A 53-year-old male with ankylosing spondylitis presented with worsening exertional dyspnea. Echocardiography revealed severe aortic regurgitation and an aortic valve replacement was performed using a mechanical valve (SJM Regent 21 mm) in consideration of his age. By the 5th postoperative week, the patient exhibited signs of worsening heart failure. On the 52nd postoperative day, intermittent prosthetic valve regurgitation was detected on echocardiography. Valve fluoroscopy revealed that the valve intermittently remained fixed in the open position, leading to a diagnosis of prosthetic valve dysfunction. Contrast-enhanced CT revealed no evidence of thrombus or tissue formation around the prosthetic valve. On the 56th postoperative day, a redo aortic valve replacement was performed with another mechanical valve (On-X 21 mm). Intraoperatively, no obvious structural abnormalities were identified. Compression of the pivot may have contributed to the dysfunction. We report a rare complication associated with a mechanical prosthetic valve.

We report on a case of a distal aortic arch aneurysm with severe shaggy aorta treated by two-stage hybrid surgery without complications. The patient was a 67-year-old man. The thoracic aortic aneurysm was identified on computed tomography imaging by his treating physician during routine follow-up for lung cancer. The patient was referred to our hospital for further investigation and treatment. The aneurysm had a maximum diameter of 68 mm with severe shaggy aorta. Based on these findings, the risk of cerebral infarction and spinal cord ischemia was considered very high. The patient underwent total arch replacement with elephant trunk, using a brain isolation technique for this initial surgery. The postoperative course was uneventful and thoracic endovascular aortic repair（TEVAR) was performed 26 days after the initial surgery. The patient was discharged on post-operative day 38, without complications.

Primary cardiac fibroelastoma is a relatively rare tumor and is often detected incidentally by echocardiography. We report a case of multiple fibroelastomas that were found incidentally by follow-up echocardiography for hypertrophic cardiomyopathy and were treated with valve-sparing excision. The patient was a 71-year-old man, in whom a 10-mm tumor on the ventricular septum below the right coronary cusp and 3-mm tumors on the left ventricular side of the left and right coronary cusps were detected. Although he had no symptoms, because the tumors were mobile, surgery was performed for preventing embolization and making a definitive diagnosis. The tumor on the ventricular septum was excised together with the surrounding endocardium and part of the myocardium. The tumors on the valve leaflets were excised with the aortic valve cusps spared. Histopathologically, all the tumors were fibroelastomas. The postoperative course was uneventful.