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Background Approximately 25% of coronary arteriovenous fistulas present aneurysmal dilatation; however, spontaneous rupture of the aneurysm is rare. Most coronary arteries branching the feeding arteries demonstrate aneurysmal formation, possibly because of shunt flow. Case report A 48-year-old woman was referred to our institution for surgical management of ruptured aneurysm of coronary arteriovenous fistula. The aneurysm was located on the left-anterior aspect of the pulmonary artery trunk, communicating with both left and right coronary arteries through two small feeding arteries draining into the pulmonary artery trunk. Both left and right coronary arteries showed normal diameter. The feeding arteries were ligated externally, and fistulous openings were closed within the aneurysm. Postoperative course was uneventful. Conclusion Aneurysm of coronary arteriovenous fistula can occur in patients without aneurysmal coronary artery. Although the association of ruptured aneurysm with coronary fistulas is relatively rare, it should be considered a potential cause of acute cardiac tamponade.

Background Saphenous vein graft aneurysm (SVGA) is a rare complication after coronary artery bypass grafting; however, it may lead to fatal conditions. A redo sternotomy poses a high risk of injury to the patent graft. Case report A 59-year-old man with chest pain was diagnosed with a giant SVGA (67 mm) anastomosed to the right coronary artery (RCA) and compressing the right atrium. Considering the high risk of injury to a patent graft through the sternum, a surgical procedure was planned without redo sternotomy. Through an upper midline abdominal incision, redo bypass grafting was performed to the distal RCA using the right gastroepiploic artery, followed by resection of the aneurysm using the right anterior lateral thoracotomy approach. The postoperative course was uneventful. Conclusion In patients with an SVGA anastomosed to the right coronary system, our surgical strategy may be a useful alternative to redo sternotomy to avoid injury to the patent graft.

Background The right gastroepiploic artery (RGEA) is a useful in-situ graft, and skeletonization is effective to prevent spasm and achieve good patency. To harvest the skeletonized RGEA easily, ultrasonic scalpel has been widely used, but the tip shape of conventional ultrasonic device was not optimal for this procedure. Recently, a novel hybrid ultrasonic/bipolar energy device (THUNDERBEAT Open Fine Jaw [TOFJ]) has been developed and is widely used in general surgery. Surgical technique The operator holds forceps in left hand and TOFJ in right hand, incises the anterior layer of the omentum, and extends the incision distally along the RGEA. The side branches and satellite veins were sealed and cut. Because the tip of the TOFJ is well-designed to easily grasp and peel off the tissue, there is no need to change instruments throughout the procedure. After the dissection was advanced distally, the proximal side was subsequently dissected. Conclusions This novel device is useful for harvesting skeletonized RGEA.

Here we report a rare case of atypical Kawasaki disease (KD) in a patient presenting with systemic arteritis affecting the coronary arteries, brain, and internal mammary arteries (IMAs). A 25-year-old man was referred to our institute with angina pectoris. Coronary angiography revealed coronary artery aneurysms and triple-vessel disease. Three-dimensional brain computed tomography showed multiple small saccular aneurysms on the vertebral and posterior inferior cerebellar arteries. Off-pump coronary artery bypass (OPCAB) grafting ​​​​​​was performed; however, the bilateral IMAs were tightly adhered and not patent. OPCAB was completed using the bilateral radial and gastroepiploic arteries. This is the first report of KD involving the IMA.

Background In the redo aortic valve replacement (AVR), removal of the previously implanted damaged prosthesis may result in a native aortic annulus defect, making it difficult to reimplant a stented prosthesis. The Solo Smart valve, a relatively new stentless bioprosthesis, is designed for the supra-annular implantation into the wall of the sinus of Valsalva and may be a useful alternative to redo-AVR. Case report We report a successful case of redo-AVR using the Solo Smart valve. Conclusion The unique feature of the Solo Smart valve is the supra-annular implantation procedure in the sinus of Valsalva without annular stitches. This bioprosthesis can be a useful alternative for redo-AVR in patients with a defect of the native aortic annulus.

Operations necessitating intervalvular fibrous body reconstruction in patients with extensive endocarditis are referred to as "Commando operations," an indicator of the procedure's difficulty. Aortic root replacement is inevitable when performing the Commando operation for extensive aortic annular defect after radical debridement. We performed a modified Commando operation, in which supra-annular aortic valve replacement with the Solo Smart stentless bioprosthesis was employed instead of aortic root replacement. Supra-annular implantation can spare damaged annular structures. This modification is expected to render complex reconstructive surgery technically less demanding.

The axillary artery is an established alternative cannulation site for peripheral cardiopulmonary bypass (CPB). However, axillary vein cannulation is not as common. Here, we present our experience with an axillo-axillary CPB combined with a femoro-femoral CPB in redo aortic root replacement. The full-flow bypass was obtained with vacuum-assisted drainage and excellent decompression of the heart was achieved without left heart venting. Although only adhesions around the aortic root graft were dissected, a comfortable surgical field could be obtained with our CPB strategy. Axillary vessels were easy to expose with a small single skin incision. Cerebral protection could be achieved in both antegrade and retrograde fashion when the circulatory arrest was required for an additional arch procedure. Our strategy based on axillo-axillary and femoro-femoral CPB was effective and feasible in redo aortic root replacement. We consider that it simplified the complex aortic reoperation.

Currently, total arch replacement (TAR) using frozen elephant trunk (FET) technique is gaining popularity for various thoracic aortic pathologies. FROZENIX is the first commercialized open stent-graft (OSG) in Japan, and it is a useful alternative to previously self-made OSG. FROZENIX is easy to deploy compared with formerly launched OSGs. However, some challenges have been identified with FROZENIX. Herein, we present the cases of two patients in whom we encountered serious unexpected kinking of FROZENIX during TAR performed using FET, which was related to its structural property. The clinical course and the bailout are described.

We report the use of intraoperative fluorescence imaging to assist in the surgical management of proximal coronary arteriovenous fistulas in four patients.

We report a 56-year-old hemodialysis patient with a spontaneously ruptured caseous calcification of the mitral annulus resulting in multiple cerebral emboli. The mass was resected without replacing the mitral valve. The patient has remained symptom-free 3.5 years following surgery.