A case of quadricuspid aortic valve is reported. The anomaly was unexpectedly found during surgery for aortic valve replacement in a 33-year-old man with aortic insufficiency. The supernumerary cusp was positioned between the right and the left coronary cusps. These three cusps were fairly uniform, although the non-coronary cusp was smaller. The cusps were excised and replaced with a Björk-Shiley valve. Congenital quadricuspid aortic valve is a rare abnormality, and only 39 cases have been reported. Most patients developed aortic insufficiency after reaching adulthood and nine patients had aortography or echocardiography. We propose to group congenital quadricuspid aortic valve into two types. Type 1: the supernumerary cusp is located anteriorly, that is, between the right and the left coronary cusps. The present case belongs to this type. Type 2: the supernumerary cusp is posterior and is situated between the right and the non-coronary cusps. In this type, the supernumerary cusp is always smaller than the other cusps.

We describe two cases of aortic regurgitation with dove-coo murmur that required aortic valve replacements. In the first case, there were three small perforations of the cusps, two in the noncoronary cusp and one in the right coronary cusp. The cause of the cusp perforations was unclear. In the second case, there were two perforations of the cusps, one in the left coronary cusp and another small one in the right coronary cusp, along with a subannular pseudoaneurysm. The cause of the cusp perforations was an infective endocarditis. Before 1955, aortic regurgitations with dove-coo murmur were mostly reported to be originated by retroversion of the valve cusps due to syphilis. After 1960, syphilis was replaced by various diseases that bring about perforations, tears and retroversions of the cusps. The condition which is concerned in the development of the dove-coo murmur is that the aortic valve cusps have lesions without calcification and preserve the flexibility.

A 60-year-old male was transferred to a critical care medical center with a complaint of sudden back pain. He already had suffered severe back pain 22 years previously when he was 38-year-old), but was not diagnosed then. On admission thoracic CT scan revealed a three-channeled structure in the descending aorta. The preoperative diagnosis was an acute redissection of a DeBakey III b dissecting aortic aneurysm. An emergency graft replacement of the descending aorta confirmed the three-channeled structure of the aorta. The remaining of media of the aorta, which occurred in the re-dissected lumen, was thin and weak. The patient was alive and well twenty-five months following the operation.

Infra-renal abdominal aortic aneurysms were electively treated by bifurcated endovascular stent grafts (Power Web^TM system, Endologix Co., USA) at 5 Japanese centers. The stent grafting (SG) was applied for candidates nominated by the selection committee after informed consent was obtained according to the IRB in each center. The delivery success rate of 60 patients (53 males) was 96.7%. There were 2 patients with type I endoleaks, resulting in a technical success rate of 93.3%. The operation time of 193±55min and blood loss of 440±240g were significantly shorter and less, respectively in the SG group when compared with 303±88min and 1, 496±2, 025g in 97 patients (83 males) treated by conventional open surgery. Endoleaks were detected in 4 patients (type I: 3, type II: 1) by CT scan taken at the time of discharge or 1 month after SG procedure. Type I endoleak was observed in patients with short and severely angulated SG landing zones. Renal artery obstruction, and temporary buttock pain caused by internal iliac artery occlusion occurred, but there was no hospital death. In 56 patients excluding an SG-unrelated death and a dropout from surveillance, there was no secondary endoleak or marked adverse events at all except 1 SG limb occlusion during a 6-month follow up period. The aneurysm size shrank in 26 patients and remained unchanged in 30 patients. No aneurysm enlargement was observed. The Power Web^TM system is appropriate for minimally invasive surgery for abdominal aortic aneurysms. Long-term follow-up studies will follow.