SUMMARYA 58-year-old Japanese woman was admitted to our hospital because of chest pain. A continuous murmur was detected at the left parasternal area. Electrocardiogram showed ST elevation in leads V 2 , V 3 and V 4 . Chest computed tomography and echocardiography demonstrated pericardial effusion and a large mass which was adjacent to the pulmonary artery. An abnormal blood flow was detected in the mass by Doppler echocardiography. Coronary angiography confirmed that the mass was a giant aneurysm of coronary arteriovenous fistula arising from both the left and right coronary arteries. This patient had no symptoms until rupture of the fistula. Rupture of a coronary arteriovenous fistula is very rare but can be a cause of chest pain and pericardial effusion. 1) Therapeutic strategies for coronary arteriovenous fistulas have not been clearly defined because the natural histories of the disorder are still uncertain.2) The majority of coronary arteriovenous fistulas are small and asymptomatic, especially in young patients. In older patients, both symptoms and fistula-related complications increase.3) Surgical repair for coronary arteriovenous fistulas is generally recommended in the presence of symptoms of heart failure or large left-to-right shunts. 4)On the other hand, the management for asymptomatic patients with a coronary arteriovenous fistula is controversial. We report the rupture of a giant aneurysm of a coronary arteriovenous fistula presented by chest pain with pericardial effusion. The patient had no fistula-related symptoms until the rupture.

Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.

ostinfarction ventricular septal perforation (VSP) remains an important complication of myocardial infarction. The prevalence is approximately 1% to 2% among patients with acute myocardial infarction, and it is often fatal unless surgical treatment is performed. Despite numerous improvements in surgical technique, the mortality remains about 19% to 40%. 1 Perioperative low-output syndrome and residual shunt are associated with a poor outcome. We operated on 4 patients with our simple technique that minimizes residual shunting.

We describe a new technique for the early surgical repair of a posterior postinfarction ventricular septal perforation (VSP) in two consecutive female patients. The occurrence of a posterior VSP is rare, and its repair is technically difficult because the posteromedial papillary muscle is located adjacent to the intraventricular septum. This modification appears to prevent leaks to the right ventricle through the VPS with a single direct patch and the use of two equine pericardial patches to form a single endocardial pouch. The women were 77 and 62 years old, and the time between the onset of acute MI and surgery was 3 and 6 days. On preoperative catheterization, Qp/Qs was 4.18 and 4.01. Neither operative death nor residual shunting was observed.

This study was undertaken to examine the long-term survival rates of patients following abdominal aortic aneurysm (AAA) repair in comparison with an age-matched normal population, and to determine by multivariate analysis the factors influencing long-term survival. Of 125 patients who underwent AAA repair prior to July 1986, 13 died during hospitalization. Of these 13 patients, 6 who suffered aneurysmal rupture all died within 30 days. The survival rate of patients with ruptured aortic aneurysms was significantly lower than that of those with nonruptured aneurysms. Of the 112 patients surviving hospitalization, 85 died within 0.48 to 24 years after their operation. The long-term survival rate of patients who had suffered a preoperative cardiovascular event was significantly lower than that of those who had not suffered a preoperative cardiovascular event. The actual survival rate was significantly lower than the expected survival rate. According to a multivariate analysis, the significant predictors of late survival were age, aneurysmal rupture, and chronic renal failure in all the patients, and age, chronic renal failure, and pre- and postoperative cardiovascular events in patients who did not die in hospital. These findings indicate the importance of improving immediate perioperative management of ruptured AAA and that cardiovascular events should be prevented, or treated during long-term follow-up.