An 87-year-old woman underwent AVR (CEP 21 mm) for aortic stenosis at age 73 years. Fourteen years later, she was treated with antibiotics for mediastinal abscess, which showed a tendency to shrink and inflammation improved. At that time, no vegetation or aortic regurgitation was observed. Eight months later, the patient was brought to the emergency room with a complaint of respiratory distress. After close examination, a severe transvalvular leakage was found at the aortic valve position. No vegetation was found. Enhanced chest computed tomography (CT) showed an aneurysm of the left sinus of Valsalva. The diagnosis of healed aortic prosthetic valve endocarditis with an aneurysm of the sinus of Valsalva was made. The CEP valve was removed at surgery, and the valve leaflet corresponding to the right coronary cusp was destroyed. The left sinus of Valsalva was dilated and a Perceval was implanted. The patient was doing well postoperatively, but a pacemaker was implanted due to atrioventricular dissection. Transthoracic echocardiography confirmed that there was no problem with prosthetic valve function at the aortic valve position, and CT showed a reduction of aneurysm of the left sinus of Valsalva. The patient was discharged from the hospital on the 30th postoperative day. Aortic valve replacement with Perceval is effective in high-risk cases of prosthetic valve endocarditis.

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.