We describe two repeated operations to treat ascending aortic pseudoaneurysms. The first was emergency patch closure of the ascending aorta due to impending rupture 8 years after an operation for type I aortic dissection under hypothermic circulatory arrest. The second was endovascular repair using a fenestrated stent graft 7 years after coronary artery bypass grafting. No specific guidelines have been established regarding optimal management for such patients. We believe that individualized management is safer, especially for repeated operations.

An echocardiogram revealed a mobile mass attached to the left coronary cusp of the aortic valve in an 81-year-old woman. The tumor was surgically removed without valve replacement. The tumor was whitish in color, with a sea anemone-like appearance, and it measured 10 mm in maximum dimension. It was histopathologically defined as papillary fibroelastoma (PFE), and the postoperative course was uneventful. Primary cardiac tumors are rare, and the majority are myxomas. However recent advances in noninvasive examination and surgery may increase the detection of PFE, which occurs most frequently on the endocardial surface of the cardiac valve. We report a case of cardiac PFE with a review of the pertinent literature.