A 64-year-old woman, with no findings of Marfan's syndrome, was addmited with dyspnea on exsertion. She had a family history of thoracic aortic disease. Moderate aortic regurgitation was diagnosed due to mild annulo-aortic ectasia (AAE) limited in the sinuses of Valsalva with moderately impaired left ventricular function. The aortography showed that the diameters of the ascending aorta, the aortic root, and the aortic ring were 38mm, 48mm, and 23.5mm. We planned aortic valve replacement, as the AAE was small and was limited in the sinuses of Valsalva, but she sufferd from A type acute dissection combined with AAE, while waiting for operation. As she fell into deep shock and cardiac arrest caused by cardiac tamponade, an emergency operation was done. The intimal tear was found in the ascending aorta, but no organic change was seen on the three cusps of the aortic valve. Total aortic root replacement with Cabrol's procedure was performed successfully. We recommend that AR with AAE should be performed with aortic root reconstruction in such cases because AAE is often combined with aortic root dissection, even if the aortic root size is small.

Objective : The aim of this study is to describe a series of patients undergoing reoperation due to hemolytic anemia after mitral valve surgery and assess the mechanisms and surgical outcomes. Methods : Between 2009 and 2014, we performed redo mitral valve surgery in 11 patients who had refractory hemolytic anemia after mitral valve surgery at Kyoto University Hospital. The mean age of the patients was 72.2±6.8 years old, and there were 5 men. Results : Preoperative echocardiography demonstrated that only 3 patients had ≥ grade 3 mitral regurgitation (MR), the rest of the patients had only mild to moderate MR. The mechanisms of severe hemolysis included paravalvular leakage (PVL) after mitral valve replacement (MVR) in 8 patients, structural valve deterioration (SVD) after MVR using a bioprosthesis in one, and residual/recurrent mitral regurgitation after mitral valve plasty (MVP) in two. All the patients except one (re-MVP) underwent MVR. The mean interval between previous operation and current operation was 14.1±9.4 years in post-MVR cases, and 2.0±1.9 years in post-MVP cases. There were three late deaths, one of which was due to cardiac death (exacerbation of heart failure due to pneumonia). There was one patient who required re-MVR for recurrent hemolysis due to PVL after MVR. Conclusion : Although hemolytic anemia after mitral valve surgery is rare, it often requires reoperation regardless of the degree of MR at late follow-up period. Thus, patients after mitral valve surgery should be carefully followed-up.

A case of clinical1y unsuspected nonspecific inflammatory aortic regurgitation is reported. A 69-year-old female patient underwent aortic valve replacement for aortic regurgitation. Pathological examination of resected aortic valve showed abscess formation and inflammatory granulation tissue in the non-coronary cusp. Therefore, we diagnosed nonspecific inflammatory aortic regurgitation. It is generally considered that the use of prednisolone for vasculitis syndrome is effective ; however, for nonspecific inflammatory aortic regurgitation its use has not been established. Prednisolone treatment could be an option for nonspecific inflammatory aortic regurgitation.