A 76-year-old woman who had undergone 5 surgical procedures and chemotherapy for retro-peritoneal liposarcoma was found to have a right ventricular aneurysm by echocardiography, magnetic resonance imaging (MRI) and right ventricular cineangiogram. We decided that it was a false aneurysm because of communication with the right ventricle through a small orifice. At operation, aneurysm was not strongly adherent, so we closed the small orifice with a purse-string suture, and covered it with part of the wall of the aneurysm. Subepicardial aneurysm of the right ventricle was diagnosed by operative and pathological findings. The postoperative course was uneventful and she was discharged on the 15th postoperative day.

A 72-year-old woman underwent surgical stent graft implantation for a huge distal arch aneurysm (12×11cm). Axillo-bifemoral bypass was added in order to restore visceral perfusion. Severe metabolic acidosis developed after the operation, and the patient died 6 hours after surgery. Autopsy showed thromboembolism of the superior mesenteric artery and aortic dissection in the descending thoracic aorta because of stent graft insertion into a false lumen. To reduce complications like this case, we should consider the peculiar anatomic features and thoroughly evaluate atheromatous changes in the aortic wall with improvement of the shape of the sheath and delivery system.

A 61-year old man was referred to our institute under a diagnosis of pulmonary aneurysm. Contrast computed tomography revealed a huge pulmonary aneurysm of 70 mm in maximal dimension at the main pulmonary trunk. No congenital heart disorders were identified on trans-thoracic or trans-esophageal echocardiography. No significant signs of pulmonary hypertension were demonstrated on right heart catheterization. Laboratory findings on admission included positive results for syphilitic antibodies. T-shaped graft replacement of the pulmonary arteries using a cardiopulmonary bypass was scheduled. The main and left pulmonary arteries were replaced with a J-Graft 26 mm in size (Japan Lifeline, Tokyo, Japan). Then, the right pulmonary artery was reconstructed with the rest of the J-Graft, and anastomosed to the side of the newly reconstructed main and left pulmonary arteries. His postoperative course was generally uneventful. Pathological findings of the excised aneurysmal walls revealed true aneurysmal formation with no specific inflammatory changes. This case was considered to be an idiopathic pulmonary aneurysm without congenital heart disorders, pulmonary hypertension, and pathologically inflammatory reactions of aneurysmal walls.

A-23-year-old man, with intellectual disability and history of self-inflicted injuries, presented with chest pain. A 3mm “picked” wound in the left chest was observed on physical examination. Chest computed tomography revealed a needle in the pericardium. Emergency surgery was performed by median sternotomy. At first we could not find the needle because it was completely buried in the heart, but when the posterior wall of the heart was exposed, the head of the needle appeared protruding from the posterior wall. It was removed and the wound of the posterior wall was closed with direct mattress sutures without cardio-pulmonary bypass. On inspection, the needle was 34mm long.

A 65-year-old man had received closure of the entry and false lumen Stanford type B acute aortic dissection via left thoratectomy 23 years previously. The patient underwent emergency graft replacement for a ruptured aneurysm of the thoraco-abdominal aorta 10 years previously. Enhanced computed tomography (ECT) revealed that the residual aortic dissection of the distal arch and the descending aorta were dilated. Reoperation via left thoracotomy usually requires a long cardiopulmonary bypass time and intraoperative bleeding. So we selected to perform open stent-grafting through median sternotomy alone, avoiding a left thoracotomy.

An 82-year-old woman fell into a state of shock during the treatment for a urinary tract infection. Computed tomography and transthoracic echocardiography revealed massive pericardial effusion. Pericardiectomy was performed in the operating room and hemorrhagic effusion was observed. Emergent sternotomy was performed, and the bleeding site was located at the posterior portion of the left ventricular outflow. We diagnosed a rupture of a left ventricular outflow tract pseudoaneurysm after infectious endocarditis. A pericardium patch closure of the pseudoaneurysm and an aortic valve replacement were performed. The patient was discharged 35 days after the operation without recurrence of infection. Left ventricular outflow tract pseudoaneurysms is an uncommon complication following infective endocarditis, aortic valve surgery or chest trauma. Transesophageal echocardiography and multidetector-row computed tomography (MDCT) is useful for identifying such lesions.

A 64-year-old man with a diagnosis of aortic valve stenosis presented with chest pain. The patient is a Jehovah's Witnesses and wanted surgery without blood transfusion. Therefore, we planned minimally invasive aortic valve replacement (MICS AVR) avoiding sternotomy. He underwent aortic valve replacement with a mechanical valve (ATS AP360 20 mm) through a right anterolateral thoracotomy at the fourth intercostal space. The value of hemoglobin was 11.2 g/dl after surgery. He recovered uneventfully and was discharged 17 days after surgery. MICS AVR has the advantage of less risk of bleeding, therefore MICS AVR is useful for Jehovah's Witness patients who refuse blood transfusion.

Pulmonary thromboembolism (PTE) is a life-threatening disease, and in severe cases is required surgical treatment. Emergency pulmonary embolectomy using retrograde pulmonary perfusion (RPP) as an adjunct was successfully performed in 2 patients suffering from massive acute PTE. After removal of the pulmonary thrombus via incision of the pulmonary artery trunk, RPP via the right upper pulmonary vein was performed, which enabled the removal of residual thrombotic material and air from the peripheral branches of pulmonary arteries.