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A multi-institutional cooperative study, that was a comparison of long-term results of the replacement of the four models of the oblique disc valve prosthesis which had been implanted on aortic and mitral position alone or double from December 1976 to September 1992 in the eight national hospitals in Japan was performed. Seven hundred and thirty-four patients and 765 prostheses that consisted of 582 patients and 610 prostheses of the Björk-Shiley (BS) valve, including 326 patients of the Spherical disc (SP) valve (49 aortic, 259 mitral, and 18 double aortic-mitral), 103 patients of the Convexoconcave disc (CC) valve (45, 51, 7) and 153 patients of the Monostrut (MS) valve (101, 49, 3), and of 152 patients (71, 78, 3) and 155 prostheses of the Omnicarbon (OC) valve were compared with their mortality and morbidity in every valve position respectively according to the approval by STS-guideline. The MS valve and the OC valve showed 0% to 11.3% of operative mortality, 0.3%/py to 1.8%/py of valve related mortality, 85.5% +/- 5.6% to 98.4% +/- 1.6% of actuarial survival rate at 10 years, and 58.5% +/- 6.4% to 82.7% +/- 5.7% of actuarial free rate of all mortality and morbidity at 10 years in every valve position. Structural deteriorations occurred in two patients of the CC valve in the mitral position only, and its rate of all valve positions showed 0.04%/py. Significant differences were seen in actuarial survival rate at 10 years after aortic valve replacement, and in operative mortality rate, improved degree of NYHA class, structural deterioration rate and actuarial free rate of all mortality and morbidity after mitral valve replacement between the group of the MS and OC valve and the group of the SP and CC valve. Therefore the MS valve or the OC valve should be selected to implant rather than the SP valve or the CC valve, and the patient who had been implanted with the CC valve should be treated considering valve position, valve position, valve size, age and activity of the patient and the manufactured date of the prosthesis.

A case of Saber-sheath type tracheo-bronchomalacia complicating bronchial asthma was treated by external fixation of Marlex mesh, and good results were obtained. The patient was a 43-year-old male who had been treated for bronchial asthma for over nearly 20 years. Since 4 years ago, dyspnea and a feeling of obstruction of the larynx developed and gradually aggravated. He lost consciousness twice and was hospitalized on an emergency basis. Pulmonary function tests performed during remission of asthma attacks revealed an obstructive disorder: FEV1.0% was 30.5% and peak flow was 4.11 L/sec. Bronchoscopy and tracheo-bronchography revealed Saber-sheath type tracheo-bronchomalacia in the trachea and the right main bronchus. The severity of the obstruction was, in terms of Johnson's classification, II. for the trachea and I. for the right main bronchus. In accordance with the method reported by Hanawa and Ikeda, external fixation was applied to the trachea and the right main bronchus; that is, Marlex mesh was applied around to the trachea and the right main bronchus, and additional Lyodura was applied over the Marlex mesh. The postoperative course was satisfactory. Both FEV1.0% and the peak flow improved, and constriction of the trachea and the right main bronchus at the time of coughing was also reduced.

A 35-year-old women complained exertional dyspnea during medication therapy for pulmonary tuberculosis. Thoracotomy was done under the diagnosis of stenosis of the left main bronchus and of obstruction of the left lower bronchus due to bronchial tuberculosis. The collapsed inferior lobe of the left lung with fibrotic change was resected. The left main bronchus was completely resected without only one cartilage ring nearest to the carina. The anastomosis of the left main bronchus end was performed to the end of the left lower lobe bronchus. This procedure of anastomosis is considered to be technically difficult for anatomical views, and its reports have been few. From our experience this operation can be performed safely by following modifications, 1) Botallo ligament was detached to obtain a wide operative filed for the end to end anastomosis of bronchus, 2) by taping of the trachea and the right main bronchus and applying traction by the tape, bronchial anastomosis was performed under direct view with great facility, and 3) omentopexy was added to prevent the suture insufficiency of the anastomosis.

A case of congenital atresia of the left main coronary ostium suffering from ventricular tachycardia underwent coronary artery bypass operation. The patient was 17 years old boy. When he was 9 years old he visited our department for the purpose of examining cardiac disease. The diagnostic impression was mitral regurgitation. At 16 years old he suddenly complained tachycardia during exercise. He admitted to our hospital and the tachycardia was proved to be ventricular tachycardia. Left ventriculogram demonstrated a small range of akinesis at the left ventricular apex. And coronary cineangiogram revealed atresia of the left main coronary artery. The left coronary artery was perfused with collateral circulations from right coronary artery. Electrophysiological study was performed. The ventricular tachycardia could be reproducibly initiated and terminated by programmed stimulation. The catheter endocardial mapping was also performed. The source of ventricular tachycardia was supposed to be at the left ventricular apex. At 18 years old coronary artery bypass operation was performed. Internal mammary artery graft was placed to the left anterior descending artery and a saphenous vein graft was placed from the ascending aorta to the left circumflex artery. A small size of myocardial infarction was recognized at the left ventricular apex. And epicardial mapping revealed that the source of arrhythmia was the same region as the myocardial infarction was recognized. Endocardial resection or cryoablation was not performed. Post-operative study was performed 8 months after surgery. The graft flow of the internal mammary artery to the left anterior descending artery was not sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

A rare case of congenital tricuspid stenosis treated with modified Fontan operation was reported. The patient was 13 years old boy and his chief complaint was cyanosis. Cyanosis appeared in his neonatal period and squatting developed in his childhood. He underwent Blalock's shunt operation at 5 years of age. His exercise tolerance was limited at the admission for the radical operation. Angiocardiography showed the annular stenosis of tricuspid valve and the moderate hypoplasia of right ventricle. The right ventricular volume was 56 ml (equivalent to 35% of the normally expected right ventricular volume) and the diameter of tricuspid annulus was 13 mm (equivalent to 58% of the normally expected diameter). Atrial septal defect was associated with but pulmonary stenosis did not exist. His left ventricular function was good and pulmonary vascular resistance was not raised. A diagnosis of tricuspid stenosis was made and Fontan's repair was considered to be possible for his correction. Operative findings showed normal architecture of tricuspid valve with the three leaflets but tricuspid annulus was narrow. Tricuspid valve stenosis was considered to be caused by the hypoplasia of tricuspid ring and surgical dilatation was found to be difficult. Therefore, modified Fontan operation (RA-RV connection) was performed. His cyanosis disappeared and exercise tolerance was improved after the operation. Cardiac catheterization and angiocardiography were performed 8 months and 28 months after the operation. His righ ventricular volume was increased to 123 ml (equivalent to 57% of the normally expected volume) followed by RA-RV connection.

A 30-year-old female with an idiopathic chylothorax who underwent successful surgical treatment was reported. The patient was referred to our hospital because of massive right pleural effusion found by chance on the X-ray. Thoracocentesis revealed chyle but the etiology was not known by examinations. Conservative treatments such as fasting, intravenous hyper-alimentation and a continuous drainage were performed for 10 weeks without remarkable improvement. A right thoracotomy revealed nothing abnormal except for the oozing of lymph from mediastinal pleura, which was sutured by 3-0 nylon. Postoperative course was uneventful and no recurrent pleural effusion has been recognized for 3 years since then. Adult chylothorax with unknown etiology like this is rare and only 13 cases have been reported in Japan. Such "idiopathic chylothorax" cases, including our case, were reviewed and discussed.

External conduit operation was performed for a 20 year-old woman with pseudotruncus arteriosus with major aorto-pulmonary collateral arteries (MAPCAs). Immediate postoperative pulmonary to systemic peak pressure ratio was 0.70, and decreased to 0.53 on the second postoperative day. She had episodes of pulmonary hypertensive crisis soon after the operation, and injection of tolazoline hydrochloride was effective on them. Seven months after surgery, cardiac catheterization revealed severe pulmonary hypertension (PH) above the systemic level. Pulmonary arterial pressure did not respond to any drug nor to inhalation of oxygen. The progression of PH may be due to the pulmonary obstructive disease, and its causes were thought to be the repetition of constriction of pulmonary arterioles, hypoxia due to the giant bullae, diminished pulmonary vascular beds due to ligation of arborized MAPCAs, and relatively high age at operation.