Gelatin-sealed branched knitted Dacron grafts (Gelseal^®, Vascutek, UK) were implanted in nine patients for surgical reconstruction of the toal aortic arch. Subjects included Stanford A type acute aortic dessection in five, distal aortic arch aneurysm in three, and aneurysm of the ascending aorta and aortic arch associated with aortic valve stenosis in one patient. There was no hospital death and a good postoperative course was obtained. This graft was soft, pliable and very useful for replacement of the aortic arch especially in emergency cases. However, intensive follow-up is necessary because it dilated about 20% in diameter one month after surgery.

A rare case of descending thoracic aortic coarctation caused by fibromuscular dysplasia is reported. A 74-year-old woman was referred to our institution because of congestive heart failure, hypertension, acute renal failure and pressure gradient between upper and lower extremities. Aortography revealed 90% stenosis of the descending mid-thoracic aorta. Descending-descending aortic bypass was performed under femoro-femoral partial cardiopulmonary bypass. The post-operative course was uneventful and the pressure gradient across the coarctation was disappeared. The patient discharged on the 28th postoperative day without any problems. The pathohistological findings revealed fibromuscular dysplasia in the media and intima of the aortic wall.

We report a successful case of graft replacement for ascending and aortic arch aneurysm which developed 5 years after CABG. A 75-year-old woman, who underwent emergency CABG (LITA-LAD, SVG-RCA) 5 years previously, was admitted to our hospital due to an abnormal shadow on chest roentogenogram. Aortogram and coronary angiogram revealed ascending and aortic arch aneurysm and patent LITA and SVG. Graft replacement of the ascending and total aortic arch was carried out using four branched grafts (Gelweave 26/10/8/8^*8). Cardiopulmonary bypass was established with right axillary arterial perfusion and bicaval cannulation. Cardiac arrest was obtained with cold blood cardioplegia using both retrograde and antegrade techniques. Selective cerebral perfusion was used for brain protection. The patient was discharged without any complication on the 27th postoperative day.