Clinical profiles were analysed of 18 children with congenital ventricular aneurysm (CVA) and diverticulum (CVD) (nine with CVA and nine with CVD). Of 18 children, only six had any symptoms, consisting of chest discomfort, palpitation, or convulsion. Heart murmurs were heard in nine of the 18 children, and a nonspecific systolic ejection murmur in one. A systolic click was heard in only four children. Dyskinesia of an abnormal protrusion of the cardiac silhouette on the chest x-ray film was detected in only three. The ECG revealed abnormal findings in all children. In those with CVA, signs of myocardial damage or left axis deviation (LAD) and left bundle branch block (LBBB) were the main findings. Among those with CVD, multiple premature ventricular contractions (PVCs) were present in four; some signs of myocardial damage were present in three. None of those with CVD had LAD or LBBB. Among the four children with right ventricular diverticulum, multiple PVCs were present in three. The lesions were detected by two-dimensional echocardiography (2DE) before angiography in 13 (72%) of 18 children. The wall kinetics of the lesions, as seen on 2DE, were in agreement with the subsequent angiographic findings.

Direct influence of EVCPP brought significant improvement of LV function in early period. Further decrease of ESVI and increase of EF were noticed from early period to mid-term period. This result suggest that the effect of EVCPP sustains long and yields reverse LV remodeling.

A 40-year-old woman was diagnosed as intrahepatic hematoma after blunt abdominal trauma. One month later computed tomography (CT) revealed the inferior vena caval thrombus extending into the right atrium. Emergency thrombectomy was performed under cardiopulmonary bypass. We believe that the thrombus, which was derived from laceration of the hepatic vein, extended through the inferior vena cava into the right atrium, and was the eve of pulmonary embolization. CT study should be repeated, once the intrahepatic hematoma was recognized. We emphasize that we should recognize the existence of such complication to prevent the catastrophic result.

Coronary angiography (CAG) of a 57-year-old woman with anterior chest discomfort revealed no stenosis of the coronary arteries but multiple coronary artery fistulas (CAFs). The sites of origin for the CAFs were the right coronary artery, left main coronary artery, left anterior descending coronary artery, and ascending aorta. The only site for drainage was the main pulmonary artery. Furthermore, a small saccular aneurysmal formation was detected. Surgical treatment was considered better than conservative treatment or coil embolization, and ligation and division of the CAFs were performed during cardiopulmonary bypass. Using a Harmonic Scalpel to expose fistulous arteries was very effective. CAG performed immediately after surgery demonstrated that all CAFs were repaired. The postoperative course was uneventful.

It has been reported that surgical repair of anterior left ventricular (LV) aneurysms is associated with reverse remodeling and improved myocardial function in the inferior LV wall. We evaluated wall motion in RCA territory using QGS in the mid-term period after endoventricular circular patch plasty (EVCPP). Eighteen patients, who underwent EVCPP, were studied by QGS before, and in the early and mid-term periods after surgery. Ten patients underwent CABG to the RCA because of RCA lesions (group B) and the other 8 patients did not have CABG to the RCA (group N). Regional wall thickening function was evaluated by the change in wall thickness through end-systole and end-diastole. We evaluated the RCA territory remote from the incision line of the EVCPP. Regional wall thickness improved significantly in the mid-term period after EVCPP in both groups. Although preoperative wall thickness was worse in group B than in group N, postoperative wall motion in group B was improved as well as in group N in the mid-term period. Inferior LV wall motion improved in patients with and without CABG in the mid-term period. We conclude that reverse remodeling occurred in the mid-term period after EVCPP.