In thoracic endovascular aneurysm repair (TEVAR), the common femoral artery is typically used as the standard vascular access. However, in some cases, alternative vascular accesses must be considered, or endovascular treatment may need to be abandoned due to vascular diameter or characteristics. A female in her 70 s presented with saccular aortic aneurysms located at the distal arch and descending aorta, possibly secondary to bacteremia. She had a history of partial arch replacement and ascending aorto-bi-iliac artery bypass for ascending aortic aneurysm, as well as calcified abdominal aortic stenosis, performed five years prior. In this case, we successfully treated the aneurysms with antegrade TEVAR, accessing through the extra-anatomical bypass graft, which was exposed in the epigastric preperitoneal space. This is the first case report of TEVAR using access from an extra-anatomical bypass graft connecting the ascending aorta to the lower extremity.

In recent years, the number of MitraClip procedures has increased among high-risk patients for open-heart surgery with mitral regurgitation. However, surgical re-intervention is sometimes required after a MitraClip procedure, and this re-intervention carries high risks considering the patients' backgrounds. We report on two cases of surgical re-intervention after MitraClip procedures. Case 1: An 82-year-old man experienced repeated heart failure due to severe mitral regurgitation (MR) caused by chronic atrial fibrillation. He underwent the MitraClip procedure because of his advanced age and frailty. However, his heart failure became uncontrollable due to an acute exacerbation of MR caused by Clip detachment. He underwent mitral valve replacement (MVR) 10 days after the MitraClip procedure. Case 2: A 72-year-old man experienced heart failure due to severe ischemic MR. The MitraClip procedure was performed because of hemorrhagic cerebral infarction and emphysema. However, two years after the MitraClip procedure, his condition was worsened due to MR and mitral stenosis. He eventually underwent MVR. If surgical re-intervention is required after a MitraClip procedure, open-heart surgery such as valve replacement is essential. When performing valve replacement surgery, it is considered important to preserve the subvalvular apparatus as much as possible to prevent complications.

In acute Stanford type A aortic dissection, except for some thrombosed false-lumen types, graft replacement is a standard treatment. On the other hand, thoracic endovascular aortic repair (TEVAR) might be considered for high-risk patients with retrograde type A aortic dissection when entry is in the descending aorta, although its efficacy in a case of an extensive thrombosed false lumen without obvious entry is unknown. We report a case of successful zone 3 TEVAR using RelayPro NBS for Stanford type A aortic dissection with a localized CT-enhanced false lumen in the proximal descending aorta. An 83-year-old woman was admitted for acute Stanford type A aortic dissection with a thrombosed false lumen of the ascending thoracic aorta. She was initially treated conservatively because of being a high-risk patient for open surgery. One week after hospitalization, the ascending aorta diameter increased and the false lumen in the proximal descending aorta grew sporadically in a CT image. We suspected that the ascending aorta was enlarged due to a partially patent false lumen of the descending thoracic aorta, and performed zone 3 TEVAR using RelayPro NBS to close a possible entry in the proximal descending aorta even though there was no obvious entry. The patient had a good postoperative course and was discharged 15 days after TEVAR. Shrinkage of the false lumen in the ascending aorta was observed in CT images two months after TEVAR.

A 71-year-old man presented to our hospital with sudden-onset epigastric pain. He reported a history of undergoing the following operations : aortic valve replacement for aortic regurgitation 11 years earlier and graft replacement of the ascending aorta for acute type A aortic dissection, 1 year earlier. His systolic blood pressure was 70 mmHg, and computed tomography revealed a pseudoaneurysm of the distal anastomosis of the ascending aorta with a connection to the right pulmonary artery. Cardiopulmonary bypass was established with cannulation of the right axillary artery and the right femoral vein, and systemic cooling was initiated before sternotomy. We identified an area showing 3 cm dehiscence at the distal aortic anastomosis after hypothermic circulatory arrest and selective cerebral perfusion. The ascending aorta was replaced as hemiarch replacement, and the defect in the right pulmonary artery was closed with bovine pericardium. The patient's postoperative course was uneventful, and he was transferred to a rehabilitation hospital on the 22nd postoperative day.

Mucolipidosis is an autosomal recessive lysosomal storage disorder that demonstrates a clinical resemblance to mucopolysaccharidosis. Accumulation of glycoproteins throughout the body causes dysfunction of several organs, in particular, valvular heart diseases are an important cause of mortality, however, there is no consensus guideline regarding the indications and optimal timing of the surgical repair because of the unclear and short natural history. Here we present 12- and 15-year-old siblings diagnosed with mucolipidosis who underwent aortic valve replacement. The senior sibling received redo-aortic valve replacement for prosthetic valve dysfunction 11 years after the initial surgery. A few surgical valve replacements in patients with mucopolysaccharidosis have been reported, however, there is no published case of aortic valve replacements in two siblings with mucolipidosis.

We encountered three cases of infra-renal infected abdominal aortic aneurysm in 2007 and 2008. Preoperative blood culture was positive in two of the three patients. All of the patients presented with fever of unknown origin. We replaced the affected segment of the abdominal aorta with a synthetic graft in 1 patient, and with a cryopreserved arterial homograft in the remaining 2 patients. An infected abdominal aortic aneurysm is a life-threatening condition. Diagnosis is often difficult, and emergency surgery may be necessitated by rupture of the aneurysm. Our experience suggests that computed tomography is effective for the diagnosis of infected aneurysms. The most effective surgical technique consists of complete resection of the aneurysm, in-situ replacement of the affected aortic segment with a synthetic graft or homograft, and omental coverage.