A 63-year-old man who underwent aortic valve replacement (AVR) for aortic stenosis (AS) associated with mildly dilated ascending aorta 28 months previously was admitted to our hospital because of severe chest pain. Computer tomography showed aortic dissection expanding from the sinus of Valsalva to the abdominal aorta. Bentall's procedure and ascending aorta-aortic arch replacement were successfully performed and his postoperative course was uneventful. The surgical management of patients with aortic stenosis associated with ascending aortic dilatation is a controversial issue. We think that Bentall's procedure may be considered as one of the strategies for AS associated with moderate dilation of the aortic root (≥50mm diameter). Following AVR, we should have regularly controlled the patient by ultrasonic cadiogram (UCG) and electively reperformed Bentall's procedure when progression of the enlargement of aortic root had been detected.

Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.

A 14-year-old boy who underwent aortic valve-sparing operation for annuloaortic ectasia at the age of 9 was referred to our service with a diagnosis of acute type A aortic dissection. Emergency total arch replacement with the elephant trunk technique was done successfully and the postoperative course was uneventful. However, computed tomography (CT) 2 weeks after the operation showed a new dissection and enlargement in left subclavian artery and folded elephant trunk. Dilatation in coronary buttons were also seen since the time of surgery. No residual dissection was found in the aorta. Careful follow up is necessary for this case due to multiple aneurysmal changes and a new dissection lesion in a short period. Loeys-Dietz syndrome (LDS) is characterized by vascular findings (aortic aneurysm and dissection) and skeletal manifestations. Due to aortic dissection occurring in smaller diameter aortas in LDS patients than in Marfan syndrome, early and aggressive surgery is recommended for patients with LDS.