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A 68-year-old male with sudden, persistent chest and back pain was referred to our hospital. Contrast-enhanced computed tomography (CT) scans revealed 56 mm thoracic aortic aneurysm (TAA)located from the distal aortic arch to the proximal descending thoracic aorta and Stanford type B acute aortic dissection (AAD) with the patent false lumen distal to the aneurysm. The AAD was not extended within the TAA. Although anti-hypertensive therapy was initiated, the patient unfortunately deceased of sudden cardiopulmonary arrest 6 days later. In the postmortem CT scans, ruptured TAA was diagnosed. Ruptured TAA complicated with AAD was extremely rare, and we report the present case with a literature review.

A 63-year-old man, who underwent urgent ascending aortic replacement for Stanford type A acute aortic dissection 8 years before, was presented with consciousness loss. Hemolytic anemia( hemoglobin 6.5 g/dl, LDH 1,477 U/l, total bilirubin 3.8 mg/dl) was diagnosed. Contrast-enhanced computed tomography(CT) scans revealed severe flexion and stenosis of the replaced ascending aortic graft with intraluminal protrusion of the lesser curvature progressing as compared with 8 years before. Thoracic endovascular aortic repair, i.e. stent-graft implantation into the ascending aortic graft, under rapid pacing was successfully performed. The graft flexion/stenosis was slightly improved, and the intraluminal protrusion of the lesser curvature was covered by the stent graft. Anemia was completely resolved. Endovascular repair for graft flexion/stenosis bringing hemolytic anemia is far less invasive than redo aortic replacement and may be a useful therapeutic tool in limited cases.

We present an 82-year-old male patient who underwent laparoscopic abdominal perineal rectal amputation and D3 lymph node dissection, including left inguinal lymph node dissection for anal canal carcinoma. Left inguinal lymph node metastasis was positive, and pT1bN2aM0, pStage Ⅲa was the final pathological diagnosis. He underwent 8 courses of capecitabine plus oxaliplatin therapy as adjuvant chemotherapy. He was examined without recurrence for 5 years postoperatively. However, he awared a perineal subcutaneous tumor and was transferred to our hospital for further examination and treatment 6 years postoperatively. Recurrence after anal canal carcinoma surgery was diagnosed based on a needle biopsy, and perineal subcutaneous tumor resection was performed. This is a rare case of late postoperative recurrence of anal canal carcinoma, which was detected due to a perineal subcutaneous tumor 6 years after surgery for anal canal carcinoma.

We report a case of a 44-year-old man with restenosis of coarctation of aorta (CoA). He had a history of descending aortic replacement for CoA using a graft 14 mm in diameter at 29 years ago. He had reoperation because of pressure gradient of 61 mmHg across the graft and intermittent claudication. Reoperation was done under unilateral lung ventilation with lung collapsed, through 3th and 5th interspace thoracotomy. Left lung adhesion was carefully released with an ultrasonically vibrating scalpel. After full heparinization, femoro-femoral bypass was started and descending aorta was clamped. The old graft was excised, and descending aortic replacement was done with a new graft of 26 mm in a diameter. His postoperative course was uneventful. The intermittent claudication disappeared.

A 44-year-old man was admitted with the diagnosis of active infective endocarditis( IE) due to Streptococcus mitis, complicated with infectious intracranial aneurysm. Preoperative echocardiography showed mobile vegetation on the mitral leaflet, size of which was 20 mm. The magnetic resonance imaging( MRI) demonstrated that the size of aneurysm was increasing, and infectious intracranial aneurysm was treated surgically. Twenty one days after the operation, the mitral valve plasty was performed. He was discharged on foot without any neurological findings. The duration between the brain surgery and the cardiac surgery was thought to be important to prevent the new neurological complication.

We report a case of traumatic aortic rupture with multiple injuries. A 20-year-old man was transferred to our hospital. He was suffering from traumatic thoracic aortic rupture with multiple injuries (femoral fracture, pelvis fracture and so 4th) due to a traffic accident. Enhanced computed tomography revealed leakage from the aortic isthmus and hematoma in the surrounding area. Emergency operation was performed. The left 4th intercostal thoracotomy was performed and a lacerated foramen was observed across the lesser curvature of the aortic isthmus. The affected site was replaced by a prosthetic graft under percutaneous cardiopulmonary system. He was treated with open fixation of the right femur 11 days after the 1st operation. The postoperative recovery was generally uneventful and he was discharged on the 51st hospital day.

A 55-year-old man was referred with a diagnosis of a left ventricular thrombus. Echocardiography revealed that he had a thrombus in the free wall of the left ventricle. Under cardiopulmonary bypass, we removed the intramural tumor. After the removal, the defect was repaired by Dor operation. Pathological examination revealed the tumor was a cardiac fibroma. He is doing well without any troubles 3 years after the operation.