Wall reinforcement with highly porous synthetic Dacron mesh was devised and evaluated in various aortic operations. Excellent attachment of the mesh to the aortic wall, good preservation of pliability of the aorta, and efficient pressure resistance with minimal scar tissue formation were the usual findings. This type fo wall reinforcement was employed in 60 patients for the following indications: 1) prevention of suture line complications; 2) wall reinforcement of aortic aneurysm without resection; 3) reinforcement of adventitia or autogenous vein following thromboendarterectomy. It is concluded that reinforcement with highly porous synthetic Dacron mesh should be superior to reinforcement with conventional prosthetic Dacron graft.

A 24-year-old housewife with congenital aneurysm of the left atrial appendage underwent a successful operation for its removal. Operation, using cardiopulmonary bypass, is indicated in all patients with atrial aneurysm. The procedure has proved uniformly safe and successful.Aneurysmal dilatation of the left atrium as a consequence of valvular heart disease is common. However, congenital or idiopathic aneurysm of the left atrium is extremely rare. Twenty-six cases verified at necropsy or operation have been reported. The purpose of this report is to present a case of congenital aneurysm of the left atrial appendage. Case reportA 24-year-old housewife was admitted to hospital in April 1976 with attacks of palpitation and atrial fibrillation. At age 10 years she was told that she had an enlarged heart and congenital heart disease was suggested. Attacks of palpitation were experienced for the first time at 18 years. Subsequent attacks of palpitation occurred frequently and lasted longer, and she received treatment with digitalis and DC conversion without any benefit. She was admitted to Hokkaido University Hospital on 10 April 1976 for investigation.The patient was a well-developed woman. On admission her pulse was irregular at 80 beats per minute. The pulses were present in all extremities, and the blood pressure was 126/60 mm mercury. There was no cyanosis or clubbing of digits. On auscultation, the heart sounds were normal, and no murmur was heard. The chest radiograph showed cardiac enlargement (CTR 615%), with a prominent convexity located at the left cardiac border in the position of the left atrial appendage (fig 1). A barium swallow showed no posterior displacement of the oesophagus. The electrocardiogram showed atrial fibrillation only. There was no evidence of ventricular hypertrophy. The echocardiographic scan revealed a large cavity behind the left ventricular wall. Cardiac catheterisation revealed that all intracardiac pressures were within normal limits and there was no evidence of an intracardiac shunt. Cardioangiography demonstrated a huge nonpulsating dilatation of the left atrial appendage from which the contrast medium cleared slowly. The left atrium and the left ventricle were displaced to the right by the dilated left atrial appendage. The diagnosis after cardiac catheterisation was congenital aneurysm of the left atrial appendage.An operation was perfomed on 23 June 1976,

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