Concomitant occurrence of acute aortic dissection and atherosclerotic aneurysm is rare. In such a circumstance, rupture of the existing aneurysm is the more likely scenario. In general, atherosclerotic plaque frequently serves to terminate the dissection process. A 65-year-old man with an abdominal aortic aneurysm was admitted due to severe back pain. Emergency CT showed acute aortic dissection (Stanford B) with a partially thrombosed pseudo-lumen and fusiform abdominal aortic aneurysm. Hemolysis occurred due to compression of the true lumen by the thrombosed pseudo-lumen. Emergency abdominal aortic graft replacement was performed successfully.

Left ventricular wall motion was evaluated after mitral valve replacement (MVR). MVR for mitral regurgitation (MR) was performed with preservation of both anterior and posterior chordae tendineae (Group I, n=12) or posterior chordae tendineae (Group II, n=9). MVR for mitral stenosis was performed with the preservation of the posterior chordae alone (MS Group, n=12). Postoperative regional wall motion was analyzed from the shortening fraction (SF) of the centerline method in 5 of antero-basal (AB), anterolateral (AL), apical (AP), diaphragmatic (DP) and posterobasal (PB) regions. The percentage of post-operative SF for preoperative value (%SF) was compared between Group I and Group II. The value of %SF improved much more in Group I than in Group II at the AL and AP regions. %EF was more significantly increased in Group I than in Group II, although postoperative ESVI and EDVI decreased in both groups. In the MS Group, EF, ESVI and EDVI did not change after surgery. The regional wall motion improved except in the calcified PB region. These results demonstrated that the preservation of both anterior and posterior chordae tendineae for MR was a useful procedure to improve postoperative LV regional wall motion. The preservation of posterior chordae for MS was sufficient to improve the regional wall motion except in the calcified submitral region.

A 72-year-old woman suffered sudden back pain 42 days after ascending aortic replacement for retrograde acute type A aortic dissection. Computed tomography (CT) revealed type B aortic dissection and a stenotic true lumen at the abdominal aorta. The celiac artery and the superior mesenteric artery (SMA) branched from the true lumen, but bilateral renal arteries were not found by DSA. Infrarenal abdominal aortic fenestration was performed at 6th day from onset, because of progressive renal dysfunction. Intestinal ischemia was not confirmed by laparotomy. After the Infrarenal aorta was clamped and transected, the proximal intima was resected in a U-shape. The proximal stump which was reinforced with teflon felt was anastomosed to an 18mm woven graft. Distal anastomosis was carried to the true lumen was carried out with closure of the false lumen. Regaining flow into the collapsed true lumen was observed by epiaortic echography. Postoperatively, continuous hemofiltration was required for several days until renal dysfunction was improved. CT showed reasonable expansion of the true lumen, and no findings of visceral ischemia except for partial infarction of the left kidney. DSA revealed that bilateral renal arteries were perfused from the true lumen through the fenestration. Neither aortic dilatation nor new ischemia have been recognized, but further close observation is necessary.

A 24-year-old man was transferred to our hospital because of traumatic rupture of the thoracic aorta suffered in a traffic accident. On admission, he had recovered from shock and was alert. Chest CT showed massive hematoma around the total extent of the descending aora and the intimal flap at the diatal descending aorta. We performed an emergency operation. Through left thoracotomy, we found dilatation of the descending aorta. Epiaortic echo revealed that the aortic intima was completely transecred between Th 10 and Th 11. The pseudoaneurysm was replaced with a Hemashield vascular graft under partial cardiopulmonary bypass. The intercostal artery was preserved. His postoperative course was uneventful and paraplegia was not seen. We reported a rare case of traumatic rupture of the distal descending thoracic aorta above the diaphragm followed by successful surgical treatment.

Four-channel aortic dissection is quite rare, and is a highly life-threatening situation predisposing to aortic rupture. We report the case of a 70-year-old woman with non-Marfan syndrome. She was evaluated at our hospital for the diagnosis of another disease. She had no symptoms. Enhanced CT revealed an ascending aortic aneurysm, 68 mm in diameter with four-channel dissection. Because of the high risk of rupture, we performed ascending aortic replacement under deep hypothermia. The cardio-pulmonary bypass (CPB) was not discontinued due to right ventricle failure. Coronary arterial bypass grafting (CABG) to the right coronary artery using the great saphenous vein was added. Even after additional CABG, CPB was not discontinued. The surgery finished under percutaneous cardiopulmonary support (PCPS). PCPS was removed on the third postoperative day. Her postoperative course was uneventful, and she was discharged without any abnormal condition. Four-channel aortic dissection has a high risk of rupture, suggesting the need for early surgical treatment.

Tracheo-Innominate artery fistula is a rare but devastating complication after tracheostomy. We report a 17-year old man who underwent the transection of the innominate artery and tracheal patch closure (under partial sternotomy) after the endovascular covered stent placement for the recurrent tracheo-innominate artery fistula. Fortunately, his postoperative course was uneventful without any new neurological, bleeding, or infective complication 34 months after the surgery.