We report a rare case of combined valvular disease concomitant with the communication between the coronary and bronchial arteries. A 76-year-old woman was given a diagnosis of chronic heart failure 8 years previously and received medical therapy but recently she had dyspnea. Ultrasound cardiography revealed aortic regurgitation and mitral regurgitation. Cardiac catheterization confirmed the combined valvular disease and also revealed an aberrant coronary artery. Cardiac computed tomography showed coronary to bronchial artery communication, which caused myocardial ischemia. We performed aortic valve replacement with a bioprosthesis, mitral valve repair, and ligation and division of the aberrant coronary artery. Apart from some postoperative bronchial bleeding that ceased spontaneously the postoperative course was uneventful.

A minimally invasive approach to coronary artery revascularization without cardiopulmonary bypass has been performed recently and its feasibility and effectiveness have been proved. However, occlusion of the coronary artery during anastomosis in the beating heart is liable to cause myocardial ischemia or infarction. To prevent these and to perform minimally invasive coronary artery bypass on the beating heart safely, intra-coronary shunt was developed and applied in animal experiments. Materials and methods: The left internal mammary artery was harvested endoscopically and anastomosed to the left anterior descending coronary artery in the beating heart without cardiopulmonary bypass in seven pigs. Three of them utilized intracoronary shunt tubes (group S) and the other did not (group C). Results: Use of an intracoronary shunt tube facilitated non-blood exposure of the coronary artery during anastomosis. In group C, three pigs out of four had ventricular fibrillation during occlusion for the anastomosis. In group S the anastomosis was accomplished without change of ECG except one case and without any elevation of CPK-MB and Troponin T during and after the anastomosis. Conclusion: These results showed that an intra-coronary shunt can prevent myocardial ischemia and may be very useful especially to those who do not develop collateral branches from other coronary arteries.

A 43-year-old man visited another hospital because of dry cough and dyspnea in a supine position after having experienced chest pain about 1 month prior to his visit. He had undergone open aortic commissurotomy and ligation of the ductus arteriosus due to congenital bicuspid valve aortic stenosis and patent ductus arteriosus at age 13. CT scan showed a dissected giant aortic aneurysm (12.0cm in diameter) of the DeBakey Type II which compressed surrounding organs, such as his trachea, bilateral main bronchus, superior vena cava, and right main pulmonary artery. Echocardiograms revealed severe aortic stenosis and a dissecting ascending aortic aneurysm. The patient was admitted to our hospital and an urgent operation was performed. Under cardiopulmonary bypass with selective cerebral perfusion, a replacement of the aortic root and the ascending-arch aorta with the inclusion technique was performed. Postoperatively, the patient suffered from ventilatory disturbance under mechanical ventilation. CT scan showed a giant aneurysmal sac containing a hematoma in the perigraft space and the false lumen of the aneurysmal wall and remaining tracheobronchial compression. A reoperation was performed for removal of the hematoma and placation of the aneurysmal sac. The subsequent postoperative course was good. The patient was weaned from mechanical ventilation at 12 days and discharged at 67 days after the initial operation. Histologically, the resected aortic wall showed cystic medial necrosis.

A 56-year-old man had aneurysms of the right subclavian artery and cerebral artery in association with congenital absence of the right internal carotid artery. The aneurysm of the subclavian artery was successfully surgically repaired through a partial sternotomy. Congenital absence of the internal carotid artery is rare vascular anomaly. This anomaly contributes to the occurrence of intracranial aneurysms. However, aneurysm of subclavian artery associated with congenital absence of the internal artery is very rare. This is the 3rd case reported in the literature.

A 76-year-old man presented with right leg numbness and general fatigue. The patient had no respiratory symptoms and negative PCR of COVID-19, but the lungs on CT scan revealed highly suspected COVID-19. The CT scan also showed occlusion from the right external iliac artery through below-knee arteries. Our surgical staff had personal protective equipment with powered air-purifying respirators and performed emergent surgical thrombectomy with the Fogarty balloon catheter. A few days after the operation, we found that the patient's antibody for COVID-19 was positive. The patient received anticoagulation and the postoperative course was uneventful. It is desirable to have more novel and precise knowledge of thrombosis in patients with COVID-19.

Though preoperative autologous donation is not acceptable for all cases partly because some are preoperatively in a severe condition, intraoperative predonation is possible in almost all cases. We retrospectively evaluated the major factors related to the prevention of homologous blood transfusion by intraoperative predonation in 25 cases following valvular surgery without preoperative autologous donation. Homologous blood was not transfused in 18 cases {Group-(-)} but in 7 cases only after CPB {Group-(+)}. The male/female ratio, type of operation, body weight, CPB dilution, CPB duration, and perioperative change in hematocrit were comparable in the 2 groups. However, the autologous blood pooled before CPB in Group-(-) was significantly more than in Group-(+) (11.3±2.5 vs 7.3±1.8ml/kg, p<0.001). In conclusion, homologous blood transfusion may be prevented by appropriate intraoperative predonation during surgery for valvular disease.