A 72-year-old woman had undergone a right upper lobectomy and thoracoplasty in 1954 and an aortic valve replacement in December 2001. She suffered from dysphagia in June 2002. X-ray film and CT-scan revealed a sternal partial nonunion. The treatment was resection of the clavicle, because of the adhesion behind the sternum and the sternal partial nonunion. The postoperative course was uneventful and she was discharged. However, she was transferred to our hospital because of hematoma and bleeding at the right clavicle 1 month after the operation. Emergency operation was performed because of injury of the ramus of artery subscapularis. We ligated the ruptured portion and additionally resected the clavicle. Her postoperative course was good. Resection of the clavicle is one choice for sternal partial nonunion after open heart surgery. However, when we resect the clavicle, we should consider preservation of the ligament, reconstruction of the ligament, and the clavicular excision range.

A 69-year-old man with type II right-sided aortic arch (RAA) underwent an off-pump coronary artery bypass grafting (OPCAB) in December, 2017. He underwent an abdominal aortic aneurysm resection and graft replacement in April, 2018. The postoperative computed tomography (CT) that was performed in May 2018 revealed aortic dissection from the ascending aorta to the aortic arch, although he was asymptomatic. We evaluated the native coronary artery and patent bypass grafts by coronary CT. Graft replacement of the ascending aorta and partial aortic arch was carried out on an elective basis and the proximal anastomotic site of the vein grafts was attached to the prosthetic graft. Stanford type A aortic dissection (AAD) after previous coronary artery bypass grafting differs from spontaneous AAD in presentation, management and outcome. We report here a successful surgical case with RAA and AAD after OPCAB.