A 39-year-old man was admitted to our hospital with symptoms of anterior chest pain and slightly dyspnea. At that time, he had chest discomfort, hypertension, and with enlargement of mediastinal shadow on chest X ray. Medical treatment rapidly improved the hypertension and the other symptoms. Transthoracic echocardiography (TTE) and enhanced chest CT revealed aortic root dilation, and trivial aortic valve regurgitation, but these examinations could not identify the cause of such as typical Stanford type A dissection. Transesophageal echocardiography (TEE) and chest MD-CT were undertaken on 7 days after the admission revealed a localized aortic dissection, intimal flap, and enlargement of sinotubular junction (STJ). An Urgent operation was performed. During the operation, a localized aortic dissection appeared to be above the left coronary cusp through the right coronary cusp of the aortic valve, but the valve findings were normal, so we decided to perform a aortic valve remodeling operation. The aortic sinuses were excised leaving 4 mm of arterial wall attached to the aortic annulus and around the coronary arteries. A Woven Dacron graft of diameter equal to the diameter of the STJ was tailored to recreate three aortic sinuses. The three commissures were suspended into the tailored graft and the neo-aortic sinuses were sutured to the aortic annulus and remnants of arterial wall. The coronary arteries were reimplanted into their respective neo-aortic sinuses and the graft anastomosed to the distal aorta. The postoperative course was uneventful. We concluded that this procedure is useful for a localized aortic dissection around the coronary orifice.

Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

We have long advocated the usefulness, accuracy and safety of carbon dioxide angiogrphy for patients with iodine allergy and renal dysfunction. In addition to its utility, no specialized apparatus is necessary for carbon dioxide angiography. Carbon dioxide as a contrast material has been adopted by consensus for use in endovascular revascularization. Here we report 4 cases of endovascular revascularization using carbon dioxide angiography. Two of the four patients had an iodine allergy, one had renal dysfunction, and the remaining one was complicated by diabetes mellitus. All patients exhibited intermittent claudication and were treated for iliac arterial stenotic lesions with percutaneous angioplasty and sequential endovascular stenting using carbon dioxide gas as a negative contrast material. All cases demonstrated improvement of the chief complaint. There were no direct or indirect complications of carbon dioxide angiography and endovascular intervention after the procedures. All 4 patients were discharged without event within 1 week after the endovascular intervention. Carbon dioxide is useful not only as an angiographic contrast material but also for endovascular intervention in patients with iodine allergy or renal dysfunction.