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A paced patient underwent mitral valve replacement for mitral stenosis using ultrasonically activated scalpel. There were minimum bleeding and no homologous blood transfusion was required. Ultrasonically activated scalpel fid not interfere the pulse generator nor the transesophageal echocardiography. Ultrasonically activated scalpel is useful for the open heart surgery in paced patients.

Aneurysm of the ductus diverticulum in the adult is rare and its rupture is fatal. A 75‐year‐old man presented with congestive heart failure that suddenly occurred with a continuous murmur. Angiography showed a left‐to‐right shunt through a large thrombosed aneurysm of the ductus diverticulum (6 cm), and the pulmonary‐to‐systemic flow ratio was 2.6. Patch closure of the orifice (3times4 cm) of the aneurysm and repair of the perforated pulmonary artery were done emergently under hypothermic cardiopulmonary bypass with selective cerebral perfusion. He recovered uneventfully. Early recognition and early intervention should be indicated in this otherwise fatal condition.