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Letters to the Editor 2 0 7 nected to the ECLS system with a Y-shaped heparinbonded connector. The ECLS flow is started and slowly increased as the CPB flow is slowly decreased and then stopped. The superior vena caval cannula used for CPB is then removed. Teflon tapes that were placed around the femoral artery and vein are loosely tied, cut short, and left in the wound so that the vessels can be easily found during the second-look operation. Both Dacron grafts are left in the subcutaneous space. One gram of kanamycin powder is placed on the wound and the wound is closed.In case of perioperative myocardial infarction, we consider the combination of ECLS and intraaortic balloon pumping to be the best means to unload the heart and augment coronary flow so that the stunned myocardium can rest and recover from the acute ischemic injury. 4 The present technique provides the following advantages: (1) Myocardial damage is avoided and systemic circulation is maintained while mechanical support is set up; (2) ischemic or congestive complications of the lower leg are lessened; (3) massive bleeding, which is the most serious complication of ECLS, is infrequent2; (We have recently stopped using heparin and now use nafamostat mesilate applied to the inflow of the centrifugal pump to achieve an activated clotting time of 140 seconds. This system can run for 48 to 72 hours without fibrin clot formation or thromboembolic complications.); (4) fewer complications are caused by reopening the chest or mediastinum, which necessitates general anesthesia. Only local anesthesia and simple surgical techniques are necessary to remove the cannulas in our method.ECLS is a reasonable mechanical support system for postcardiotomy cardiac failure, especially in the case of perioperative myocardial infarction. Our technique is recommended to allow easy weaning from CPB and to safely maintain long-term mechanical support.

The purpose of this communication is to propose a new surgical procedure to enlarge the hypoplastic aortic valve ring of more than 20 mm and to permit the replacement of the aortic valve with a suitable prosthesis. The aortic incision is extended about 20 mm across the fibrous origin of the mitral ring downwards into the aortic leaflet of the mitral valve. A fusiform Dacron patch was sutured to the defect in the aortic leaflet of the mitral valve with running suture lines. In acute experiments mitral valve abnormalities are excluded by hemodynamic data, angiocardiography and echocardiography.