We present a case of ruptured aneurysm of the sinus of Valsalva with congenitally bicuspid aortic valve and aortic regurgitation. A 50-year-old woman was admitted with congestive heart failure. Transesophageal echocardiography demonstrated that an aneurysm originating from the anterior sinus of Valsalva had ruptured into right ventricular outflow tract. With the aid of cardiopulmonary bypass, the aneurysm was repaired with direct closure through an aortotomy and aortic valve replacement with a Carbomedics 21mm was successfully performed. Because of the marked calcification of her cusps and shortening and thickening of the free-edge, valvuloplasty for the insufficient bicuspid valve was not applied in this case. However, valvuloplasty should be considered as the first surgical procedure of choice, even in cases of bicuspid aortic valve associated with ruptured aneurysm of the sinus of Valsalva and aortic regurgitation.

A 72-year-old man presented with a chief complaint of chest pain. Since ECG showed ST elevation in leads III and _aV_F, suggestive of acute myocardial infarction, we performed emergency coronary angiography which revealed total occlusion of RCA#3, 75% stenosis of LAD#6, and 99% stenosis of LAD#7. Thus, RCA occlusion was the likely cause of the chest pain, and a drug-eluting stent (DES) was placed in RCA#3. OPCAB of the LITA to the LAD (LITA-LAD) was performed 44 days later. The volume of postoperative drainage was very low, and, since the DES was in place, the administration of aspirin 100 mg once daily and ticlopidine 200 mg twice daily was started on the first morning after surgery. On the second morning after surgery, the CVP rose rapidly to 16, and then to 23 mmHg. Chest CT revealed massive hemopericardium and hemomediastinum, and re-thoracotomy was performed for hematoma removal. There was no bleeding at the anastomosis or graft sites, with minimal bleeding from mediastinal adipose tissue. Thereafter, his condition improved uneventfully, and he was discharged on the 19th postoperative day. Since the DES was in place, the administration of antiplatelet agents was resumed in the early postoperative period to prevent occlusion, which resulted in the development of cardiac tamponade due to bleeding. We report the case of severe postoperative complication due to DES placement.

A 71-year-old man with obstruction of the left anterior descending branch (#7) suffered an acute myocardial infarction. A ventricular septal perforation (VSP) and a widespread left ventricular aneurysm were detected in the anteroseptal region by both cardiac ultrasonography and cardiac catheterization. Surgery was performed at week 7 after onset. After establishing extracorporeal circulation, the left ventricular aneurysm was longitudinally excised from the left side of the left anterior descending branch while the patient was maintained in a state of cardiac arrest. A septal anterior ventricular exclusion (SAVE) operation was performed using oblong equine pericardial patches to exclude the left ventricular aneurysm and the VSP portion. The VSP was directly closed with sutures because the surrounding tissues were relatively strong at week 7 after the onset of the myocardial infarction and the portion was excluded with an equine pericardial patch. At the same time, CABG (LITA-LAD) was also performed. After surgery, left ventriculography found no residual shunts and we were able to obtain both a good morphology and satisfactory functioning of the left ventricle. The present method is thus considered to be an effective surgical method that excludes both the VSP portion and the infracted portion, while improving the morphology of the left ventricle for VSP with a left ventricular aneurysm.