A 75-year-old male with an aneurysm in the transverse aortic arch with aberrant right subclavian artery was surgically treated successfully. Preoperative angiograms suggested abnormal expansion of neck vessels but this was not confirmed before operation. At operation, right aberrant subclavian artery was confirmed and the transverse aortic arch was replaced with a 22mm woven Dacron graft and four brachiocephalic vessles were reconstructed by interposition of four 8mm Dacron grafts between those vessels and the arch prosthesis. The postoperative course was uneventful and the postoperative angiograms indicated successful transverse aortic arch reconstruction.

The number of operations performed for cardiovascular disease has increased since recent improvements in diagnostic and the therapeutic technology have led to a remarkable increase in the life expectancy of patients with Marfan syndrome. On the other hand, operative procedures can be difficult when patients have complications of connective tissue abnormalities such as thoracic deformities, lung diseases and ophthalmic lesions. Although recent surgical outcomes have improved, those of secondary surgery are more difficult. We describe aortic root replacement to treat perivalvular leakage after aortic valve replacement in a patient with Marfan syndrome with a severe thoracic deformity.

A 72-year-old woman underwent simultaneous combined surgical treatment for descending aortic aneurysm, coronary artery disease and left common iliac artery stenoses. The operation was performed through the left posterolateral thoracotomy via the 6th intercostal space and a left retroperitoneal approach. At first, 10mm woven Dacron graft was anastomosed to the abdominal aorta as an inlet of the cardiopulmonary bypass and the left femoral vein was used for venous drainage. A saphenous vein graft was anastomosed to the left anterior descending artery during partial cardiopulmonary bypass with the heart beating. Secondly, the aneurysm was replaced with 24mm woven Dacron graft. Thirdly, the proximal end of the vein graft was anastomosed to the Dacron graft of the descending aorta. Finally after cardiopulmonary bypass was terminated, the distal end of the woven Dacron graft for arterial perfusion was anastomosed to the left external iliac artery in end-to-side fashion. The postoperative course was uneventful. We conclude that simultaneous operation for descending aortic aneurysm and coronary artery bypass grafting through left thoracotomy with the heart beating is useful in these combined diseases.

A 28-year-old woman with no underlying health issues was injured in a motorcycle accident and taken to our hospital by ambulance when she was 26 years old. Though she was diagnosed with multiple trauma, upon arrival at the hospital neither cardiac murmurs nor cardiac abnormalities on transthoracic echocardiography were detected. She was managed conservatively, and discharged on hospital day 16. She experienced dyspnea upon mild effort, and an early diastolic murmur appeared. She was again referred to our hospital, and diagnosed with severe aortic regurgitation. We scheduled an aortic valve replacement using an bioprosthetic valve because she intended to give birth. We also considered simultaneous aortic root enlargement as her aortic annulus was small. We performed the surgery 2 years after the initial motorcycle accident. Perioperatively, we noticed that her non-coronary cusp was torn. We converted the procedure to an aortic valve repair using an autologous pericardial patch. Her aortic regurgitation disappeared after the operation, and she was discharged on postoperative day 14. We successfully preserved the aortic valve cusps and avoided the need for anticoagulant therapy.

The UBE woven 150cc WYK graft is a non-sealed graft that became available commercially in January 2005, and does not need to be preclotted before implantation. Subjects in this study comprised 50 patients with abdominal aortic aneurysms or common iliac arterial aneurysms, who received prosthetic Y grafts in our institution. Subjects were divided into 2 groups: the U group (n=26), with implantation of the UBE graft, and the I group (n=24) who received implantation of an INTERGARD^TM woven Y graft. Intraoperative bleeding, inflammatory response and duration of postoperative hospitalization were evaluated in each group. Significant differences were noted between C-reactive protein levels, frequency of recurrence of fever and duration of postoperative hospitalization. No differences were noted between intraoperative bleeding and time. The UBE woven 150cc WYK graft, compared with the INTERGARD^TM woven Y graft, required no extra time for implantation and appeared to offer advantages such reduced immunoreaction after surgery. However, follow-up for sufficient late-phase evaluation of the grafts is required.

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.