HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.

A retrospective study was performed in 30 patients who were treated for type A intramural hematoma from 1999 to 2008, of whom 24 were initially treated without surgical intervention. These 24 patients were followed up for 3.3 +/- 3.5 years (range, 0 days to 10.0 years). Four hospital deaths occurred (hospital mortality, 16.7%), there were 2 late deaths, and 2 other patients needed an operation during the follow-up period. The event-free survival rate (freedom from death or surgery) at 5 years was significantly lower in patients with maximal aortic diameter > or =48 mm than in those with diameters <48 mm (28.6% +/- 17.1% vs. 88.2% +/- 7.8%). Maximal aortic diameter > or =48 mm and computed tomography findings of a small intimal defect were significant predictors of rupture or progression of ascending aortic dissection. The outcome of medical treatment for type A intramural hematoma was acceptable during both the early and late periods, but patients with a relatively large aortic diameter or an intimal defect in the ascending aorta have a high probability of adverse outcome, and must be considered for surgery.

Video clip is available online. Bronchial artery aneurysms (BAAs) are rare. They may be asymptomatic and detected incidentally; however, they can cause airway bleeding, mediastinal bleeding, and sometimes death if they rupture. Here, we present a case of a BAA that was detected secondary to chest pain. It was difficult to diagnose, but bronchial artery embolization (BAE) revealed good results. CLINICAL SUMMARYAn 82-year-old woman presented with chest pain. An enhanced computed tomography (CT) scan that was conducted at a previous hospital suspected an impending rupture of an aortic arch aneurysm. She was therefore FIGURE 1. A, Enhanced computed tomography scan showing a soft tissue-shadow on the caudal side of the aortic arch, and a nodular contrast region inside (arrow). B, In a sagittal plane, the contrast region seemed to be continuous with the aortic arch, but it was unclear if the contrast region was inside the adventitia of the aorta (arrow).

Abstract:Pericardial cysts are rare abnormalities and are usually asymptomatic. Although several case reports on their diagnosis and treatment have been published, those on hemorrhagic pericardial cysts remain limited. We herein report the case of a 70-year-old man with a hemorrhagic pericardial cyst complicated with constrictive pericarditis 2 years after the initial diagnosis.

Cor triatriatum is a rare congenital heart disease. A 57-year-old woman had cor triatriatum with severe mitral valve regurgitation (MR) and atrial fibrillation (AF). We performed mitral valve repair, left atrial appendage resection, and maze procedure by resection of the anomalous septum in the left atrium. As a result, MR was