We report a case of angiosarcoma of the right atrium manifesting as cardiac tamponade. The patient was a 34-year-old woman. Echocardiography, CT scans, MRI and coronary angiography revealed a tumor arising in the right atrium. Radical excision of the tumor with cardiopulmonary bypass was performed. The resected tumor measured 5×6×3cm, and microscopic examination revealed angiosarcoma. Adjunctive radiation therapy was performed and she had high quality of her life for more than 2 years. However, she died of hemorrhage caused by liver metastasis of the tumor on the 29th postoperative month.

We report a case of pseudoaneurysm of the left internal iliac artery after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. A 75-year-old man was referred to us with lumbar pain and recurring fever. One year previously he was treated for bladder cancer with transurethral resection, followed by adjuvant intravesical BCG therapy lasting 11 months. Computed tomography scanning demonstrated a pseudoaneurysm and perianeurysmal inflammatory changes in the region of the left internal iliac artery. An emergency operation was performed under a diagnosis of impending rupture of the tuberculous left internal iliac arterial aneurysm. Because of the urinary tract stenosis, which was caused by the aneurysm, we inserted a ureteral stent preoperatively. We performed aneurysmectomy and femorofemoral cross over bypass. After 10 months of antituberculous chemotherapy, CT showed no recurrence of infectious aneurysm. Although intravesical BCG therapy is generally considered safe, serious complications including vascular complication have been reported. A mycotic origin should be considered when an aneurysm is discovered after BCG therapy. The prophylactic use of a ureteral stent in mycotic iliac arterial surgery may lead to minor complications.

We report a case of cholesterol crystal embolism (CCE) after endovascular aortic repair for abdominal aortic aneurysm (AAA). A 68-year-old man with AAA underwent endovascular aortic repair. He complained of left lower abdominal pain after the operation. Abdominal CT showed renal infarction on postoperative day 10. Renal dysfunction developed after postoperative day 17. A biopsy of the renal infarct lesion demonstrated characteristic cholesterol clefts in the small arteries. We diagnosed CCE. Steroid therapy was administered and the patient's condition improved remarkably. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.

Immunoglobulin G4 (IgG4)-related disease can occur in various organs, most of which comprise glandular or ductal tissue. We report a case of IgG4-related disease which occurred in a cardiovascular lesion. A 69-year-old man was found to have a tumorous lesion around the coronary artery. Open chest biopsy showed the diffuse lymphoplasmacytic infiltration, occasional eosinophils and numerous IgG4-positive plasma cells within the lesions. The serum concentration of IgG4 in the postoperative period was 1,080 mg/dl (reference range, <135). We diagnosed IgG4-related periarteritis manifesting as a tumor around the coronary artery. This case suggests that IgG4-related disease can occur around the coronary artery and manifest as a periarterial mass lesion.

A 49-year-old man who had no history of cardiac disease or intravenous drug abuse was referred to our hospital complaining of fever despite antibiotic chemotherapy. Blood culture was positive for Streptococcus agalactiae, and transesophageal echocardiography revealed vegetation attached to the tricuspid valve and moderate tricuspid regurgitation. Two-thirds of the anterior leaflet and a part of the posterior leaflet of the tricuspid valve were excised with the vegetation, and the remaining anterior leaflet was sutured to the posterior leaflet after annular plication. DeVega's annuloplasty was added to a diameter of two fingers. Following this procedure tricuspid regurgitation was minimal.

A 51-year-old man underwent arch replacement for a thoracic aortic succular aneurysm in December 1996. The pathological examination indicated aortitis to be the cause of the aneurysm. At that time we did not surgically treat the abdominal aortic aneurysm (AAA) which was only 32mm in diameter. Sixteen months after the first operation, he complained of a pulsatile tumor in his left leg. Angiography revealed an aneurysm of the left superficial femoral artery. The artery distal to the aneurysm was occluded, and the left popliteal artery received collateral blood flow from the deep femoral artery. The size of the AAA increased to 48mm, an indication of repair. Aneurysmectomy of the left superficial femoral artery and replacement of the abdominal aorta were performed simultaneously. The operative findings showed that the aneurysm of the left superficial femoral artery had been ruptured and formed a pseudoaneurysm. The pathological findings demonstrated both aneurysm aortitis. After the second operation, he was given steroid therapy to control the inflammatory reaction and he has been well for one year.