A 64-year-old man was admitted to our hospital because of a feeling of compression of the chest 5 years previously. Aneurysm of the right sinus of Valsalva was unexpectedly diagnosed by detailed examinations. He was admitted for the surgery, because dilated aneurysm caused severe stenosis of right ventricular outflow tract (RVOT) and aortic regurgitation (AR) progressed. He underwent surgical repair consisting of patch closure of the aneurysm, aortic valve replacement, right coronary artery (RCA) bypass grafting with right internal thoracic artery (RITA), and aneurysmal wall was closed with suture after partial resection. The postoperative course was uneventful. Postoperative angiography revealed that aneurysm of the right sinus of Valsalva was not enhanced and the RITA graft was patent. The pressure gradient between RV and PA immediately reduced after operation. Postoperative CT showed that the stenosis of the RVOT completely disappeared with the elimination of the aneurysm.

The patient was a 57-year-old woman. In 1974, she had undergone aortic valve replacement using a Starr-Edwards ball valve to treat aortic stenosis at another hospital. In 1989, she had undergone percutaneous transluminal mitral commissurotomy (PTMC) for mitral stenosis at our hospital. In December 2003, she was admitted with cardiac failure of NYHA III to our hospital. Echocardiography showed the progressive changes of mitral stenosis and the prosthetic aortic valve. In January 2004, the mitral valve was replaced using a Carbo Medics prosthesis and the Starr-Edwards aortic valve was replaced using a BICARBON prosthesis, together with tricuspid ring annuloplasty. The cloth wear of the Starr-Edwards valve cage and a pannus formation at the valve seat was found at operation. The patient was discharged, and now is rehabilitated in good health.

A 66-year-old man who suffered from intermittent abdominal and back pain underwent medical examinations at our hospital. A high value of leukocyte, inflammatory reaction and IgG4 was detected, and computed tomography demonstrated that there was thickened soft tissue around the abdominal aorta which extended to the superior mesenteric artery and the renal arteries. He was given a diagnosis of retroperitoneal fibrosis, and prednisolone (PSL) was administered. Although the decrease in thickness of the soft tissue around the aorta was seen, the enlargement of the aorta mainly near the orifice of the celiac artery was shown. We were consulted on this thoracoabdominal aortic aneurysm (Crawford type IV) at this time, and considered that this aneurismal change had occurred secondary to chronic periaortitis. In a few weeks, the rapid expansion of this aneurysm was occurred, so we planned early surgical treatment after tapering of PSL. He underwent graft replacement of thoracoabdominal aorta with rifampicin-bonded graft, because the infection could not be denied as a cause of this aneurysmal change. Although Streptococcus pneumoniae was detected in the specimens from the periaortic tissue, false lumen and aortic wall in the culture test, he had a good post operative course with prolonged antibiotic therapy.

Congenital anomaly of the coronary artery is rare. We have to care about the injury of the aberrant coronary artery and ischemic complication during and after the heart valve surgery. We experienced a good clinical course of aortic valve replacement (AVR) with concomitant coronary artery bypass grafting (CABG) for aortic stenosis coexisting with anomalous aortic origin of the right coronary artery. A 72-year-old woman had suffered from dyspnea and palpitation on effort, and we diagnosed severe aortic stenosis. Preoperative examination revealed the right coronary artery arising from the left coronary sinus with a stenotic lesion in the interarterial course between the aorta and main pulmonary artery. She underwent AVR and CABG using a saphenous vein graft. The peripheral anastomosis of the bypass grafting was performed before starting cardiopulmonary bypass and the blood cardioplegia was infused into right coronary artery through the bypass graft during cardiac arrest. The postoperative course was uneventful and the patent bypass graft was confirmed by computed tomographic angiography.