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From January 1998 to December 2002, a total of 120 patients underwent aortic valve surgery at our institution. Of these, 26 patients (22%) had congenital bicuspid aortic valve (BAV). Main valvular lesion of BAV was aortic valve stenosis (AS) in 17 and regurgitation (AR) in 9. There was no significant difference in the aortic annular size between BAV and non-BAV cases measured by echocardiography preoperatively [22.8 +/- 2.0 mm versus 22.5 +/- 2.2 mm in AS (NS), and 25.4 +/- 2.4 mm versus 23.4 +/- 2.5 mm in AR (NS)]. At operation, however, supraannular type prosthetic valve was selected more frequently in BAV than in non-BAV because of the difficulty of implanting the proper size prosthetic valve in annular position in BAV [10/25 (40%) in BAV versus 18/91 (20%) in non-BAV (p < 0.05)]. Moreover, ascending aortic dimension in BAV cases was significantly larger than in non-BAV cases [43.7 +/- 7.3 mm versus 39.6 +/- 7.3 mm (p<0.05)]. These features were more prominent in non-raphe BAV cases. These results suggested that operative procedure including prosthetic valve selection needs careful consideration in BAV especially no-raphe patients.

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A 65-year-old man who underwent mitral valve plasty was readmitted the hospital with severe dyspnea and hypotension 7 months after operation. Results of computerized tomographic scanning and transesophageal echocardiography showed pericardial thickening and left ventricle out flow stenosis due to a constrictive epicardial peel. At the time of reoperation, he underwent both pericardial and epicardial stripping. He demonstrated only limited hemodynamic improvement after pericardial stripping. His hemodynamic status improved markedly after epicardial stripping. His postoperative course was uneventful and no complication was recognized. Epicardial stripping is important in patients with epicardial sclerosis.

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A 1-year-old baby boy underwent Mustard operation for simple transposition of the great arteries. He began to complain of fatigability with moderate cyanosis and polycytemia at the age of 23. Cardiac catheterization revealed baffle leaks at the superior vena cava (SVC) channel, but baffle stenosis was not diagnosed then. After the patch closure of the baffle leaks, he suffered from hypoxia and high SVC pressure. Baffle stenosis at the entry of the SVC channel into the functional right atrium was diagnosed by re-catheterization. Patch enlargement of the baffle stenosis was successfully performed. We must take it into consideration that baffle leaks following Mustard operation often coexist with baffle stenosis, requiring vigorous pre- and intra-operative exploration.

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Three adults, 2 with tricuspid aortic valve and 1 with bicuspid valve, underwent valvuloplasty for aortic valve regurgitation resulting from cusp prolapse. Surgical procedures consisted of combined cusp plication by triangular cusp resection and subcommissural annuloplasty. Doppler echocardiography revealed trivial aortic valve regurgitation intraoperatively and less than I/IV at discharge in all cases. After mean follow-up of 15 months, 2 tricuspid aortic valve patients remain I/IV regurgitation and II/IV in the bicuspid patient. Although long-term results remain unclear, our results show that this procedure is feasible and beneficial in patients with aortic valve regurgitation due to cusp prolapse.

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A 53-year-old Japanese man with Werner's syndrome underwent successful apico-aortic conduit bypass operation. Preoperative examination showed severe calcification in the aortic root and ascending aorta. A composite graft was implanted from the left ventricular apex to the descending thoracic aorta with femoro-femoral bypass. To our knowledge, this case is the first surgical correction of a cardiac lesion in a patient with Werner's syndrome.

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Since 1978 we have been using a new double ringed graft for the treatment for dissecting aneurysm of the aorta. This prosthesis is a segment of a woven Dacron graft with two stainless steel rings, fixed and sutured in place, 10 or 12 mm apart, at each end of the graft. The operative procedure is as follows: the graft is tied into the true lumen of the dissected aorta; tape is ligated around the aorta and fixed between the two rings; and suturing of the aortic layers is done over the inserted graft. This technique has been applied in 11 cases of dissecting aneurysm. Eight patients survived, and 3 died soon after surgery due to complications. The safety of this method was ascertained by experimental and pathohistological studies.

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A 6-month-old female infant with anomalous origin of the left coronary artery underwent an end-to-end anastomosis of the left subclavian artery to the left coronary artery. A cuff of the pulmonary artery was used for the anastomosis. The child continued to have mitral regurgitation but has done well with medical treatment over the last four years. Cardiac catheterization 26 months after operation confirmed a patent graft without narrowing, improved contractility of the left ventricle, normal end-diastolic pressure of the left ventricle, and persistent mitral regurgitation. This technique is applicable in infants regardless of the size of the left coronary artery.

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