To determine the hemostatic effets of aprotinin in coronary artery bypass surgery, a prospective study was performed. Thirty four patients (group A) who received aprotinin (2×10⁶ unit) in the cardiopulmonary circuit were compared with 31 control patients (group C) who did not. Activated clotting time was measured in group A for 60 minutes during cardiopulmonary bypass, but no significant difference was observed in the platelet counts of the two groups. Intraoperative blood loss was 366ml in group A compared with 514ml in group C, and postoperative blood loss was 354ml versus 570ml, respectively (p<0.05). Total blood loss was significantly reduced in group A by 34% compared with group C (720ml versus 1, 084ml, p<0.05). There was no difference in incidence of perioperative myocardial damage. It seems necessary to investigate the complications of the hemostatic effects of aprotinin and it effects on graft patency.

No case of graft replacement for abdominal aortic aneurysm in a case of congenital deficiency of coagulation factor X III has yet been reported. Recently we performed graft replacement of 66-year-old man with congenital deficiency of coagulation factor X III. Concentrated factor X III separated from human placenta (Fibrogamin^®) was used during, before and after the operation. We measured factor X III activity, and when the activity was so low that replacement therapy was necessary, we administered Fibrogamin immediately. We maintained coagulation factor X III activity at over 70%. No adverse reaction of factor X III replacement therapy was observed. The postoperative course was uneventful and the patient did not have delayed wound healing.

A 68-year-old woman complained of hemoptic shock and recovered with conservative treatment. Ruptured descending aorta into the left lung was diagnosed. Graft replacement of the descending aorta was successfully performed. We speculated that spontaneous rupture of the descending aorta into the left lung might have occurred due to high blood pressure affecting the weak aortic wall with sclerotic change, causing hemoptysis. The ruptured descending aorta was successfully replaced without dissection between the ruptured aorta and the left lung. The postoperative course was uneventful with neither pulmonary nor infectious complications.

A 45-year-old woman who was a Jehovah's Witness was admitted to our hospital with a complaint of palpitation and sort on-effort. A ruptured aneurysm of the sinus of Valsalva (RASV) associated with stenosis of the right ventricular outflow was diagnosed. Operative findings revealed a RASV with a double chambered right ventricle (DCRV) and a ventricular septal defect (VSD). RASV, DCRV and VSD were successfully repaired with extracorporeal circulation without use of homologous blood. We reported this case because congenital combination of RASV, DCRV and VSD is very rare.

A 69-year-old man complained of abdominal pain with inflammatory reaction. Abdominal aortic aneurysm (AAA) with a left main trunk lesion was diagnosed and he successfully underwent Y-graft replacement of the abdominal aorta and coronary artery bypass grafting. Finally AAA was classified as “inflammatory” by histopathological findings. We present this case of “inflammatory AAA” associated with coronary artery disease, and discuss it with a review of literatures.

A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA)．Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.