A 65-year-old man was referred to our hospital for surgical treatment of left ventricular aneurysm (LVA) with mural thrombus. Systemic lupus erythematosus had been diagnosed when he was 57 and antiphospholipid syndrome (APS) had been diagnosed at age 61. Steroid and anticoagulant therapy with warfarin has been continuously performed. He suffered acute myocardial infarction at the age of 64, and percutaneous coronary intervention was performed to the diagonal branch. Seven months later, coronary angiography showed occlusion of the diagonal branch and left ventriculography showed a large LVA. Left ventricular reconstruction was performed and his postoperative course was uneventful. Cardiac surgery for the patients with APS was reported to have high morbidity and mortality. Perioperative anticoagulant management was very important for such patients.

In this report, we present our initial experience of endoscopic saphenous vein harvesting (ESVH) using the Vasoview System. ESVH was performed in 72 patients between May 2006 and October 2007. The mean patient age was 73±6.7 years, and 54 (75%) were men. The success rate of ESVH was 98.6% (71/72). The mean harvest time was 36±11 min. The mean number of side branches requiring repair was 1.19±1.21. Comparing the first 5 cases with the last 5 cases, the time for harvesting time and the number of repaired branches improved significantly. Wound complications occurred in 2 patients (2.7%) postoperatively. The intraoperative mean graft flow was 25±13 ml/min. The early patency was 87% (47/54) as evaluated by postoperative angiography or CT. The intraoperative graft flow and early patency were satisfactory. ESVH is easy to adopt and has excellent cosmetic advantages.

A 69-year-old man had been treated with total arch replacement for acute Stanford type A aortic dissection. He had cardiac failure at 9 years after his previous operation. Computed tomography and transesophageal echocardiography showed re-dissection of the aortic root and aortic regurgitation. He was referred to our hospital for surgical treatment. In the second operation, aortic root replacement was performed. Re-dissection of the aortic root at the site of the non-coronary sinus was noted intraoperatively, and intraoperative findings suggested necrosis of the aortic wall related to the use of GRF glue. Care should be taken to ensure proper use of GRF glue. The aortic root replacement using a Freestyle valve provided good hemodynamic function and low thrombogenicity. The use of this valve in this case which had residual dissection of the descending aorta seemed useful because of the excellent hemodynamic function without anticoagulant therapy.

A brachiocepharic artery aneurysm is relatively rare in comparison with other peripheral artery aneurysms. A 62-year-old woman who had had a sudden chest pain 1 year previously was referred to our hospital because of a right upper mediastinal mass on a chest roentgenogram. Computed tomography demonstrated the dissection and dilatation of the innominate artery. The dissection extended to the right carotid artery and right subclavian artery. Furthermore, the ascending aorta was dilated. We performed reconstruction of the innominate artery with a Y-shaped composite graft and replacement of the ascending aorta and total aortic arch. Her postoperative course was uneventful with no neurological event. We describe our surgical strategy in this report with a review of the literature because operative methods and plans are various according to the shape and extent of the aneurysm of the brachiocepharic artery.

In this study, we report early and mid-term outcomes of endoscopic saphenous vein (SV) harvesting (EVH) for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178 (67.9%) patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7 (2.8%) patients. The early and mid-term patency was 95.8% (276/288) and 74.2% (187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization (82.5% vs. 73.6%, p=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.

The patient was a 74-year-old man who was brought to the emergency room with severe chest pain and shock. Transthoracic echocardiography showed moderate pericardial effusion, and contrast-enhanced computed tomography (CT) showed a dilated ascending aorta with hematoma. However, no evidence of an intimal flap in the aorta was found. Bloody pericardial effusion was suggested by the CT attenuation value ; therefore, type A aortic dissection was highly suspected. At surgery, an extramural hematoma was observed on the ascending aorta. An 8-mm dehiscence that had penetrated the adventitia was identified just above the commissure between the right and left coronary cusps of the aortic valve, without dissection in the ascending aorta, and thus spontaneous aortic root rupture was diagnosed. The dehiscence was closed directly with a mattress suture from outside of the sinus, and the dilated ascending aorta was replaced. The patient's postoperative course was unremarkable, and he was discharged 14 days after surgery.