A case of left ventricular pseudoaneurysm formation at an atypical site in the left ventricle is described. A 32-year-old man underwent mitral valve replacement and he was taken to the intensive care unit (ICU) in good condition. Two hours later, he sustained massive bleeding from the chest drainage tubes, hypotension, and shock. We reopened the sternotomy in the ICU and found massive bleeding from the lateral wall of the left ventricle. Under cardiopulmonary bypass and cardiac arrest, the myocardial laceration was closed with Teflon felt-buttressed interrupted sutures and then the involved area was covered with a Xeno-medica^TM patch. Postoperative echocardiography, computed tomography, and left ventriculography revealed pseudoaneurysm formation at antero-lateral wall of left ventricle. Because the patient was asymptomatic, he was discharged from our hospital without reoperation. However we are closely following him in the outpatient clinic.

A 52-year-old man with a 10-year history of severe diabetes was referred to our hospital with hemorrhage from a methicillin-resistant Staphylococcus aureus-infected femoral artery following the use of an arterial closure device (Prostar XL: Perclosure, Co., Ltd., Redwood, CA, USA). At surgery, the common femoral artery showed a circular area of disintegration, 9mm in diameter, due to massive infection. One month after femoral angioplasty with a saphenous vein patch, re-hemorrhage occurred as a result of uncontrollable infection. Next, an obturator foramen (OF) bypass was performed and the infected femoral artery was removed. Two months after OF bypass, the wound healed and the patient was well. We conclude that OF bypass is a satisfactory method of treatment for compromised patients with an infected femoral artery.

We report a 57-year-old male who suffered from ascending aortic aneurysmal dilatation complicated with acute localized dissection. He had received aortic valve replacement with a prosthesis for severe aortic regurgitation resulting from valve degeneration and annular dilatation 4 years previously at which time the maximal ascending aortic diameter had been 45mm so that a procedure for the aorta itself was not done. On the present occasion an aortogram showed a maximal aortic diameter of 90mm and localized dissection from above the right coronary ostium to near the connection to the brachiocephalic artery. A successful composite valve-graft replacement of the ascending aorta (Bentall procedure with Piehler's modification) was carried out on a semi-emergency basis. This experience with this case implies that certain intervention for associated moderate aortic dilatation should be considered when an aortic valve replacement is performed.