A 90-year-old man was admitted to the emergency room with acute right back pain. Immediate computed tomography (CT) scan demonstrated a large retroperitoneal hematoma and the presence of a ruptured 7-cm in diameter right internal iliac artery aneurysm. The patient subsequently developed rapid onset of hemorrhagic shock, which prompted an emergency operation. He made an uneventful recovery and was discharged on the 27th day after surgery without any problems. Isolated internal iliac artery aneurysms are rare but are dangerous and are associated with a high incidence of rupture and operative mortality. Repair of the aneurysms can be challenging, particularly in the face of rupture.

A 43-year-old woman was admitted with heart murmur. Transthoracic echocardiography (TTE) and aortgraphy revealed severe aortic regurgitation and also transesophageal echocardiography (TEE) and multi-row detector computed tomography (MDCT) demonstrated quadricuspid aortic valve. Combined cardiac surgery such as aortic valve replacement and replacement of the ascending aorta was successfully performed. Quadricuspid aortic valve is a rare anomaly. MDCT is a useful device for the morphological and functional evaluation of the aortic valve disease non-invasively.

Inflammatory aneurysms of the thoracic aorta are extremely uncommon. We present a 58 year-old man with an inflammatory aneurysm of the aortic arch. He was admitted because of chest pain. Coronary angiographies showed severe stenosis of the left anterior descending artery and computed tomography revealed an aneurysm of the distal aortic arch. We conducted combined graft replacement of the aortic arch and coronary artery bypass grafting. During the operation, the patient was noted to have extensive peri-aneurysmal fibrosis and inflammation with a thick aneurysmal wall. To avoid excessive hemorrhage, distal anastomosis was performed using the graft inclusion technique. He was discharged 35 days after operation without any major complication. Pathological evaluation of the aneurysmal wall revealed destruction of the mural structure and inflammatory cell infiltration in the adventitia.

Off-pump coronary artery bypass (OPCAB) has recently increased in popularity, but the longterm results are still unknown. We evaluated the mid-term results of OPCAB surgery using multi-slice computed tomography (MSCT), which is a non-invasive postoperative evaluation method. Thirty-one consecutive patients who underwent OPCAB surgery at least 2 years prior to the study were selected. The age was 50 to 79 years (66.9±6.5) and the ratio of men to women was 26: 5. Coronary angiography was performed in all patients at 2 weeks postoperatively. The follow-up was complete, and mean follow-up was 30.9 months. There were no hospital deaths and 1 non-cardiac late death. The graft patency rate in coronary angiography was left internal thoracic artery (LITA) 30/30 (100%), right internal thoracic artery (RITA) 2/2 (100%), radial artery (RA) 14/15 (93%), saphenous vein graft (SVG) 15/17 (88%). No graft became occluded on MSCT study and all patients have been angina-free during the follow-up period. We suggest that OPCAB is feasible in most patients with good patency and low mortality. MSCT is an effective follow up method for the morphological findings and noninvasive quantitative evaluation of the bypass grafts.