A 24-year-old man with systemic lupus erythematosus (SLE) had received long term steroid therapy 10 years prior to this admission. He presented with sudden-onset chest pain. Enhanced CT scan showed the presence of an aortic arch aneurysm 63mm in maximum diameter and a hematoma surrounding the anterior mediastinum. The diameter of the descending thoracic aorta was also dilated to 5cm. We performed ascending and total arch replacement on December 8, 2005. From the 11th postoperative day, he developed fever, indicating mediastinitis. Open drainage was carried out for one week resulting in gradual lysis of fever and the levels of WBC and CRP returned to normal values. The omentum was transplanted to close the defect in the mediastinum. The rest of the postoperative course was uneventful. He was discharged from the hospital last January 25, 2006. Although close medical follow-up was implemented, he had severe chest pain in the morning on June 9, 2006. Enhanced CT showed an expanding descending aortic aneurysm 60mm in diameter. Since antihypertensive therapy was effective, we considered an elective operation. On the 3rd hospital day, he complained of a severe back pain wherein he rapidly progressed into a state of shock. He died due to rupture of the descending aortic aneurysm. We needed emergency operation or endovascular stent graft therapy because of the risk of rupture.

A 64-year-old man had a history of interstitial pneumonia and emphysema since 2000. He underwent video-assisted thoracic surgery (VATS) for lung carcinoma at another hospital on June 30, 2003. Because he suddenly suffered anterior chest pain with shock in September 11 2003, he came to our emergency room. His blood pressure showed 90mmHg, his consciousness level was drowsy and it changed to shock status. Cardiac tamponade was diagnosed by cardiac echography showing an echo-free space and pericardiocentesis was carried out for urgent management of acute tamponade. After the removal of pericardial effusion, his consciousness and blood pressure returned to a normal level. As pericardial blood effusion was continued without aortic dissection by CT, we performed an emergency operation. We set up an external cardiac bypass immediately and removed a massive hematoma weighing 422g, we colud then find the ruptured circumflex coronary artery with a small hole of pericardium penetrating the left pleural space and repaired that ruptured coronary artery during cardiac arrest. His postoperative course was uneventful, and he was discharged on October 6.

A 70-year-old man who had undergone felt repair for a left ventricular free wall rupture associated with acute myocardial infarction at age 66. A computed tomography at 4 years postoperatively showed left ventricular pseudoaneurysm and a 1-cm perforating hole. A patch closure with a Dacron patch was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. The postoperative course was uneventful and he was discharged on the 18th postoperative day.

We performed extraanatomic bypass from the thoracic aorta to bifemoral arteries for 4 aortoiliac occlusive disease (AIOD) patients (including 2 dialysis patients) with severe calcification of abdominal aorta and 5 high aortic occlusion (HAO) patients between January 2001 and September 2006. The average age was 69 years old (range 46-80) including 6 men. Two HAO cases were in the acute phase, one of whom had accompanying lower limb paralysis. Two of the AIOD cases showed small aorta syndrome. The mean operation time was 145min and intra- or postoperative bleeding was very low. We lost one peritoneal dialysis patient with AIOD in the 2nd postoperative week, due to infection from the CAPD tube. Perigraft seroma which is a complication of the artificial blood vessel itself was seen in 3 patients but graft patency was 100 percent at 2 years postoperatively.