A 40-year old man with chest pain was admitted to our hospital. A three-dimensional CT revealed an unruptured left coronary sinus of Valsalva aneurysm and mild stenosis of the left main trunk. An echocardiogram revealed severe aortic regurgitation. He was operated on with an aortic root replacement procedure. Though the procedure was itself uneventful, he could not be weaned from cardiopulmonary bypass because of unexpected coronary events ; relative stenosis of the RCA and stretched LMT due to a huge aneurysm of the sinus of Valsalva. Additional CABG with LITA to LAD and SVG to RCA led to weaning from cardiopulmonary bypass. Left coronary sinus of Valsalva aneurysm is rare, and it requires early surgical intervention for an increase in the diameter of the aneurysm together with myocardial ischemia due to compression of the coronary artery.

A 62-year-old man was referred to our hospital because of dyspnea. Electrocardiogram showed chronic atrial fibrillation and echocardiogram revealed severe tricuspid regurgitation. His history included a motorbike accident at age 17, and a heart murmur was pointed out in the following year. He developed paroxysmal atrial fibrillation when he was 45 years old. Heart failure was not controlled by medication and tricuspid valve repair was indicated. At surgery, the anterior leaflet of tricuspid valve was widely prolapsed due to chordal rupture. We performed chordal reconstruction with 4 expanded polytetrafluoroethylene (CV-5®) sutures, and ring annuloplasty. Furthermore, a small fenestration at the tricuspid annulus was noticed and was closed with a direct suture. The biatrial modified Maze procedure was performed subsequently. The patient is doing well without TR recurrence, and restored sinus rhythm is maintained. We report successful repair of traumatic tricuspid regurgitation.

Background : Fungal mycotic aneurysm is rare ; however, special care and treatment are required for the deep fungal infection itself. Case : The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions : Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.

Paroxysmal atrial fibrillation (pAf) is an arrhythmia that often occurs in the elderly. The quality of life often declines due to severe palpitations caused by pAf. We present a case of recurrent pAf that occurred on postoperative day 2 of coronary artery bypass grafting and pulmonary vein isolation for unstable angina pectoris and pAf. The patient was a 62-year-old man who complained of palpitations, which was consistent with pAf on the monitor ECG. During hospitalization, the patient was constantly wearing an ECG monitor. During pAf, the heart rate was around 120 bpm, and pAf could continue for up to and beyond 24 hours. Paroxysmal atrial fibrillation with strong palpitations was observed every day, even after starting beta-blockers and anticoagulants. After discharge, a Japanese Kampo medicine called shakanzoto was taken for a month, but there was no improvement. After that, it was changed to another Japanese Kampo medicine called saikokaryukotsuboreito, because abdominal examination revealed kyokyokuman (hypochondriac discomfort and distension (resistance)) and saiboki (brisk pulsation in the para-umbilical region). Palpitations quickly improved dramatically. It was speculated that not only palpitations but also pAf had been improved.

A woman in her 60 s presented with chest pain. The electrocardiography showed ST depressed in V3-V6, ST elevation in aVR, and negative T in I, II, aVL, and aVF. Laboratory examination revealed that creatinine kinase isoenzyme-MB and troponin I were elevated. Transthoracic echocardiography revealed moderate aortic regurgitation. Enhanced computed tomography did not show an aortic dissection. Acute coronary syndrome was suspected and cardiac catheterization was done. Aortography showed an intimal flap inside the Valsalva sinus. An emergency operation was performed. Surgical view: the intimal tear affected almost all the circumference of the aorta in the Valsalva sinus and the aortic dissection with a localized and moving intimal flap affected the coronary flow and the aortic dissection caused severe aortic regurgitation and decreased the coronary flow. An aortic root replacement was successfully performed, and the postoperative course was uneventful.