[Ascending aortic aneurysms operated through redo median sternotomy under selective cerebral perfusion]

Case 1: A 34-year-old man who had received ventricular septal closure at 4 years old was found to suffer from annuloaortic ectasia with severe aortic regurgitation and giant ascending aortic aneurysm accompanying with dissection. Median sternotomy was performed under selective cerebral perfusion to control bleeding when the aorta was injured. He was successfully replaced the ascending aorta and the aortic valve with the composite graft including an aortic prosthetic valve by modified Piehler's procedure. Case 2: A 44-year-old man received mitral valve replacement and tricuspid annuloplasty due to mitral regurgitation with tricuspid regurgitation. After surgery, he suffered from mediastinitis. Three months later, he was found to have pseudoaneurysm of the ascending aorta. During the sternotomy done under selective cerebral perfusion, the pseudoaneurysm was injured but bleeding was controlled easily. The defect of the aorta was closed successfully using a Dacron patch and covered with the right sternocleidomastoid muscle flap. Sternotomy under selective cerebral perfusion is very useful and safe for such patients as to have risks to injure the aorta or the heart during the sternotomy.