A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.

Small bowel ileus due to the parasitic infection caused by omophagia of freshwater fish is relatively rare. We present a case of small bowel ileus possibly caused by inflammatory change associated with Gnathostoma doloresi infection. A 62-year-old man underwent partial resection of the small bowel under a diagnosis of ileus due to complete obstruction of the small bowel. He had eaten a few slices of raw freshwater fish four weeks before abdominal pain appeared, and he contracted creeping disease with several welts on the abdominal wall. Chronic inflammatory change suggestive of parasite infection was observed in the resected specimen. An immunoserodiagnostic study using microenzyme-linked immunosorbent assay led to a diagnosis of Gnathostoma doloresi infection. The postoperative course was favorable, and the patient was discharged 12 days after surgery. Only two cases of ileus due to Gnathostoma doloresi infection have ever been reported.

We report the successful repair of left main coronary artery obstruction with aortitis syndrome. She was a 39-year-old woman and was admitted to Saiseikai Kumamoto Hospital because of angina pectoris. Her bilateral radial artery pulsation was not palpable. Total occlusion of the left main coronary artery (LMT) and bilateral subclavian artery was detected by angiography. Patch enlargement of the LMT was performed using a Distaflo (Impra Carbon PTFE) graft. Postoperative coronary angiography showed an adequate LMT diameter and sufficient blood flow.

A 68-year-old woman was referred to our hospital with arrhythmia and cardiomegaly. She lost consciousness in the waiting room. After urgent hospitalization, cardiac ultrasonography showed cardiac tamponade, and urgent pericardial drainage was performed. A ruptured coronary aneurysm with a fistulous communication was diagnosed by CT scan and coronary angiography. Under extracorporeal circulation, ligation of the unusual coronary vessels and resection of the aneurysm were performed. The postoperative course was uneventful and she was discharged on the 25th postoperative day. No ischemic signs were observed on treadmill test at one year after surgery. Most congenital coronary aneurysms are asymptomatic; however, once rupture occurs, it is important to diagnose this condition rapidly and treat surgically.