A 61-year-old woman had extracardiac unruptured aneurysms of the right and noncoronary sinuses of Valsalva, detected incidentally on electrocardiogram taken for a physical checkup. Two-dimensional echocardiography revealed that the sizes of the aneurysm of the right and noncoronary sinuses were 41×40 and 38×28mm respectively, but the shape of left coronary sinus was almost normal. The aortic valve leaflet was normal and the diameter of the aortic annulus and sinotubular junction was 23 and 27mm respectively. The Doppler color-flow echocardiogram showed moderate aortic regurgitation which resulted in prolapse of the right aortic cusp due to deformity of the annulus. We performed modified aortic root remodeling using a tailored Dacron graft to preserve the native aortic valve. Right and noncoronary sinuses of Valsalva were all excised with a small button of the aortic wall around the ostia of the right coronary artery. The left coronary sinus was left as it was. Then each commissure received sub-commissural annuloplasty and was pulled up. The defect of Valsalva was reconstructed with a 26mm Dacron tube graft, the proximal end of which was tailored to a scallop shape and that correspond to left coronary sinus was excised. The right coronary artery was reimplanted utilizing the Carrel patch method. Although we needed additional CABG to the right coronary artery and IABP support due to vasospasm of the right coronary artery, the postoperative course was uneventful. Echocardiography of the aortic valve before discharge showed a normal function without regurgitation.

Introduction: Calciphylaxis is a rare disorder characterized by painful ischemic skin ulcers. There is currently no approved therapy and its pain management is often challenging. Case: A 40-year-old female was diagnosed with calciphylaxis seven years after starting hemodialysis. Despite the administration of sodium thiosulfate intravenous and intralesional combination therapy, the ulcers progressed on both lower limbs and buttocks. She suffered from terrible and opioid refractory pain due to ulcers. After careful consideration of the appropriateness, a lumbar sympathetic ganglion block (LSGB) was performed. Six months later, all the ulcers had re-epithelialized and she was relieved of pain. Conclusion: While the appropriateness of LSGB must be carefully evaluated, it could be a treatment option for patients with central-type calciphylaxis.