Cardiac injuries caused by blunt chest trauma have a high mortality rate, and not only a median sternotomy but also a clamshell thoracotomy can be an alternative approach. In this report, we describe a case in hemostasis was achieved by clamshell thoracotomy in a left atrial appendage injury caused by blunt thoracic trauma. The patient is a 49-year-old woman. After an argument with her husband, she jumped off the balcony of her home on the 6th floor and fell in a supine position. She was brought to the hospital in shock, and pericardial effusion was found on FAST. She had cardiac arrest due to cardiac tamponade, and left anterolateral thoracotomy was performed to open the pericardium. After the removing the hematoma in the pericardial sac was removed, the patient experienced a return of spontaneous circulation, but a large amount of blood was seen spurting out, and the patient was transferred to a clamshell thoracotomy to secure the visual field. An injury of about 8 mm was observed in the left atrial appendage, which was sutured after establishing ECMO. The patient was discharged from the ICU on postoperative day 20 and discharged home unassisted on postoperative day 77. The cause of blunt cardiac injury is often traffic trauma, but this is a very rare case in which the patient suffered a left atrial appendage injury due to a fall trauma and clamshell thoracotomy was able to save her life. Therefore, clamshell thoracotomy is one of the options to open the chest in certain clinical situation.

Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.

A very rare case of congenital adrenocortical insufficiency accompanied with ventricular septal defect, is presented. Surgical treatment together with glucocorticoid replacement therapy was performed. The patient, a 4-month-old girl with congenital adrenocortical insufficiency, had been treated with a long-term adrenocortical hormones replacement. Surgical treatment for ventricular septal defect was applied in order to reduce the risk of heart failure. The administration dose of glucocorticoid was determined according to the body surface area and chronologic change of serum cortisol. Following the surgical treatment, and with adequate glucocorticoid replacement, the patient showed a good clinical outcome. In conclusion, we showed a beneficial treatment protocol with adequate glucocorticoid replacement in open heart surgery for a case of congenital adrenocortical insufficiency.