Recent studies have reported parasympathetic ganglia supplying the regions around the sinoatrial node (SAN) are situated in the pulmonary vein fat pad (PVFP). Otherwise, in coronary artery bypass grafting (CABG) without cardiopulmonary bypass, cardiac surgeons expect effective support technique on heart rate. The purpose of this study was to determine the feasibility of inducing sinus bradycardia by stimulating these parasympathetic nerve fibers to the SAN in humans. Nine patients were anesthetized and median sternotomy was performed. Bipolar electrodes were sewn onto PVFP to stimulate parasympathetic nerve fibers to the SAN. PVFP was electrically stimulated with a 4-9 V pulse of 0.1msec and a frequency of 5, 10, 20, or 50Hz. Sinus bradycardia was induced by selective stimulation of the parasympathetic nerve fibers to the sinoatrial node. The response was frequency-dependent up to 20Hz. Heart rate was significantly reduced from 90.1±12.4 to 71.4±15.7 (beats/min) at 20Hz. This technique could be applied for reducing heart beats in CABG without cardiopulmonary bypass. However, there are problems in maintaining of the effect.

A 74-year-old male who had a medical history of thoracic endovascular aortic repair (TEVAR) was referred to us for endoleakage. A total of 21 years ago, he underwent emergent descending aortic grafting for aortic aneurysm rupture at his age of 53. After that, 19 years ago, he underwent TEVAR with Matsui-Kitamura stent graft (MKSG) due to pseudoaneurysm formation at the proximal anastomotic site at the age of 55. CT revealed type III endoleakage due to fracture of MKSG and graft. We proceeded to perform TEVAR with Relay Plus successfully, and his endoleakage disappeared. His postoperative course was uneventful. He was discharged from our hospital on the 9th day after the operation, and is now doing well.

This study reports a 38-year-old man who suffered traumatic thoracic aorta injury due to a fall accident during mountain climbing, and was saved by swift helicopter transport and emergency surgery. Approximately 2 h after the accident, the subject was brought to the hospital by the emergency helicopter transport service. Contrast-enhanced CT of the thorax and abdomen revealed leakage of the contrast medium from the aortic isthmus and a hematoma in the surrounding area. Thus, traumatic thoracic aorta injury was diagnosed and emergency surgery was performed. The patient went into a state of shock after being given anesthesia. Further rupture was diagnosed and a left fourth intercostal thoracotomy was performed immediately in order to control the hemorrhage. Concurrently, a partial cardio-pulmonary bypass was used. A lacerated foramen was observed across 1/3 of the lesser curvature of the aortic isthmus ; the affected site was replaced by a prosthetic graft. The postoperative recovery was generally uneventful, and the patient was discharged from the hospital 30 days after the operation.

Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.

A 70-year-old woman diagnosed with angina pectoris was scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) using the left internal thoracic artery and the saphenous vein (SVG). We performed a proximal anastomosis of the SVG to the ascending aorta using a clampless proximal anastomotic device. When this device was removed from the ascending aorta after completion of the SVG proximal anastomosis, we noticed the extensive appearance of an ascending aortic adventitial hematoma. Transesophageal echocardiography revealed a flap in the ascending aorta, which was diagnosed as an iatrogenic aortic dissection. The decision was made to immediately perform an additional aortic replacement. There was an intimal tear consistent with the device insertion site, which was identified as the site for the development of aortic dissection. After performing an ascending aortic replacement, coronary artery bypass grafting was performed. Her postoperative course was uneventful, and enhanced CT on postoperative day 12 showed aortic dissection up to the level of the abdominal aorta, but the false lumen was completely thrombosed. Iatrogenic aortic dissection caused by proximal anastomotic device during OPCAB is a very rare but serious complication, and early intraoperative diagnosis and prompt additional surgical treatment were considered necessary to save the patient's life.

A 66-year-old woman attended our hospital for ascending aortic aneurysm. She was admitted with sudden back pain and acute aortic dissection of Stanford type B was revealed by computed tomography. We performed replacement of the ascending aorta and aortic arch with the frozen elephant trunk technique. The left pleural drainage fluid turned cloudy white after diet initiation on postoperative day 2. We diagnosed chylothorax with biochemical analysis and stopped oral intake completely, but the drainage increased to 3,700 ml/day. On postoperative day 8, completely thoracoscopic ligation of thoracic duct was performed. The drainage decreased immediately after the procedure. She could start meals on postoperative day 12 and was discharged on postoperative day 22. We conclude that a completely thoracoscopic ligation of thoracic duct for persistent chylothorax after aortic surgery can lead to early resolution.