Arterial switch operation (ASO) has been the standard anatomic repair for D-transposition of the great arteries (d-TGA) since Jatene et al. first described it in 1975. While survival is excellent, some patients develop late complications requiring reoperation, including neo-aortic regurgitation (neo-AR) and root dilatation (ARD). Mechanisms of neo-AR are multifactorial, and management depends on whether the pathology is leaflet- or root-driven. When neo-AR is secondary to ARD, options include valve-sparing root replacement (VSRR) or composite root replacement (Bentall procedure) using either a mechanical or a bioprosthetic valve. In cases of isolated neo-AR without significant ARD, valve repair with annular stabilization can be considered. Alternatively, such cases may be managed with the Ross procedure, first described as 'Switch-Back Ross' by Hazekamp et al., although this approach remains less commonly employed. The specific surgical choice should integrate anatomy, physiology, and patient-specific factors within a shared decision-making framework. This review focuses on the Ross procedure after ASO, with emphasis on operative pearls, expected complications, and durability considerations. We illustrate these principles through the case of a 19-year-old man, late after ASO, who presented with severe neo-AR and mild ARD. He underwent a 'supported' Ross with external annuloplasty and recovered uneventfully. This case underscores the feasibility of the Ross procedure when valve repair is nondurable and emphasizes annular stabilization as key to long-term success, contributing to the limited literature on this approach in post-ASO patients.

Tricuspid regurgitation, associated with poor functional status and reduced survival, is common in patients with rheumatic heart disease after left-sided valve replacement. Although repair is preferred over replacement, surgical repair remains technically challenging. A 60-year-old woman presented with recurrent bilateral leg oedema for 2 years and dizziness with palpitations for 2 months. She had undergone mechanical mitral and aortic valve replacement 18 years earlier for rheumatic heart disease. Echocardiography demonstrated severe central tricuspid regurgitation with preserved prosthetic valve function and atrial arrhythmia. Via median sternotomy and cardiopulmonary bypass, classic rheumatic pathology of the tricuspid valve was identified. Repair consisted of detachment of the anterior and posterior leaflets, augmentation with an annuloplasty-shaped bovine pericardial patch to increase leaflet height and coaptation, and implantation of a partial rigid annuloplasty ring slightly smaller than the patch. Intra-operative echocardiography showed trace residual tricuspid regurgitation. Recovery was uneventful, with early resolution of oedema. Leaflet augmentation combined with partial ring annuloplasty is a simple and reproducible technique that restores early valve competence in complex rheumatic tricuspid regurgitation. Long-term follow-up is required to confirm durability.

We report the case of a 72-year-old woman with a HeartMate III left ventricular assist device who developed severe aortic regurgitation and New York Heart Association Class III symptoms. Given her high surgical risk and the presence of a small aortic annulus (mean diameter 18.4 mm), transfemoral transcatheter aortic valve replacement was performed using a 26-mm Evolut PRO+ self-expanding valve under transesophageal echocardiographic guidance. Temporary reduction of left ventricular assist device (LVAD) speed prevented ventricular migration during deployment. The procedure resulted in complete resolution of regurgitation without complications. This case demonstrates the feasibility and safety of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic regurgitation in patients with LVADs and small annuli, when meticulous pre-procedural planning and careful intraoperative management are employed.

The global burden of heart failure continues to increase, with left ventricular assist devices (LVADs) representing a critical therapeutic option for advanced heart failure. The third-generation HeartMate 3, utilizing magnetically levitated centrifugal pump technology, has achieved significant improvements in survival rates and reduced hemocompatibility-related adverse events. However, substantial challenges persist, including driveline infection, aortic insufficiency, right ventricular failure, thromboembolic and bleeding events, and quality-of-life constraints.

Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology's safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications-including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)-occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency.

We describe a young patient with incomplete quadricuspid aortic valve, poor medication adherence, and multiple dental caries. Aortic valve repair was selected over replacement and successfully performed by tricuspidization, folding the accessory cusp toward the commissure between the right and noncoronary cusps while preserving the raphe. The postoperative course was uneventful, and mild aortic insufficiency persisted without progression at 2 years.

Mucolipidosis III gamma (ML IIIγ) is a slowly progressive inborn error of metabolism mainly affecting skeletal, joint, and connective tissues. Clinical onset is in early childhood; the progressive course results in severe functional impairment and significant morbidity from chronic pain. Cardiorespiratory complications (restrictive lung disease from thoracic involvement and thickening and insufficiency of the mitral and aortic valves) are rarely clinically significant. Motor milestones can be affected due to joint disease. A few (probably <5%) affected individuals display mild cognitive impairment.