A 67-year-old man suffered sudden chest pain. Computed tomography with contrast medium revealed dissection from the ascending aorta to the bilateral iliac arteries and hematoma around the left external iliac artery. Type A acute aortic dissection complicated with rupture of the left external iliac artery was diagnosed. Urgent endovascular repair (stent-graft implantation) was first performed for the arterial rupture more critical than the aortic dissection. On the next day after satisfactory hemostasis and hemodynamical stabilization, semi-urgent ascending aortic replacement was achieved, and the patient survived. Acute aortic dissection complicated with rupture of the aortic branch was extremely rare, and only 5 cases have been reported in the English literature.

We report a 49-year-old man with retrograde type A acute aortic dissection with patent false lumen in the ascending aorta. The patient successfully underwent urgent thoracic endovascular repair (TEVAR) to cover the primary entry on the onset (admission) day. The false lumen from the ascending aorta to the proximal descending thoracic aorta was completely thrombosed, gradually shrank, and finally disappeared. In conclusion, TEVAR for retrograde type A acute aortic dissection with a patent ascending false lumen is far less invasive than aortic replacement (with cardiopulmonary bypass, cardiac arrest, and circulatory arrest) and may be useful in selected patients with a primary entry located at least approximately 2 cm distal to the origin of the left subclavian artery.

Primary cardiac synovial sarcoma is extremely rare, and approximately100 cases had been reported according to a literature review in 2019. We herein reported a case of primary pericardial synovial sarcoma originating from the epicardium with cardiac tamponade. Pericardiocentesis, subsequent complete tumorectomy under cardiopulmonary bypass and cardiac arrest, and adjuvant chemoradiotherapy was performed, and the patient survived for 3 years with neither recurrence nor metastasis.

A 63-year-old female suddenly suffered right hemiplegia. Multiple cerebral infarctions in the nucleus basalis and the frontal and temporal lobes perfused by the left middle cerebral artery were diagnosed. A left atrial myxoma probably causing the cerebral infarctions was identified. The patient underwent anticoagulation therapy with heparin to prevent recurrent cerebral infarctions while waiting for surgical resection of the myxoma. Motor aphasia, however, occurred on the 8th day after the onset of the cerebral infarctions. Extensive hemorrhagic cerebral infarctions involving the left temporal and frontal lobes with a midline shift occurred, and accordingly the anticoagulation therapy was discontinued. After a 6-week interval from the hemorrhagic cerebral infarctions, the left atrial myxoma was successfully resected, and the patient was discharged from the hospital without any new neurological complications. Even if left atrial myxoma complicates extensive hemorrhagic cerebral infarctions, surgical resection may be safely performed allowing a sufficient interval. Anticoagulation therapy to prevent recurrent cerebral infarctions while waiting for surgery after cerebral infarctions should be avoided because of the risk of hemorrhagic cerebral infarctions, and early surgery should be considered.

We report a case of semi-urgent infected endograft explanation following thoracic endovascular aortic repair (TEVAR) for distal anastomotic (DA) infectious pseudoaneurysm after total arch replacement (TAR). A 70-year-old male underwent TAR for distal arch saccular aneurysm 10 years before and open bifurcated graft replacement for an abdominal aortic aneurysm 5 years before. The patient was admitted 3 years before because of repeated pyrexia of 40°C. Contrast-enhanced CT scans revealed suspected vegetation and infectious pseudoaneurysm at the DA of the TAR, and semi-urgent TEVAR was performed on the next day. Antibiotic therapy was initiated for Staphylococcus capitis detected in a blood culture, and the patient was discharged after a negative blood culture. At this time, he was admitted owing to face and below-knee edema and dyspnea. Because a blood culture identified Methicillin-resistant Staphylococcus capitis and antibiotic therapy uncontrolled infection, we performed explanation of the infected endograft and distal end of the TAR graft and replacement of the descending thoracic aorta with a rifampicin-bonded graft under moderate hypothermic circulatory arrest with retrograde cerebral perfusion via the 4th intercostal posterolateral thoracotomy. Postoperative 6-week antibiotic therapy was continued and the patient was discharged in good condition after a negative blood culture on postoperative day 46.