A 72-year-old man consulted a local physician due to an episode of loss of consciousness. When chest CT was performed after amelioration of symptoms, aneurysmal dilation was detected at the distal aortic arch. On CT, a distal aortic arch aneurysm appeared to be a sacciform aneurysm measuring 55mm in maximum diameter. In addition, coronary arteriography demonstrated complete obstruction of left anterior descending branch #6, while left ventriculography demonstrated left ventricular aneurysm due to old myocardial infarction. The left ventricular end-diastolic volume was increased to 285ml, and the end-systolic volume was increased to 224ml. Moreover, the left ventricular ejection fraction was markedly decreased to 21%. The distal aortic arch aneurysm was treated by total aortic arch replacement. Considering the postoperative development of cardiac failure, the left ventricular aneurysm was simultaneously treated by endoventricular patch plasty, the so-called Dor operation. The postoperative course of this patient was satisfactory, because the end-diastolic volume was decreased to 241ml, and the end-systolic volume was also decreased to 147ml. Furthermore, the left ventricular ejection fraction was increased to 39%, demonstrating an improvement in left ventricular function. In Japan, there have not been any reports describing simultaneous surgery for thoracic aortic aneurysm complicated by left ventricular aneurysm. Therefore, the present study reports the course of this patient, including the indications of endoventricular patch plasty.

Destructive aortic valve endocarditis or poor controlled aortitis cause the development of left ventricular-aortic discontinuity. We reported our experience with aortic root replacement for cases of severe aortic annular destruction. Between 1999 and 2006, 9 patients with severe aortic annular destruction underwent aortic root replacement at our institute. There were 8 men and one women with a mean age of 55 years. Seven patients were in New York Heart Association functional class III. Four of 9 patients had native valve endocarditis, 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2, aortic root replacements in 2) and one had active aortitis with a detached mechanical valve. Radical debridement of the infected cavity and necrotic tissue was performed in all cases, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 3 cases. Antibiotic-saturated fibrin glue was applied to the cavity. Aortic root replacement was achieved with a pulmonary autograft (Ross procedure) in 4 and stentless aortic root xenograft in 4. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary implantation method. No mortality was observed during hospitalization and follow-up. Reoperation within 5 years was not necessary in 66.7% of the patients. Excellent outcome can be achieved by radical exclusion of the abscess cavity and viable pulmonary autograft or stentless aortic root xenograft in patients with severe aortic annular destruction.