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A 64-year-old male patient who presented with symptoms indicative of hemolytic anemia was referred to our hospital. After obtaining the patient’s history, it was found that hemolysis occurred 14 years after he underwent ascending aortic replacement for acute type A aortic dissection. Enhanced computed tomography revealed an aortic pseudoaneurysm at the proximal anastomosis, which was thought to be the cause of hemolysis. Furthermore, aortic valve regurgitation and dilatation of the sinus of Valsalva were also found on a transthoracic echocardiogram. Therefore, the Bentall procedure was performed. During the surgery, aortic pseudoaneurysm formation and vascular graft stenosis were observed. The postoperative course was uneventful, and hemolysis diminished soon after the surgery.

A 72-year-old woman who had undergone three atrial catheter ablations for chronic atrial fibrillation was referred for surgical treatment for severe atrial functional mitral regurgitation. She suffered not only dyspnea but also dysphagia due to esophagus compression by a giant left atrium 15×12×11 centimeters in size. In her surgery, mitral valve repair using a 36-millimeter artificial ring, tricuspid annuloplasty and resection of the left atrial appendage were performed. In addition, the posterior, lateral, and superior wall of left atrium, 4 centimeters in width, was extensively resected to reduce left atrial volume. Postoperative echocardiography showed a decrease in both mitral and tricuspid regurgitation to trivial levels as well as an improvement in left ventricular diastolic function. Postoperatively her dysphagia disappeared and NYHA class improved from III to I. In her chest X ray, the cardiothoracic ratio fell from 80% to 56%, and the tracheal bifurcation angle decreased from 110 to 90 degrees. In a patient with a giant left atrium due to atrial functional mitral regurgitation, a favorable clinical outcome resulted from double valve repair combined with extensive left atrial resection.