The patient was a 57-year-old woman. Even though she had received a diagnosis of tetralogy of Fallot as an student of elementary school, she did not consent to undertake surgical repair. Consequently, she had been observed until age 56, although she suffered from atrial fibrillation during this period. She decided to undergo surgical correction as she suffered from severe heart failure. The surgical repair included Maze procedure, a patch repair of ventricular septal defect, a repair of the right ventricular outflow tract and a pulmonary valve replacement. The right ventricular pressure reduced to around two-fifths of high left ventricular pressure postoperatively, and she was discharged without any complication.

A 26-year-old woman at 40 weeks of gestation attended our emergency department due to sudden onset of chest and back pain, although she had experienced no previous abnormalities. The patient was very tall, had spider fingers and scoliosis, all of which indicated Marfan's syndrome. Enhanced computed tomography and cardiac ultrasonography revealed acute aortic dissection and annulo-aortic ectasia with aortic regurgitation. Thereafter, a baby weighing 3,070g was delivered by emergency Caesarean section and then a Bentall-type operation was performed consecutively. An intraoperative injection of heparin resulted in minimal uterine bleeding. Surgery at the 40th week of gestation was successful for both the mother and the neonate.

A 71-year-old man had undergone branched open stent grafting for a distal arch aneurysm in May 2006. He subsequently developed multiple episodes of postoperative endoleak successfully treated by TEVAR in January and November 2009. He visited our hospital complaining of back pain in May 2011. Chest computed tomography showed increasing size of the aneurysm and recurrent endoleak of the distal stent graft, and impending rupture of the aneurysm was diagnosed. Considering the technical difficulty of repair by TEVAR, we performed graft replacement of the aneurysm with removal of the previous stent graft. The postoperative course was unremarkable and he was discharged on postoperative day 11.