A 49-year-old man with impaired left ventricular function successfully underwent a one-stage operation of coronary artery bypass grafting (CABG) and replacement of infrarenal abdominal aortic aneurysm (AAA). Left ventricular ejection fraction, left ventricular end-diastolic and mean pulmonary artery pressures were 24%, 25mmHg and 33mmHg, respectively. The AAA was 6cm in diameter and accompanied by bilateral common iliac artery aneurysm. After completion of CABG, AAA replacement was performed during extracorporeal circulation. There were no hemodynamic changes associated with aortic clamping or declamping under the mechanical cardiac assist during AAA surgery. This procedure appeared to be a feasible one-stage procedure in patients with AAA and coronary artery disease accompanied by impaired left ventricular function.

Aortitis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Surgical treatment for obstructive lesions due to aortitis syndrome therefore is difficult in many cases. The patient was a 23-year-old female who at the age of 19 had been diagnosed as aortitis syndrome with cerebral vessel involvement, and she subsequently received steroids. She increasingly experienced syncopal attacks, and was indicated for surgical treatment. Angiography revealed obstruction of the left common carotid and left subclavian arteries, and severe stenosis of the right common carotid and right vertebral arteries. She underwent bilateral ascending aorta-carotid artery bypass operation with 7mm ring-supported EPTFE grafts. After the operation she developed clinical signs of temporary brain damage due to hyperperfusion syndrome, but she now completely recovered and maintains a good clinical condition.