Hidden in Plain Sight: Discovering Giant Cell Aortopathy During Surgical Mitral Valve Repair.

Giant cell arteritis (GCA) is an inflammatory cranial and/or extracranial vasculitis. Although cranial GCA is widely recognized, extracranial GCA is underdiagnosed because of its nonspecific and atypical presentations. We report a case of asymptomatic extracranial GCA with ascending thoracic aortopathy discovered incidentally during surgical mitral valve repair. (Level of Difficulty: Intermediate.).

First-in-Man Simultaneous Aortic and Mitral Valve Transcatheter Implantation Using Patient-Customized Prostheses.

Valve disease in the presence of porcelain aorta and severe peripheral artery disease challenge physicians in choosing the appropriate therapy. We used a total transcatheter approach, simultaneously implanting a dedicated mitral and aortic valve prosthesis treating a patient with mitral and aortic valve disease at an extremely high surgical risk. (Level of Difficulty: Advanced.).

Loop technique with ink-dot marking test: An alternative strategy to the ink test.

OBJECTIVE: We assessed the long-term outcomes of the loop technique with the ink-dot marking test, an alternative to the ink test for aligning the mitral valve (MV) leaflet height, during MV repair. METHODS: We retrospectively reviewed 351 patients who underwent MV repair with the loop technique via median sternotomy or right mini-thoracotomy. The ink-dot marking test involves creation of a dotted line between the rough and clear zones in the anterior leaflet and the center of the posterior leaflet by gentian violet. According to this marking, we adjusted the fixing position of the loops with or without the loop-in-loop technique and additional neochordal repair. RESULTS: This study involved 141 women and 210 men (mean age, 63.7 ± 13.0 years). Forty-one patients required additional adjustment after the ink-dot marking test. No significant differences were found in the need for second arrest between patients who did and did not require additional adjustment after the ink-dot marking test (3 vs 32 patients, P = .782). Predischarge transthoracic echocardiography showed trivial residual MV regurgitation (MR) in 285 patients, mild in 64, and moderate in 2. Ten patients needed reoperations (9 MV replacements and 1 MV re-repair) because of recurrent MR during postoperative follow-up. The 3-, 5-, and 10-year postoperative cumulative incidence of moderate to severe recurrent MR was 3.6%, 6.0%, and 19.8%, respectively. CONCLUSIONS: The loop technique with the ink-dot marking test provided good early and long-term results. This test may help to decrease residual MR, especially when using the loop technique.

Tragic End or Expected Destiny?: Pulmonary Edema Due to Sewing Ring Dehiscence of Bioprosthetic Mitral Valve.

The present case is unique because it describes transcatheter mitral valve replacement with a valve-in-valve procedure in an emergent setting of pulmonary edema and cardiogenic shock. Although transcatheter mitral valve replacement is in its initial phase, it remains a viable option in an emergency. Further research is needed to evaluate the short term and long-term outcomes. (Level of Difficulty: Beginner.).