PA-LA communication is a rare congenital heart disease consisting of direct communication between a branch of the PA and LA through an aneurysmal structure. This disease reveals the central cyanosis with clubbed fingers and surgical repair is needed when symptoms are apparent. Computed tomography is highly recommended for definitive diagnosis. Angiographic catheterization is also recommended to support the diagnosis and decide on the treatment. PA-LA communication is categorized into 4 types. Two types do not need cardiopulmonary bypass (CPB) when treated surgically, but the others need CPB. A 16-year-old girl with clubbed fingers was found to have PA-LA communication by 3DCT. She underwent surgery and was discharged in good condition. The surgical procedure was done through median sternotomy without CPB. The anomalous aneurysmal fistula was doubly ligated. No communication was found after ligation by TEE.

A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.

Mitral valve surgeries for cases with mitral annular calcification (MAC) are challenging because of the operative complications. For a case of MS with MAC, we achieved mitral valve plasty by ultrasonic decalcification alone. An 82-year-old male with edema and dyspnea was diagnosed with AS and MS with MAC. MAC was so severe that MVR was challenging. There were calcifications at the anterior commissure and the anterior mitral leaflet (AML), and removal of them was expected to improve the valve function. Therefore, anterior commissurotomy and ultrasonic decalcification of the anterior commissural annulus was performed using cavitron ultrasonic surgical aspiration (CUSA). Following the resection of the aortic valve, we carried out decalcification of the AML through the aortic valve orifice. After AVR, a trans-esophageal echocardiogram showed MS was ameliorated. Two years after surgery, recurrence of MS was not recognized. Some mitral cases with MAC can be treated by only decalcification to avoid risky valve replacement.

The patient is a 66-year-old woman. She had been taking steroids for some years for rheumatoid arthritis and had been using crutches for some years because of multiple joint deformities. She presented herself to an orthopedic clinic for right upper extremity numbness and was diagnosed with cervical spondylosis and was kept under observation. However, 7 days later, a pulsatile mass on her right upper arm was found and she was referred to our hospital. Contrast-enhanced CT revealed a right brachial artery aneurysm (19×17×16 mm）, and the numbness was considered to be a symptom of nerve compression caused by the aneurysm. Since the cause of the brachial artery aneurysm was long-term inappropriate use of crutches, we confirmed that the patient would not use crutches and would use other assistive devices after the surgery, and then performed aneurysm resection and direct anastomosis under general anesthesia. Aneurysms of the upper extremities are rare and are often traumatic or iatrogenic pseudoaneurysms, and surgery is recommended because they can cause complications such as embolism, nerve compression, and rupture. In revascularization in cases where the aneurysm is caused by crutches, it is necessary to consider the risk of recurrence. In our case, we were able to perform direct anastomosis by switching the walking aid from crutches to Lofstrand clutches.