Total correction for a chronic aortic dissection, producing progressive enlargement of the false lumen of the aorta involving wide range of aorta and aortic manifestation of Marfan's syndrome is a very difficult procedure. However, with the recent development in surgical techniques and management, it became possible to replace total or subtotal aorta with the prosthetic graft. Recently, we treated a 24 y/o male patient with annuloaortic ectasia, DeBakey type II+IIIb aortic dissection, and obstruction of right common iliac artery, associated with Marfan's syndrome with a two-staged operation. For the first stage, we performed Cabrol's procedure on his lesions in ascending aorta. About 2 years after that, for the second stage, replacement of total descending and abdominal aorta was pertformed.

Those cases in which a dissected lumen closes early in the onset of acute aortic dissection and produce a“dissected lumen with no blood flow”are regarded as a clinico-pathological entity and are called a“closing aortic dissection”, and the clinical picture and clinical course of 14 cases in which the clinical course could be observed from early onset were reported. Although 13 cases resulted in complete closure of the dissected lumen, one case initially showed incomplete closure, but subsequently closed completely. Two cases resulted in reopening of the blood flow, but the disease recurred, and by four and six weeks each had incompletely or completely reclosed. Consequently, there were three cases of entry observed and scars of entry were found in three other cases. And in eight cases, there was nothing observed at all. Although one patient died because of complications of secondary type I acute dissection, all the others survived. All told, the developmental mechanism of this disease was alluded to.

A case of tricuspid regurgitation due to nonpenetrating chest trauma was presented. A 58-year-old man who had an episcde of a traffic accident 18 years ago was admitted because of the edema of the lower extremities and easy fatigability. On physical examination, engorgement of the jugular vein, enlagement of the liver and the slight edema of the lower extremities were observed. Systolic regurgitant murmur with Rivero-Carvallo sign was audible. Chest X-ray film revealed marked cardiomegaly and electrocardiogram presented atial fibrillation and complete right bundle branch block. Two-dimentional echocardiography revealed marked dilatation of the right atrium and ventricle, and systolic exertion of anterior and posterior leaflets of tricuspid valve. On cardiac catheterization, right atrial v wave was 23mm Hg. At operation, the pericardium was adheded to the epicardium, and the chorda tendae of the anterior and posterior leaflet were ruptured. Tricuspid valve replacement with 33mm Carpentier-Edwards pericardial prosthetic valve was performed without any complications. To the best of our knowledge, this is the 19th operated case of traumatic tricuspid regurgitation in Japan.

Celiac artery aneurysm is very uncommon. We report an even more rare case in which a life threatening ruptured aneurysm was treated successfully by an emergency interventional procedure. A 72-year-old man was transferred to our hospital with a chief complaint of severe epigastralgia. In the emergency room, the patient was already in shock and emergency CT scan suggested severe intraperitoneal bleeding. The diagnosis of ruptured celiac artery aneurysm was confirmed by subsequent angiographic examinations and immediate hemostasis was successfully achieved by transcatheter arterial embolization. One year after the embolization, the patient remains asymptomatic and follow-up CT scans revealed reduction in size and thrombotic occlusion of the aneurysm.

Case reports of traumatic aortic regurgitation are rare. We report a case of a 62-year-old man injured by falling from a paraglider. After recovering from multiple injuries and discharge, he began to suffer from dyspnea. Severe aortic regurgitation and pseudoaneurysm of the sinus of Valsalva were diagnosed by ultrasound cardio graphy (UCG) and multi-detector-row computer tomography (MDCT). After cardiac failure was controlled, we operated. The commissure between the left and the right coronary cusps was detached from the aortic wall, and a modified Bentall operation was performed. The patient recovered well and was discharged uneventfully.

From the surgical stand point of view we have classified 129 patients with aortic dissections, of which anatomic variations were clearly identified. In addition to the DeBakey's nomenclature, we newly employed two groups, aortic arch type and abdominal aortic type. Futhermore, each type was divided into subgroups. This report provides practical and suitable operative approaches according to anatomic variations of the aortic dissecting aneurysms. 1. Twenty-one patients had type I dissections. Thirteen of 21 (62%) were combined with aortic valve regurgitations. 2. Ten patients had type II dissections. Eight of 10 (80%) showed aortic valve regurgitation. This type was further divided into three subgroups. 3. Eighty patients had type III dissections, consisting of 18 type III a and 62 type III b dissections. The type III a dissection included all the cases in which dissections did not involve major branches of the abdominal aorta. Retrograde dissections to the proximal ascending aorta were found in eight patients out of 80 (10%). 4. Twelve patients had aortic arch type dissections. This group was divided into two subgroups, according to the extent of the aortic dissection. 5. Six patients had abdominal aortic type dissections. This group was also subdivided into two. 6. On the basis of the types of dissections outlined above, the most suitable radical operative procedure was selectively proposed in each case.

The patient is a 47-year-old male who presented with abnormal shadows in his chest X-ray. On the third intercostal space, diastolic regurgitant murmur and systolic ejection murmur were heard. X-ray of the chest showed a projection of the right second costal arch in addition to the right atrium shadow. Cardiac catheterization showed no abnormalities except for a rise in the left ventricular end diastolic pressure which was 18mmHg. The patient was found to have Grade II aortic regurgitation. All there findings diagnosis of the case as extra-cardiac right Valsalva sinus aneurysm with aortic regurgitation. Incision of the aneurysm, showed a Valsalva sinus aneurysm having an opening of approximately 3cm just above the right aortic valve ring with the orifice of the right coronary artery occluded. Complete patch closure was performed with elevation of the aortic valve ring. No reconstruction for the right coronary artery was made.