Pregnancy- and juvenile-associated osteoporosis is a rare condition that may lead to pathological fractures and severe vertebral deformities throughout life. We present the case of an 84-year-old female with a history of osteoporosis, diagnosed by dual-energy X-ray absorptiometry (DXA) during her first pregnancy. Over a period of more than six decades, she sustained multiple osteoporotic vertebral compression fractures of the T12, L1, and L3 vertebral bodies, leading to progressive kyphoscoliosis and significant loss of height. During routine follow-up for chronic obstructive pulmonary disease, a computed tomography scan requested by the Pulmonology Department revealed marked elongation and deviation of the thoracoabdominal aorta secondary to the underlying spinal deformity. Given these findings, the patient was referred to the Angiology Department for further evaluation. This case highlights a rarely described interaction between long-standing musculoskeletal deformities and vascular anatomy, particularly involving displacement and remodeling of major vessels such as the aorta. These findings emphasize the importance of cross-sectional imaging and a multidisciplinary approach in the assessment of complex chronic conditions with multisystem involvement.

This case study reports on a 43-year-old man with a history of mitral and aortic valve replacements, who presented with worsening dyspnea, palpitations, chest pain, and vertigo. Despite stable vital signs and fluoroscopy, imaging revealed large, mobile masses near the mitral valve, likely indicating left atrial myxomas causing mechanical obstruction. Urgent CT scans ruled out embolism, and surgical intervention was performed, revealing two sizable tumoral masses attached to the left atrium. Preoperative coronary angiography showed normal coronary arteries. This case underscores the importance of comprehensive diagnostic evaluation and a multidisciplinary approach in managing complex cardiac conditions, particularly in patients with previous valve replacements.

Takayasu arteritis (TA) is a form of vasculitis that primarily affects the large arteries of the body. Involvement of the coronary arteries is uncommon, whereas cardiac myxomas are benign growths within the heart that can cause problems by embolization or by obstruction. Both diseases are rare, and coexistence of both is exceptionally uncommon. An 84-year-old man with a 30-year history of TA (type V) on low-dose prednisone and weekly methotrexate was found to have a large left atrial myxoma in addition to diffuse coronary aneurysms on routine follow-up. The increased inflammatory markers, erythrocyte sedimentation rate (ESR) 52 mm/h and C-reactive protein (CRP) 18 mg/L, and magnetic resonance imaging (MRI) of the thoracic aorta (wall thickening with mural enhancement of the ascending aorta and arch) confirmed active vasculitis. His modified National Institutes of Health (NIH) score was 5 (active TA). Echocardiography revealed a mass, measuring 3.5 × 3.0 cm in size, arising from the left atrium. The mass caused mild mitral inflow obstruction resulting in a mean transmitral gradient of 3.5 mmHg across the valve and mild to moderate regurgitation. The estimated pulmonary artery pressure was mildly elevated at 34 mmHg. The patient was, however, asymptomatic and had a good functional status. The coronary arteries were significantly dilated. The left anterior descending (LAD) artery was chronically occluded, and the right coronary artery (RCA) was dilated, forming a huge aneurysm. Given the patient's age, any surgical approach would be associated with prohibitive risk. Thus, management of the coronary artery abnormalities in this patient with active TA consisted of immunosuppressive therapy, anticoagulation, and guideline-directed medical therapy (GDMT) for hyperlipidemia. This case highlights the importance of a comprehensive inflammatory and hemodynamic assessment of the patient with TA before any surgical intervention can be considered. In an elderly patient with active disease and in stable hemodynamic condition, even a large, mobile atrial myxoma with mild hemodynamic impact may be managed conservatively with anticoagulation and close surveillance when surgical risk is prohibitive.

Background: Coarctation of the aorta (CoA) is a congenital narrowing of the aortic isthmus near the ductus arteriosus or ligamentum arteriosum. Despite successful anatomical repair, patients remain at risk of recoarctation, arterial hypertension, and diffuse aortopathy, suggesting intrinsic vessel-wall abnormalities beyond localized obstruction. The developmental and molecular basis of these persistent vascular features remains incompletely understood. Methods: Human aortic tissue samples were obtained from 8 male infants with CoA and 6 age- and sex-matched controls aged <1 year. Total RNA was isolated, and gene expression profiling was performed using whole human genome oligo microarrays (Agilent). Differentially expressed transcripts were subjected to pathway, network, and upstream regulator analyses using Ingenuity Pathway Analysis (IPA, Qiagen). Selected candidate genes were evaluated by RT-qPCR in independent verification sets. Results: Transcriptomic profiling identified 402 analysis-ready transcripts distinguishing CoA from control tissue. Exploratory pathway analyses suggested extracellular matrix remodeling characterized by collagen turnover, integrin-mediated cell-matrix interactions, wound-healing signaling, and fibrosis-associated programs. In addition, enrichment analyses identified developmental annotations involving retinoic acid (RA)/RAR/RXR signaling, HOX-associated developmental programs, and a shared HOX/MEIS-associated signature. Network and upstream regulator analyses further suggested associations with cytoskeletal, muscle-associated, and epigenetic regulatory pathways, including KAT6A, KAT6B, retinoic acid/RAR/RXR signaling, DNMT3B, KMT2A, and ARID1A. RT-qPCR independently confirmed increased expression of EDN1, AGTR2, IRS4, and TFAP2B.Conclusions: Infantile CoA tissue exhibited molecular signatures consistent with vessel-wall remodeling accompanied by developmental, vascular signaling, and smooth muscle/cytoskeletal regulatory programs. These findings support the hypothesis that developmental patterning signals and postnatal extracellular matrix remodeling coexist within CoA tissue and may contribute to persistent vascular abnormalities beyond anatomical repair. Given the exploratory nature of the study, these observations should be considered hypothesis-generating and require validation in independent cohorts.

Introduction: Giant sinus of Valsalva aneurysms (SVA) represent a rare cardiovascular pathology that may remain asymptomatic for an extended period. However, they are associated with a high risk of life-threatening complications, including compression of adjacent structures and aneurysm rupture. Case presentation: We report a clinical case of a 71-year-old female patient with a long-standing history of arterial hypertension and cardiac arrhythmias, in which echocardiography revealed aneurysmal dilatation of the right coronary sinus. Cardiac computed tomography (CT) confirmed the presence of a giant aneurysm of the right sinus of Valsalva measuring 70 × 51 × 49 mm, compressing the outflow tracts of both ventricles (right-up to 7 mm, left-up to 8 mm) and the left inferior pulmonary vein (up to 3 mm), which clinically manifested as dyspnoea, lower-extremity oedema, and rhythm disturbances. The patient successfully underwent complex reconstructive surgery, including aortic root replacement and valve repair. Despite the technical success of the operation, the patient died from pneumonia three months postoperatively. Discussion: This observation underscores the critical role of imaging modalities (echocardiography and CT) in verifying this pathology. The use of multimodal imaging facilitated both a timely diagnosis and a detailed three-dimensional evaluation of the aneurysm's relationship with adjacent structures. This information, in turn, guided personalised surgical planning. Conclusions: This case highlights the necessity of considering giant SVA in the differential diagnostic workup of patients who present with unexplained symptoms of heart failure.

A child with genetically confirmed Williams-Beuren syndrome, having moderate supravalvular aortic stenosis, was diagnosed with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a rarely described combination. This coexistence created competing physiological stress on coronary perfusion as myocardial oxygen delivery to the left ventricle depended on right coronary collateral circulation in the presence of fixed left ventricular outflow obstruction. The child underwent combined surgical repair with reimplantation of the left coronary artery into the aorta and supravalvular aortoplasty. Anaesthesia was induced gradually to avoid abrupt haemodynamic changes, invasive monitoring was established early, and ventilation was adjusted to maintain normocapnia and moderate oxygenation to limit factors that could aggravate coronary steal physiology. The child was separated from bypass on minimal inotropic support and had an uneventful postoperative recovery. This case illustrates the relevance of controlled induction, meticulous haemodynamic balance and coordinated team management for a successful outcome in such a complex case.

Failure to wean from cardiopulmonary bypass (CPB) is a rare but critical intraoperative challenge. Common causes include residual structural defects (causing intracardiac shunting, prosthetic valve leaks), left ventricle outflow tract obstruction, ventricular dysfunction, or vasoplegic syndrome. We present the case of a 56-year-old man with severe aortic stenosis who underwent surgical aortic valve replacement. Separation from CPB failed repeatedly due to acute right ventricular dysfunction detected on transesophageal echo. The patient was found to have a congenital anomalous high origin of the right coronary artery (RCA), likely compromised during surgery. Timely recognition and surgical revascularization of the RCA with a saphenous vein graft restored right ventricular function and facilitated successful weaning. This case highlights the importance of intraoperative echocardiography, awareness of anomalous coronary anatomy, and prompt multidisciplinary decision-making in managing difficult separation from CPB.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a diagnostic challenge with multiple underlying mechanisms, including coronary embolism. We report the case of a 50-year-old woman with a history of rheumatic fever who was admitted for acute chest pain. Electrocardiography showed atrial fibrillation with inferolateral ischemic changes, and elevated troponin levels confirmed myocardial infarction. Transthoracic echocardiography revealed moderate mitral stenosis, severe aortic stenosis, and left atrial enlargement. Coronary angiography demonstrated thrombotic occlusion of the second obtuse marginal branch without significant atherosclerotic disease. Transesophageal echocardiography identified a left atrial appendage thrombus, supporting a cardioembolic mechanism. This case emphasizes the importance of considering coronary embolism in MINOCA, particularly in patients with valvular atrial fibrillation, and highlights the role of a structured diagnostic approach in guiding diagnosis and management.

Severe aortic stenosis (AS) carries a poor prognosis when symptomatic, particularly in cardiogenic shock (CS). Emergency transcatheter aortic valve replacement (TAVR) is rarely performed but may represent a rescue therapy. Coexistent carotid artery stenosis (CAS) further increases procedural risk. We report the case of an 83-year-old female patient with severe AS and beginning CS. Imaging revealed severe right internal CAS and occlusion of the left internal carotid artery. Despite the use of norepinephrine, the patient progressed to deteriorating CS with acute kidney injury and impaired mental status. Given high surgical risk, a combined strategy was performed: right carotid stenting followed by transfemoral TAVR. Post-procedure, renal replacement therapy was initiated with rapid recovery of renal function. The patient was hemodynamically stabilized and discharged 14 days after the procedure with normalized ventricular function and a well-functioning prosthesis. This case illustrates the feasibility of consecutive transfemoral TAVR and interventional revascularization of CAS as life-saving rescue therapy in severe AS complicated by CS and cerebrovascular disease (CVD). A combined interventional approach addressing both CVD and valve obstruction enabled procedural safety and favorable recovery, supporting TAVR as a viable option in selected high-risk patients.