We describe a rare complication and treatment progression that occurred in a 64-year-old man with an aortic abdominal aneurysm AAA that had been treated by endovascular aneurysm repair EVAR. He had undergone EVAR to treat an infra-renal type AAA 21 months previously and returned to the emergency department with back pain. Contrast-enhanced computed tomography CT revealed acute type B aortic dissection, so he was admitted and conservative medical management was started. Acute stomachache and limb pain appeared on hospital day 7, which prevented him from moving his lower limbs. The main body of the stent graft had collapsed, blocking blood flow, and contrast was not found in arteries from the collapsed stent graft portion to the knee level on emergency contrast CT images of the leg. His legs were revascularized by an extra-anatomical right axial-bilateral external iliac bypass. His symptoms disappeared and reperfusion injury was avoided. The collapsed stent graft had retained its original shape at 11 and 18 days after surgery. Furthermore, follow-up CT 4.5 years later showed that the stent graft retained its original form.

A 14-year-old boy was diagnosed with an anomalous left coronary artery coursing between the ascending aorta and the main pulmonary artery and associated with a single coronary ostium. Owing to the high risk of sudden cardiac death, surgery was performed although he was asymptomatic with no sign of myocardial ischemia. Reimplantation of an anomalous left coronary artery is generally considered difficult because an aortic cuff is unavailable for coronary anastomosis; however, we accomplished a successful direct reimplantation in this patient. This procedure offers another choice in the surgical treatment of anomalous left coronary artery.

A 67-year-old man with dilated cardiomyopathy was admitted to our hospital for treatment of cardiac failure. After using heparin because cerebral infarction developed during hospitalization, in acknowledgment of thrombocytopenia, we reach the diagnosis of HIT. We judged surgery to be necessary because heart failure had difficulty with catecholamine secession and the left ventricular dilation progressed rapidly, and performed left ventriculoplasty, mitral valve plasty. There were no complications such as the thrombosis during cardiopulmonary bypass, and the postoperative course was good without leading to re-thoracotomy due to bleeding. He passes without a heart failure symptom by the follow of one year 6 months after surgery at home.

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