We encountered 3 cases of protein S deficiency accompanied by coronary artery disease (CAD). None of the patients had been given diagnoses of congenital protein S deficiency prior to referral to our department. Our examination revealed three-vessel CAD with distal lesions. CAD was of early onset in two patients in their 40 s. In 2 of the 3 patients, off-pump coronary artery bypass was performed, and continuous heparin infusion was postoperatively changed to oral warfarin. These patients had a favorable postoperative course and graft patency was maintained. In the third patient, who underwent repeated percutaneous coronary revascularization, in whom coronary artery bypass was contraindicated, oral warfarin alleviated the symptoms of CAD. No disease progression was observed in coronary angiography performed at the one-year follow-up examination.

We report a case of PDA with post aortic left innominate vein (PALIV). A 3-year-old boy was admitted to our department for surgical treatment of PDA. Preoperative UCG and venography demonstrated PALIV clearly. It was possible to observe PALIV directly during the operation for PDA.

During aortic arch replacement in response to an aortic arch aneurysm sealed rupture, we experienced a case in which weaning from cardio-pulmonary bypass (CPB) became difficult, and pulmonary artery stenosis developed due to expanded hematoma. A 77-year-old man was raced to our hospital due to subjective symptom of chest/back pain. With a recognition of aortic arch aneurysm and hematoma around the aneurysm, it was diagnosed as an aortic arch aneurysm sealed rupture. Even though an elective aortic arch replacement was implemented using an open stent graft, reduction in blood pressure and poor oxygenation was observed at the process of CPB weaning. As a result of intraoperative pulmonary arteriography, severe stenosis was revealed on both left and right pulmonary arteries. With placement of a self-expanding stent, weaning from CPB was successfully completed. Being transferred to other hospital on day 60 after the surgery in order to continue rehabilitation, the man visits our hospital as an outpatient on his own as of now. As it is considered to be a rare case that weaning from CPB was successfully performed by pulmonary stenting in response to progressed intraoperative pulmonary artery stenosis caused by expanded hematoma after heparin administration, the details are reported here.