Coral reef aorta (CRA) is characterized by dense, rock-hard intraluminal calcified plaques that can cause critical aortic stenosis or occlusion. We report the case of a 59-year-old man who presented with accelerated hypertension, acute decompensated heart failure, bilateral pleural effusions, acute kidney injury, adrenal insufficiency, and progressive inability to ambulate. Computed tomography angiography demonstrated a near-occlusive supraceliac CRA lesion with markedly reduced infraceliac aortic flow. The lesion was successfully treated with intravascular lithotripsy-assisted stenting, During the procedure, a partially deployed WALLSTENT (Boston Scientific) was used for temporary distal embolic protection. The postoperative course was uneventful, with resolution of heart failure, normalization of renal function, improvement in adrenal function, and reduction in antihypertensive requirements from four to two agents. The patient remained asymptomatic at the 6-month follow-up. This case suggests that endovascular management using intravascular lithotripsy-assisted stenting with temporary WALLSTENT-based embolic protection may be feasible for selected patients with complex supraceliac CRA.

Valvular heart disease (VHD) affects millions worldwide and remains a major cause of morbidity and mortality, placing a substantial and growing burden on healthcare systems. Over the past two decades, transcatheter therapies have emerged to meet this challenge, transforming the management of aortic, mitral, and tricuspid valve disease. Initially developed for inoperable or high-risk surgical patients, procedures such as transcatheter aortic valve implantation (TAVI) and mitral transcatheter edge-to-edge repair (M-TEER) are now routinely offered across a broader risk spectrum. More recently, tricuspid therapies, including tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter valve replacement (TTVR), have emerged to address a significant unmet clinical need. With transcatheter interventions becoming more widely available, clinicians across general and acute medical specialities are increasingly likely to encounter patients before and after these procedures. Familiarity with these therapies will support better decision-making and coordinated care. This review summarises the evolution of transcatheter valve therapy, its role alongside surgery, and the evidence supporting its use. Surgery remains the gold standard for younger or low-risk patients, particularly where long-term durability is essential. Transcatheter therapies now offer safe and effective treatment for older patients, including those with frailty or significant comorbidity, supported by landmark trials, which have demonstrated favourable clinical outcomes in carefully selected populations and underpinned guideline endorsement across risk categories. The importance of the multidisciplinary Heart Team is emphasised, ensuring treatment decisions reflect individual anatomy, comorbidity burden, life expectancy, and procedural risk. As device technology, imaging, and procedural expertise continue to advance, the integration of surgical and transcatheter approaches will support more individualised care and broaden access to definitive treatment for patients across the clinical spectrum.

Hearts change their wall thickness (concentric growth) and chamber size (eccentric growth) as they adapt to circulatory demands and the intrinsic function of their contractile cells. Factors associated with wall thickening include variants of sarcomeric proteins that enhance contractility, mitochondrial dysfunction, and hypertension. Chambers can dilate due to many factors including sarcomeric variants that depress contractility and aortic and / or mitral valve insufficiency. Despite intensive study, the mechanisms that regulate cardiac growth remain unclear. It is also uncertain whether inherited variants induce growth via the same mechanisms as more common clinical pathologies, such as hypertension. Here we show that computer simulations of a beating left ventricle reproduce both variant and non-variant-related growth patterns when myocytes grow concentrically to regulate intracellular ATP concentration and eccentrically to maintain titin-based intracellular stress. The simulations support the hypothesis that cardiac growth reflects homeostatic feedback through three interacting systems whereby myocytes add or remove mitochondria and sarcomeres (1) in parallel to match ATP generation to myocardial energy demand, and (2) in series to regulate passive tension, while (3) the autonomic nervous system regulates cardiac power, and thus myocardial ATPase, via baroreflex control. The new framework provides a mechanistic basis for the patterns of eccentric and concentric growth induced by a wide range of clinically-relevant conditions and could facilitate in silico testing of potential therapies for cardiac disease.

Crossed fused renal ectopia (CFRE) is a rare congenital anomaly in which one kidney crosses the midline and fuses with its contralateral counterpart due to abnormal migration during fetal development. Although often asymptomatic, associated anatomical variation may have important clinical and surgical implications. This report describes a rare CFRE Type E (L-shaped) identified during routine anatomical dissection. A 76-year-old male anatomical donor was found to have right-to-left renal ectopy with fusion at the inferior pole of the left kidney. The fused renal unit demonstrated complex vasculature, including five renal arteries and three renal veins with numerous tributaries. Two ureters were present with atypical positioning. The donor's medical history included hypertension, atrial flutter, hypothyroidism, and aortic insufficiency, with a self-reported history of bilateral pleural effusions, pneumonia, and renal cell carcinoma. While CFRE may not require intervention, the extent of vascular and ureteral variation observed in this case has direct implications for surgical planning, including nephrectomy, transplantation, and urologic procedures. Such variation may complicate intraoperative management if unrecognized. This case highlights a unique presentation of CFRE Type E with significant anatomical complexity. Recognition of such variants may improve diagnostic accuracy and surgical preparedness, and their inclusion in anatomical education may enhance clinical awareness among trainees.

We report a case of severe Kawasaki disease with giant coronary artery aneurysms, multiple systemic arterial aneurysms, and delayed-onset, independently progressive bivalvular insufficiency due to direct valvulitis. Despite controlled inflammation and favourable coronary evolution under immunosuppressive therapy, the patient required surgical valve repair. This case highlights the unpredictable nature of complex Kawasaki disease phenotypes and underscores the need for comprehensive vascular imaging and lifelong follow-up, as atypical features may lead to independent complications.

This systematic review and meta-analysis aimed to evaluate risk factors for acute kidney injury (AKI) after surgery for Stanford type A aortic dissection. We searched Web of Science, PubMed, Embase, Proquest, Cochrane Library, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature databases from inception to January 2026. A total of 58 case-control studies were included, assessed using the Newcastle-Ottawa Scale. Meta-analysis identified numerous significant perioperative factors. Key demographic and preoperative risk factors included age, body mass index, hypertension history, preoperative renal insufficiency, elevated cystatin C, lactate, serum creatinine, white blood cell count, and renal malperfusion, while a higher left ventricular ejection fraction was protective. Intraoperative factors such as prolonged cardiopulmonary bypass time, increased red blood cell transfusion, and total aortic arch replacement increased AKI risk, whereas higher intraoperative urine output was protective. Postoperatively, prolonged mechanical ventilation and acute respiratory insufficiency were also high-risk factors. In conclusion, multiple preoperative, intraoperative, and postoperative factors significantly influence AKI risk following Stanford type A aortic dissection surgery. Comprehensive perioperative assessment of these factors may help clinicians implement targeted management to reduce AKI incidence and improve patient outcomes.

Aortic insufficiency (AI) is a progressive complication of continuous-flow left ventricular assist device support and remains inconsistently graded during HeartMate 3 (HM3) therapy. Using a closed-loop cardiovascular simulation, we analyzed 2,312 physiologically screened HM3 profiles at pump speeds of 5,000 and 6,000 rpm to evaluate Doppler-based approaches for AI detection, defined by regurgitant fraction of greater than or equal to 30%. Established Doppler markers, including systolic-to-diastolic ratio (S/D), diastolic acceleration, and diastolic flow fraction (DFF), were compared with a derived Diastolic Dominance Index (DDI), which integrates systolic attenuation and diastolic predominance into a single metric. Systolic-to-diastolic ratio demonstrated strong discrimination (area under the receiver-operating characteristic curve [AUC]: 0.93 at 5,000 RPM; 0.86 at 6,000 RPM). Diastolic Dominance Index showed comparable performance (AUC: 0.87 and 0.83) and exhibited more stable discrimination across pump speeds, while providing a zero-centered index in which positive values indicate AI severity. Pump power alone was nondiagnostic, but in cases near the DDI decision boundary, it improved classification, achieving an AUC of 0.93 at 6,000 RPM. Simple rule-based combinations of DDI and power achieved greater than 90% accuracy at both speeds. By unifying established Doppler features into a single physiologic index and pairing it with an energetic adjudicator, this framework enables speed-robust, reproducible, and clinically interpretable AI grading during HM3 support. https://links.lww.com/ASAIO/B917.