We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

A 65-year-old woman was referred for progressive dyspnea and leg edema. Physical examination revealed a continuous murmur along the right sternal border. Enhanced computed tomography showed an aneurysm that extended to the right atrium. Aortic angiography confirmed the rupture of the valsalva aneurysm into the right atrium. The patient underwent emergency surgery to close the aneurysm ostium and suture closure of the right atrial fistula. The patient's postoperative course was uneventful.