Fifty-two-year-old man who suffered from headache and left neck pain was brought to a nearby hospital by ambulance. Anisocoria and disorder in the field of view of the left eye were observed. Emergency brain MRA showed obstruction of the left internal carotid artery. The patient was transported to our hospital for emergency surgery for suspected acute type A aortic dissection on CT scan. Operative findings revealed a thrombus attached to the ascending aorta continued to left common carotid artery. Thrombectomy for left carotid artery and partial arch replacement were performed. The patient was discharged in good condition on the 16th postoperative day. We encountered a very rare mural thrombus in the ascending aorta.

A 52-year old man was referred to our hospital for atrial fibrillation ablation therapy. A multislice computed tomography study demonstrated a giant coronary artery aneurysm situated just proximal to the left anterior descending (LAD), LAD stenosis and coronary-pulmonary artery fistula. The fistula was ligated and the aneurysm was resected under cardiopulmonary bypass. The left internal thoracic artery was used as a bypass graft to the LAD as well as a patch for closure of the LAD orifice to avoid left circumflex artery stenosis. We report a rare case of giant LAD aneurysm with coronary-pulmonary artery fistula.

The patient is a 39-year-old-man who had rheumatic heart disease and had undergone mitral and aortic valve replacements with mechanical St. Jude prostheses as well as tricuspid valve repair and a MAZE procedure 17 years previously. He was admitted with ventricular tachycardia (VT) and an implantable cardioverter-defibrillator (ICD) was implanted. Four months later, he was admitted again with VT, and attempts to manage the VT with drugs were not successful. We performed electro-anatomical mapping and ablation for VT by re-median sternotomy. His postoperative course was uneventful. At 15 months after surgery, no recurrence of VT was recognized.