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A 69-year-old male was referred to our hospital after being diagnosed as having pericarditis with pericardial effusion. The symptoms of tamponade disappeared after the effusion was drained;although the cause of pericarditis remained unidentified. About 4 months later, the tamponade symptoms recurred due to the thickened nodular pericardium. Partial pericardiectomy was performed, however the patient died on the 52nd day after surgery. Immunohistological examination with calretinin led to the diagnosis of primary malignant pericardial mesothelioma, which was an extremely rare pathology. Because the hyaluronic acid content of the effusion has been reported as a diagnostic aid for malignant mesothelioma, routine examination of the hyaluronic acid content for pericarditis with pericardial effusion may be necessary for early diagnosis and to improve prognosis.

A 60-year-old male was referred to our hospital due to suspected chronic heart failure. He also had a symptom of ischemic heart disease. The multi-detector row computed tomography (MDCT) demonstrated the coronary-pulmonary artery fistula with a giant coronary aneurysm, which was partly thrombosed. Two abnormal arteries to the aneurysm and the outflow to the pulmonary artery were clearly detected. Intraoperative epicardial echocardiography revealed the complete interruption of blood flow and the thrombus formation in the coronary aneurysm, that was achieved just by ligation of 2 arteries under off-pump surgery. Generally, congenital coronary-pulmonary artery fistula has complex morphological variations. In this case, MDCT and epicardial echocardiography were useful for the surgical decision-making to avoid the residual and/or the recurrent fistula.

A 69-year-old male with a history of total esophagectomy and substernal placement of the gastric tube for esophageal carcinoma was admitted due to an unstable angina. Cardiac catheterization revealed a severe stenosis just proximal to the left anterior descending coronary artery and a 75% stenosis of the right coronary artery. Intraaortic balloon pumping was started in the catheter laboratory. Off-pump coronary artery bypass grafting was performed through left thoracotomy. The left internal mammary artery could not be utilized as a bypass graft to the left anterior descending artery due to severe substernal adhesion. Percutaneous coronary intervention was selected for the revascularization of the right coronary artery lesion.

Warm blood cardioplegia and normothermic cardiopulmonary bypass (CPB) have been used in coronary artery bypass grafting (CABG). The method of myocardial protection was intermittent combined antegrade and retrograde warm blood cardioplegia with terminal warm blood cardioplegia. We performed elective CABG in 30 patients above the age of 70 years (elderly group). These patients were compared with 30 patients below 70 years who underwent elective CABG (young group). No significant differences were observed about the preoperative data between two groups. No significant differences were obtained in the postoperative cardiac function, cerebral or renal complication between two groups. Warm blood cardioplegia and normothermic CPB were not associated with adverse effects on postoperative recovery in elderly as well as young patients. We may conclude that warm blood cardioplegia with normothermic CPB is a safe procedure for CABG in elderly as well as young patients.

Allogeneic blood transfusion still carries risks of transfusion reaction and infection. We examined the effect of a preoperative autologous blood donation (800-1,200 g) by subcutaneous epoetin alpha injection on a series of patients undergoing elective coronary artery bypass grafting (CABG). CABG was being performed with increased frequency in elderly patients. We have performed CABG in 18 patients over 65 years of age (elderly group). These patients were compared with 20 patients under 64 years of age (younger group). Postoperative bleeding and allogeneic blood transfusion were significantly larger in quantity in the elderly group than the younger group (p < 0.05). The incidence of allogeneic blood usage was significantly higher in the elderly group than the younger group (p < 0.05). Therefore, a preoperative autologous blood donation in CABG was considered to be not so effective for saving allogeneic blood transfusion and preventing transfusion reaction or infection in elderly patients.

It has been pointed out in general that the resistance against infection is decreased in the diabetic patients. This problem is very important in patients undergoing major surgery. In cardiovascular surgery, the median wound infection may result in life threatening sequelae. We have used the internal thoracic artery as the appropriate graft for its excellent long-term patency. In this series of the diabetic patients who underwent coronary artery bypass grafting with bilateral internal thoracic artery grafts, the incidence of postoperative mediastinitis was significantly higher than other cases. Therefore the use of bilateral internal thoracic artery grafts should be avoided, if possible in the diabetic patients.

We discussed on the long-term anterior chest median wound keloid after the cardiac surgery by using a questionnaire. The risk of the anterior chest median wound keloid was high significantly in the cases using the bilateral internal thoracic artery compared with the cases using no internal thoracic artery. Participation of the decreased blood supply was highly suggested as the cause of this keloid formation.

We have experienced a simple, safe and convenient technique for supporting the arterial or saphenous vein graft in the coronary artery bypass grafting. This graft supporter is made of cotton cloth with a 50 percent polyester mix. The supporter is twenty centimeters long and two centimeters wide. This supporter provides the complete fixation of the graft without the holding by the co-operater. Therefore the supporter allows very easy, safe and accurate graft anastomosis with the native coronary artery or the ascendinbg aorta. No complication was encountered in association with this procedure in 127 operations.

We discussed on the long-term anterior chest wound pain after the cardiac surgery by using a questionnaire. The risk of the left anterior chest wound pain was high significantly in the cases using the left internal thoracic artery compared with other cases. Participation of the division of the left upper pericardium and the adjacent soft tissue was highly suggested as the cause of this pain.

We have used the coronary artery exposing tape devised by Akio Matsuura in 93 patients undergoing coronary artery bypass grafting. We could perform graft anastomosis more easily and safely by the use of this tape than by the conventional simple compression method of the heart with the gauzes. The heart was lifted anteriorly with the rotation by the tape pulled to the left side or to the caudal side. The right coronary artery branches were exposed excellently by the simple traction of the tape to the caudal side. The circumflex coronary artery branches were well exposed by one tape pulled to the left side and another tape to the right side over the heart with the counterclockwise rotation of the heart. In these procedures no complication was encountered in association with the traction of this tape.

We experienced the safe and easy insertion method with the J-shaped left ventricular vent catheter. The catheter tip (about 15 cm) was vended in the J shape with the inner stainless steel introducer. This J-shaped catheter was inserted into the left atrium through the right upper pulmonary vein. Then this catheter was held vertically and only the outer silicone catheter was pushed into the left ventricle. In this method the catheter tip is turned to the front in the left atrium and inserted easily into the left ventricle along the anterior wall of the left atrium through the anterior margin of the mitral valve orifice.

We treated four cases with mediastinitis after coronary artery bypass grafting using the right gastroepiploic artery. These four patients were treated with the pedicled omentum. Omental transfer was successful in three cases. After the harvest of the right gastroepiploic arterial graft, the residual omentum was viable. The residual omentum was applicable for the treatment of mediastinitis.

We reported a case of left atrial myxoma in advanced age. The case was eighty years old man. He admitted with congestive heart failure. He was diagnosed as left atrial myxoma by echocardiography. The open heart surgery was done. The myxoma was 79 g in weight and 8.5x5x3 cm in size. Post operative course was uneventful. The echocardiography is useful for diagnosis of the left atrial myxoma. The left atrial myxoma should be operated when it is diagnosed how the patient is advanced age. The septal-superior exposure gives a good operative field.