Infective endocarditis with apical abscess is very rare. A 49-year-old man was admitted in a diabetic coma. The next day, he suddenly developed chest pain and headache. Echocardiogram revealed mitral valve vegetations and mitral regurgitation, and brain CT showed multiple cerebral hemorrhage that was thought to be due to cerebral embolism. Surgery was performed on the 10th hospital day for progressive heart failure. During surgery, an abscess was noted at the apex, but the abscess cavity was not connected to the cardiac cavity. The mitral valve was replaced, and the abscess cavity was resected. The defect of the ventricle was repaired with an 8×5cm Goretex sheet. Cultures of blood, vegetation, and the abscess were negative. It was thought that the abscess formation in the apex was caused by infectious coronary embolism, since cerebral embolism and chest pain happened simultaneously, and the abscess cavity was isolated and not in communication with the cardiac cavity.

The patient was a 61-year-old male, who underwent thoracoabdominal aortic aneurysm repair with Gelseal Triaxial prosthetic graft 2 years previously. False-aneurysm due to prosthetic graft dilatation was diagnosed. The direct closure of the ostium of the disruption of the anastomosis was successfully performed by an emergency operation. The postoperative course was uneventful. This case suggests that prosthetic graft dilatation may cause false-aneurysm at the site of end-to-side anastomosis.

A 65-year-old woman was admitted with a diagnosis of unstable angina after PTCA. She was diagnosed with acromegaly 8 years ago. She underwent an emergency coronary artery bypass grafting (LITA-LAD, SVG-HL-Cx). Serum growth hormone (GH) levels were 65.5ng/ml (normal limit<5ng/ml) before the operation. During a cardiopulmonary bypass GH levels elevated to 92.7ng/ml, but decreased to 15.9ng/ml after the operation. After 3 postoperative days GH levels increased gradually again and blood sugar levels became unstable. Finally it was necessary to increase the dose of bromocriptine. To our knowledge, there are only a few patients who have undergone coronary artery bypass grafting associated with acromegaly. This case suggests it is important to control GH levels at the operation and during the postoperative period.