[Mitral Valve Repair in a Jehovah's Witnesses Patient with Post Myocardial Infarction Papillary Muscle Rupture;Report of a Case].

A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason( Jehovah's Witness). Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova's Witnessess patient.

[Adult coarctation of aorta repaired under partial selective cerebral perfusion].

We report a case of an adult coarctation of aorta in a 46-year-old woman repaired with partial selective cerebral perfusion. Preoperative cardiac catheterization revealed that pressure gradient between the upper and lower limb was more than 60 mmHg. Under general anesthesia, we entered the left thoracic cavity through standard thoracomy, and removed the coarctation of aorta under partial selective cerebral circulation. The left common carotid artery and the descending aorta were cannulated and perfused, and the main pulmonary artery was cannulated for venous drainage. The aortic arch was cross-clamped just proximal to the left common carotid artery. Reconstruction was carried out by graft replacement using a side armed 16 mm Dacron graft between the aortic arch and the descending aorta, and the left subclavian artery was connected to the side arm of the graft. Postoperatively, there is no pressure difference between the upper and lower extremities.