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大動脈弁手術203例で, 術後急性冠灌流不全を右冠動脈5例, 左冠動脈2例, 両冠動脈1例の8例 (4%) に経験した. 主症状は, 右冠動脈灌流不全では, 体外循環離脱困難な右心不全3例, 下壁梗塞による左心不全2例, 左冠動脈灌流不全では, 広範梗塞による左心ポンプ不全1例, 心室停止2例であった. 発症直後CABGを追加施行した4症例は全例救命された. Cabrol 手術1例, Piehler 法と弓部置換の同時手術1例の死亡2例では左冠動脈口に縫着した人工血管の血栓閉塞を認めた. 救命6例は術後冠動脈造影で新たな冠動脈病変は認めなかった. 発症原因として, 冠動脈 spasm と拡張障害を伴った左室肥大心における周術期冠予備量の不足が推測された. Piehler 法や Cabrol 手術では冠動脈吻合グラフトの圧迫や吻合部狭窄も示唆された. 救命措置は灌流不全の冠動脈に速やかにCABGを追加する方法が確実であった. 予防対策として適切な手術時間の決定と, 逆行性冠灌流法を含む確実な心筋保護法の応用が考慮された.

Successful resection of an ascending aortic aneurysm under cardiopulmonary bypass associated with auxiliary carotid and coronary perfusion is reported. The advantages of the cardiopulmonary bypass such as the present method in surgery of aneurysms of the ascending aorta and aortic arch are discussed.

Six cases of aneurysm of the membranous ventricular septum were obtainable in Japanease literature and additional 3 cases of our own were presented in the paper. An autopsy case disclosed various appearances of arrhythmias during life. Three cases showed bulges of the membranous portion of the ventricular septum with ruptures over the domes. A bulge into the right atrium was recognized in a case with hypoplasia of the aorta. The rest 4 cases were found in connection with ventricular septal defects during surgery.

Thirteen patients with severe tetralogy of Fallot underwent reconstruction for hypoplastic pulmonary artery and diffuse tubular outflow tract obstruction using a preserved homograft or heterograft patch with single or double cusps. The early and late results with our valve-retaining patch provide encouragement for the further application of this method to patients having extremely hypoplastic right ventricular outflow tracts. Pulmonic grafts appear to be preferable to aortic grafts, although further evaluation of these pulmonary homografts and heterografts is needed.

Three cases of the single atrium (cor triloculare biventricularis) were operated upon successfully, and diagnostic and surgical aspects of this rare malformation were discussed.