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Autotransfusion of the shed mediastinal blood after cardiac operations was performed in 20 cases (ATS group). Safety and efficacy of the autotransfusion were studied comparing with the 10 cases without autotransfusion (control group). A 65.1 +/- 17.1% of bleeding volume within 24 hours after surgery was autotransfused in the ATS group. The ATS group received 1,396 +/- 1,674 ml of the banked blood compared with 780 +/- 1,194 ml for the control group. There was no significant difference between two groups in regard to saving the banked blood. Hematological and biochemical studies after surgery in the ATS and control groups revealed that CPK, BUN and creatinine of the ATS group were significantly higher than those of the control group, although these changes were transitory and trivial. However, prothrombin time of the ATS group was lower than that of control group, so there may be the possibility that this technique itself increases the hemorrhage. Since the cardiotomy filter was obstructed with clots in cases of massive bleeding, shed mediastinal blood may not be fully defibrinogenated in the cases with massive bleeding. These results lead to the following conclusions: autotransfusion of the shed mediastinal blood after cardiac operations is a safe method, but the efficacy of it is doubtful.

Cardiac surgeons have hesitated to perform valvuloplasty for MR caused by elongated or ruptured chordae of the anterior leaflet (AL) of the mitral valve. We experienced three cases of successful chordal reconstruction (CR) to the AL last year. Two of them were due to elongation of all chordae tendineae to the AL. Four CRs, one chordal shortening, cleft closure and ring annuloplasty (AP) were performed in one case, and 8 CRs to the AL, two to the posterior leaflet, commissural closure and ring AP in another. In the third case 2 CRs combined with Reed's AP, closure of ASD and tricuspid AP were performed. The MR disappeared in one case and improved to grade I in others postoperatively. NYHA classes improved from class III or IV to I or II postoperatively. The MRs have not increased 6 to 12 months after the surgery. The CR with PTFE suture enabled to do the valvuloplasty for the chordal abnormalities of the AL without valve resection. This technique seems to be adequate for repairing a major prolapse of the AL caused by multiple chordal abnormalities.

The effects of pulsatile and nonpulsatile flow during cardiopulmonary bypass (CPB) with of centrifugal pump (Sarns) and membrane oxygenator, on blood cells, hemodynamics, and hormonal response were studied. In the pulsatile group (group P) in which pulsatile flow was generated by centrifugal pump and a 20 Fr arterial cannula was used, hemolysis and reduction of platelet count during CPB were more marked than in the nonpulsatile group (group NP), in which the same type of circuit was used. When the 20 Fr arterial cannula was replaced with a 24 Fr cannula (group Pc), the rate of hemolysis during CPB was significantly reduced compared with that in group P (p less than 0.05). The rate of rise in plasma free hemoglobin from 10 to 70 minutes CPB in group Pc was 15.0 mg/dl/hr, this value did not exceed that in either group NP or in group Pr, in which a roller pump rather than centrifugal pump was used to generate pulsatile flow. These findings show that pulsatile CPB with a centrifugal pump produces no deleterious hematologic effect in clinical use. The rise in the level of angiotensin II in group P was significantly smaller than that in group NP (p less than 0.05), and the rise in plasma renin activity and levels of angiotensin I, adrenalin and noradrenaline were smaller than those in group NP, although these differences were no significance. These findings indicate that the centrifugal pump generates pulsatile flow effectively, although not so effectively as to prevent the rise in peripheral vascular resistance. During CPB, there was no change in levels of thyroid hormones, including free T3, free T4 and reverse T3, in either pulsatile groups P and Pc or nonpulsatile group. TSH level in group Pc was significantly elevated in contrast with that in the nonpulsatile group (p less than 0.05), in which no change in TSH level was seen. It is suggested that pulsatile perfusion using a centrifugal pump might maintain sufficient hypothalamic-pituitary function to permit secretion of TSH in response to various stimuli.

Two surgical cases of acute pulmonary embolism with severe cardiocirculatory impairment were reported. In the first case, emergent open pulmonary embolectomy with cardiopulmonary bypass was not effective, and multiple and organized emboli were indicative. In the second case, complete pulmonary thromboembolectomy was accomplished under extracorporeal circulation with remarkable hemodynamic improvement. It was suggested that urgent pulmonary angiography was necessary for definitive diagnosis and medical treatment, and that indications for pulmonary embolectomy included all patients with massive emboli in the main branches of the pulmonary artery. Monitoring of pulmonary arterial pressure was important to assess the effect of thrombolytic therapy, and the system of emergent cardiopulmonary bypass was required for immediate and effective cardiopulmonary resuscitation.