Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm², and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA.

Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass’ blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is a complex myocardial disease in which structural remodeling extends beyond conventional parameters such as maximal wall thickness (MWT). This study aimed to evaluate isoperimetric analysis as a geometry-based approach for characterizing left ventricular (LV) morphology and to compare its performance with fractal analysis in distinguishing HCM from non-HCM subjects. Methods: This retrospective study included 120 subjects (60 HCM and 60 controls) who underwent clinically indicated CMR. Endocardial contours were delineated on short-axis cine images at end-diastole. The isoperimetric index (IPI), cavity-corrected IPI (CC-IPI), and fractal dimension (FD) were calculated. Group comparisons, correlations, and receiver operating characteristic analyses were performed. Results: Patients with HCM showed significantly higher IPI and CC-IPI values than controls (p < 0.001), including in sex-stratified analyses. IPI and CC-IPI correlated strongly with MWT (r = 0.867) and LV mass index (r = 0.807 and 0.803, respectively), moderately with native T1 (r = 0.567), and weakly with end-diastolic volume index (r = 0.256 and 0.253, respectively) and stroke volume (r = 0.237 and 0.229, respectively). No association was observed with late gadolinium enhancement. IPI and CC-IPI showed a strong linear correlation (R² = 0.997), with both indices demonstrating high discriminatory performance (AUC = 1.00). Conclusions: HCM is associated with notable alterations in LV endocardial geometry beyond myocardial hypertrophy alone. IPI and CC-IPI provide simple, size-normalized, and physiologically interpretable morphologic descriptors that complement conventional CMR parameters and FD-based contour complexity analysis.