The case involved a 73-year-old woman who underwent surgical resection for right renal cell carcinoma extending to the inferior vena cava. During surgery the tumor thrombus disappeared from the inferior vena cava. We performed transesophageal echocardiography and detected the tumor thrombus in the right ventricle. Therefore, we immediately tried to remove the thrombus using cardiopulmonary bypass. However, we could not find the tumor thrombus in the right ventricle or in the main pulmonary artery. We used angioscopy of the pulmonary artery and detected the tumor thrombus at the orifice of the inferior pulmonary artery. The tumor thrombus was removed under direct visualization. In the event of an intraoperative pulmonary embolism, simple and safe techniques for exact and rapid diagnosis are needed. Intraoperative angioscopy allows direct visualization of the pulmonary arterial branches and appears to be very useful for detection of tumor thrombi even in emergency cases.

Since arteriosclerosis is a general progressive disease, an aneurysm of the thoracic aorta is not infrequently complicated by ischemic heart disease. Therefore, assessment of indications of surgical treatment and selection of the surgical procedure and auxiliary procedures on the basis of accurate preoperative evaluation of ischemic heart disease are considered to be very important for improving the results of operations for thoracic aortic aneurysm. Recently. we successfully operated on a 64-year-old patient with a left ventricular aneurysm and a descending aortic aneurysm. One-stage operation was performed by a left thoracotomy approach and partial left heart bypass by draining the pulmonary artery into the femoral artery with mild hypothermia. The approach and the auxiliary procedures employed in this patient are considered to be a useful combination applicable also to one-stage operation for descending aortic aneurysm and coronary artery bypass grafting.

A 73-year-old woman was diagnosed with coronary artery aneurysms associated with coronary-pulmonary arterial fistula in a preoperative examination for transverse colon cancer. One of the aneurysms (28 mm) originated from a branch of the right coronary artery and the other two (16 and 12 mm) originated from a branch of the left coronary artery. We performed surgery to prevent their rupture because the right coronary artery aneurysm showed a tendency to enlarge. Surgery was performed through a median sternotomy under cardiopulmonary bypass. Suture closure of the inflow and outflow of the aneurysm was performed. The coronary-pulmonary arterial fistula was ligated. In addition, suture closure of the outflow of the coronary-pulmonary artery fistula into the pulmonary artery was performed, under direct view after incision of the pulmonary trunk. No residual shunt blood flow in the coronary-pulmonary arterial fistula was observed on postoperative echocardiography. Furthermore, no coronary aneurysm and coronary-pulmonary arterial fistula was recognized on postoperative coronary computed tomography. The patient made an uneventful recovery and was discharged from the hospital on postoperative day 12.