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Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients.

Certain benefits are clearly associated with the use of off-pump coronary artery bypass grafting (CABG) as compared with the on-pump CABG. The superiority is more evident in patients with multiple co morbidities including renal failure.We reviewed the medical records of a 67-year-old male with a past medical history that was significant for multiple cardiovascular diseases and new-onset end-stage renal disease. The case was suffering from dyspnea and work-up was suggestive of non-ST elevation myocardial infarction and congestive heart failure.During the hospital course, he developed end-stage renal disease requiring hemodialysis. Further cardiac evaluation presented three-vessel coronary artery disease. The patient underwent off-pump CABG. Post-operatively, the patient had minimal complications and did not receive hemodialysis for 53 days.Off-pump CABG has evident short-term benefits for patients with the end-stage renal disease requiring dialysis, including possible improvement in cardiac function and avoidance of hemodialysis

Introduction: Infective endocarditis is well known to produce neurologic complications from septic emboli, which mandates a multidisciplinary approach between neurosurgery and cardiac surgery. However, literature is not clear as to the optimal interval length between neurosurgery and cardiac surgery.Presentation of Cases: The first case involves a 60-year-old woman with significant past medical history presenting with native valve methicillin-resistant staphylococcus aureus (MRSA) endocarditis causing cerebral vascular infarcts. The second case involves a 45-year-old man with no significant past medical history presenting with infective endocarditis of the aortic and mitral valve.Discussion: Cardiac surgery was performed 27 and 17 days after neurosurgery intervention for each case, respectively. All operations were successful with few complications. Guidelines suggest waiting at least one week until valvular surgery, but other reports suggest earlier surgery produces preferable outcomes. In the cases presented, both patients experienced no further significant events to date after receiving cardiac surgery >3 weeks after the initial ischemic stroke event. Conclusion: Neurological deficits mandate a collaborative approach between neurosurgery and cardiac surgery. Significance between time of neurosurgical intervention and cardiac surgery remains controversial, but waiting at least one week shows positive results.

Transcatheter aortic valve replacement (TAVR) is a novel therapeutic intervention for the replacement of severely stenotic aortic valves in high-risk patients for standard surgical procedures. Since the initial PARTNER trial results, use of TAVR has been on the rise each year. New delivery methods and different valves have been developed and modified in order to promote the minimally invasive procedure and reduce common complications, such as stroke. This review article focuses on the current data on the indications, risks, benefits, and future directions of TAVR. Recently, TAVR has been considered as a standard-of-care procedure. While this technique is used frequently in high-risk surgical candidates, studies have been focusing on the application of this method for younger patients with lower surgical risk. Moreover, several studies have proposed promising results regarding the use of valve-in-valve technique or the procedure in which the valve is placed within a previously implemented bioprosthetic valve. However, ischemic strokes and paravalvular leak remain a matter of debate in these surgeries. New methods and devices have been developed to reduce the incidence of post-procedural stroke. While the third generation of TAVR valves (i.e., Edwards Sapien 3 and Medtronic Evolut R) addresses the issue of paravalvular leak structurally, results on their efficacy in reducing the risk of paravalvular leak are yet to be obtained. Furthermore, TAVR enters the field of hybrid methods in the treatment of cardiac issues via both surgical and catheter-based approaches. Finally, while TAVR is primarily performed on cases with aortic stenosis, new valves and methods have been proposed regarding the application of this technique in aortic regurgitation, as well as other aortic pathologies. TAVR is a suitable therapeutic approach for the treatment of aortic stenosis in high-risk patients. Considering the promising results in the current patient population, recent studies have been conducted to evaluate the efficacy of this approach as a standard-of-care procedure.

This case report was an attempt to present the importance of diagnostic echocardiography and closure of a patent foramen ovale in carcinoid heart disease. Herein, we present a case of a 48-year-old woman with a carcinoid metastasis presenting with tricuspid regurgitation, pulmonic stenosis, patent foramen ovale, and borderline left ventricular ejection fraction on an echocardiogram. Surgical intervention included closing the patent foramen ovale and replacing the tricuspid valve via mini-sternotomy. The tricuspid valve was repaired and the ejection fraction was preserved. The patient had an uncomplicated post-operative course. As indicated in this report, closing the patent foramen ovale along with fixing malfunctioning valves can improve the ejection fraction and the associated symptoms.