A 61-year old man was referred to our institute under a diagnosis of pulmonary aneurysm. Contrast computed tomography revealed a huge pulmonary aneurysm of 70 mm in maximal dimension at the main pulmonary trunk. No congenital heart disorders were identified on trans-thoracic or trans-esophageal echocardiography. No significant signs of pulmonary hypertension were demonstrated on right heart catheterization. Laboratory findings on admission included positive results for syphilitic antibodies. T-shaped graft replacement of the pulmonary arteries using a cardiopulmonary bypass was scheduled. The main and left pulmonary arteries were replaced with a J-Graft 26 mm in size (Japan Lifeline, Tokyo, Japan). Then, the right pulmonary artery was reconstructed with the rest of the J-Graft, and anastomosed to the side of the newly reconstructed main and left pulmonary arteries. His postoperative course was generally uneventful. Pathological findings of the excised aneurysmal walls revealed true aneurysmal formation with no specific inflammatory changes. This case was considered to be an idiopathic pulmonary aneurysm without congenital heart disorders, pulmonary hypertension, and pathologically inflammatory reactions of aneurysmal walls.

We report a case of secondary aortoenteric fistula (SAEF). A 76-year-old man who had undergone bifurcated graft replacement for an abdominal aortic aneurysm 18 years previously was admitted to our hospital on 2008. Since the patient was in hemorrhagic shock and had several comorbidities, he first underwent emergency endovascular aneurysmal repair (EVAR). The patient recovered from shock, and then the duodenal fistula was closed and a temporary tube enterostomy was made on the next day. The patient's recovery was uneventful and he was discharged 34 days after EVAR without any sign of infection. However, the patient was admitted for a recurrent SAEF 16 months after the procedure. Although emergency surgery was performed, he died due to sepsis 11 days after surgery. EVAR could be useful to control bleeding associated with SAEF ; however, it would be necessary for a long-term results to perform additional radical surgery subsequently to ensure the patients' hemodynamic recovery.

A 64-year-old man with a diagnosis of aortic valve stenosis presented with chest pain. The patient is a Jehovah's Witnesses and wanted surgery without blood transfusion. Therefore, we planned minimally invasive aortic valve replacement (MICS AVR) avoiding sternotomy. He underwent aortic valve replacement with a mechanical valve (ATS AP360 20 mm) through a right anterolateral thoracotomy at the fourth intercostal space. The value of hemoglobin was 11.2 g/dl after surgery. He recovered uneventfully and was discharged 17 days after surgery. MICS AVR has the advantage of less risk of bleeding, therefore MICS AVR is useful for Jehovah's Witness patients who refuse blood transfusion.

Pulmonary thromboembolism (PTE) is a life-threatening disease, and in severe cases is required surgical treatment. Emergency pulmonary embolectomy using retrograde pulmonary perfusion (RPP) as an adjunct was successfully performed in 2 patients suffering from massive acute PTE. After removal of the pulmonary thrombus via incision of the pulmonary artery trunk, RPP via the right upper pulmonary vein was performed, which enabled the removal of residual thrombotic material and air from the peripheral branches of pulmonary arteries.