Cor triatriatum is a rare congenital cardiac abnormality, consisting of an obstructing membrane between the pulmonary veins and the mitral valve in varying patterns. The entitiy can mimick the pathophysiology of mitral stenosis, necessitating surgical resection. Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed. We report two cases with cor triatriatum where intraoperative balloon dilatation of the membrane was attempted followed by surgical resection, to explore the feasibility of cathether-based interventional strategies for cor triatriatum. Various anatomical variations exist of cor triatriatum, depending on the drainage of the pulmonary veins and the drainage of the proximal chamber in the right or left atrium. Only isolated forms of cor triatriatum where all pulmonary veins ultimately drain into the left atrium can be recommended for percutaneous strategies. In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities. Furthermore, long-term efficacy of these strategies remains to be confirmed. As such, surgical treatment of cor triatriatum remains the mainstay of treatment in adult patients, especially when other cardiovascular anomalies are present which require surgical correction.

Patients with connective tissue disease and aortic root aneurysm are at risk of dissection and progression of the dilation. Standard treatment of aortic root aneurysm is either a total root replacement or valve-sparing root replacement. Both procedures have drawbacks such as the need for anticoagulation and long term exposure to the chance of reoperation or endocarditis. The ExoVasc® Personalized External Aortic Root Support (PEARS) is a perivascular stent, that has been introduced to reduce these risks while aiming for a similar beneficial outcome on late aortic complications. To report the safety and efficacy of PEARS in the first 90 patients with connective tissue disease and aortic root aneurysm in the Netherlands. From January 2018 to February 2023, 90 patients underwent surgery with the intention of either an isolated PEARS procedure, or PEARS as a concomitant procedure or a Ross-PEARS procedure in two affiliated centers. Isolated PEARS was generally performed off-pump under sustained induced hypotension. Patient characteristics, preoperative and postoperative echocardiography and computed tomography or magnetic resonance imaging were assessed. Median age was 37 (SD±15) years and 62 (69%) patients were male. Among all patients 37% had Marfan syndrome, 8% Loeys-Dietz syndrome and 32% had a bicuspid aortic valve (BAV). Sixty (67%) patients were planned for isolated PEARS, 21 (23%) underwent Ross-PEARS and 9 (10%) patients underwent PEARS as a concomitant procedure. Mean aortic root diameter at the level of the sinus of Valsalva was 44.6 ± 7.0 mm prior to surgery and 38.6 ± 5.6 mm at the follow-up (p < .001). Two patients in the isolated PEARS group were converted to conventional surgery, resulting in a procedural success rate of 96.6%. One Ross PEARS patient had to be reoperated on the first postoperative day because of compression of the RCA by the PEARS prosthesis. Median follow-up duration was 6 months (IQR 3-18, range 0-45). No death, endocarditis or dissection occurred during follow-up. One patient had a transient ischemic attack (TIA) 1 year after surgery (mitral valve plasty and PEARS as concomitant procedure). Three patients were reoperated in the follow-up period. At follow-up aortic root and ascending aortic diameters were all significantly reduced. The PEARS procedure can be performed with acceptable operative risk and no dissections were observed during follow-up. PEARS has been adapted as a valid alternative treatment strategy in our centers. Complications related to coronary artery origin are an important issue.

• This pilot study shows safety and feasibility of continuous postoperative pericardial flushing (CPPF) in experimental setting; • CPPF improves chest tube patency and postoperative drainage; • CPPF may reduce postoperative bleeding complications after cardiac surgery.

: OBJECTIVES: Tracheobronchomalacia (TBM) is characterized by collapse of trachea, bronchi or both, leading to dyspnoea, expiratory stridor, coughing or recurrent airway infections. Surgical treatment with aortopexy is warranted for severe TBM. We describe a modified aortopexy technique with aortic wall strap sutures that evenly distributes the traction force over the full width of the aortic arch. The aim of this study was to determine the outcomes of this modified anterior aortopexy technique. METHODS: Retrospective chart review of all patients undergoing aortopexy with aortic wall strap sutures for TBM between January 2010 and June 2020 in 2 tertiary hospitals in the Netherlands. RESULTS: Twenty-four patients [median age 9 months (interquartile range 2–117 months); 71% male] underwent aortopexy with the modified technique for TBM (52%), tracheomalacia (40%) or bonchomalacia (8%). Aortopexy was successful in 91.7%, defined as relief or decrease of respiratory symptoms and no need for respiratory support. Complications occurred in 8.3% and mortality was 4%. CONCLUSIONS: Aortopexy with non-absorbable strap sutures seems an effective and safe treatment for severe TBM. This study supports the hypothesis that strap sutures provide a solid and reliable traction force, but future comparative studies should confirm the benefit of strap sutures over conventional techniques.

OBJECTIVES: Aortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative aortic valve visualization and pressurization (AVP) device, enabling valve inspection under physiological conditions, and measuring aortic valve insufficiency (AI) during cardioplegic arrest. METHODS: The AVP device is attached to the (neo)aorta, after any type of aortic valve repair, while the heart is arrested. The root is pressurized (60–80 mmHg) using a saline solution and an endoscope is introduced. The valve is inspected, and the amount of valvular leakage is measured. Postoperative ‘gold standard’ transesophageal echocardiogram measurements of AI are performed and compared against regurgitation volume measured. RESULTS: In 24 patients undergoing valve-sparing root replacement, the AVP device was used. In 22 patients, postoperative echocardiographic AI was ≤ grade 1. The median leakage was 90 ml/min, IQR 60–120 ml/min. In 3 patients, additional adjustments after visual inspection was performed. In 2 patients, with complex anatomy, the valve was replaced. In one, after evaluation with the device, there was undesirable result visually and residual AI of 330 ml/min, and in another, 260 ml/min residual AI was measured and valve restriction on visual inspection. CONCLUSIONS: The novel AVP device enables intraoperative evaluation of the valve under physiological conditions, while still on arrested heart, and allows for targeted adjustments. The AVP device can be an important aid for intraoperative evaluation of the aortic valve, during valve repair and valve-sparing procedures, thereby making the operative result more predictable and the operation more efficient.

Introduction: Increasing survival of adult congenital heart disease (ACHD) patients comes at the price of a range of late complications—arrhythmias, heart failure, and valvular dysfunction. Transcatheter valve interventions have become a legitimate alternative to conventional surgical treatment in selected acquired heart disease patients. However, literature on technical aspects, hemodynamic effects, and clinical outcomes of percutaneous atrioventricular (AV) valve interventions in ACHD patients is scarce. Method: This is a descriptive cohort from CAHAL (Center of Congenital Heart Disease Amsterdam-Leiden). ACHD patients with severe AV valve regurgitation who underwent a transcatheter intervention in the period 2020–2022 were included. Demographic, clinical, procedural, and follow-up data were collected from patient records. Results: Five ACHD patients with severe or torrential AV valve regurgitation are described. Two patients underwent a transcatheter edge-to-edge repair (TEER), one patient underwent a valve-in-valve procedure, one patient received a Cardioband system, and one patient received both a Cardioband system and TEER. No periprocedural complications occurred. Post-procedural AV valve regurgitation as well as NYHA functional class improved in all patients. The median post-procedural NYHA functional class improved from 3.0 (IQR [2.5–4.0]) to 2.0 (IQR [1.5–2.5]). One patient died 9 months after the procedure due to advanced heart failure with multiorgan dysfunction. Conclusion: Transcatheter valve repair is feasible and safe in selected complex ACHD patients. A dedicated heart team is essential for determining an individualized treatment strategy as well as pre- and periprocedural imaging to address the underlying mechanism(s) of AV regurgitation and guide the transcatheter intervention. Long-term follow-up is essential to evaluate the clinical outcomes of transcatheter AV valve repair in ACHD patients.