A 38-year-old Marfanoid male was evaluated for an aortic root false aneurysm. Five years previously, he presented with severe aortic insufficiency, a 9.4-cm ascending aortic aneurysm, severe mitral regurgitation, and a coarctation of the aorta just distal the origin of the left subclavian artery. At the time of surgery, the aortic root was replaced with a #29-mm St. Jude mechanical composite graft (St. Jude Medical Inc., St. Paul, MN). The coronary ostia were directly reimplanted into the composite graft, remnants of the aneurysm were wrapped around the graft, and a Cabrol decompression graft was performed to the right atrium. The mitral valve was replaced with a #31-mm St. Jude mechanical valve, and the coarctation was repaired with an ascending aorta-supraceliac aorto bypass graft using a #18mm Vascutek prosthesis (Terumo Gelsoft, Vascutek, Inchinnan, UK).The patient now returned with chest pain and dyspnea. A multislice computed tomography (CT) angiogram showed a large false aneurysm due to a leak resulting from the detachment of the right coronary ostial button (Figure 1).At the time of surgery cardiopulmonary bypass was instituted with an arterial cannula in the right subclavian artery and a venous cannula in the right femoral vein. Following a redo mediansternotomy the false aneurysm was purposefully entered, blood clots were removed, and the bleeding site of the detached right coronary button was identified.The aorta was then crossclamped and the heart arrested with cold blood cardioplegia directly administered through the right coronary ostium. The right coronary button was completely detached and the residual opening in the aortic conduit was closed with a polytetrafluoroethylene patch. The right coronary button was anastomosed in an end to end fashion to an 8-mm Gore-Tex graft (Gore Inc, Flagstaff, AZ) using a running 4-0 Gore-Tex suture (Figures 2A and 2B). This was then anastomosed end to side to the previously placed ascending aorto supraceliac aortic bypass graft using a 4-0 running Gore-Tex suture (Figures 2A and 2B). The crossclamp and bypass times were 154 and 54 min, respectively. The patient tolerated the procedure well and had an uncomplicated postoperative course. A postoperative CT angiogram showed a patent Gore-Tex interposition graft (Figure 2). ORCID Ivan Budimirhttp://orcid.org/0000-0002-0202-9208 FIGURE 1 Preoperative MSCT. Aortic root false aneurysm (yellow arrow). MSCT, multislice computed tomography J Card Surg. 2017;32:595-596. wileyonlinelibrary.com/journal/jocs

Internal carotid artery (ICA) aneurysms are rare. The symptoms are related to cerebral embolization, local compression and rupture. Options for treatment include open surgery or endovascular treatment with a covered stent. We report a case of a 67 year old woman with bilateral idiopathic internal carotid artery aneurysms, found during the diagnostic evaluation for an episode of syncope. The right ICA aneurysm was treated with resection and end-to-end anastomosis of the ICA. There were no perioperative complications. Six months later the patient underwent endovascular repair of left carotid artery aneurysm with a covered stent. There were no complications in postoperative period. Treatment options for ICA aneurysms are surgical or endovascular, depending of size, location and anatomic relation to surrounding structures.

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