Aortic root replacement with a Freestyle^TM stentless porcine valve (Medtronic Inc.) was performed on a 32-year-old woman for aortic root aneurysm. The patient had been given a diagnosis of systemic lupus erythematosus and had been maintained on steroid therapy for 15 years. Lupus anticoagulant was present and the anticardiolipin antibody titer was abnormal as follows: IgG, 2.0IU/ml (normal<1.0IU/ml). For the patient requiring aortic root reconstruction, many options are available. The use of a biological valved conduit should be considered for patients in whom anticoagulation is not desirable. The Freestyle^TM stentless porcine valve offers an acceptable alternative to mechanical prostheses, especially for cases with contraindication for anticoagulant therapy, associated with antiphospholipid antibodies.

A 58-year-old man was admitted with a diagnosis of an acute Stanford type A aortic dissection after 20-year-long steroid therapy for hypopituitarism. The graft replacement of the ascending aorta was performed as an emergency procedure under deep hypothermic selective cerebral perfusion. We administered 1, 000mg of methylprednisolone during cardiopulmonary bypass, injected 500mg/day of hydrocortisone during postoperative day 1 to 4, and then administered orally 40mg/day of hydrocortisone. Then 200μg of levothyroxine sodium was given orally from postoperative day 6. There are some reports about acute aortic dissection associated with long-term steroid therapy in SLE or aortitis syndrome, but reports involving hypopituitarism are very rare.

A 85-year-old man was admitted to our hospital with a right iliac artery anastomotic pseudoaneurysm after aorto-biiliac Y-shaped graft replacement for the treatment of abdominal aortic and biiliac aneurysms. We performed an endovascular intervention of this anastomotic pseudoaneurysm with an ePTFE-covered stent-graft. This method seemed to be very useful even in such a high-risk patient, because it can be done under local anesthesia.

Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Myocardial infarction is the leading cause of postoperative death and late death after AAA repair. In an attempt to reduce the incidence of perioperative myocardial infarction, routine coronary angiography has been recommended in all patients scheduled for elective AAA repair, and staged myocardial revasculization has been performed using percutaneous transluminal coronary angioplasty (PTCA), if indicated. From March 1987 to February 1995, 40 consecutive patients receiving elective repair of AAA underwent preoperatively coronary angiography. Twenty-one of the 40 patients (53%) had CAD, and in 9 coronary revasculization was indicated. Seven of those patients underwent successful PTCA prior to surgery. One patient had PTCA following surgery for AAA because of technical difficulties in advancing a catheter due to the elongated abdominal aorta. The other patient with triple vessel disease was considered to be unsuitable for PTCA in those days and underwent coronary bypass grafting before AAA repair. There was no operative mortality or perioperative myocardial infarction during and after the repair of AAA. Our results suggest that PTCA should be considered one of the best treatment strategy options for patients with coexistent AAA and CAD.