[Off-pump coronary artery bypass for old myocardial infarction associated with jejunotomy for obstructive ileus due to gall bladder stone; report of a case].

In non-cardiac operative cases with inflammatory digestive organ disease, bacterial translocation (BT) often results from non-enteral nutrition postoperatively. If coronary artery bypass grafting (CABG) is performed in the case having old myocardial infarction (OMI) and inflammatory digestive organ disease at first before non-cardiac operation, he seems vulnerable to have severe complications such as multiple organ failure due to systemic inflammatory response syndrome (SIRS) and preexisting BT postoperatively. We performed a off-pump CABG (OPCAB) for OMI associated with jejunotomy for obstructive ileus due to gall bladder stone. No complication was found in the postoperative course. We conclude that combined operation, non-cardiac surgery after OPCAB is worth considering in those cases. And we think OPCAB is better than conventional CABG in such cases, because cardiopulmonary bypass is known to ponder comparable damages to immune system, coagulation system and others.

[The case report of minimal access CABG for triple-vessel disease].

A 55-year-old male patient underwent CABG for triple-vessel disease using the minimal access approach. The procedure was performed through a limited (10 cm) left para-sternal thoracotomy using extracorporeal circulation established with a usual aortic cannula, and pulmonary arterial and right atrial drainage. The myocardium was protected by antegrade administration of cold cardioplegic solution while the aorta was being cross-clampled. The saphenous vein graft was connected sequentially to the 4 PD and OM branches, and the left internal thoracic artery was grafted to the LAD. The postoperative course was uneventful and coronary angiography showed that all three grafts were patent. The patient was discharged one week postoperatively.

[A successful surgical treatment of cor triatriatum with VSD, PDA and CoA].

A successful repair of cor triatriatum with VSD, PDA and CoA is reported. A two-month-old boy was admitted for evaluation of growth failure and cyanosis. Physical examination on admission revealed systolic murmurs at left sternal border. Chest X-ray showed increased pulmonary vascularities without cardiomegaly. Echocardiography showed abnormal wall in left atrium with VSD, PDA and CoA. An emergency operation consisting of patch closure of VSD, ligation of PDA and resection of the anomalous left atrial membrane were performed. At postoperative course, an episode of pulmonary hypertension crisis happened. But the patient tolerated this episode and survived.

[Successful surgical treatment of total anomalous pulmonary venous connection (supracardiac Ib type) showing an unusual shape of the pulmonary veins in an infant].

An experience of a 9-month-old infant with Darling's type Ib of total anomalous pulmonary venous connection is presented. In this case, the left pulmonary vein traveled horizontally behind the atrium, entered the right thoracic cavity and drained into the SVC together with the right lower, middle and upper pulmonary veins. The patient was treated with repair using Gersony-Malm's method and plasty of SVC because of the stenosis of the common pulmonary vein's entrance to the SVC. Her postoperative course was uneventful, and the result was satisfactory. To our knowledge, our case is the first successful correction not associated with other complex cardiac anomalies in the world.

[A case report of coronary artery bypass grafting with the left internal mammary, the right gastroepiploic, and the inferior epigastric arteries].

We performed coronary artery bypass grafting with the left internal mammary artery, right gastroepiploic artery, and inferior epigastric artery on a 60-year-old male. The inferior epigastric artery used as a free graft was placed between the in situ left internal mammary graft proximally and the obtuse marginal branch distally. Both the left internal mammary graft to the left anterior descending artery and the right gastroepiploic artery to the right coronary artery were used as an in situ graft. All grafts were patent two weeks after the operation and the patient was free from angina at three months follow-up period.

[A case of tricuspid atresia with unroofed coronary sinus].

Tricuspid atresia with unroofed coronary sinus is an extremely rare cardiac anomaly. A 15-year-old boy who was successfully operated was suspected this disease preoperatively. We speculated this disease by right atrial angiography and underwent the direct suture closure of a coronary sinus defect and Fontan's operation. When we perform Fontan's operation on tricuspid atresia, we should take the existence of unroofed coronary sinus into our consideration. The echocardiography, cardiac catheterization and angiography, especially, right atrial angiography had to be carried out preoperatively. During the operation, it is important to check over the influence of cardioplegic solution from the ostium of coronary sinus. If not, elaborate inspection have to be done on the back wall of the left atrium through ASD to search for abnormal communication directly or by inserting sound from coronary sinus.

[Mixed type total anomalous pulmonary venous connection with the left upper pulmonary vein draining into the innominate vein and the other pulmonary veins into the coronary sinus--surgical correction in 2 infants].

Surgical repair of the mixed type total anomalous pulmonary venous connection (TAPVC) in infancy is known to be difficult. In this report, experience of two infants with the mixed type TAPVC with the left upper pulmonary vein (PV) draining into the innominate vein and the other PVs into the coronary sinus (IIa + Ia (left upper PV) type TAPVC) is presented. In such cases, it has been said that the left upper PV should be left uncorrected, but we anastomosed the left upper PV, that was thin and fragile, to the left atrium and corrected all the other anomalous PVs. The results were satisfactory. Recently, Extra-Corporeal circulation, microsurgery, and other techniques have significantly progressed, so we consider that the anastomosis is possible in most infants with IIa + Ia (left upper PV) type TAPVC. In the future, careful clinical follow-up and repeat catheterizations should be done, and we'd like to examine the long term patency of the left upper PV.

[Subtotal cor triatrium with left partial anomalous pulmonary venous connection--successful correction in an infant].

This report concerns a 10-month-old infant with subtotal cor triatrium associated with left sided partial anomalous pulmonary venous connection to the innominate vein. In the operation, we found that the fossa ovalis existed between the right atrium and the accessory atrial chamber. We performed a radical operation which consisted of a resection of the intra-left-atrial diaphragma and a anastomosis of the vertical vein to the left atrium. His postoperative course was uneventful, and the result was satisfactory. We have presented and reviewed our case, and then discussed the embryogenesis and the hemodynamics. To our knowledge, our case represents the first successful surgical repair of this combination of defects in Japan.