The patient was a 78-year-old man who presented with dyspnea and decreased SpO₂ in the sitting and standing positions. Transthoracic echocardiography revealed a patent foramen ovale (PFO), and a microbubble test showed Grade 1 in the supine position and Grade 4 in the sitting position, suggesting an increase in shunt volume when seated. Chest CT revealed age-related kyphosis and right atrial compression by the ascending aorta. The patient was diagnosed with platypnea-orthodeoxia syndrome (POS) due to PFO, and a PFO closure was performed using minimally invasive cardiac surgery (MICS). The postoperative course was favorable, and the patient was discharged on the 20th postoperative day. Although percutaneous device closure is generally performed for PFO closure, MICS was useful in this case due to the anatomical unsuitability caused by an atrial septal aneurysm.

Chronic contained rupture of an abdominal aortic aneurysm （AAA） is a rare condition that can present with atypical symptoms, making diagnosis challenging. We report a case of chronic contained rupture of an AAA with vertebral destruction presenting as right lower extremity pain. A 78-year-old man with a history of mitral valve replacement and pyogenic spondylitis （L2-L3） presented with a two-month history of low back pain and a four-day history of right lower extremity pain and numbness. Computed tomography revealed a 61 mm diameter ruptured AAA with an irregular margin. Magnetic resonance imaging demonstrated vertebral destruction at L4-L5. The patient underwent open surgical repair with a rifampicin-soaked graft and debridement. Intraoperatively, a large defect was found at the posterior aspect of the aneurysm, exposing the destroyed vertebral bodies. Postoperatively, the patient required spinal immobilization for persistent neurological symptoms, which improved and the patient was discharged on postoperative day 55.

A 62-year-old man with Marfan syndrome had a modified Bentall procedure and total arch replacement for annuloaortic ectasia, aortic insufficiency and thoracic aortic aneurysm fifteen years ago at another hospital. A follow-up CT revealed bilateral coronary artery aneurysms and an aortic root pseudoaneurysm, and thus he was referred to our hospital. The previous prosthetic valve was removed, followed by the re-Bentall procedure. Coronary artery aneurysms were resected and consequently coronary arteries were reconstructed directly. Although the shortcoming of the Bentall procedure was pseudoaneurysm, the outcomes of the modified Bentall procedure have shown some improvements. However, as there is still a high risk of postoperative complication in connective tissue diseases, long-term follow-up is required.