A 74-year-old man with chronic renal failure complained of back pain. Computed tomography revealed an infected thoracic pseudoaneurysm at the descending thoracic aorta. An endovascular stent graft was repaired with exclusion of a false aneurysm. After surgery, he complained of post-prandial cough, minor hemoptysis and deglutition with difficulty. Esophagoscopy and bronchoscopy showed a fistula between the left main bronchus and the esophageal diverticulum. Fistulectomy was planned after his general condition became stabilized, but the patient died of rebleeding on day 64 after stent grafting. The histological examination revealed a congenital bronchoesophageal fistula.

Extensive calcification of the mitral annulus presents a formidable technical challenge to surgeons and increases the risk of serious complications such as intractable hemorrhage, atrioventricular disruption, and ventricular rupture during mitral valve surgery. We present a case of aortic and mitral valve replacements for a patient with extensive calcification of an intervalvular fibrous body. A 76-year-old woman was admitted with dyspnea on effort, leg edema and syncope. Transthoracic echocardiography showed severe aortic stenosis, and mitral stenosis with regurgitation, and extensive mitral annular calcification. Decalcification was performed with CUSA and we selected a trans-aortic-valve approach for decalcification of the intervalvular fibrous body. The calcification was left to a certain extent in order to preserve annular strength. Postoperative echocardiography showed no perivalvular leakage from either prostheses. The patient was transferred to a local hospital for further rehabilitation.