We report the case of a 9-year-old male with severe congenital pulmonary valve stenosis referred to our centre for percutaneous valvotomy. On admission, trans-thoracic echocardiogram confirmed a unicuspid pulmonary valve with a peak/mean pulmonary valve gradient of 91/53 mmHg and a pulmonary annulus of 13.8 mm (−0.8 Z Score). It also showed an enlarged RV (RV/LV ratio 0,9). During cardiac catheterisation, an additional atrial septal defect (secundum) with significant left to right shunt (Qp/Qs > 2) was diagnosed, which was not amenable to percutaneous closure. The patient was referred for surgical repair.The atrial septal defect was closed by a direct running suture. The repair of the unicuspid valve consisted in bicuspidisation by a large commissurotomy to the left anterior wall of the pulmonary artery. The neo-commissure was created with two separate patches of autologous pericardium secured to the wall of the pulmonary root. The adjustment of the effective height of the pulmonary valve leaflets was done by trimming the patches and a triangular plication of the newly created posterior leaflet. Perioperative echocardiogram showed a peak gradient of 15 mm Hg and trivial pulmonary regurgitation. The total cross-clamp time was 92 min and the bypass time 123 min with a favourable evolution after the surgery.The particularity of the case is represented by the complexity of the bicuspidisation procedure. Using this technique, a tailored approach is needed for every patient.

Background: Cardiac erosion after transcatheter closure of secundum atrial septal defect (ASD) is a rare (0.1–0.3%) but potentially life-threatening complication. Available evidence remains limited to isolated case reports and small case series. Methods: A case-based review was conducted in accordance with CABARET recommendations. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through January 2026. Adult cases with anatomically confirmed aortic or aorto-atrial erosion after transcatheter closure of a secundum ASD were included. Clinical, anatomical, procedural, imaging, management, and outcome data were synthesized descriptively. An illustrative case with aorto-atrial erosion was included. Results: A total of 40 cases, including the present case, were identified. Median age was 39.5 years, and 27 were female. Chest pain was the most common symptom, reported in 16 cases, whereas six patients were asymptomatic at diagnosis. Median time to erosion was 81 days (range, 0.25–4745 days). A deficient rim was reported in 22 patients, and device oversizing in 17 patients. All erosions involved the aortic wall, most frequently at the atrial roof adjacent to the non-coronary sinus. Aorta-right atrial and aorta-left atrial were the predominant anatomical patterns, reported in 21 and 14 patients, respectively. Surgical intervention was required in 36 cases, which consisted of device explantation with atrial and/or aortic repair. Conclusions: Aortic and aorto-atrial erosion after transcatheter secundum ASD closure is an uncommon but severe complication with heterogeneous clinical presentation and timing. Among published erosion cases, female sex, a deficient retro-aortic rim, device oversizing, and mild aortic root dilation were recurrent characteristics. Careful anatomical assessment, multimodality imaging, and continued follow-up remain essential for early recognition of cardiac erosions.

Background and Objectives: Totally endoscopic aortic valve replacement (TE-AVR) is a minimally invasive technique offering potential benefits of reduced surgical trauma and faster recovery compared with median sternotomy or other minimally invasive access. While isolated aortic valve replacement (AVR) is well established through conventional and minimally invasive access, large-scale evidence for the totally endoscopic approach remains limited. This meta-analysis aimed to systematically assess the safety and feasibility of TE-AVR by aggregating perioperative outcomes, including mortality, stroke, conversion, bleeding, paravalvular leak (PVL), and atrial fibrillation (AF). Materials and Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed, following PRISMA 2020 guidelines. Observational studies and randomized controlled trials reporting outcomes of totally endoscopic or thoracoscopic AVR were eligible. After independent screening and selection, data were analyzed using a single-arm proportion model. Leave-one-out sensitivity analyses were performed to evaluate the influence of individual studies. The protocol was registered in PROSPERO (CRD42024610128). Results: A total of 11 studies comprising 1135 patients were included. The pooled perioperative mortality was 0.00% (95% CI 0.00–0.23; I² = 0.0%), indicating highly consistent results across cohorts. The stroke incidence was 0.69% (95% CI 0.00–2.07; I² = 42.7%), confirming the low cerebrovascular risk of this approach. Conversion to sternotomy occurred in 0.00% of cases (95% CI 0.00–0.17; I² = 0.0%), with no statistical heterogeneity observed. Reintervention for bleeding occurred in 1.75% (95% CI 0.34–3.85; I² = 43.4%), while PVL was reported in 1.24% (95% CI 0.00–4.22; I² = 64.0%). AF incidence was 10.54% (95% CI 3.79–19.70; I² = 90.5%), with substantial between-study heterogeneity, likely related to non-standardized definitions of new-onset AF and variability in postoperative rhythm monitoring and reporting across studies. Conclusions: TE-AVR is a safe and feasible technique associated with very low perioperative mortality, bleeding, and stroke rates, as well as low PVL incidence. The absent conversion rate in our pooled analysis highlights the technical reliability of the procedure. Variability in AF reporting underscores the need for future randomized studies with harmonized definitions. Overall, TE-AVR offers a promising minimally invasive alternative for aortic valve replacement, with potential advantages in recovery (pooled ICU stay 1.86 days), hospital stay (pooled 7.98 days), and aesthetic outcomes.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide

We report the case of a 39-year-old pregnant woman with a history of drug abuse who was admitted to the cardiology department with a diagnosis of tricuspid valve endocarditis. After the multidisciplinary team decided on a conservative treatment with antibiotherapy, the pregnancy was closely monitored. After 4 weeks of treatment, the patient developed extreme thoracic pain and pericardial effusion that was considered infectious and did not require urgent surgery. One month after giving birth to her baby, the patient was admitted to our hospital for the completion of the preoperative protocol. During this admission, multimodal imaging revealed a penetrating metallic foreign body in the wall of the right ventricle. The patient was finally admitted to the Cardiovascular Surgery Unit, where she underwent surgical removal of the foreign body and a complex tricuspid valve repair. The postoperative course was uneventful, and our patient was discharged from the ICU 2 days later.

Vascular tunnels deriving from one of the aortic sinuses and flowing into the right atrium are known as aorto-right atrial tunnels. These are rare extracardiac vascular structures. Completely intracardiac tunnels are an even more rare congenital malformation. We present 2 cases exhibiting intracardiac and extracardiac aorto-right atrial tunnels. The first patient presented an intracardiac vascular structure originating from the left coronary sinus, running downward, intracavitary through the left atrium, without any communication, ending in the right atrium. The vascular structure was resected, with reconstruction of the coronary sinus and left coronary artery reimplantation. The second patient presented a vascular tunnel originating in the right coronary sinus, going between the atria and ending in the right atrium. The tunnel was resected, the right coronary sinus reconstructed, and right internal mammal artery-right coronary artery coronary artery bypass grafting was performed. We advocate for early surgical closure, even in asymptomatic patients, to avoid further complications.