A false aneurysm in a coronary anastomotic region is known to be an important complication after a modified Bentall procedure. We report a successful case of a 40-year-old woman in whom we performed repair of a false aneurysm in the left main trunk (LMT), using transection of the main pulmonary artery. The modified Bentall procedure and coronary artery bypass grafting (CABG) on the right coronary artery had been performed 6 years earlier, with diagnoses of Marfan syndrome, annuloaortic ectasia, aortic regurgitation, aortic dissection (DeBakey type II), and right ventricular infarction. The patient was admitted with a syncopal attack, and we diagnosed a false aneurysm in the anastomotic region of the left coronary artery. Repair of the LMT and CABG on the left anterior descending coronary artery with the left internal thoracic artery (LITA-RAD) was performed. For repair of the LMT, we used a surgical approach using transection of the main pulmonary artery to create a favorable surgical field.

We describe a case where a thrombus was effectively removed with a 20 Fr argyle^® thoracic catheter (Nippon Sherwood Medical Industries Ltd.) and the life of the patient was saved by thrombectory for an acute pulmonary thromboembolism. The patient was a 43-year-old woman. Emergency operation was indicated by a severe acute pulmonary thromboembolism and intracardiac floating thrombi afte an orthopedic surgery. A 20 Fr thoracic catheter connected to a cleaning type intraoperative blood salvage device was used to remove thrombi in a pulmonary artery and a good result was obtained. The advantages of this catheter include: 1) suitable hardness; 2) a protective round tip; 3) an aperture at the tip for the suction of small or crushabe thrombi and the removal of thrombi having a certain level of hardness with the shape intact; and 4) adjustable flexion of the catheter to easily detect a peripheral pulmonary artery. However, care should be taken when using the catheter to avoid damage to pulmonary artery walls.

Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.

A 44-year-old man was given a diagnosis of severe ischemic heart disease and Leriche's syndrome. He had critical ischemia in the lower extremities and ischemic gangrene in a toe of the left foot. We planned a one-stage operation for these fatal diseases. To prevent irreversible ischemia of the lower limbs after mobilization of internal thoracic arteries or during extracorporeal circulation, we performed aorto-ilio femoral bypass grafting with extra-peritoneal approach first. Then conventional coronary artery bypass grafting was carried out for three coronary arteries with bilateral internal thoracic arteries (ITAs) and the saphenous vein. The postoperative course was uneventful.

We report a case of successful one-stage resection of intravenous leiomyomatosis (IVL) with extension into the main pulmonary artery. The patient was a 50-year-old woman, who was admitted to our hospital with clinical signs of syncope. Computed tomography (CT) and 3 D helical CT images showed a tumor arising in the left side of the uterus with extension into the pulmonary outflow tract. One-stage radical operation with cardiopulmonary bypass was performed. Because IVL is related to many fields concerning various organs, it is important that general surgeons, gynecologists and cardiovascular surgeons cooperate with each other.