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Two patients with thoracic aortic aneurysm ruptured to the lung are reported. They had a previous history of a large amount of hemoptysis requiring uregent hospitalization. Surgical treatment was performed in each of the patients after the emergent pre-operative examinations. The first patient was a 71-year-old male with a huge syphilitic fusiform aortic arch aneurysm ruptured to the left lung, who had a large amount of hemoptysis and vertigo. Graft interposition was undertaken employing cardiopulmonary bypass and separate perfusion of brachiocephalic vessels, but weaning from the circulatory supporting unit did not succeed because of uncontrolled bleeding from the dissected damaged lung. The second patient was a 75-year-old male with an egg-shaped saccular descending thoracic aortic aneurysm ruptured to the left lung. He was operated on by aneurysmectomy under partial cardiopulmonary bypass. No complications appeared after the operation. In the technics of ruptured thoracic aortic aneurysm repair, dissection of the damaged lung from the aneurysm must be avoided if possible.

Pulmonary lesions are often observed in patients with progressive systemic sclerosis (PSS). A rare case of bronchial carcinoid that was found at operation for ruptured giant bulla in a patient with PSS is reported. The patient, a 37-year-old female, had been treated for PSS since 1971. She was admitted to our hospital because of dyspnea and chest pain in January 1981. Chest X-ray films revealed left pneumothorax. As continuous left thoracic drainage was ineffective, surgical treatment was undertaken. At operation a solid tumor (3×3cm) was newly recognized in the left S9, together with ruptured giant bulla in the left S8. Therefore, left lower lobectomy was performed. Histological examination revealed that the tumor was argynophilic bronchial carcinoid and the bulla had interstitial pneumonia. Although the postoperative course seemed uneventful, bone metastases (the fourth lumbar vertebral body) appeared 15 months after operation, and she died 17 months after operation.

Twelve patients with heart valve surgery over the age of 65 were investigated postoperatively by the cardiac catheterization method at rest and during the dopamine infusion test. Cardiac lesions were mitral stenosis in five patients and mitral regurgitation and/or aortic regurgitation in seven. The patients ranged from 67 to 73 (average 70.0)years old and the mean follow-up period was 38.9 months.The functional state recovered from 2.9 to 1.6 according to the NYHA classification after the follow-up term, so the left ventricular pump function referred to the cardiac index, stroke volume index and left ventricular stroke work index did not change significantly. However left ventricular systolic function referred to the left ventricular end-systolic pressure to end-systolic volume index ratio, end-systolic wall stress to endo-systolic volume index ratio and tension-volume ejection fraction were markedly increasd in the cases of left ventricular volume overload from valvular regurgitation. After the dopamine infusion test, ejection time was shortened, and forward stroke flow was increased because of the decrease in regurgitant flow, in contrast to the absence of a change in total stroke flow.