We performed surgical correction of a single atrium in a 46-year-old man, who had suffered from congestive heart failure (NYHA II) and pulmonary hypertension (58/23 (36) /mmHg). An intra-atrial shunt (L-R 71%, R-L 14%) due to single atrium and mild mitral and tricuspid regurgitation were detected. The operation consisted of making a new atrial septum with an autologous pericardial patch and direct mitral cleft suture. The post-operative course was uneventful.

Injury to the thoracic aorta is often fatal. We encountered a case of aortic rupture caused by a traffic accident. A 20-year-old man was transferred to our hospital because of right elbow fracture and enlargement of the upper mediastinum on X-ray. We diagnosed aortic isthmus rupture by chest CT with enhancement. He did not have chest pain, but complained of severe pain in the right elbow. His hemodynamic condition was stable, but his right arm become swollen with increasing sensory disturbance. Chest CT and blood cell count showed no interval change between results at a previous hospital and ours. So we decided to operate on his right arm before aortic rupture. After the open reduction of his fractured elbow, pleural effusion increased although his hemodynamic condition was stable. Then the descending aorta was replaced under partial cardio-pulmonary bypass. His post-operative course was uneventful.

We encountered a rare case of aortic regurgitation due to rheumatoid arthritis. A 53-year-old man was admitted with severe heart failure due to aortic regurgitation. He had been treated for rheumatoid arthritis for 5 years with methotrexate. After treatment for heart failure, his aortic valve was successfully replaced with an Omnicarbon prosthetic valve. Histopathological examination of the excised aortic valve showed rheumatoid granuloma. His post-operative course was uneventful.