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.

Infectious endocarditis (IE) concomitant with patent ductus arteriosus (PDA) is now considered rare because the early treatment of PDA in infancy has become standard. We report a case of PDA with IE diagnosed by computed tomography (CT). A 51-year-old man complained of arthralgia and numbness of the left extremities. He had fever of 39°C and left hemiplegia, and was referred to our hospital. A chest X-ray film showed infiltration in both lungs. CT revealed a mass lesion in the main pulmonary artery and a tubular connection between the main pulmonary artery and the aortic arch. Multiple small infarctions were also found in the brain, lungs, kidneys and spleen. Ultrasonic cardiography revealed a bi-leaflet aortic valve, and vegetations on the aortic and mitral valves. Staphylococcus aureus was detected by culture of an intravenous catheter tip. These findings suggested IE concomitant with PDA, and we started intravenous administration of antibiotics. However, congestive heart failure occurred due to severe aortic and mitral regurgitation 2 days after hospital admission, and therefore, we performed emergency surgery. The main pulmonary artery was incised after cardiopulmonary bypass was initiated. A 20-mm length of vegetation was found on the orifice of the PDA. The vegetation was removed and the PDA directly closed. Aortic and mitral valve replacement was then performed. The post-operative course was uneventful and his neurological symptoms did not exacerbate. No sign of IE recurrence was observed 2 years after the surgery. CT clearly showed PDA and vegetation in the main pulmonary artery, although ultrasonic cardiography did not. CT was useful to make a diagnosis of PDA with IE in the present case.

A 62-year-old man with Marfan syndrome had a modified Bentall procedure and total arch replacement for annuloaortic ectasia, aortic insufficiency and thoracic aortic aneurysm fifteen years ago at another hospital. A follow-up CT revealed bilateral coronary artery aneurysms and an aortic root pseudoaneurysm, and thus he was referred to our hospital. The previous prosthetic valve was removed, followed by the re-Bentall procedure. Coronary artery aneurysms were resected and consequently coronary arteries were reconstructed directly. Although the shortcoming of the Bentall procedure was pseudoaneurysm, the outcomes of the modified Bentall procedure have shown some improvements. However, as there is still a high risk of postoperative complication in connective tissue diseases, long-term follow-up is required.

We report the successful treatment of a rare case of chronic expanding hematoma and visceral pericardium thickening constrictive pericarditis with no history of trauma or surgery. A 70-year-old woman, who had no history of trauma or surgery was admitted for exertional dyspnea. An echocardiographic study demonstrated a mass located anterior to the right ventricle that severely compressed the right ventricle toward the ventricular septum. Enhanced chest computed tomography demonstrated pericardial calcification and a 125-mm heterogeneous mass in the middle mediastinum. A mosaic pattern was seen on T1, T2-weighted magnetic resonance imaging. Surgical resection of the mass and removal of the visceral pericardium were planned to treat heart failure and to confirm the diagnosis of the mass. The mass was old degenerated coagula. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The postoperative course was uneventful. There has been no sign of recurrence 19 months after the operation.

Right pulmonary artery-left atrial communication is a rare congenital heart disease that is usually diagnosed before adulthood, and its main symptoms are cyanosis and dyspnea on exertion. We report a 51-year-old man with a large aneurysm of the right pulmonary artery and left atrial communication, which was diagnosed after a brain abscess. We are concerned that simple ligation alone may cause embolism, so we report on the use of an autologous pericardial patch to close the opening to the left atrium.