A 69-year-old man was admitted to our hospital due to cardiomegaly on plain chest radiography. He did not have any history of chest pain, trauma or fever of unknown origin. Echocardiography showed severe aortic valve regurgitation. Standard enhanced computed tomography (CT) showed a localized dissection or an aneurysm of the noncoronary sinus of Valsalva. However it is difficult to make a definite diagnosis because of cardiac beating artifact. Cardiac multidetecter-row CT demonstrated an aneurysm of the noncoronary sinus of Valsalva connected to the sinus with a small aperture. Aortic valve replacement and patch closure were performed. The postoperative course was uneventful and follow-up CT showed thrombus formation in the sinus Valsalva aneurysm. Cardiac multidetecter-row CT was useful for accurate diagnosis of aortic root disease.

Four-channel aortic dissection is quite rare, and is a highly life-threatening situation predisposing to aortic rupture. We report the case of a 70-year-old woman with non-Marfan syndrome. She was evaluated at our hospital for the diagnosis of another disease. She had no symptoms. Enhanced CT revealed an ascending aortic aneurysm, 68 mm in diameter with four-channel dissection. Because of the high risk of rupture, we performed ascending aortic replacement under deep hypothermia. The cardio-pulmonary bypass (CPB) was not discontinued due to right ventricle failure. Coronary arterial bypass grafting (CABG) to the right coronary artery using the great saphenous vein was added. Even after additional CABG, CPB was not discontinued. The surgery finished under percutaneous cardiopulmonary support (PCPS). PCPS was removed on the third postoperative day. Her postoperative course was uneventful, and she was discharged without any abnormal condition. Four-channel aortic dissection has a high risk of rupture, suggesting the need for early surgical treatment.

The patient was an 81-year-old woman who had undergone TAVI (Evolut PRO® 26 mm) for severe aortic stenosis at our hospital approximately 6 months previously. She was discharged from the hospital without any postoperative complications, but at 6 months after the surgery, fever, back pain, and high inflammatory findings were observed. Based on lumbar spine MRI findings, the patient was diagnosed with pyogenic spondylitis and epidural abscess, and drainage surgery was performed. Enterococcus faecalis was identified from a blood culture. MRI of the head showed scattered subacute infarcts in the right frontal lobe, and transthoracic echocardiography revealed hyperintense deposits at the aortic valve leaflet, suggesting vegetation. The diagnosis of PVE was made and medical therapy was initiated. However, the vegetation gradually increased in size and mobility, and a surgical approach was indicated. A surgical procedure was performed through a median sternotomy to remove the prosthetic valve and replace the aortic valve. The postoperative course was good, with no recurrence of infection, and the patient was transferred to another hospital for rehabilitation on the 26th postoperative day. In general, TAVI patients are older and have more comorbidities, and surgery is associated with a higher degree of risk. However, radical surgery should be considered if medical therapy is not effective in PVE after TAVI. We reported a case of surgical aortic valve replacement for PVE after TAVI.