A 79-year-old woman with aortic stenosis due to a calcified small aortic root and severe coronary stenosis (at the left anterior descending artery) underwent aortic valve replacement with a 19mm CarboMedics “Top Hat” supra-annular aortic valve and coronary artery bypass grafting. The postoperative course was uneventful. It was found that by using the CarboMedics supra-annular aortic valve, at least one more large sized valve could be implanted compared to the standard aortic valve. This valve is useful in difficult cases to enlarge the narrow aortic annulus, such as in patients with a severe calcified small aortic root, left ventricular dysfunction or elderly cases. In addition, the operative risk may be decreased and operative time shortened using this valve.

A rare case with mycotic abdominal aortic pseudoaneurysm due to Salmonella Infection is described. A 75 year-old female had been diagnosed as an abdominal aortic aneurysm by ultrasonics at the other hospital during the examination of fever of unknown origin and abdominal pain. At admission to our hospital, the temperature was 39.5°C. A pulsatile mass, about the size of five cm in diameter, was present with no inflammatory findings in the abdomen. Ultrasonics and angiography revealed a saccular infrarenal aortic aneurysm. The blood culture was positive for Salmonella choleraesuis. Aneurysmectomy and graft interposition were performed five weeks after admission, because of enlargement of the size of aneurysm and the continuing infective signs in spite of antibacterial therapy. The patient narrowly escaped from rupture of the pseudoaneurysm by the body of third lumber vertebra. On microscopic examination, infective findings were seen in the wall of pseudoaneurysm. After treatment with antibiotics for four weeks, the patient was discharged from the hospital. She remains asymptomatic for a year after the operation. Only eight cases of mycotic abdominal aortic aneurysm have been reported previously in Japan, and five cases, including our case, were due to Salmonella infection. The results of this surgical operations, carefully considered for infection, were good, but it seems better to select alternatively the surgical operation as soon as possible when antibacterial therapy is not effective.

We report two operated cases of papillary fibroelastoma of the aortic valve. Case 1: A 56-year-old man was referred to our hospital with hyperlipidemia. On echocardiogram, he was found to have a mobile mass attached to the NCC of the aortic valve. At operation, a sea anemone-like tumor was found attached to the free edge of the RCC and resection of the tumor was performed without valve replacement. Case 2: A 75-year-old woman was referred with heart murmur, and echocardiogram showed a tumor of the NCC of the aortic valve. At operation, the tumor was attached to the NCC and resection of the tumor was performed. On each case, microscopic examinations showed typical findings of PFE. The patients' postoperative courses were unremarkable.

Patient 1 was a 62-year-old woman who had been treated for hypertension for three years. Stanford A type acute aortic dissection occurred accompanied by right coronary ischemia. CABG and graft replacement of the ascending aorta were performed 8 hours after the onset of coronary ischemia, but after cardiopulmonary bypass the patient could not be weaned from the RVAD because of right ventricular infarction. On the 8th day after operation, she died due to right heart failure. Patient 2 was a 72-year-old male. Stanford A acute aortic dissection occurred and right coronary ischemia appeared during UCG examination in the ICU. CABG and graft replacement of the ascending aorta and the aortic arch were carried out less than 1 hour from the onset of coronary ischemia. The postoperative course was satisfactory and uncomplicated. If the dissection extends to the aortic root, it is important to monitor the ECG carefully to detect myocardial ischemic changes. In cases with coronary ischemia, early operation and CABG are mandatory.