The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known. We reported that SE mitral caged-disk valves implanted ＞20 years previously should be carefully followed up, and that SE caged-disk valves implanted ＞30 years previously should be electively replaced with modern prosthetic valves in our experience. We found the removed valve 39 years after implantation, which seemed minimal structural deterioration. The patient was discharged on the 10th postoperative day without any complications.

Anomalous aortic origin of a coronary artery is a rare congenital anomaly that can cause myocardial ischemia and ventricular arrhythmia. This disease initially manifests as cardiac arrest in half of patients. The indications and surgical strategy remain unclear, especially in patients who are asymptomatic and have poor ischemic findings. We report a surgical strategy to treat anomalous aortic origin of the right coronary artery. A 47-year-old man with a chief complaint of chest tightness was diagnosed with anomalous aortic origin of the right coronary artery, which branches from the left sinus of Valsalva and runs an inter-arterial course. Although no objective myocardial ischemia was identified with blood tests, electrocardiography, or cardiac catheterization, we suspected that the cause of the thoracic symptoms was sharp branching of the right coronary artery, which was compressed between the ascending aorta and the pulmonary artery. To reduce the risk of sudden death in the future, we performed reimplantation of the right coronary artery. Good imaging results were obtained, and the patient is currently undergoing outpatient follow up and has not experienced recurrence of chest symptoms. We conclude that our surgical strategy to treat anomalous aortic origin of a coronary artery may be useful in the clinic.

A 46 year-old man underwent double valve replacement for valve insufficiency due to infective endocarditis. Upon withdrawal from extracorporeal circulation and administration of 8 units of fresh frozen plasma, a large amount of yellow serous secretion was aspirated from the trachea, and rapid and exacerbated oxygenation was observed. We determined that the patient was not congested, based on his hemodynamics; instead, he appeared to have acquired transfusion-related acute lung injury (TRALI). The patient was given a steroid infusion. By the time the patient returned to the intensive care unit, his oxygenation capacity improved and the secretions from his trachea decreased. The patient was weaned off the ventilator on the second post-operative day. Inhaled nitric oxide was very effective in improving oxygenation. We conjectured that TRALI should be recognized as a differential diagnosis for poor oxygenation after withdrawal from extracorporeal circulation.

The frozen elephant trunk technique (FET) for the treatment of acute aortic dissection is associated with more favorable remodeling in the descending aorta compared to those patients without FET, but it may also be associated with postoperative spinal cord injury (SCI) and actually,some postoperative SCI cases after FET are reported. Several risk factors for SCI are known and one of them is due to the occlusion of intercostal arteries from false lumen. A 71-year-old woman underwent total arch replacement with FET, but after surgery, she noticed decreased movement in both lower extremities and was suspected of postoperative paraplegia. She went through cerebrospinal fluid drainage but didn't get better at all. According to the preoperative contrast computed tomography images, seven out of ten intercostal arteries were originating from the false lumen and six of them were occluded after surgery. When most of intercostal arteries are originating from the false lumen and there is no entry inside the descending and abdominal aorta, the intercostal arteries may be occluded due to thrombosis of the false lumen and it may cause spinal cord ischemia after surgery.