We experienced a rare case of Marfan's syndrome with annulo-aortic ectasia, 
aortic regurgitation and Prinzmetal's variant angina. In a modified Bentall's 
operation (button technique), perioperative severe coronary artery spasm 
occurred in spite of the preventive use of nitroglycerin infusion, which 
resulted in profound ventricular fibrillation and subsequent chordal rupture of 
the mitral valve with Sellers IV regurgitation. Use of nicardipine contained in 
cardioplegia, continuous infusion of nicardipine and nitroglycerin after aortic 
declamping completely prevented coronary spasm throughout the course of a second 
surgery for mitral valve replacement. It is worthy to report this case because 
of rarities such as Marfan's syndrome accompanied by Prinzmetal's variant 
angina, perioperative coronary artery spasm in modified Bentall's operation, and 
perioperative chordal rupture of the mitral valve and progression of mitral 
valve regurgitation. We also stress the efficacy of a new calcium antagonist, 
nicardipine, to prevent coronary artery spasm during open heart surgery.