A 63-year-old man who underwent aortic valve replacement (AVR) for aortic stenosis (AS) associated with mildly dilated ascending aorta 28 months previously was admitted to our hospital because of severe chest pain. Computer tomography showed aortic dissection expanding from the sinus of Valsalva to the abdominal aorta. Bentall's procedure and ascending aorta-aortic arch replacement were successfully performed and his postoperative course was uneventful. The surgical management of patients with aortic stenosis associated with ascending aortic dilatation is a controversial issue. We think that Bentall's procedure may be considered as one of the strategies for AS associated with moderate dilation of the aortic root (≥50mm diameter). Following AVR, we should have regularly controlled the patient by ultrasonic cadiogram (UCG) and electively reperformed Bentall's procedure when progression of the enlargement of aortic root had been detected.

We report a case of surgical treatment for pseudoaneurysm 4 years after Patch-and-Glue Repair of left ventricle free wall rupture (LVFWR) due to acute myocardial infarction (AMI) in 2004 in a 74-year-old woman, she had been followed in our hospital. And 2 years later, echocardiography and MRI showed a pseudoaneurysm at the repair spot which was growing very slowly. Since we found a thrombus in the pseudoaneurysm, a redo operation was performed in 2008. The pseudoaneurysm was successfully extirpated, under cardiopulmonary bypass. The infracted area had degenerated to scar tissue and we could suture tightly without worrying about a fissure in the wall. We can use Patch-and-Glue Repair to rescue the LVFWR patients due to AMI in the acute stage because it is possible to remove the pseudoaneurysm in the future, on pseudoaneurysm excision in a firmly infarcted area is possible in the chronic stage.

Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.

Extensive calcification of the mitral annulus presents a formidable technical challenge to surgeons and increases the risk of serious complications such as intractable hemorrhage, atrioventricular disruption, and ventricular rupture during mitral valve surgery. We present a case of aortic and mitral valve replacements for a patient with extensive calcification of an intervalvular fibrous body. A 76-year-old woman was admitted with dyspnea on effort, leg edema and syncope. Transthoracic echocardiography showed severe aortic stenosis, and mitral stenosis with regurgitation, and extensive mitral annular calcification. Decalcification was performed with CUSA and we selected a trans-aortic-valve approach for decalcification of the intervalvular fibrous body. The calcification was left to a certain extent in order to preserve annular strength. Postoperative echocardiography showed no perivalvular leakage from either prostheses. The patient was transferred to a local hospital for further rehabilitation.