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 84-year-old woman underwent aortic root replacement with stentless bioprosthesis and coronary artery bypass grafting. Four years later, she presented with dyspnea. Transthoracic echocardiography revealed aortic regurgitation, dilation and dissection of the sinus of Valsalva. A Bentall operation was performed by using prosthetic graft and bioprosthetic valve. Intimal tear caused the aortic wall dissection and aneurysm of the Freestyle valve.