Giant right coronary artery aneurysm: the saphenous vein bridge technique.

A giant coronary artery aneurysm is defined as an irreversible dilation that is 1.5-times more than the diameter of a healthy adjacent coronary artery. It is a rare disease with an incidence of 0.2% to 4.9%. Coronary artery aneurysms are usually corrected with a coronary artery bypass graft. We describe how to perform a saphenous vein bridge to repair a giant coronary artery aneurysm. When applicable, this technique allows sparing of the coronary artery ostia and restores the coronary anatomy.

[Simultaneous transcatheter transapical native mitral and aortic valve implantation]. / Sostituzione transcatetere transapicale simultanea delle valvole aortica e mitralica native.

Concomitant severe aortic and mitral stenosis in patients who are not candidates for traditional surgery is a complex scenario that becomes increasingly more common with population aging. While transcatheter aortic valve replacement (TAVR) has emerged as a new lifeline for patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement, transcatheter mitral valve replacement (TMVR) is still in the early clinical phase. TMVR can be an alternative to surgical valve replacement for high surgical risk patients with bioprosthetic mitral valves, annuloplasty rings, or severe mitral annular calcification (MAC). Despite the growing use of TMVR, left ventricular outflow tract obstruction remains a major challenge and a life-threatening complication of this procedure mostly among patients undergoing valve-in-MAC procedures. Preprocedural planning with imaging is essential in understanding and reducing the risk for these complications.We describe a case of simultaneous transcatheter double valve replacement into native valves from transapical access in a 77-year-old female patient with severe symptomatic aortic and mitral stenosis associated with MAC.

Primary hemangioma of the mitral valve: an unusual presentation.

Cardiac hemangiomas are rare tumors, the presence of these neoplasms in heart valves is an exceptional finding, mainly because of their histological features. Normally, transesophageal echocardiography is used to establish a diagnosis of cardiac tumor, though careful interpretation is needed to avoid diagnostic errors. Herein is described an unusual presentation of a primary hemangioma of the mitral valve which was diagnosed as a prolapsing left atrial myxoma. The patient underwent successful surgical excision of the neoplasm, followed by mitral valve repair.

Large left atrial myxoma with severe mitral regurgitation: the inverted T-shaped biatrial incision revisited.

Cardiac myxomas are primary cardiac tumors. In some cases of atrial myxoma, the standard left atriotomy alone does not enable safe tumor resection and easy access to the mitral valve. We report the cases of 2 patients with huge left atrial myxomas associated with severe mitral valve regurgitation who underwent an inverted T-shaped biatrial incision for tumor excision and mitral repair. This approach reduces tumor fragmentation and permits good mitral valve exposure.

Double papillary fibroelastoma of the aortic valve.

A case of asymptomatic aortic valve fibroelastoma was diagnosed by transthoracic and transesophageal echocardiography in a 77-year-old man. A 2nd tumor was found at surgery. Both fibroelastomas were removed surgically without aortic valve replacement. During surgical excision of a cardiac fibroelastoma, the entire area surrounding the lesion should be inspected carefully for additional lesions. Such lesions can be missed on echocardiographic evaluation.

Spontaneous acute coronary dissection after cocaine abuse in a young woman.

Spontaneous coronary artery dissection is an unusual trigger for acute coronary syndrome or sudden death, occurring more frequently in relatively young people and mainly in the female sex. The underlying mechanism is not completely understood, but predisposing factors may include metabolism and collagen synthesis disorders. The case of a 34-year-old woman who underwent coronary angiography for acute anterolateral myocardial ischemia after cocaine abuse is reported. Dissection of the left main trunk extending to both proximal descending anterior and circumflex arteries was detected and the patient was promptly and successfully managed with tirofiban hydrochloride infusion and urgent coronary artery bypass grafting.