A sixty three years old male was performed total aortic arch replacement under a separate cardiopulmonary bypass with moderate hypothermia and 600-800ml/min in cerebral perfusion flow which had been getting general consent. A brain ischemia was increased during the operation and the patient was sufferd from brain death. Autopsy revealed the brain edema due to a cerebral transverse sinus thrombus originated by right internal jugular vein thrombosis which was caused by intimal injury by repeated puncture of the vein prior to the operation. This is the first case of accident that occured during the aortic arch surgery.

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We experienced a patient of thoracoabdominal aortic aneurysm complicated with abdominal angina due to obstruction of the celiac and the superior mesenteric arteries. Bilateral renal artery stenoses were also present. At the operation we used the Biomedicus centrifugal pump and the heparin bonded tube for partial bypass. Following endarterectomy of the obstructed arteries, graft replacement of the thoracoabdominal aorta using inclusion technique was performed. Although endarterectomy of the superior mesenteric artery was not successful and its reconstruction was abandoned, the celiac artery and the bilateral renal arteries were reconstructed successfully. Postprandial pain was totally disappeared after the operation.

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Preoperatively, hypertrophic non-obstructive cardiomyopathy with asymmetrical septal hypertrophy was found in a 66-year-old man with a chief complain of effort angina whose CAG showed stenosis of 70% in LCA (seg 5) and 100% in RCA (seg 1) with collaterals from LAD. Although graft flows, 240ml to LAD and 28ml/min to RCA, were obtained, it was necessary to place the patient on the assisted circulation and catecholamines when the weaning from CPB was being tried due to “stone heart” despite patient had been on IABP during surgery and short anoxic arrest time of 44min. Postoperative hemodynamic recovery was slow with low cardiac output improved lately by the continuous use of IABP and DBcAMP. Catecholamines and vasodilators often cause disturbance of hemodynamics in hypertrophic obstructive type but seem to be effective in non-obstructive type. Importance of myocardial protection, use of IABP, careful administration of β-stimulants and DBcAMP are discussed in surgery of patients with cardiomyopathy.

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