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A 28-year-old man was admitted to hospital for investigation of a 2-week history of angina occurring on exertion. Coronary angiography showed an isolated left coronary ostial stenosis and left main trunk plasty was performed 2 weeks later. The pathological diagnosis of the left coronary ostial stenosis was fibromuscular dysplasia, which makes this a rare case.

A successful case of human atrial natriuretic peptide (HANP) infusion therapy for a neonate who developed congestive heart failure (CHF) after total repair of total anomalous pulmonary venous connection was performed on the first day of life. Following 14h of HANP infusion at incremental doses of 0.125-0.25 microg x kg(-1) x min(-1) urine output and hemodynamics dramatically improved. Urine output increased from 1.1 to 10.6 ml/h (p<0.0001) and good urinary output (13.0 ml/h) was maintained even after discontinuation of the infusion. During the infusion, the heart rate decreased from 166 to 152 beats/min (p<0.0001), and the systemic systolic blood pressure increased from 82 to 103 mmHg (p<0.0001). Central venous pressure was not significantly affected by HANP infusion. This is the first successful case of HANP infusion therapy as the first treatment of post-operative pulmonary hypertension in this age group. This therapy can be used safely and may be useful in neonates with CHF resulting from other causes, but more investigation is needed.

We encountered a 67-year-old woman with a left atrial myxoma which was discovered during echocardiographic examination and emergency coronary arteriography just after an onset of acute inferior myocardial infarction. Coronary arteriography disclosed an abrupt and total occlusion of the right coronary artery and an abnormally large and tortuous atrial circumflex branch feeding a left atrial mass. These findings were the most useful for diagnosis. Aorto-coronary bypass surgery and excision of the myxoma were performed simultaneously by emergency operation. The postoperative course was uneventful. Myocardial infarction in this patient is believed to have been caused by coronary embolization from the left atrial myxoma.

Infective aneurysm showing dilatation of all three coronary sinuses of Valsalva due to infective endocarditis is extremely rare. We present the first report of such a case complicated by left single coronary artery. The patient was a 55-year-old man with a past history of untreated diabetes mellitus, cerebral infarction, aortic regurgitation and high-grade fever. He was admitted with a complaint of easy fatigability. In a treadmill exercise test, asymptomatic ischemic depression of the ST segment was observed. Two-dimensional echocardiography revealed marked dilatation of all three sinuses of Valsalva, and a mural thrombus within the dilated right sinus of Valsalva. On magnetic resonance imaging, an abnormal signal in the markedly dilated right sinus of Valsalva was revealed. Coronary arteriography showed left single coronary artery (L1 type by Sharbaugh's classification). The histopathological features of the affected aorta were thought to represent the healing stage of infective endocarditis. With regard to the myocardial ischemia in this patient, it was thought to have arisen mainly through aortic regurgitation and coronary atherosclerosis due to single coronary artery, and partly influenced by untreated diabetes mellitus.

The surgical results in patients with severe congenital heart disease, who underwent surgical treatment between 1978 and 1981 at the National Cardiovascular Center, Japan, were analyzed. The surgical mortality rates were 4% for cases of ventricular septal defect associated with pulmonary hypertension in patients under 2 years of age, 16.7% for complete atrio-ventricular canal, 11% for coarctation of the aorta associated with ventricular septal defect, 40% for pure pulmonary atresia without Ebstein anomaly, 44% for total anomalous pulmonary venous return, 14.8% for transposition of the great arteries, 44% for double outlet right ventricle and 1.1% for tetralogy of Fallot. The surgical results have been improving and postoperative residua and sequelae have been decreasing through our persistent efforts. Today's main problem is a relatively poor performance in cases which need surgical intervention early in life, i.e., under 3 months of age. Therefore, we think that our effort to improve the surgical results for new-borns or very young infants is most necessary.

One of the major causes of postoperative morbidity and mortality after valve replacement surgery is the prosthetic valve substitute itself. In this discussion, therefore, we make a fundamental evaluation of hydrodynamic valve function and present our clinical results following valve replacement with the Björk-Shiley valve prosthesis, the Hancock porcine xenograft and the Ionescu-Shiley bovine pericardial xenograft. In an experimental study using a mechanical simulator system, the pericardial xenograft displayed superior hydrodynamic characteristics compared to other two valve substitutes. Postoperative hemodynamic evaluation further indicated that the pericardial xenograft performed significantly better than the porcine xenograft regarding transvalvular pressure gradient, effective valve area and cusp opening. In addition, data from 387 patients with aortic, mitral or both types of valve replacement who had received one of the three kinds of valve substitute were analyzed. Systemic thromboembolic complications occurred in one patient with an aortic Björk-Shiley valve (0.6% per patient-year), six with mitral Hancock xenografts (2.8% per patient-year) and one with an aortic and mitral Hancock xenograft (2.2% per patient-year). The incidence of prosthetic valve endocarditis was 0.84% per patient-year for the Hancock xenograft and 1.84% per patient-year for the Ionescu-Shiley xenograft. It was concluded that the hemodynamic and antithrombogenic advantages of the pericardial xenograft proven by our mid-term follow-up study make it the valve substitute of choice. However, careful attention is required regarding prosthetic valve endocarditis tissue heart valves, which are more susceptible to infection than mechanical ones, and the long-term durability of the pericardial xenograft remains to be confirmed.