Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.

Isolated mitral regurgitation without supravalvular aortic stenosis is rarely identified in Williams syndrome. We describe the case of a 24-year-old man with isolated mitral regurgitation in Williams syndrome. Severe regurgitation due to prolapse of the anterior leaflet was noted in an echocardiogram and color Doppler, and a left ventriculogram showed grade IV regurgitation. No pressure gradient between the left ventricle and the ascending aorta was found. Mitral regurgitation had been noted since his birth, and pediatricians suspected Williams syndrome because of postnatal growth deficiency, mental deficiency, unusual personality, and unusual facial features in his childhood. The diagnosis was confirmed by demonstration of the hemizygous deletion of 7q11.23 in the karyotype by the fluorescent in situ hybridization technique after his admission to our department. The patient underwent mitral valve replacement, and microscopic examination of the excised valve revealed myxomatous degeneration.

A 68-year-old man underwent double-valve replacement (DVR) for active infective endocarditis caused by Enterococcus faecalis. Postoperative coronary angiography (CAG) revealed a saccular aneurysm originating from the distal portion of LMCA with severe stenosis at the ostium of the left anterior descending (LAD) artery and left circumflex artery (LCx). Emergent surgical resection with concomitant coronary artery bypass grafting were performed. Mycotic coronary artery aneurysms have a great tendency to rupture, and this may result in cardiac tamponade and sudden death. Early recognition and prompt surgical intervention is mandatory to minimize those fatal complications.Keywords: coronary artery aneurysm, mycotic, left main coronary artery, infective endocarditisWe present a case of successful treatment for mycotic left main coronary artery aneurysm following doublevalve replacement for infective endocarditis. Case ReportA 68-year-old man was referred to our hospital with high grade fever. He had a history of self-catheterization due to neurogenic bladder and obstructive nephropathy. Transthoracic echocardiography (TTE) confirmed severe aortic and mitral regurgitation with vegetations and severe destruction on both of those valves. Blood cultures on admission were positive for Enterococcus faecalis, and; therefore, intravenous administration of ampicillin sodium and gentamicin sulfate was initiated for active infective endocarditis. Although further investigation of the aortic root and coronary arteries was considered, cardiac catheterization was avoided because of the friable vegetation of the aortic valve. Progressive heart failure necessitated emergent surgical intervention. And then he underwent double-valve replacement (DVR) with bileaflet mechanical valves (#21 and #31, St Jude Medical Inc., USA for aortic and mitral valve, respectively). Following surgery, the antibiotic treatment was continued, and body temperature fell down with decreased white blood cell

Mid-term results of mitral valve replacement combined with chordae tendineae replacement in patients with mitral stenosis.

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis is described. An abdominal aortic aneurysm, 48-mm in diameter, in a 68-year-old woman with HLA-B27-associated ankylosing spondylitis was successfully replaced with a tube graft. The suture lines of the aortic wall were reinforced with Teflon felt strips. Pathologic examination of the aneurysmal wall revealed hyalinization of the connective tissue, with numerous lymphocytic infiltrates, remarkable calcification, and no elastic fibers. The original structure of the arterial wall was not recognized. These findings are compatible with aortitis reported in ankylosing spondylitis.