Although several methods of stent grafting for patients with distal aortic arch aneurysm have been reported, these methods had several complications such as endoleak, migration, or cerebrovascular accident. We developed a new stent grafting method using the MK stent-graft (Matsui-Kitamura stent-graft, Kitamura Inc., Kanazawa, Japan) following bypass grafting of arch vessels under left heart bypass. We performed this method for 3 patients associated with severe pulmonary dysfunction or renal dysfunction. There were no postoperative complications, endoleak or migration. All 3 patients were discharged in good condition. It is concluded that this method might be useful method for patients with distal aortic arch aneurysm complicated by severe organ dysfunction, or in elderly patients.

A 70-year-old female with a pulmonary embolism was admitted to a local hospital. On admission, transthoracic echocardiography detected a mobile cardiac tumor on the aortic valve. After medical treatment for a pulmonary embolism, she was slated for a resection of the tumor in our hospital. Although preoperative examinations showed an isolated tumor attached to the non-coronary cusp without valve dysfunction, meticulous intraoperative inspection revealed multiple fine villous tumors located in the left coronary cusp of the aortic valve. Being immersed in saline solution, these tumors had resembled a distinctive sea anemone-like appearance. These fine tumors could not be detected with intraoperative transesophageal echocardiography even in a retrospective manner. We eventually performed aortic valve replacement. The tumors of the two cusps were pathologically diagnosed as papillary fibroelastoma. Of note, a macroscopically undetected tumor was identified in the right coronary cusp by histopathological evaluation. Careful intraoperative observation is essential for surgical decision and patient’s prognosis. It is also considered that latent tumor might be concealed even in seemingly normal adjacent cusps in a case with multiple papillary fibroelastomas.