with a liposarcoma are symptomatic and that 15% have an asymptomatic liposarcoma discovered on a routine chest radiograph. Liposarcomas are usually large. The cases reported by Klimstra and associates 3 ranged from 6 to 40 cm, with a mean weight of 1500 g. Enzinger and Weiss 4 divided liposarcomas into the following 5 major morphologic subtypes: well differentiated, myxoid, round cell, dedifferentiated, and pleomorphic. Myxoid liposarcomas account for 40% to 50% of these tumors. Welldifferentiated liposarcomas are a less-aggressive neoplasm and can produce metastases. Complete surgical excision is the preferred therapeutic choice. Recurrence can occur in a subtotal resection despite adjuvant therapy. The pseudoencapsulated lesions that can be completely removed have a better prognosis than the noncapsulated and less well-differentiated tumors; however, most primary chest wall soft tissue sarcomas (70%) are low grade. Local recurrence was reported in 33% of patients in the study by Greager and colleagues. 5 The presence of local recurrence has no significant effect on the overall survival. 1 Radiotherapy may be effective in the control of local recurrence, but its role is unclear.

We describe an alternative technique through median sternotomy to perform total arch replacement for an extended distal arch aneurysm. After initiating cardiopulmonary bypass, the left pleura is opened widely from the aortic arch to the diaphragm and the left lung is mobilized to the right side with the heart. The descending aorta is visible through the window of the pleural incision. This technique provides excellent exposure, facilitating aneurysm resection, control of the descending aorta and successful completion of the distal anastomosis. In our experience of 26 cases who had distal aortic arch aneurysm with downstream extension, total arch replacement was achieved through a median sternotomy without the need for left anterolateral thoracotomy. This procedure reduced perioperative bleeding and resulted in satisfactory clinical outcomes.

Single coronary artery (SCA) in the absence of other major congenital cardiovascular anomalies is rare. We report an extremely rare case of acute aortic dissection in an octogenarian who had a single left coronary artery with the right coronary artery originating from the distal circumflex. A single ostium was incidentally detected by visual inspection during an operation. We diagnosed the anomaly in detail by postoperative 64-slice multi-detector computed tomography. As we performed an emergency operation, it was difficult to recognize SCA preoperatively. In this situation, it is very important to establish adequate myocardial protection and careful dissection is necessary to avoid iatrogenic injury.

A 67-year-old woman admitted with severe hypertension, atrial fibrillation, and dyspnea was found to have hypertension and congestive heart failure due to stenosis of the descending aorta. Atypical aortic coarctation was diagnosed. Extra-anatomical bypass was performed from the ascending aorta to the terminal abdominal aorta and the pulmonary vein was isolated. The graft was arranged to pass through the left thoracic cavity from the pericardium via a transretroperitoneal approach to the terminal abdominal aorta. Direct contact was avoided between the graft and the abdominal organs, and the pressure gradient between the ascending aorta and the abdominal aorta was decreased.

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