A 57-year-old female was admitted for severe back pain. CT, aortography and transesophageal echocardiography showed enlargement of the ascending aorta with large entry and dissection of the descending thoracic and abdominal aorta with entry located at the distal arch. She had left leg ischemia due to a narrow true lumen. Using cardiopulmonary bypass with circulatory arrest and cervical perfusion, the ascending aorta and arch were replaced and three cervical vessels were reconstructed. A stent graft was inserted into the descending aorta and anastomosed to the distal end of the graft and native aorta. There were no postoperative complications. Postoperative CT showed no leakage at the stent graft attachment. This surgical stent graft operation for chronic type A and acute type B dissection was a relatively minimal invasive and effective method.

An 84-year-old woman was admitted on an emergency basis for dyspnea and cyanosis. Large left ventricular aneurysm with uncontrollable ventricular tachycardia was diagnosed. After intubation and intraaortic balloon pumping insertion, ventricular aneurysmal exclusion with patch plication (Dor's method) was successfully performed. The postoperative course was uneventful and the patient was discharged 2 months after the operation. Left ventricular function improved and ventricular tachycardia disappeared. The patient is now doing well with (NYHA functional class 2) eight months after the operation.

Fulminant myocarditis is known as a disastrous disease that requires intensive care with mechanical cardiopulmonary support. Percutaneous cardiopulmonary bypass (PCPS), which is referred to as extracorporeal membrane oxygenation, is usually used for fulminant myocarditis. However, in some cases, PCPS may be ineffective because of circulatory insufficiency and could be associated with various severe complications such as multiple organ failure or leg ischemia. In such cases, placement of a ventricular assist device (VAD) is required. A 46-year-old man with fever and severe fatigue was admitted to a local hospital and diagnosed as having fulminant myocarditis. Although an intra-aortic balloon pump and PCPS were introduced, cardiac function was not recovered, causing multiple organ failure and leg ischemia. Hence, he was transferred to our hospital for further mechanical support. Transesophageal echocardiography (TEE) revealed severe biventricular cardiac dysfunction, and radiography showed pulmonary edema. His total bilirubin level was 6.9 mg/dl and platelet level was 3,300/μl. Thus, we implanted a biventricular assist device (BiVAD). At 12 days after the implantation, TEE revealed improvement of cardiac function, and blood biochemical examination revealed recovery of multiple organ function. Thereafter, the patient was weaned from the BiVAD successfully. After the operation, the patient underwent a long rehabilitation. He was discharged 51 days after the operation, without any neurological or cardiac complication.

AAAD (Acute type A aortic dissection) may cause trauma, due to a fall down with LOC (loss of consciousness), which can be missed when the disturbance of consciousness is prolonged. Intraoperative heparinization may result in persistent bleeding, and trauma due to a fall with LOC associated with acute aortic dissection should always be kept in mind. An 81-year-old woman underwent emergency surgery for ruptured AAAD with LOC. Preoperative hemodynamics were unstable and low blood pressure persistent even after release of the cardiac tamponade. The partial arch replacement with brachiocephalic artery reconstruction was performed. Before the chest was closed, a large amount of bloody ascites was noted in abdomen and multiple traumas of the liver were found, resulting in a diagnosis of traumatic liver injury due to a fall with LOC. The patient had liver cirrhosis and coagulation abnormality, and hemostasis was difficult to achieve. The operation was finished with gauze packing and placed ABTHERA® was placed for open abdominal wounds. The abdomen was closed in the second stages. The patient's postoperative course was good, and the patient was transferred for continued rehabilitation.