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We presented a case of a 48-year-old male with failed delivery of the Palmaz-Schatz stent, who subsequently required CABG with successful retrieval of the stent. The patient had presented recurrent angina, approximately one and a half year since the last PTCA to the LAD. Re-PTCA was performed, but resulted in a severe local dissection. The stent implantation was tried, but was inadvertently dropped in the vessel. Since the patient was hemodynamically stable, we tried to remove the stent with Retriever endovascular snare, which ended up with interlocking the stent in the more proximal segment of the LAD and the snare itself was not removed. We, therefore, resort to the emergent operation, with successful retrieval of the snare device and the stent and carried on to the the bypass operation to the distal LAD without any complications. To our best knowledge, this is the first report in Japan for surgical retrieval of the Palmaz-Schatz stent, which was failed in delivery and interlocked in the vessel with retriever device.

To reduce the rate and the volume of homologous blood transfusion, we have used autologous platelet rich plasma (PRP) in adult open heart surgery. From Jan. 1988 to Jun 1992, 191 patients have underwent open heart surgery of coronary artery disease or valvular heart disease in our institution. We divided these patients into two groups: (1) PRP group; autologous PRP was used in 99 cases, (2) C (Control) group; autologous PRP was not used in 92 cases. Patient characteristics of age, sex, body weight, preoperative hematocrit values, preoperative platelet counts, and CPB time were same in these groups. Intraoperative and postoperative blood loss in PRP group were significantly less than those in C group (376 ml and 458 ml vs 511 ml and 568 ml; p < 0.01). Homologous blood transfusion rate (number of patients receiving homologous blood transfusion/all patients) was lower in PRP group (11.1% vs 32.6%; p < 0.01). The volume of homologous blood transfusion in the patients receiving transfusion were smaller in PRP group (7.5 U vs 13.3 U; p < 0.05). We conclude autologous PRP is useful in adult open heart surgery to reduce the perioperative blood loss, the rate, and the volume of homologous blood transfusion.

A case of complete circumferential rupture of the thoracic aorta due to blunt chest trauma is presented. A 46-year-old woman was admitted after a traffic accident. The admission chest X-ray film demonstrated rib fractures and mediastinal widening. CT scanning and aortography were performed, but acute rupture of the aorta was not detected. Twelve days later, aortography was performed again and an aneurysm was noted at the aortic isthmus. Surgery was performed immediately and aorta was found to be completely disrupted for a length of 1 cm. A short segmental prosthesis was interposed between the two ends of the aorta under temporary bypass. Patients with aortic rupture due to blunt chest trauma are increasing, but only a few cases treated in the acute stage have been reported. To our knowledge, this is the 6th case of complete aortic disruption which has been treated successfully in the acute stage in Japan.

A total of 230 vein grafts were studied angiographically in 116 unselected survivors of 260 coronary bypass operations performed from May 1977 through October 1989 in order to investigate atherosclerotic changes in coronary vein grafts after operation. These patients were divided into three groups according to the interval from operation to angiography. In group A (30 patients) the interval was less than one year (mean interval 8.2 months), in group B (73 patients) from one to five years (mean interval 19.2 months) and in group C (13 patients) more than 5 years (mean interval 96.6 months). Fifty-five vein grafts were in group A, 153 vein grafts in group B and 22 vein grafts in group C. The graft patency rate of each group was 83.6%, 89.5% and 90.9% respectively (N.S.). To classify angiographic appearances we believe to be caused by atherosclerosis, we devised a grading system. Category I indicated that the graft outline was completely smooth without any irregularity; Category II indicated that less than 50% of the estimated surface area of the graft intima was irregular; Category III indicated that more than 50% of the intima was involved. Significant stenosis indicated narrowing reducing the lumen to less than 50% of the graft. Of the 203 patent grafts 181 grafts (89%) were in Category I, 22 grafts (11%) in Category II, but no graft in Category III. In group A of the 46 patent grafts 45 grafts (98%) were classified as Category I and 1 graft (2%) was classified as Category II.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of 33-year-old woman with aberrant right subclavian artery was reported. She was admitted to the hospital complaining of progressive dysphagia of six months' duration. The esophagogram revealed an oblique tubular defect in the superior thoracic esophagus. Aortograms confirmed the presence of an anomalous right subclavian artery arising as a fourth branch of the aortic arch, passing behind the esophagus in its course to the right arm. Operation was performed on Sept. 4, 1990. Through a median sternotomy, the ascending aorta and the two carotids were dissected free. With gentle forward retraction of the ascending aorta to the left, the origin of the aberrant right subclavian artery could easily be exposed. The right subclavian artery was then divided and its origin from the distal aortic arch oversewn. The vessel was removed from the retroesophageal position and blood flow reestablished to the right arm by an end-to-side anastomosis to the right carotid artery, using a temporary shunt tube. These procedures were accomplished without difficulty. Postoperatively, the patient made an uneventful recovery and was discharged 16 days after the procedure. A postoperative esophagogram confirmed the removal of the esophageal compression. The blood pressure was equal in the two upper extremities. In follow-up study, her symptoms had completely disappeared.