A 31-year-old man fell into syncope caused by compression by a machine in his factory. He was taken to the nearest hospital at once for treatment. His chest X-ray seemed normal and his general condition improved. He received no medical treatment and was allowed to return home. Two days later, he went to the hospital for further investigation, and contrast-enhanced chest computed tomography (CT) was performed. Chest CT showed aortic dissection from the ascending aorta to the aortic arch. Therefore, he was admitted for bed rest with antihypertensive therapy. He was discharged on the 35th day after the accident. However, the diameter of the ascending aorta was found to have become dilated, and so he underwent ascending aorta and hemiarch replacement at our hospital. His postoperative course was uneventful, and he was discharged on the 16th postoperative day. We report a rare case of an acute aortic dissection caused by blunt chest trauma.

An 8 year-old boy had a cardiac murmur pointed out on day three after birth and was given a diagnosis of ventricular septal defect (VSD). He underwent VSD patch closure at two months after birth. He was also found the having Loeys-Dietz syndrome on the basis of mutation of TGFBR2 and physical examination at the age of 2 years. He had been followed up at pediatrics clinic of our hospital since then, and was hospitalized for a 46.5-mm extension of valsalva sinus diameter and moderate aortic insufficiency. The aortic valve was three-cusped and had no abnormality. We performed valve-sparing aortic root replacement. He was discharged on day 18 after the operation without any problems in the postoperative course. Use of an artificial heart valve for the surgery of the aortic root lesion in childhood will probably cause reoperation in the future and difficulty in Warfarin anticoagulation control. A careful decision is needed in the choice of an operation method. Valve-sparing aortic root replacement is a useful operation for patients without aortic valve abnormality.

A pseudoaneurysm of the thoracic aorta after cardiac surgery is a rare complication, but can be life-threatening when it is ruptured. The pseudoaneurysm itself presents no symptoms in many cases, or may be similar to an atherosclerotic aortic aneurysm. Therefore, it is usually found incidently during imaging studies. We encountered 3 cases of pseudoaneurysm of the thoracic aorta that developed during the long-term follow-up after congenital cardiac surgery. None of the patients experienced specific symptoms associated with the pseudoaneurysm, and were diagnosed by chest roentgenograms and computed tomography. Most patients who undergo surgery for congenital heart defects as adolescents are free from medical treatment, and do not regularly see a doctor after the surgery. It is important to consider the possibility of a pseudoaneurysm in patients having a history of cardiac surgery.

Background : The Japanese Society for Dialysis Therapy in 2011 reports that the number of hemodialysis patients has been increasing and that there is an increase in long-term hemodialysis patients and the aging of hemodialysis induction. Therefore, it can be expected that the number of valve surgeries in chronic hemodialysis patients will increase. However, there are many problems between chronic hemodialysis and valve surgery. Objectives : To describe the results of valve surgery in chronic hemodialysis patients at our institution and evaluate the selection of prosthetic valve and associated problems. Methods : Between January 2001 and June 2011, a total of 29 patients on chronic hemodialysis including 3 patients for re-operation, underwent valve replacements. The average age was 67.3±9.3 years and 17 (65%) were men. The average dialysis duration was 7.9±6.4 years. The etiologies of renal failure were 8 for chronic glomerulonephritis (31%), 8 for nephrosclerosis (31%) and 3 for diabetic nephropathy (12%). Results : There were 2 (7.7%) in-hospital deaths, which resulted from ischemia of intestine and multiple organ failure due to heart failure. Twelve (46%) patients died during the follow-up period and the 5-year survival rate after surgery was as poor as another authors have reported previously (30.6%). However, the 5-year survival rate after hemodialysis introduction was 87.1%, which was better than the report of the Japanese Society for Dialysis Therapy in 2011 (60%). Average age was significantly higher in bioprosthetic valves than in mechanical valves (p=0.02). There was no significant difference in survival rate among mechanical and bioprosthetic valves (p=0.75). There was no significant difference in valve-related complication free rate among mechanical (27.5%) and bioprosthetic valves (23.4%) (p=0.9). Three patients with mechanical valves had cerebral hemorrhage, and 1 patient with bioprosthetic valve had structural valve deterioration. Conclusions : Surgical result of valvular disease in hemodialysis patients was as poor as another authors reported previously (5-year survival rate : 30.6%), but survival rate after hemodialysis introduction was not very poor (87.1%). There was no significant difference in survival rate among mechanical and bioprosthetic valves. Bioprosthetic valve has the risk of reoperation due to early structural valve deterioration, but there was no significant difference in valve-related complication free rates. Therefore, we should select prosthetic valve in consideration of individual cases.