A 70-year-old man was admitted suffering from chest and back pain. He was assessed by enhanced computed tomography (eCT) and a thrombosed acute DeBakey type IIIb aortic dissection with an ulcer like projection (ULP) was diagnosed and treated medically. Five days later, he complained suddenly of dyspnea and was diagnosed by eCT as having a pulmonary thromboembolism. Anticoagulant therapy was started reluctantly. The patient's symptoms improved, however, 16 days later he complained of severe chest and back pain. Enhanced CT showed enlargement of the ULP, which was diagnosed as an impending aortic rupture. Open stent-grafting was selected as a less-invasive treatment method. A stent-graft was introduced into the descending aorta via the transected aortic arch and the entry of the ULP was closed. Postoperative course was smooth and uneventful. We consider that open stent-grafting via the aortic arch is an alternative method for repair of acute type B aortic dissection with an ULP in the descending aorta, in cases where direct closure of the intimal tear is difficult.

A 52-year-old man suffered from rupture of a right aortic arch and a descending aortic aneurysm. The patient was treated with an open stent grafting technique, and complete revascularization was achieved. Twelve days after the operation, a computed tomographic scan revealed a fistula between the distal esophagus and the excluded aneurysm sac. Twenty-six days later, the patient was treated by an esophagectomy, a cervical esophagogastrostomy, as well as a feeding jejunostomy. The infectious parietal thrombus was partially debrided, and the aneurysm sac was filled with omentum. The patient recovered uneventfully. The patient has been followed for 18 months with no signs of infection.

We report a case of successful operation for multiple giant aneurysms with a right coronary artery fistula from the right coronary artery to the left atrium. A 35-years-old woman was found to have a right coronary artery aneurysm with a maximum diameter of 85mm, and two other coronary artery aneurysms with maximum diameters of 40 mm along the coronary fistula, which arose from the proximal right coronary artery, traversed the root of the left atrium, and drained into the left atrium. Surgical treatment was indicated to relieve symptoms and to prevent possible rupture of the aneurysms. She underwent resection of coronary artery aneurysms, closure of orifices of the fistula and coronary bypass grafting to the right coronary artery with cardiopulmonary bypass. Her postoperative course was uneventful, and she was discharged in good condition.