction of blood from hepatic vein, the IVC was incised, 3cm in length, and membranous tissue causing obstruction was resected. The defect of the IVC wall was repaired with ringed EPTFE patch. Postoperatively, both central venous and portal pressure were decreased, 21 mmHg to 10mmHg and 26cm H₂O to 21cm H₂O, respectively, with good patency of the IVC on venogram. Now the patient is up and well, 11 months after operation. Thus, complete removal of obstruction under direct vision is thought to be important for surgical treatment of Budd-Chiari syndrome.

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A case of 41-year-old man with large candidal vegetation on the tricuspid valve was reported. He was presented with high fever and newly developed heart murmur. Four months before admission, he had suffered from head trauma which required intravenous hyperalimentation and injection of multiple antibiotics through catheter indwelling the superior vena cava. On admission, echocardiogram showed large vegetation on the tricuspid valve, although blood cultures were sterile. At operation, tricuspid valve was replaced with St. Jude Medical prosthesis because large vegetation developed from the anterior tricuspid leaflet was confirmed. Candida albicans was detected by microscopic examination of the vegetation. The total of 1500mg of Amphotericine-B were administered intravenously after operation. His postoperative course was uneventful. We discussed about the availability of echocardiogram for diagnosis and the effectiveness of a combination of chemotherapy and valve replacement for treament of fungal endocarditis.

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Ischemic cardiomyopathy with a severe left ventricular dysfunction and enlargement, is a dismal prognosis, but can be a surgical candidate. So, differential diagnosis of ischemic cardiomyopathy from other cardiomyopathies and evaluation of myocardial viability are important. We successfully performed coronary artery bypass in a 68-year-old patient with ischemic cardiomyopathy. His preoperative left ventricular function showed an end-diastolic volume of 281.8cc/M/m², pressure of 30mmHg, and ejection fraction of 13.1%. We conclude that coronary artery revascularization provides significant benefits for ischemic cardiomyopathy with reversible myocardial ischemia.

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It is known that subaortic stenosis (SAS) occasionally progress after the repair of Co/A. And it may progress if the initial repair is incomplete. We successfully repaired a 6-year-old girl with recurrent SAS with aortic and mitral regurgitations and pulmonary hypertension (Pp/Ps=0.74) progressed after the initial repair for SAS. She had been operated at 4-year-old with transaortic resection of subaortic myocardium and the membrane. He SAS had progressed since the coarctectomy at 7 months of her age. At that procedure, right coronary cusp was lacerated and repaired. In may 1989, Konno operation with 21 St. Jude Medical aortic prosthesis and mitral valve replacement with 25 St. Jude Medical prosthesis were performed. Interventricular septum, aortic root and right ventricular outflow tract were reconstructed employing composite patch with preserved equine pericardium and Dacron velour. So mitral annulus was dilated because of the volume over loading due to aortic regurgitation, that complete repair was not able to do with mitral valvulo and annuloplasty. After the procedure severe cardiac and respiratory failure occurred and continued for over 10 days. And hemolytic anemia with homoglobiuria appeared. It continued for 14 days. In spite of those complications, the girl became well and goes to school with the administration of warfarin and dipyridamole. We recommend that Konno operation could be the first indication for the children with narrow aortic root when incomplete repair was made during the initial repair for subaortic stenosis.

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We describe a 52 year old woman who had an aneurysm involving the common hepatic artery directly originating from the aorta. It was successfully treated by aneurysmectomy without needing the arterial reconstruction. An aneurysm of the common hepatic artery that has an anomalous origin from the aorta is very rare and only 4 cases including the present case were reported in Japanese literature on our survey. The features and management of hepatic aneurysm are discussed.

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Myxoma of the left ventricle is exceedingly rare and to the best of our knowledge not a single case of its recurrence has been reported in Japan. We have recently experienced a case in which a myxomatous tumor of the left ventricle recurred at the same site as the primary lesion 2.5 years after operation and was treated by surgical excision. The patient was a 28-year-old female who, under the diagnosis of myxoma of the left ventricle, underwent surgical removal of the tumor and mitral valve replacement at her age of 25 years. Although her postoperative course was uneventful, she was noticed, at her age of 28 years, of her inaudible prosthetic valve clicks on auscultation at the outpatient service. Echocardiography revealed a tumor mass in the left ventricle, which tended to grow with the elapse of time. Echocardiography on rehospitalization disclosed a mobile cystic tumor on the posterior wall of the left ventricle, while pulmonary arteriography also revealed a movable tumor in the left ventricle. Intraoperatively, there was noted a solid tumor, composed partly of cystic structure, on the posterior wall of the left ventricle and quick pathology led to a suspected diagnosis of myxoma. Since the tumor was found to have involved the ventricular septum and myocardial tissue of the posterior wall of the left ventricle, its complete surgical excision was impossible. The tumor, with its growth pattern and morphology, was diagnosed as a malignant clinical behavior one, although histopathological evidence indicates its benignancy.

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A case of a 51-year old male with pulmonary valve endocarditis accompanied by aortic regurgitation, and ruptured aneurysm of Valsalva sinus was reported. Repeated blood cultures grew α-streptococcus on a single occasion. After medical treatment, resection of pulmonary valve vegetation, resection and patch closure of aneurysm, and aortic valve replacement were performed successfully. Twenty one cases of pulmonary valve endocarditis reported in Japan, including our case, were collected and reviewed. Causative organism was streptococcus in 93% of cases. No case of intravenous drug abuse was found in this series. A variety of preexisting heart diseses were found in 20 cases out of 21 (95%). All these diseases were congenital ones, such as ven-tricular septal defect, patent ductus arteriosus, pulmonary stenosis and ruptured aneurysm of Valsalva sinus. This fact means that jet lesion of pulmonary valve is a major predisposing factor of pulmonary valve endocarditis. Surgical procedures were reported in 12 cases: resection of vegetation in 4 cases, resection of pulmonary valve in 2, and pulmonary valve replacement in 5. Appropriate surgical procedures should be chosen, depending upon the activity of infective endocarditis, severity of destruction of the valve, and pulmonary vascular resistance.

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A 37-year-old female was admitted to our hospital because of haemoptysis. She had undergone descending thoracic aorta-abdominal aorta bypass grafting 11 years previously. Then the diagnosis was atypical coarctation due to aortitis syndrome. No follow up had been continued. Angiogram and CTscan disclosed a false aneurysm at the anastomotic site of the descending thoracic aorta, which was ruptured into the left lung. An emergency operation was performed. A new extra-anatomical ascending aorta abdominal aorta bypass was constructed using 16mm Dacron prosthesis, and three permanent clamps were employed for thromboexclusion of the descending aorta, previous bypass graft and the ruptured aneurysm. At present, three years after the operation, she is leading normal life with medication of hypotensive drugs. Pathogenesis, surgical approach and long-term postoperative care were discussed.

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