Background/Objectives: Heart disease affects 0.1% to 4% of pregnant women, with congenital heart defects being the leading cause in developed countries. While maternal mortality is generally low, pre-existing cardiac conditions substantially increase adverse outcome risks. This report describes the multidisciplinary management of a pregnant patient with a bicuspid aortic valve, severe aortic stenosis, and ascending aortic ectasia. Case Presentation: A 34-year-old pregnant woman, asymptomatic but at high risk (World Health Organization Class III) for hemodynamic decompensation, was closely monitored throughout gestation. At 36 weeks, intrauterine growth restriction was detected, prompting an elective cesarean delivery at 38 weeks. Postpartum, the patient developed pre-eclampsia, which was managed successfully. Imaging revealed progressive aortic dilation, leading to surgical aortic valve replacement and ascending aorta reduction plasty. Post-operatively, atrioventricular reentrant tachycardia from an unrecognized accessory pathway developed; medical therapy effectively controlled the arrhythmia after failed catheter ablation. One year later, both mother and child remained in good health. Discussion: This case illustrates the complexity of managing pregnancy in women with congenital heart disease and significant aortic pathology. The physiological changes of pregnancy can exacerbate underlying lesions, necessitating individualized risk assessment, vigilant monitoring, and timely intervention. Conclusions: A multidisciplinary approach involving cardiology, obstetrics, anesthesiology, and genetics is essential to optimize outcomes for pregnant women with significant heart disease. As advances in care allow more women with congenital heart defects to reach childbearing age, structured care pathways remain vital for ensuring safe pregnancies and long-term cardiovascular health.

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.