Objective: The aim was to assess the long-term outcomes, safety, and durability of total endoscopic mitral valve repair for Barlow mitral valve disease. Methods: A retrospective analysis of 98 patients undergoing minimal invasive total endoscopic mitral valve repair for Barlow mitral valve disease was conducted between May 2009 and December 2023. A non-resectional repair approach using artificial neochordae and/or ring annuloplasty was performed. Clinical and echocardiographic follow-ups were completed. Rates per patient-years with 95% confidence intervals (CI) for all time-to-event outcomes were calculated. Results: The mean age was 59 ± 12, and 43% were female. Minimally invasive mitral valve repair was successfully performed in all 98 patients with no conversions to sternotomy or mitral valve replacement. There was no mitral valve-related reoperation during the hospital stay. Procedural safety was as follows: no in-hospital mortality, no stroke, and no perioperative myocardial infarction. The mean follow-up was 4.1 ± 3.1 years. Survival at seven years was 87% (95% CI 63% to 96%). Freedom from myocardial infarction, stroke, and congestive heart failure was 89% (95% CI 60% to 97%), 93% (95% CI 82% to 97%), and 100%, respectively. Recurrent mitral valve insufficiency at Grade ≥ 2 was diagnosed in n = 4 (4.1%) of cases. Conclusions: Minimally invasive mitral valve repair using a non-resectional technique for Barlow disease can be performed with a low complication rate. The total endoscopic approach is safe in the long term, with minimal risk of reoperation and recurrent mitral valve insufficiency.

Reverse Takotsubo syndrome (rTTS) is an acute cardiomyopathy characterized by prominent dysfunction in the basilar and mid-ventricular segments with apical hyperkinesis, often triggered by excessive stress hormone release. Sepsis can exacerbate this process. We present a unique case of a 27-year-old male with no chronic illnesses who developed sepsis-triggered rTTS resulting in cardiogenic shock. The initial presentation included nausea, vomiting, tachypnea, and fluctuating blood pressure. Laboratory findings revealed elevated cardiac and inflammatory markers, metabolic acidosis, and bacteremia caused by Staphylococcus aureus. Echocardiography showed an initial left ventricular ejection fraction (LVEF) of 45% with basal mid-ventricular hypokinesia and apical hyperkinesis, characteristic of rTTS. Coronary angiography excluded obstructive coronary artery disease. The patient developed cardiogenic shock (SCAI Stage D) requiring vasopressors and mechanical circulatory support with an Impella CP® device. Complications included acute kidney injury requiring renal replacement therapy and posterior reversible encephalopathy syndrome (PRES). With targeted antimicrobial therapy and supportive care, the patient's LVEF improved to 60-65%, and he made a significant clinical recovery. This case highlights the importance of recognizing sepsis as a trigger for rTTS and the potential for full recovery with prompt, aggressive management, including mechanical circulatory support.

Reverse Takotsubo syndrome (rTTS) is an acute cardiomyopathy characterized by prominent dysfunction in the basilar and mid-ventricular segments with apical hyperkinesis, often triggered by excessive stress hormone release. Sepsis can exacerbate this process. We present a unique case of a 27-year-old male with no chronic illnesses who developed sepsis-triggered rTTS resulting in cardiogenic shock. The initial presentation included nausea, vomiting, tachypnea, and fluctuating blood pressure. Laboratory findings revealed elevated cardiac and inflammatory markers, metabolic acidosis, and bacteremia caused by Staphylococcus aureus. Echocardiography showed an initial left ventricular ejection fraction (LVEF) of 45% with basal mid-ventricular hypokinesia and apical hyperkinesis, characteristic of rTTS. Coronary angiography excluded obstructive coronary artery disease. The patient developed cardiogenic shock (SCAI Stage D) requiring vasopressors and mechanical circulatory support with an Impella CP® device. Complications included acute kidney injury requiring renal replacement therapy and posterior reversible encephalopathy syndrome (PRES). With targeted antimicrobial therapy and supportive care, the patient's LVEF improved to 60-65%, and he made a significant clinical recovery. This case highlights the importance of recognizing sepsis as a trigger for rTTS and the potential for full recovery with prompt, aggressive management, including mechanical circulatory support.

Coronary artery bypass grafting is frequently performed in combination with valve surgery; however, minimally invasive approaches for such combined procedures remain limited due to challenges in exposure and access. While bilateral minimally invasive strategies have been described in selected cases, standardized access concepts for concomitant procedures are not well defined. This study aimed to assess the anatomical accessibility and procedural workflow of a minimally invasive biaxillary access strategy for combined coronary and valve surgery in a human cadaver model. Combined coronary artery bypass grafting and valve procedures were performed in nine Thiel/ethanol-fixed human cadavers using a biaxillary access approach. Anatomical exposure, conduit length, graft harvesting and anastomosis times, and valve positioning were evaluated by macroscopic inspection and postprocedural three-dimensional computed tomography imaging. All planned procedural steps were completed in all nine cadavers. The mean left and right internal thoracic artery lengths were 18.1 ± 1.8 cm and 18.9 ± 1.9 cm, respectively. The average bilateral internal thoracic artery harvest and anastomosis times were 52.0 ± 17.6 min and 46.6 ± 12.6 min, respectively. Postprocedural three-dimensional computed tomography imaging and macroscopic inspection demonstrated consistent graft positioning and anatomical valve seating across all specimens. This cadaveric study demonstrates that a minimally invasive biaxillary access strategy allows anatomical exposure and supports a conceptual procedural workflow for combined coronary and valve interventions. These findings represent an early-stage technical proof-of-concept and require further validation before clinical application can be considered.

Echinococcosis classifies as a helminthic zoonosis affecting more than 3 million people. The outcome depends on the affected organ and implicated structures, with a lack of treatment in the long-term resulting in up to 90% of patients dying; even after treatment, the overall lifespan is reduced by 1–2 years. Postoperative death can reach as high as 2.2% if E. granulosum cysts are involved with organs other than the liver and lungs, which are considered very rare. This case aims to document this unique and personalized surgical approach for this rare presentation of splenic hydatid cysts. We present the case of a 43-year-old white female patient of Central European (Swiss) ethnic background who presented with an Echinococcus infection of the spleen. Following a biking accident, a chest x-ray incidentally revealed a solitary hydatid cyst in the spleen, characterized by extensive plate-like wall calcifications and measuring over 8-cm in length. The unilocular characteristics with a thick wall presence in combination with a high degree of calcification, absence of daughter cysts, positive serum markers are characteristic of a type V hydatid cyst (Gharbi classification)/CE5m (World Health Organization–Informal Working Group on Echinococcosis classification). With guidelines lacking a diagnostic and preoperative investigation pathway for splenic involvement, we conducted a full series with three dimensional reconstruction in computed tomography and magnetic resonance imaging of the anatomical relationship between the hydatid cyst and surrounding parenchymatous organs. Owing to chronic inflammation, extensive adhesions, and a cyst twice the size of the spleen with close localization to the hilum, an open surgical approach was conducted. The risk of spontaneous rupture and anaphylactic shock, especially with likely prior hemorrhage, further supported this decision. To minimize recurrence and complications, total pericystectomy with splenectomy was performed. Perioperative immunization was ensured to prevent overwhelming postsplenectomy infection. After 6 weeks of preoperative albendazole therapy, total splenectomy in hydatid cyst infestation offers the advantage of reduced intraoperative risk and lower recurrence rate. A follow-up 1 month, and 4 month postintervention including clinical evaluation, imaging, and laboratory findings were inconspicuous, revealing no need for further intervention. Thus far, only consensus among experts can be retrieved when making decisions regarding the treatment of splenic involvement of hydatid cysts. This unique case of successful cyst removal via total splenectomy, with an uncomplicated postoperative course, contributes to the development of treatment guidelines for splenic hydatid cysts. The Valais region should be recognized as an additional risk factor for echinococcal infection, particularly owing to the consumption of wild berries and contaminated food or water. Given the chronic inflammation, potential adhesions, and cyst size—twice the size of the spleen—an open surgical approach was deemed necessary. The risk of hemorrhage and spontaneous rupture further justified surgical excision to minimize recurrence and complications. Adequate perioperative immunization was implemented to prevent overwhelming postsplenectomy infection. Although hepatic hydatid cyst management is well-established, splenic involvement requires a patient-centered, organ-specific approach owing to unique anatomical and immunological considerations.