Entrapment of an undeflated angioplasty balloon with subsequent shaft disruption is a rare, life-threatening complication of percutaneous coronary intervention (PCI). When percutaneous retrieval fails, emergency surgical extraction with concomitant revascularization may be the only lifesaving option. Shaft disruption of a non-deflating angioplasty balloon represents an exceptionally rare subset of PCI device entrapment, with only isolated cases reported in the literature. A 76-year-old hypertensive and diabetic woman presented with a 5-day history of exertional dyspnea, palpitations, and generalized fatigue. Diagnostic coronary angiography revealed triple-vessel coronary artery disease involving distal left main, proximal left anterior descending artery (LAD), ramus, left circumflex (LCx), and right coronary artery (RCA). She underwent multivessel PCI. LCx and ramus were stented uneventfully. During attempted LAD lesion preparation, the dilatation balloon failed to deflate; the distal tip collapsed while the proximal segment remained inflated; a stent was therefore never deployed in the LAD. Attempts to withdraw the balloon led to shaft fracture, with the partially inflated balloon retained in the LAD and guidewire fragment prolapsing into the aorta. Multiple retrieval maneuvers with fresh guidewires failed and hemodynamics deteriorated despite intra-aortic balloon pump (IABP) and dual inotropic support. Emergency surgery revealed hemorrhagic pericardial effusion and a hematoma along the proximal LAD. Under cardiopulmonary bypass (CPB), an oblique aortotomy exposed the guidewire exiting the left coronary ostium. The retained wire (≈25 cm) and inflated 2-cm balloon were extracted en bloc. Two reversed saphenous vein grafts (rSVGs) were placed to mid-LAD and posterior descending artery (PDA). The patient was weaned off bypass uneventfully and discharged on postoperative day 6. Entrapment of an undeflatable balloon during LAD PCI with shaft disruption is exceedingly rare. Early recognition, prompt surgical conversion, and complete revascularization are crucial for survival in this high-risk complication.

Hypertrophic obstructive cardiomyopathy is characterized by asymmetric septal hypertrophy and dynamic left ventricular outflow tract obstruction, often associated with systolic anterior motion of the mitral valve. In symptomatic patients who are not responders to medical therapy, surgical septal myectomy is considered the gold standard. We present a case of totally endoscopic transaortic septal myectomy performed in a symptomatic patient with severe left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve. Preoperative imaging demonstrated marked asymmetric septal hypertrophy, hyperdynamic ventricular function and significant outflow tract gradient. The procedure was performed using a totally endoscopic approach with femoro-femoral cardiopulmonary bypass and transthoracic aortic cross-clamping. After the pericardial opening and aortotomy, a transaortic septal myectomy was performed under three-dimensional endoscopic visualization. Intraoperative transoesophageal echocardiography confirmed resolution of systolic anterior motion and marked reduction of outflow tract obstruction. Postoperative transthoracic echocardiography demonstrated preserved ventricular function and absence of systolic anterior motion, and a peak gradient of 18 mmHg. This case highlights the feasibility and reproducibility of a totally endoscopic approach for septal myectomy, combining the effectiveness of conventional surgery with the advantages of a non-sternotomy technique.

Bicuspid aortic valve (BAV) is the most common congenital heart disease. It is often associated with aortic abnormalities and, more rarely, with coronary anomalies that may influence surgical strategy. We describe a 38-year-old patient with a Sievers type I BAV. Coronary CT angiography revealed an abnormally high proximal origin of the right coronary artery, with a 10 mm ectatic dilation at its origin followed by a return to normal caliber. This feature prompted a change in operative strategy: mechanical aortic valve replacement instead of a Ross procedure, more distal aortic clamping, and a «lazy-S» aortotomy. The procedure was completed without complications. Coronary anomalies are more frequent in patients with BAV than in the general population. Their preoperative identification is essential to prevent intraoperative complications. Multimodal imaging plays a key role in optimizing surgical planning in line with current recommendations. Coronary anomalies associated with BAV should be systematically screened for before any valve surgery. This case highlights the importance of thorough preoperative assessment and appropriate technical adaptation to ensure operative safety.

Cardiac surgery induces systemic stress responses that may compromise intestinal homeostasis in animal patients, yet the underlying mechanisms remain poorly understood. This study investigated postoperative intestinal pathophysiology in a porcine model, focusing on the activation of the NF-κB pathway and its impact on intestinal stem cell function. Thirty-two large white pigs (40-50 kg) were randomized into control and model groups; the model group underwent simulated cardiac procedures involving aortotomy and left ventricular outflow tract exposure under standardized anesthesia. Our findings revealed significant NF-κB pathway activation and upregulation of matrix metalloproteinases (MMPs) in the intestine following surgery. Intestinal stem cells isolated from crypts showed downregulated expression of key barrier proteins. Notably, organoids derived from the model group exhibited impaired early proliferative capacity and delayed morphogenesis, despite preserved differentiation potential upon extended culture. This suggests a stress-induced state that favors the maintenance of stemness over commitment to differentiation. These results delineate an NF-κB/MMP-mediated mechanism linking surgical stress to intestinal barrier dysfunction and stem cell dysregulation in this large animal model. Crucially, the study provides insights that may help improve perioperative care and reduce gastrointestinal complications in animal patients undergoing major surgeries, thereby enhancing animal welfare. The identified pathways offer potential targets for developing supportive therapies in veterinary practice.

Sutureless aortic valves, such as the Perceval (Corcym) valve, provide important procedural advantages and favorable mid- to long-term outcomes; however, potentially serious aortic complications related to their self-expanding stent structure remain incompletely understood. Thus, we report the case of an 85-year-old woman who developed early-onset localized ascending aortic dissection after aortic valve replacement with a sutureless valve. The entry tear was located at the level of the stent edge, slightly proximal to the aortotomy suture line, and the dissection extended only between these two points, suggesting a localized stent-aortic wall interaction with external mechanical stress as a potential trigger.

The double-patch-without-ventriculotomy technique represents a less aggressive surgical option for post-ischaemic ventricular septal defect (VSD). It allows repair without placing sutures in the ischaemic and perilesional frail tissue. VSD closure is obtained through two composite semirigid patches placed on both sides of the defect and kept together by two button-seam fashion sutures. The left patch must exceed the VSD maximum diameter by 2 cm, while the right patch can be 0.5 cm smaller. The technique requires a biventricular approach through transverse aortotomy and right atriotomy. A vessel loop is passed through the defect, helping the parachuting of the left side patch over the VSD. After positioning the left patch, the ends of the button-seam sutures are passed through the right patch. The right patch is then parachuted through the atriotomy, covering the VSD right side. Finally, both patches are tied together, and valvular and subvalvular apparatus checked for correct functioning.

Ruptured sinus of Valsalva aneurysm (RSVA) associated with ventricular septal defect (VSD) is a rare but clinically significant condition requiring surgical intervention. We report 2 cases of RSVA with concomitant infundibular VSD successfully treated using a totally endoscopic approach through an aortotomy alone. Both patients were young adults presenting with heart failure symptoms caused by left-to-right shunting. Patch repair of the sinus of Valsalva aneurysm and VSD closure were performed under totally endoscopic visualization. Postoperative echocardiography showed no residual shunt. Both patients were discharged uneventfully. Mild aortic regurgitation was observed but remained stable during mid-term follow-up. Totally endoscopic repair of RSVA associated with VSD could be a feasible option.

Surgery for radiation-associated valve disease is technically demanding due to challenging exposure, extensive calcification, and risk of paravalvular leak or atrioventricular groove disruption. An oblique aortotomy revealed heavy calcification extending to the aortomitral continuity, where only a 23 mm sizer could barely pass. The aortotomy was extended into the non-coronary sinus adjacent to the left-non commissure. An extended transseptal approach was employed and connected to the aortotomy. The anterior mitral leaflet was excised. From trigone to trigone, non-everting buttressed stitches were placed in the posterior annulus to avoid the mitral annular calcification. A 2-cm-wide felt strip collar, corresponding to the mitral annular calcification depth, was secured to a 31 mm mitral bioprosthesis with running polypropylene sutures. The valve stitches were passed through the felt strip, and after tying them down, a folded bovine pericardial patch was sewn to the anterior annulus of the mitral prosthesis using a running suture. One side of the patch was used to close the dome of the left atrium; the other side was used to close the aortotomy. A 27 mm aortic prosthesis was then easily implanted due to root enlargement. The aortotomy was closed, and the patient was weaned from cardiopulmonary bypass without difficulty.

Endovascular aneurysm repair (EVAR) is a treatment method that has become increasingly popular for abdominal aortic aneurysms (AAA) due to its ease of application, reduced hospital stay, and its suitability as an alternative for patients who cannot tolerate open surgery. Although the early outcomes of EVAR are better than those of open surgery, complications such as endoleak, migration, thrombosis or kinking of the endograft limbs, graft infection, and secondary rupture may occur. In this study, we present a patient who underwent EVAR at another institution approximately 10 years earlier and was admitted to our clinic with complaints of deterioration in general condition, fever, and melena. Laboratory examination of 73-year-old man revealed a white blood cell (WBC) count of 17,100, hemoglobin level of 9.5 g/dL, and C-reactive protein (CRP) level of 261 g/L. Computed tomography (CT) revealed thrombosis within the EVAR graft, free air surrounding the graft, fractures in the graft stents, and displacement of the right limb beyond the aorta at the level of the iliac bifurcation. The endograft was observed to have migrated toward the duodenum and formed a fistula. The pa-tient, who presented with sepsis, underwent emergency surgery. Initially, a left axillofemoral bypass was performed to relieve ischemia in the left leg. Subsequently, a laparotomy was performed with the joint participation of the general surgery and cardiovascular surgery departments. Intra-abdominal fecal contamination and rupture of the sigmoid colon were observed. The abdomen was lavaged, the sigmoid colon and rectum were excised, and a colostomy was created. An aortotomy was then performed, and the main body of the graft and its left limb were removed. The duodenum was opened, and the fistulized right limb of the endograft was also removed. No additional vascular intervention was required due to abdominal contamination, adequate collateral circulation in the right leg, likely due to the chronic nature of the process, and the absence of ischemia. The aorta was ligated at the infrarenal level, and the patient, who required high-dose inotropic support, was transferred to the intensive care unit. The patient died in the eighth postoperative hour. To our knowledge, this case represents a rare and unique complication that has not been previously reported in the literature. By presenting this case, we aim to draw attention to the long-term complications of EVAR and emphasize the importance of open surgery in patients with a high life expectancy.

Background: To describe an aortic arch incision and closure technique (AICT) for proximal fixation of a frozen elephant trunk (FET) and to report early outcomes. Methods: We retrospectively reviewed 15 consecutive patients who underwent distal arch repair with an FET using AICT (mean age 77 ± 7 years; 14 men). Indications were distal arch aneurysm (n = 12), acute Stanford type B dissection (n = 2), and distal arch enlargement after thoracic endovascular aortic repair (n = 1). Under circulatory arrest, an oblique arch aortotomy was created, the FET was deployed antegrade, trimmed, and sutured to the native aortic wall during simultaneous closure, allowing extended posterior fixation. Clinical outcomes and postoperative computed tomography were assessed. Results: No ischemic complications related to graft kinking or thrombosis, reoperation for bleeding, stroke, spinal cord ischemia, or organ failure occurred. One patient died of pneumonia on postoperative day 47 (6.7%). Cervical branch reconstruction was required in 12 patients (80%), whereas two patients with type III arch morphology and acute angulation were treated without debranching via a Zone 3 aortotomy. At a median follow-up of 29 months, no proximal endoleak was observed; one distal endoleak occurred without reintervention. Coronary bypass grafts remained patent in all patients with concomitant or prior CABG. Conclusions: AICT provided secure proximal FET fixation and arch closure while preserving the ascending aorta, offering an alternative to total arch replacement in selected distal arch pathologies.