Spinal cord ischemia after surgery of thoracoabdominal aortic aneurysm is still one of the serious complications encountered. We adopted a surgical technique with reconstruction of intercostal arteries together in 3 cases in order to prevent intraoperative spinal cord ischemia. The posterior wall of the aorta, including the intercostal arteries, was trimmed and seamed, then anastomosed to the branched graft to the stem graft under deep hypothermia. This technique is simply performed with a running suture and enabled reconstruction of the intercostal arteries together below the fourth intercostal artery. Postoperative complications due to spinal cord ischemia or aneurysmal change of the reconstructed aorta have not appeared in the 4 years since operation.

We report a 64-year-old woman with fungal prosthetic valve endocarditis. She underwent the aortic valve replacement (SJM 19 A^®) with annular enlargement using autologous pericardium. She had a persistent fever and congestive heart failure 8 months after surgery. Echocardiogram demonstrated vegetations of the aortic prosthetic valve, perivalvular leakage and third degree mitral valve regurgitation. Double valve replacement was performed concomitant with aortic annular enlargement using a xenograft. The aortic valve prosthesis was found to be detached from the aortic annulus on the side of the left coronary sinus and also from the implanted autologous pericardium. There were vegetations on the aortic prosthesis and the autologous pericardium. Histopathological findings led to the diagnosis of fungal endocarditis of the aortic prosthetic valve and antifungal therapy was started on the second postoperative day. She is in good condition 5 years later without any relapse of inflammation and has been receiving antifungal treatment. The surgical method of aortoatrioplasty with double valve replacement was effective for fungal prosthetic valve endocarditis after aortic valve replacement with annular enlargement.