The patient was a 73-year-old female who developed a ventricular septal perforation (VSP) following an acute anterior myocardial infarction, requiring emergency surgery. We made an incision in the right ventricle (RV) wall, 2 centimeters away from, and parallel to, the left anterior descending coronary artery (LAD). We found an aproximately 15 mm perforation. The VSP was closed by the extended sandwich patch technique, taking care not to the injure LAD. Furthermore, coronary artery bypass graft (CABG) left internal thoracic artery (LITA) to LAD was performed. The postoperative course was good, and no residual shunt was detected on the echocardiogram on the fifth day after surgery. Postoperative coronary artery computed tomography (CT) showed all grafts, including the LITA-LAD, were patent, and the patient was discharged on the twelfth day after surgery. There is controversial about whether or not to perform revascularization of the culprit artery during VSP repair. Based on this case, it was thought that complete revascularization, including the culprit artery, should be considered in cases of VSP.

A 79-years-old female underwent total arch replacement for an aortic arch aneurysm. A postoperative CT scan showed no abnormalities on the anastomotic sites, including the supra-aortic neck vessels. However, 10 months after the operation, she visited our outpatient clinic to complain of left shoulder pain. A CT scan demonstrated complete occlusion of the left subclavian artery, and doppler echography detected a subclavian steal phenomenon. Eleven months after the operation, the patient was transferred to our hospital because of the transient loss of consciousness and progressive aphasia. MRI revealed hyperintensive lesions in the boundary area between the left temporal and occipital lobes, enlarged in a DWI (diffusion-weighted image) with time. Axillary-axillary bypass grafting was performed to suppress the progression of cerebral ischemia caused by a subclavian steal phenomenon. Aphasia seemed to be improved soon after the bypass and diminished on postoperative day 2. The hyperintensive area on DWI regressed, and no other lesion was found on a postoperative MRI. She was discharged without apparent sequelae, including aphasia. We report a successful case of revascularization for subclavian steal syndrome with aphasia.