An 84-year-old man visited a local doctor, complaining of general fatigue for the last 2 months and dyspnea at rest since the last few days. His echocardiogram revealed a defect hole measuring 1.5 cm at the base of the ventricular septum and left-to-right shunt blood flow. The diagnosis of ventricular septal perforation due to subacute myocardial infarction was confirmed, and an emergency surgery was performed. A right atrial oblique incision revealed a perforation just below the tricuspid valve septal apex. The perforation site was closed using the sandwich patch technique with two bovine pericardial membrane patches. The patient was transferred to the hospital for rehabilitation on day 18 postoperatively.

Case 1: Sixty-seven-year-old male. Presented with exertional dyspnea, raising suspicion for constrictive pericarditis. His condition rapidly progressed to a state of shock, necessitating emergency surgery under percutaneous cardiopulmonary support. Pericardiectomy using the waffle procedure was performed. However, there was limited improvement in hemodynamics, and he died on the 17th postoperative day. Postoperative pathological examination diagnosed epithelioid malignant pericardial mesothelioma. Case 2: Sixty-nine-year-old female. Presented with exertional dyspnea, raising suspicion for constrictive pericarditis. While being transported for surgical intervention, she went into shock, followed by cardiopulmonary resuscitation and initiation of percutaneous cardiopulmonary support. Waiting for the improvement of multiple organ failure, pericardiectomy using the waffle procedure was conducted. However, there was limited improvement in hemodynamics, and she died on the 2nd postoperative day. Postoperative pathological examination diagnosed sarcomatoid malignant pericardial mesothelioma.

An 82-year-old woman was transferred to our hospital due to an abrupt back pain. She exhibited a cardiac tamponade and her CT angiography revealed Stanford type-A acute aortic dissection without abdominal extension. Emergent surgery for partial arch replacement was performed. After a few days of stable postoperative course, she suffered 38 degrees fever with an elevated inflammatory response and complained of a slight abdominal pain. Her CT scan revealed an intra-abdominal abscess with a small intestine necrosis. Emergent surgery for partial small intestine resection was performed. Her postoperative course was stable and she was discharged to a rehabilitation hospital 52 days after the first operation.

Non-occlusive mesenteric ischemia (NOMI) after cardiovascular surgery is a disease with a poor prognosis that is difficult to diagnose and treat. We report a case of NOMI diagnosed and treated immediately after open heart surgery. A 77-year-old man was admitted to our hospital due to heart failure. Echocardiography showed the diagnosis of severe aortic stenosis. He underwent surgery for the replacement of the aortic valve. After surgery, the hemodynamics became unstable and lactate continued to rise. Contrast abdominal computed tomography revealed a smaller SMV sign and ischemic area in the intestinal wall. We suspected NOMI, and continuous intravenous administration of prostaglandin was started. Angiography revealed scattered vascular stenosis in the superior and inferior mesenteric arteries, which led to the diagnosis of NOMI, and selective infusion of papaverine hydrochloride was started. Thereafter, hemodynamic improvement was observed and the patient was able to survive. To facilitate early diagnosis and treatment of NOMI, it is important to establish a protocol at the time of onset of illness to ensure smooth treatment.

A 50-year-old man was admitted to our hospital due to chest pain. He had a history of chronic pancreatitis associated with a pancreatic pseudocyst. Coronary angiography revealed stenotic lesions in left main trunk and right coronary artery coronary artery bypass grafting (RITA-LAD, LITA-OM, SVG-#4PD) were performed. The postoperative course was uneventful without any complications, and he was discharged on the 9th day after surgery. A week later, fatigue and dyspnea appeared. Echocardiography showed a large mount of pericardial fluid and echo-guided pericardiocentesis was performed. One week after the procedure the pericardial fluid reaccumulated. Pericardial drainage resulted in continuous drainage of pericardial fluid. A 7 French plastic stent was placed in the pancreatic pseudocyst, which decompressed the pancreatic pseudocyst, which led to the disappearance of pericardial effusion accumulation. The possible relation between a recurrent pericardial fluid accumulation and a pancreatic pseudocyst was suspected.