The aorta, once viewed as a passive conduit, is now recognized as an active organ crucial for hemodynamic regulation and vascular homeostasis. Thoracic aortic aneurysms (TAAs), particularly those involving the ascending aorta, often remain silent until life-threatening complications such as dissection or rupture occur. Current management primarily relies on aortic diameter criteria, yet up to 60% of type A dissections occur at sizes below the 5.5 cm surgical threshold, revealing the limitations of this approach. This narrative review summarizes recent advances in understanding ascending aortic aneurysms, including insights into their genetic and degenerative mechanisms, the role of novel morphological and hemodynamic markers, and the potential of advanced imaging techniques. It also explores evolving surgical strategies, from conventional open repair, still the gold standard, to minimally invasive and investigational endovascular approaches. By integrating biological, morphological, and clinical factors, emerging strategies aim to move beyond diameter alone toward more personalized risk assessment. This paradigm shift may improve early detection, optimize surgical timing, and ultimately enhance outcomes for patients with ascending aortic aneurysms.

The treatment of complex transposition of the great arteries with a ventricular septal defect and pulmonary stenosis/left outflow tract obstruction poses significant challenges. The decision between performing a Rastelli procedure, a Nikaidoh procedure or a double root rotation depends on the cardiac anatomy, especially the location of the ventricular septal defect, its spatial relationship with the great arteries, the presence of straddling of the atrioventricular valve and the appreciation of the pulmonary valve. In our centre, our goal is to provide the most physiologic repair tailored to each patient’s unique anatomy and to try to preserve the pulmonary valve in the pulmonary position, despite some degree of residual stenosis. We demonstrate three different surgical techniques adapted for various anatomies: one en bloc double root rotation, one double root translocation with separation of the roots and one modified Nikaidoh procedure.

Out-of-Hospital Cardiac Arrest (OHCA) is a rare but devastating event with an incidence of less than 10 cases per 100,000 population. We present a case of exercise-induced cardiac arrest in a previously healthy adolescent athlete, ultimately diagnosed with an anomalous origin of the left coronary artery. A 12-year-old athletic boy with no significant medical history experienced syncope at the finish line of a 3000-meter race. Initial assessment revealed severe hemodynamic instability progressing to cardiac arrest (bradycardic pulseless electrical activity) requiring cardiopulmonary resuscitation. Return of spontaneous circulation was achieved after 4 minutes. The patient subsequently developed acute pulmonary edema requiring emergency intubation. Cardiac computed tomographic angiography revealed an anomalous left coronary artery originating from the right coronary ostium with a malignant interarterial course. The patient underwent successful surgical reimplantation of the left coronary artery. He was discharged after 18 days with no neurological sequelae and subsequently returned to competitive sports with cardiologic clearance. This case highlights the importance of rapid emergency response and comprehensive diagnostic evaluation in young athletes presenting with exerciseinduced cardiac events. Anomalous coronary arteries should be considered in the differential diagnosis of exercise-related syncope or cardiac arrest in seemingly healthy young individuals.

Background: Tetralogy of Fallot is a congenital heart defect that requires early surgical correction. However, in developing countries, many patients undergo delayed treatment due to limited healthcare resources. This study aims to identify risk factors for postoperative complications in humanitarian patients undergoing late Tetralogy of Fallot repair, defined as surgery performed after 12 months of age. Methods: A retrospective analysis was conducted on 115 humanitarian paediatric patients with a median age of 1444 days (approximately 4 years) who underwent complete Tetralogy of Fallot correction. In this humanitarian programme, patients from developing nations underwent surgical repair at our tertiary referral centre in a high-resource country. Postoperative complications were monitored within the first 30 days after surgery. Two multivariable logistic regression models were used to analyse pre/perioperative (Model 1) and postoperative (Model 2) risk factors for complications. Results: Complications occurred in 24.3% of patients. No deaths were recorded. In Model 1, smaller pulmonary valve annulus (OR = 0.066; p < 0.01) and the use of right ventricle to pulmonary artery conduit (OR = 13.252; p < 0.01) were significantly associated with a higher risk of complications. In Model 2, prolonged invasive ventilation time (OR = 1.068; p < 0.01) and extended hospitalisation time (OR = 1.093; p = 0.04) were significantly associated with complications. Conclusions: Late surgical correction of Tetralogy of Fallot in humanitarian paediatric patients can be performed with low mortality but carries a significant risk of postoperative complications. The predictive models provide useful tools for proactive clinical monitoring, personalised management, and optimisation of hospital resources.

Coronary artery anomalies (CAAs) represent a rare but clinically significant group of congenital abnormalities, often implicated in sudden cardiac death among young individuals. Despite increasing recognition, standardized diagnostic and management pathways remain underdeveloped, particularly regarding surgical intervention. This narrative review aims to synthesize current evidence on the classification, pathophysiology, and contemporary treatment options for CAAs, with a specific focus on the surgical indications and guidelines. A systematic literature search was conducted through February 2025 across PubMed, Embase, Google Scholar, and UpToDate, using relevant MeSH terms and keywords related to coronary anomalies, sudden cardiac death, imaging modalities, and treatment strategies. Priority was given to high-level evidence including guidelines, systematic reviews, and large observational studies, in English and French. CAAs encompass a wide anatomical and clinical spectrum. Among these, anomalies of origin and course, such as anomalous aortic origin of a coronary artery (AAOCA), are now better defined and integrated into international guidelines, with surgical repair (e.g., unroofing, reimplantation, bypass) increasingly recommended in symptomatic patients or those with high-risk anatomical features. In contrast, anomalies like myocardial bridges, coronary artery fistulas, or ectasia remain controversial in both diagnosis and management, with inconsistent thresholds for medical versus surgical treatment. The variability in care stems from the lack of a unified classification system, limited prospective data, and underutilization or misinterpretation of imaging modalities such as coronary CT angiography and intravascular imaging. The management of coronary artery anomalies is evolving, particularly in the domain of surgical indications. Clear consensus exists only for select anomalies, leaving others subject to individualized, often non-standardized decisions. There is an urgent need for a harmonized diagnostic framework and outcome-based criteria to guide surgical and non-surgical interventions. A multidisciplinary, evidence-informed approach is essential to optimize outcomes and reduce the risk of sudden cardiac events.

Coronary artery anomalies (CAAs) are a rare but clinically significant group of congenital abnormalities that are associated with myocardial ischaemia, malignant arrhythmias and sudden cardiac death, particularly in young people and athletes. Despite increasing recognition of these conditions and advances in cardiovascular imaging, there are still significant challenges regarding their classification, risk stratification and management, particularly with respect to surgical indications. This review provides a comprehensive overview of the current evidence on the classification, pathophysiology, diagnosis and management of CAAs, with a particular focus on surgical decision-making and contemporary guideline recommendations. A systematic literature search was conducted up to February 2025 using PubMed and Google Scholar. Priority was given to international guidelines, consensus statements, systematic reviews, meta-analyses and large observational studies. CAAs encompass a broad spectrum of anatomical variants and clinical presentations. Among these, anomalies of coronary origin are the most extensively studied. Surgical management is well established for coronary arteries arising from the pulmonary artery, particularly for anomalous left coronary artery from the pulmonary artery (ALCAPA). Substantial advances have also been made in the diagnosis, risk stratification, and treatment of anomalous aortic origin of a coronary artery (AAOCA), which has become a major focus of contemporary guideline recommendations. For patients with AAOCA, surgical correction, including unroofing, coronary reimplantation or coronary artery bypass grafting, is recommended for individuals with symptoms and/or high-risk anatomical features. In contrast, the diagnosis and management of myocardial bridging, coronary artery fistulas, and coronary artery ectasia remain controversial, with considerable variability in the indications for medical, percutaneous, and surgical treatment. The management of CAAs is an evolving field. While there is consensus for a limited number of anomalies, most cases still require individualised decision-making. It is essential to develop standardised diagnostic frameworks, improved risk stratification tools and outcome-based management criteria. A multidisciplinary, evidence-based approach involving cardiologists, cardiac imagers, interventional cardiologists and cardiac surgeons is crucial in order to optimise patient outcomes and reduce the risk of adverse cardiovascular events, including sudden cardiac death.