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 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.