We report a case of emergency operation for ruptured abdominal aortic aneurysm with intraoperative cardiac arrest. The patient was a 71-year-old man with a past history of CABG and total gastrectomy. A transperitoneal approach was used for operation. Intraoperatively, a large retroperitoneal hematoma and intestinal adhesion were found. This large retroperitoneal hematoma increased, followed by cardiac arrest. Immediately left thoracotomy, direct cardiac massage and digital compression to the descending aorta were performed. After aneurysmal opening, an occlusion balloon was inserted in descending aorta. The infrarenal aorta was exposed and clamped. Cardiopulmonary resuscitation was successful. The aneurysm was replaced with a bifurcated artificial vessel and distal anastomosis to the bilateral femoral arteries. There were no signs of cardiac or renal failure in the early postoperative period. The postoperative recovery was successful.

A 35-year-old man was referred to our hospital for surgical repair of grade IV/IV aortic regurgitation secondary to a congenital unicuspid aortic valve accompanied by aneurysm of the ascending aorta. The aortic valve was the unicuspid unicommissural type and a fully developed commissure was located in the left lateral position (left coronary/right coronary). The anterior (non-coronary/right coronary) and posterior (non-coronary/left coronary) borders were rudimentary with calcified raphe. We performed aortic valve repair in combination with valve sparing root replacement (reimplantation) and partial arch replacement. We converted the unicuspid into a bicuspid aortic valve by preserving his own free margin tissue and creating a neocommissure to the 180 degrees opposite side of the left lateral commissure at the same height by enlarging the cusp with a glutaraldehyde-treated autologous pericardium patch to the cusp belly. The patient was discharged on the 17th postoperative day with trace aortic regurgitation. We successfully repaired the unicuspid aortic valve by augmenting the cusp size using a pericardium patch in order to preserve the free margin of the cusp.