Yacoub valve-sparing aortic root replacement with a concomitant repair of Tetralogy of Fallot: a case reportJuan Wu1, MB, Qi An2, MD, Yongjun Qian2, MD, PhD1Out-patient Department, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, China2Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, ChinaCorresponding Author: Dr. Yongjun Qian, MD, PhDE-mail: [email protected]

Here we report a case of a previously unoperated 35-year-old male TOF patient. He was admitted due to dyspnea, initial physical examination demonstrated cyanosis and heart murmurs. Echocardiography suggested secundum atrial septal defect, perimembranous ventricular septal defect and mild-severe aortic regurgitation. Computed tomography angiography indicated aortic root dilation and suspicious right coronary artery aneurysm. Concurrent repair of TOF and VSARR was performed successfully and the patient had a satisfactory recovery.

Surgical retrieval of embolized atrial septum defect closure device from right pulmonary veinYu Xiong1, Yongjun Qian2#1 Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.2 Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041 Chengdu, Sichuan, P.R. China.# Correspondence: Yongjun Qian, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People’s Republic of China; fax: + 86 28 85422897; e-mail: [email protected] .

Background: Ventricular septal defect (VSD) is one of the most common congenital cardiac defects, However, in some cases VSD sites are difficult to expose due to obstruction from chordal attachments and leaflets of the tricuspid valve (TV)[6](#ref-0006). To systematically review the efficacy and safety of tricuspid valve detachment,( TVD) versus conventional surgical repair ( non-TVD) in the treatment of ventricular septal defect ( VSD) ．This article is aimed to compare the many outcomes from existing studies and provide evidence regarding the necessity of performing TVD. Methods:We searched the following databases: PubMed via NCBI, the Cochrane Central Register of Controlled Trials (no date restriction),Medline via Ovid (from 1966 to May 2020); Embase via Ovid (no date restriction) and China National Knowledge Infrastructure for studies comparing the efficacy of tricuspid valve detachment (TVD) and other surgical techniques in VSD repair. Cardiopulmonary bypass time, Cross-clamp time; postoperative complications including residual defect ,Postoperative atrioventricular block ,Implantation of pacemakers, tricuspid regurgitation ;Length of stay, Length of ICU stay were analyzed． Results: Only 9 studies were included after selection (Table 1), including 7 retrospective cohort studies, 1 respective cohort study and 1 prospective observational stud，a patient pool of 1404 patients with 374 underwent TVD and 1030 underwent non-TVD procedures,met the inclusion criteria．Meta analysis has drawn to the following conclusions. Firstly, TVD prolongs CPB time (MD=7.75, 95% CI=2.60-12.89, p=0.003) and cross-clamp time(MD=7.77, 95% CI=4.76-10.78, p<0.001) compared with non-TVD techniques in VSD repair surgeries. Secondly, no significant difference exists in LOS, length of ICU stay, postoperative atrioventricular block, implantation of pacemakers, incidence of ≥mild TR postoperatively and at discharge, as well as incidence of ≥small residual VSD after surgery and during follow-up( all P ＞ 0. 05). Thirdly, application of TVD increases the risk of TR during follow-up(OR=2.42, 95% CI=1.55-3.76, p<0.001). Conclusion: VSD closure using TVD technique results in longer CPB and cross-clamp time, and increases risk of TR during follow-up. TVD provides equally viable and safe alternative in treating VSD．

We reported a case of a 53-year-old patient with coarctation of aorta and multiple aneurysmatic changes on aortic arch. Enhanced CT and reconstruction revealed significant coarctation and multiple aneurysmatic dilatation. The patient underwent stent implantation and was discharged with symptoms relived. Follow-up examination progression of aneurysms, however, without symptoms.

Human hydatid disease occurs after infection with Echinococcus granulosus, mainly involved liver and lung. Here we reported a 48-year-old woman, who presented to our hospital with intermittent chest pain. Transthoracic echocardiography, Enhanced CT and MRI of heart were performed, revealed the cyst located at the interventricular septum near the right ventricular apex. Other organs including lung and liver were not involved. The cyst was successfully removed, while postoperatively pathological biopsy confirmed the infection of Echinococcus granulosus, thus, she was finally diagnosed as isolated cardiac hydatid cyst.

In this case, we reported an old female with a rare combination of the Scimitar Syndrome and pulmonary artery aneurysm, and she presented with chest pain, fatigue and shortness when admitted in our hospital. Further cardiac examination including echocardiography and computed tomography angiogram were performed and revealed these rare anomalies. Surgical procedure was carried out to cure the patient. This patient stayed in ICU for few days without any major complications and discharged from hospital after 10 days.

Introduction: Left atrial appendage aneurysm (LAAA) is an extremely rare cardiac abnormality with potentially life-threatening risks. Most LAAA were detected because of the symptoms triggered by it, while asymptomatic LAAA were detected incidentally. Once LAAA is diagnosed, early surgical intervention is generally recommended. Case presentation: We reported a case of an 18-year-old female with giant congenital LAAA without any symptoms or surgical history. In an incidental transthoracic echocardiography (TTE) examination, a saccular structure adjacent to her left rear of the heart was encountered. Further CT and MRI examination established the diagnosis of LAAA. The LAAA was corrected via open heart surgery with cardiopulmonary bypass, and this patient recovered well and discharged uneventfully. Conclusion: TTE is the primary tool to diagnose LAAA. Transesophageal echocardiography (TEE), CT and MRI can be used for more accurate diagnosis. Early operation is a generally recommended and widely used intervention to prevent adverse events.

A 69-year-old woman presented to the emergency department for symptoms of acute right heart failure including progressive exertional dyspnea and limbs weakness. Physical examination showed slight cyanosis and cold limbs. She underwent percutaneous transcatheter closure of a secundum ASD through femoral vein eight months before. On further investigation, transthoracic echocardiography (TTE) revealed severe tricuspid regurgitation and the migrated ASD device (Figure 1), and the embolization seemed to be located near the left ventricular inflow tract. Computed tomography (CT) and three-dimensional reconstruction confirmed the left-side migration of the device, and revealed obstruction of RPV caused by the embolization (Figure 2).

We presented a multimodal imaging approach to identifying aortic arch aneurysm with a concurrent coarctation of the aorta in a 52-year-old woman. We successfully adopted a new operative method and described the management of whole process. The detailed imaging and intraoperative data have not been reported in the literature before. This case highlighted the feasibility and successful surgical intervention in a patient with coarctation of the aorta and a concurrent enormous aortic arch aneurysm. An extra-anatomical bypass is an innovative surgical technique that is proved effective and beneficial.