A 34-year-old woman was referred to us because of severe aortic regurgitation and annuloaortic ectasia. She also showed a high level of CRP and stenosis of cervical arteries and aortitis syndrome was diagnosed. A translocated Bentall's procedure was performed after administration of corticosteroid. An SJM valve prosthesis was translocated from 1cm above the distal end of the graft and this composite graft was anastomosed to the aortic annulus with buttress sutures reinforced with Dacron felt. Both coronary orifices were reconstructed with small sized Dacron grafts, interposed from the coronary orifices to the composite graft. There was not any complication postoperatively. This procedure is preferable in cases with aortitis syndrome, because it decreases risk of prosthetic detachment in the aortic valve position.

A 61-year-old man was admitted with acute cardiac failure associated with atypical aortic coarctation and severe left ventricular hypertrophy. Angiography and MRI showed that all branches from the aortic arch were occluded, and that cerebral circulation was supplied via collateral flow from small aortic branches either proximal or distal to the coarctation and by the right vertebral artery receiving retrograde flow from the right internal thoracic and right thoracodorsal arteries. Cerebral CT revealed massive cerebral infarction in the perfusion area of the right mid-cerebral artery. Aortitis syndrome was diagnosed from these findings, and ascending-abdominal aortic bypass grafting with aorto-right subclavian bypass was performed after successful conservative treatment for cardiac failure. Because of remarkable increase in the aortic blood pressure on partial clamping of the ascending aorta, proximal aortic anastomosis was performed under extracorporeal circulation. Near infrared spectroscopy (NIRS) was used to monitor the intraoperative cerebral circulation. The perfusion flow rate was maintained in order not to reduce the regional brain oxygen saturation below the critical level. No cerebral complication was encountered postoperatively. Cases of aortitis syndrome with occlusion of all arch branches are rare. NIRS was suggested to be useful to evaluate cerebral circulation during operation in such cases in which cerebral blood flow can be severely affected.

A 53-year-old woman had dyspnea on effort since half a year previously and was categorized as NYHA II. She had suffered from chronic atrial fibrillation (AF) for three years. She had undergone aortic valve replacement using a Starr-Edwards ball valve (SEV) for aortic regurgitation and mitral commissurotomy for mitral stenosis 29 years previously. Echocardiography revealed mitral stenosis with an orifice area of 0.9cm² and neither dysfunction of the SEV nor abnormal findings on the valve itself. She underwent mitral valve replacement and left atrial maze procedure for AF. Because of the intraoperative findings of the cloth wear-covered SEV cage, redo aortic valve replacement was performed simultaneously. St. Jude Medical valves were used for valve prostheses. There was no complication and the ECG returned to sinus rhythm postoperatively. These has been no report of a patient with such a long period between SEV implantation and replacement in Japan. This experience made us realize again the importance of attention to the cloth wear covered cage during long term follow up for SEV.