Immunoglobulin G4-Related Aortitis and Severe Aortic Valve Stenosis Treated With Transcatheter Aortic Valve Replacement and Immunosuppression.

IgG4-related disease is an immune-mediated fibro-inflammatory disorder with multisystemic involvement. Aortitis and peri-aortitis are the most common cardiovascular manifestations of the disease. We present the case of a 65-year-old man with symptomatic severe aortic stenosis and concomitant IgG4 aortitis. The diagnosis was confirmed by IgG4 serum levels, positive positron emission computed tomography (PET-CT) scans, and pathology from mediastinal dissection. Surgical aortic valve replacement (SAVR) was unfeasible owing to extensive mediastinal fibrosis, and transcatheter aortic valve replacement (TAVR) was successfully performed. As ascending aorta access for SAVR in IgG4 aortitis with long-run fibrosis entails a high risk of mortality, TAVR could be considered in certain suitable patients.

Subxyphoid approach for closed-chest atrial fibrillation surgery: the one hand operation.

Although the classical Cox maze operation has been shown to be effective for curing atrial fibrillation, it is not popular due to its complexity and associated morbidity. This has led to the development of alternative methods for the creation of the Cox maze pattern. These methods are based on the creation of lines of tissue necrosis on the atrial tissue. These new methods have been shown to be equally as effective as the Cox maze operation. We describe a new technique for epicardial microwave atrial ablation for pulmonary vein isolation. This technique is performed on patients without sternotomy, through the subxyphoid process to reduce pulmonary complications.