The patient was 70-year-old man. Distal aortic arch aneurysm of the maximum diameter of 55 mm was pointed out by Computed tomography. He underwent total arch replacement with median sternotomy. The next day, white cloudy fluid was flowing out from his left thoracic drain, and the amount increased and chylothorax was diagnosis. We selected conservative therspy with fasting and octoleotide subcutaneous injection. After 19 days chylothorax did not improve. We performed percutaneous thoracic duct embolization which is minimam invasive therapy. After embolization, he could start the meal, and the chest drain was extubated. He was discharged in good condition 49 days after first operation.

We encountered a case of aortic root replacement of a prosthesis-patient mismatch (PPM) after performing aortic valve replacement (AVR) with the Björk-Shiley Monostrut (BSM) valve. The patient was a 55-year-old female. She underwent AVR with a bioprosthesis for the treatment of congenital aortic stenosis at 20 years of age ; AVR was performed again using the BSM valve at 28 years of age. Congestive heart failure gradually worsened, and she was referred to our hospital at 55 years of age, where she was diagnosed with PPM after AVR. Under general anesthesia, standard median resternotomy was performed, and cardiopulmonary bypass was established with right femoral artery and right femoral vein cannulation. Cardiac arrest was achieved with the antegrade application of a cold, crystalloid, cardioplegic solution. The BSM valve was removed, and her annulus was extremely small, measuring less than 19 mm. We performed an aortic root replacement with a 21 mm mechanical valve composite graft because aortic root enlargement was difficult owing to the fragility of her annulus and very severe adhesion surrounding the ascending aorta. The postoperative course was uneventful. Postoperative ultrasonic echocardiography showed reduced transvalvular mean gradients. Although the BSM valve is durable, non-structural valvular deterioration surrounding the implanted BSM valve may occur and should be monitored.