Giant ascending aortic aneurysm after aortic valve replacement

Giant ascending aortic aneurysms are rare clinical entities and are accompanied by a high annual risk of rupture. We present the imaging, intraoperative, and pathology findings of such a case.     

Attempt at off-label balloon valvuloplasty post-dilation for intuity sutureless valve

Alternatives to traditional aortic valve replacement now form part of the valve surgeon's armamentarium. Sutureless valves offer decreased bypass and crossclamp times, excellent maneuverability, and promising outcomes. We present a case of a sutureless aortic valve replacement for a late failed David procedure, complicated by postoperative development of severe paravalvular regurgitation. We attempted off-label balloon post-dilation to improve expansion of the valve, however paravalvular regurgitation persisted. The patient underwent subsequent aortic valve replacement using a mechanical valve and experienced no further paravalvular leak.     

Placement of a rapid deployment aortic valve in a patient with severely calcified aortic root homograft

Significant aortic calcification is a known sequelae of homograft aortic root replacement and creates a treatment challenge if these patients require cardiac reintervention. The standard surgical option for patients requiring an aortic valve replacement in the setting of a calcified aortic homograft has been a Bentall procedure, which is high-risk with extended cross-clamp, cardiopulmonary bypass and operative times. We present a patient with a severely calcified aortic homograft who underwent successful valve replacement using a rapid deployment aortic valve leaving the aortic root and arch intact and avoiding the more extensive redo aortic root replacement. Similar cases in the literature are rare.     

How to perform a late explantation of a Sapien XT transcatheter aortic prosthesis

Starting as a therapeutically option for high-risk surgical patients with degenerative aortic valve stenosis, the transcatheter aortic valve implantation method is probably going to become the method of choice for this pathology also in younger and low-risk patients. As bioprosthesis are prone to degeneration, requiring a redo procedure, whenever a valve in valve procedure is contraindicated, a surgical valve replacement will become necessary. We describe a simple surgical method for explantation of a Sapien XT prosthesis that was implanted 7 years previously in a calcified aortic valve.     

Concomitant surgical aortic valve replacement with bilateral orthotopic lung transplantation

Concomitant cardiac surgery at the time of lung transplantation while uncommon has been shown to have acceptable morbidity and mortality. We present a case of a 66-year-old man with a history of interstitial pulmonary fibrosis with end-stage lung disease who presented with moderate aortic stenosis and severe aortic regurgitation. He underwent a bioprosthetic surgical aortic valve replacement at the time of bilateral orthotopic lung transplant and recovered without any major complications.     

Challenging corrective redo surgery in a patient presenting with severe aortic redilatation following an aortic root reduction aortoplasty with concomitant external wrapping

We report a case of severe long‐term failure of an aortic root reduction aortoplasty with external wrapping. The patient presented 13 years after the initial surgery with a large redilatation of the aortic root and major atrophy of the native aortic root wall inside the external wrap. This subsequently necessitated challenging corrective redo surgery with a Bentall procedure. This case highlights the potential long‐term risk of redilatation posed by using reduction aortoplasty with concomitant aortic external wrapping as a technique to treat largely aneurysmal aortic roots.     

Seismocardiography and 4D flow MRI reveal impact of aortic valve replacement on chest acceleration and aortic hemodynamics

Aortic valve replacement (AVR) is a common treatment for severe aortic valve disease, which can adversely affect blood flow in the aorta. Seismocardiography (SCG) measures physical vibrations at the exterior of the chest, which can be sensitive to altered cardiac function and flow dynamics. Magnetic resonance imaging (MRI) can image blood movement, and it can provide depiction and quantification of aortic flow. Here we present SCG and MRI measurements from before and after AVR and ascending aorta replacement, in the case of a woman with bicuspid aortic valve disease and a dilated ascending aorta. SCG measurements show elevated energy during systole indicating stenotic flow before surgery and lowered systolic energy levels after replacement with a prosthetic valve. MRI shows jetting, helical flow before surgery, and cohesive flow after.     

Surgical resection of the giant right coronary artery aneurysm

A 74‐year‐old man had undergone two‐vessel coronary artery bypass grafting (CABG), 19 years ago, with the left internal mammary artery (LITA) to the left anterior descending artery and the saphenous vein graft (SVG) to the posterior descending artery. In outpatient care, a thoracic aortic aneurysm was suspected by the chest X‐ray. In the computed tomography, appeared the distal arch aortic aneurysm, abdominal aortic aneurysm (AAA), and giant right coronary artery aneurysm (rCAA). The diameter of rCAA was 70 mm and it oppressed the right atrium and ventricle of the heart. The patient was referred to our hospital. After the initial treatment of distal arch aneurysm and AAA, surgical treatment for the rCAA was performed. The rCAA was resected completely and CABG with new SVG was performed without cardiopulmonary bypass. The histopathology of rCAA wall revealed that the etiology was an atherosclerotic change. The postoperative course was good, the oppressed right heart system was released and the hemodynamics of the tricuspid valve showed improvement.