This is the first reported case of a self-expanding aortic valve explanted from the ascending aorta consisting of a Dacron prosthesis. We describe a 75-year-old male with bicuspid aortic valve regurgitation initially treated with a David procedure. Following degeneration, a “valve-in-repaired-valve” transcatheter aortic valve implantation (TAVI) was performed. Six years later, he presented with dyspnea, severe insufficiency, and paravalvular leakage. An interdisciplinary team opted for redo surgery. The patient underwent successful redo aortic valve replacement with an EpicMax bioprosthesis via resternotomy. Despite a complex postoperative course, he recovered well. This case underscores key challenges in lifetime management, including TAVI durability, sizing, and reoperative strategies.
Background:Heterotaxy with abdominal situs inversus complicates cardiac surgery due to mirror-image anatomy and associated venous anomalies. Case Description:A 61-year-old woman with heterotaxy, abdominal situs inversus, atrial fibrillation, and prior dual-chamber cardiac pacemaker implantation presented with New York Heart Association class III dyspnea and severe secondary mitral and tricuspid regurgitation. Preoperative imaging revealed a narrow left-sided inferior vena cava and persistent left superior vena cava. Minimally invasive multivalvular repair via right minithoracotomy was successfully performed using dual-site venous drainage. Conclusion:Tailored venous drainage based on detailed preoperative imaging enables safe minimally invasive surgery in patients with complex venous anatomy.
Background Metal hypersensitivity represents a rare but important challenge in cardiothoracic surgery, particularly during prosthesis selection for aortic valve replacement. Case Description A 63-year-old woman with critical bicuspid aortic stenosis and moderate left ventricular dysfunction was found to have severe hypersensitivity to multiple metal alloys, including nickel, palladium, and iridium. Following multidisciplinary evaluation, standard surgical aortic valve replacement was considered unsafe. A transfemoral transcatheter aortic valve implantation using a cobalt-chromium transcatheter valve was successfully performed without complications. Conclusion This case highlights the importance of individualized, multidisciplinary decision-making when managing patients with significant metal hypersensitivity.
This case report describes a 23-year-old male with a history of bicuspid aortic valve endocarditis managed with an emergency Ross procedure in 2020, whereby a xenograft pulmonary conduit prosthesis was implanted in the pulmonary position, followed by pulmonary conduit stenosis treated initially with high-pressure balloon dilatation 3 years later. The consequent diagnosis of iatrogenic aortopulmonary (AP) window, combined with severe recurrent pulmonary conduit stenosis, necessitated reoperation with right ventricle-to-pulmonary artery homograft replacement and repair of the AP shunt.
Background:Redo aortic interventions after failed transcatheter aortic valve replacement (TAVR) are challenging, particularly with low coronary heights and dense frame ingrowth. Case Description:An 83-year-old woman with prior TAVR developed severe prosthetic stenosis. Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) with implantation of a balloon-expandable aortic valve and intraoperative low-dose indocyanine green (ICG) near-infrared (NIR) angiography was performed. Real-time NIR imaging confirmed symmetric coronary opacification. The valve was well seated with improved ejection fraction (60-65%), and recovery was uneventful. Conclusion:SURPLUS with ICG-NIR angiography ensured coronary patency and safe hemodynamic restoration.
Background:Parachute mitral valve (PMV) is a rare congenital anomaly where all chordae tendineae insert into a single papillary muscle, causing stenosis or regurgitation. Adult presentations are uncommon and often underdiagnosed. Case Description:A 35-year-old male presented with exertional dyspnea. Echocardiography demonstrated severe mitral stenosis, reduced ejection fraction, a bicuspid aortic valve, and pulmonary hypertension. Intraoperative findings confirmed true PMV. Due to anatomical complexity, a 27-mm mechanical prosthesis replacement was performed successfully, with rapid postoperative recovery. Conclusion:Adult PMV requires high clinical suspicion and often surgical confirmation. Valve replacement is effective in complex cases, emphasizing the importance of early diagnosis and intervention.
Gastrointestinal bleeding (GIB) is the most common and potentially life-threatening bleeding complication in pediatric patients on left ventricular assist devices (LVAD), particularly under anticoagulation. We report a 13-year-old female with dilated cardiomyopathy on HeartMate 3 support who developed acute GIB after participating in a “Hot Chip Challenge,” consuming excessive spicy chips. The bleeding required blood transfusion and intensive management. This case highlights the potential impact of lifestyle factors, especially dietary choices, on GIB risk in pediatric LVAD patients.
Background:In patients on direct oral anticoagulants (DOAC), emergency surgery is characterized by the occurrence of a massively increased tendency to bleed. Currently, there is no approved antidote for postoperative patients, making specific therapy challenging in these situations. Case Description:Emergency surgery was required for a 72-year-old male patient who was in cardiogenic shock due to severe aortic regurgitation resulting from acute prosthetic valve endocarditis. Due to atrial fibrillation, the patient was on apixaban, a factor Xa (FXa) inhibitor anticoagulant, until surgery. We used the ADVanced Organ Support (ADVOS) albumin hemodialysis system postoperatively to treat persisting shock with multi-organ failure, acidosis, and DOAC removal. Serial drug-level measurements revealed strongly accelerated apixaban clearance. In line with this, we observed only moderate drainage losses. Conclusion:ADVOS accelerates the removal of apixaban and is a promising therapy for preventing bleeding complications in patients receiving DOAC therapy after emergency surgery.
Background Nutcracker Syndrome is a rare condition caused by compression of the left renal vein, often underdiagnosed in adolescents. Case Description We report a 16-year-old male with painful left testicular swelling and grade 3 varicocele. Imaging confirmed anterior Nutcracker Syndrome. He underwent successful left renal vein transposition with complete symptom resolution and normal imaging at 24 months. Conclusion Nutcracker Syndrome should be considered in young patients with varicocele and testicular pain. Renal vein transposition is a safe and effective treatment when conservative approaches fail, with long-term clinical and radiological benefits.
Background:Ectopia cordis (EC) is an exceptionally rare congenital anomaly with a poor prognosis, particularly in resource-limited settings. Case Description:We present a newborn with complete thoracic EC who underwent surgical correction on day 5 of life. Although cardiac repositioning and soft tissue coverage were achieved, the infant died 72 hours postoperatively from septic shock, reflecting the significant challenges faced in such contexts. Conclusion:This case underscores the urgent need for improved antenatal care and technical resources to enhance outcomes for complex congenital anomalies in sub-Saharan Africa.
Cardiogenic shock in the setting of a ruptured papillary muscle can be extremely challenging to manage. We report two cases of successful and safe hemodynamic optimization with a modern axial-flow temporary left ventricular assist device, the Impella 5.5, prior to mitral valve replacement for this indication.
Cardiomyopathy is the leading indication for transplantation in children. Mechanical cardiac support systems play a significant role in treating severe pediatric heart failure for cardiomyoptahy or myocarditis either for recovery or as bridge to transplant. In most cases of chronic heart failure extending over the acute inflammatory phase transplantation is necessary. Organ shortage results in a necessity for further treatment options in terminal heart failure. A new and controversially discussed approach to treat failing (left) ventricles includes pulmonary banding; In some observational studies pulmonary artery banding was performed in patients with severe (left) heart failure and adequate function of the right ventricle. The effect is postulated by improving the contra-lateral (left) ventricular function with intraventricular cross-talk and subsequent myocardial changes. Whereas selected patients may however benefit from PA banding with subsequent training of the left ventricle, nevertheless this strategy is controversially discussed. A 3-year-old girl with inflammatory myocarditis required left ventricular assist device (LVAD, Berlin Heart)) support. After repetitive weaning failure, pulmonary artery (PA) banding was performed during LVAD support that resulted in an improvement of the left ventricular function and finally LVAD explantation. Selected patients may benefit from PA banding with subsequent training of the left ventricle even in the setting of LVAD. This case here is the first reported case where PA banding was successful in the weaning process of a child on mechanical circulatory support (MCS). This principle of pulmonary banding to improve left ventricular function in severe heart failure can apparently also be applied to patients on left ventricular assist devices (LVAD).
Background:Congenital heart disease, repaired or unrepaired, requires lifelong follow-up. Carcinoid disease, rheumatic heart disease, and infective endocarditis can damage all four cardiac valves. Multiple valve replacement has a poor outcome. Case Description:A 23-year-old male underwent single-stage quadruple valve (mechanical [mitral and aortic] and bioprosthetic [tricuspid and pulmonary]) replacement due to rheumatic carditis and surgical complications. Over 8 years of follow-up, he is asymptomatic, has no prosthetic valve-related complications, and has improved cardiac function. Conclusion:Single-stage quadruple valve replacement with mechanical and bioprosthetic valves has a good long-term outcome. To the best of our knowledge, this is the longest follow-up study from India.
Vertebral artery fenestration (VAF) is a rare anatomical variation of the vertebral artery that may affect the safety of clinical surgeries and interventional treatments. Although ultrasound is widely used to assess neck vessels, its application in diagnosing VAF has not been extensively investigated. This article reports a case of an 82-year-old male patient who was diagnosed with VAF following a neck vessel ultrasound examination prompted by poor blood sugar control. The ultrasound revealed an abnormal course of the left vertebral artery, leading to the diagnosis of VAF. Ultrasound, with its noninvasive nature and real-time imaging capabilities, is a valuable initial screening tool for diagnosing VAF. Despite its limitations, its ability to identify vascular anomalies such as VAF highlights its critical role in early detection, potentially improving patient outcomes and guiding clinical decision-making.
Background:Abdominal aortic aneurysms frequently coincide with popliteal artery aneurysms. The association with multiple peripheral aneurysms, sometimes called polyaneurysmal disease, is less frequent. Case Description:An 82-year-old male was diagnosed with polyaneurysmal disease. He was treated by femoral, popliteal, and profundal interposition grafts as well as fenestrated endovascular repair (FEVAR) using an Anaconda (Terumo Aortic, Inchinnan, Scotland) endoprosthesis combined with BeGraft peripheral and BeFlared (BF) bridging stent grafts (Bentley InnoMed, Hechingen, Germany). Conclusion:Polyaneurysmal disease in an aged patient can be treated successfully by thorough case planning, staging of procedures, and combining different vascular surgical techniques. It demonstrates the smooth implantation of the BeFlared in an Anaconda FEVAR.
Background Neoaortic pseudoaneurysm after previous surgery is rare and life-threatening. Case Description We present a case of a 6th redo surgery in a 23-year-old male patient with a history of hypoplastic left heart syndrome presenting with transsternal penetration of aortic pseudoaneurysm. The previously implanted Dacron prosthesis showed semicircular dehiscence. It was exchanged by a Vascutek prosthesis during circulatory arrest and selective antegrade cerebral perfusion. Conclusion Control imaging at 1 year after surgery was unobtrusive. Three years after surgery, the patient is alive and doing well.
Background Cardiac myxomas are the most common primary cardiac neoplasms. Case Description We present a case of a middle-aged lady with cardiac myxoma in her left atrium awaiting semi-elective surgery. During the preoperative period, the patient presented emergently with acute bilateral lower limb ischemia. This lady was fortunate to have these emboli fired towards a tissue with ischemia tolerance capacity. If these emboli had been directed toward the central nervous system, this patient would have experienced devastating complications and even death. Conclusion This presentation opens the debate on the timing of surgical intervention in myxoma patients.
Background Minimally invasive lateral thoracotomies may cause severe postoperative pain and discomfort. We describe an intraoperative intercostal cryo-neuronal pain block as one possibility for postoperative pain relief. Case description A 63-year-old male patient underwent minimally invasive mitral valve repair. To reduce postoperative pain, an intercostal cryo-neuronal ablation was performed. The consecutive course was pain-free. Conclusion Intraoperative cryo-neuronal nerve block may be a standard procedure during minimally invasive cardiac surgery.
Dilated cardiomyopathy (DCM) is one of the main causes for end-stage heart failure. Until the transplantation, left ventricular assist devices (LVAD) have become an established treatment. We report a case of a 66-year-old patient with ischemic and DCM and suspected aortic ulcer formation. LVAD was implanted in the same session with a supracoronary aortic replacement. Bilateral cannulation of the subclavian arteries omitted the need of circulatory arrest and proximal aortic cross-clamping. Pneumonia-associated decarboxylation failure prolonged the postoperative intensive care period. The patient was finally discharged home on the 115(th) postoperative day.
