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A 48-year-old woman was admitted for surgery on a lung tumor found incidentally. Her medical history showed a synovial sarcoma of left inguinal region which was resected 12 years ago. We performed segmentectomy of left S4 + 5 to removed the metastatic tumor. Histological examination revealed that the tumor was metastatic synovial sarcoma. Synovial sarcoma can metastasize to lung frequently but such a long disease free interval as 12 years is quite uncommon.

A 70-year-old woman who had a left atrial thrombus without mitral valve disease was reported. On admission her electrocardiogram showed atrial fibrillation, but there was no cardiac murmur. Transthoracic echocardiogram revealed a dilated left atrium and an intact mitral valve, but did not detect any thrombus. Transesophageal echocardiogram, however, demonstrated the thrombus attaching to the left atrial appendage. Removal of the thrombus and maze procedure were performed at the same time. Although a pacemaker (DDDR mode) was required postoperatively, she spends uneventful daily life at two years after the surgery.

We report a case of 67-year-old woman with severe aortic stenosis complicated by polycythemia vera (PV). She has been treated for PV with busulfan over the past three years. On admission, she had increase in white blood cell, red blood cell and platelet count. The pressure gradient between left ventricle and aorta was 170 mmHg. Aortic valve was bicuspid and replaced with a 21 mm Carpentier-Edwards pericardial xenoprosthesis. Ascending aorta with a diameter 6.0 cm was replaced simultaneously with a 30 mm Dacron graft (Hemashield). Post-CPB course was uneventful except for a tendency to the prolongation of activated clotting time. She was discharged from the hospital in good condition.

Between August 1980 and December 1995, 29 patients have undergone valve replacement for active infective endocarditis (IE) at our institute. Twenty five patients had native valve endocarditis (NVE) and 4 had prosthetic valve endocarditis (PVE). The indication for surgery in 29 patients was congestive heart failure, septicemia or systemic embolization. Twenty six patients had vegetation. Eleven patients had AVRs, including one modified Bentall operation, 10 had MVRs and four had DVRs with mechanical prosthetic valve. There were eleven early death (38%) and one late death. Operative mortality rate has reduced to 24% after 1991. We conclude that early surgical intervention should be taken according to the hemodynamic state of the patients irrespective of the presence of septicemia.

A 56-year-old man was admitted to our medical center because of acute anterior myocardial infarction. Emergent percutaneous transluminal coronary angioplasty (PTCA) resulted in successful dilatation at the stenotic lesion of the left anterior descending artery (LAD). Three months later, coronary angiography showed not only a restenosis but also an aneurysm formation at the same portion. This lesion was too risky to redo PTCA. We successfully performed coronary bypass grafting with the internal thoracic artery.

In eight hundred and sixteen consecutive patients undergoing coronary artery bypass grafting (CABG) within the past 19 years (1974 to 1993), repeated CABG were performed on 12 patients (1.47%). The main reasons for repeated CABG were graft failure (GF), progression of native disease (NP) and incomplete revascularization (IR). The incidence of GF only and GF combined NP were high either within a half year or around 5 years after CABG. When the recurrence of angina is noted after CABG, the catheter intervention should be chosen at first but the reoperation should be done not so late. Although all patients survived from reoperation, three patients continued to have mild angina pectories. If a reoperation is inevitable, maximum utilization of arterial graft and accomplishment of complete revascularization are emphasized.