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Graphical abstract, Highlights • Cardiac echinococcosis is a rare but potentially fatal manifestation of hydatid disease. • Antiparasitic agents with surgical cyst excision is the treatment of choice. • Heart team decision-based management is warranted in cases of other organ involvement.

Compared to mitral valve aneurysms, aortic valve (AV) aneurysm is a more rare and serious complication of infective endocarditis (IE). Early surgical intervention and valve replacement are required in order to prevent further complications such as embolization and rupture of aneurysm. We described a case of severe aortic regurgitation (AR) as a result of an aortic valve aneurysm in a patient with history of end-stage renal disease (ESRD) in whom the hemodialysis catheter had not been changed for a year.

Double aortic arch, the most common vascular ring, causes a complete ring surrounding the esophagus and trachea that leads to compressive symptoms. This report describes a young woman with a history of totally corrected tetralogy of Fallot who was a candidate for pulmonic valve replacement. A double aortic arch was detected incidentally by echocardiography and cardiac computed tomography. (Level of Difficulty: Intermediate.), Graphical abstract, Double aortic arch, the most common vascular ring, causes a complete ring surrounding the esophagus and trachea that leads to compressive symptoms…

Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year’s follow-up.

The IgG4-related disease is a distinct, steroid-responsive fibro-inflammatory disorder of unknown etiology. This multiorgan disease is characterized by tumefactive lesions that contain rich infiltrations of IgG4-positive plasma cells, with the pancreas, and the salivary and lacrimal glands being the main involved. The more common cardiovascular involvements include inflammatory peri-aortitis, coronary arteritis, and pericarditis. Intra-cardiac tumefactive lesions are rarely reported. Herein, we describe a challenging case of IgG4-related disease with a long-time lag between initiation of symptoms to proper diagnosis with biopsy-proven cardiac and retroperitoneal and possible pituitary gland involvement. Concerning the rarity of the cardiac lesion in our case, we conducted a literature review of similar case reports.

Entrapment of coronary angioplasty hardware is a rare but serious complication of coronary interventions which may be managed percutaneously or surgically. We described a case of an entrapped coronary stent in a patient with a history of failed coronary intervention with no documents available. In transesophageal echocardiography, there was a linear echo density in the ascending aorta stuck in the right coronary artery resembling a dissection flap but based on the history of failed coronary intervention, this odd structure was supposed to be a retained angioplasty device. The patient underwent surgical removal of the entrapped device which was a fractured stent.

Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. We searched the literature and performed a systematic review of previous cases. A total of 37 cases of IMD with VSR were included (1 our original and 36 literature cases). Mean age was 68 ± 8 years and 20 (54.1%) patients were male. Anterior and inferior MI were observed in 14 (37.8%) and 23 (62.2%) cases, respectively. The dissected area was the septum, RV, both septum and RV, or LV apex in 21 (56.8%), 9 (24.3%), 5 (13.5%), and 2 (5.4%), respectively. Apicoseptal and inferoseptal VSR were observed in 15 (40.5%) and 22 (59.5%) cases, respectively. At least one occluded artery was observed in 29 (90.6%) of cases. Reperfusion therapy was done for 15 (40.5%) cases before the VSR occurred. Surgery, percutaneous, and medical therapy were done for 26 (70.3%), 3 (8.1%), and 7 (18.9%) cases, respectively. The mortality rate was significantly higher in the medical versus surgical-treated group (85.7% versus 42.3%, P = .027). There was a trend to higher mortality in the group with dissection of both septum and RV (P = .15). We concluded that echocardiography has a critical role in diagnosing this complication. Surgery is mandatory in IMD with VSR.

Introduction: Shone syndrome is a rare congenital anomaly consisting of multiple levels of obstruction in the left side of the heart and aorta. In its complete form it comprises four types of lesions: (1) parachute mitral valve; (2) supravalvular ring of left atrium; (3) subaortic stenosis of either the muscular or membranous type; or (4) coarctation of the aorta. Shone complex is rarely associated with patent ductus arteriosus. Only two other cases of such association has previously been reported. Case Presentation: We report an 18 year old male referred to our center for aortic and mitral valve replacement who was a near complete case of Shone syndrome associated with a history of repaired coarctation and patent ductus arteriosus during infancy and subsequently repair of aortic valve at 3 years of age. Now he became symptomatic due to the progression of aortic stenosis and congenital mitral valve stenosis. Echocardiography revealed unicuspid aortic valve with severe stenosis and parachute mitral valve deformity with supravalvular ring resulting in severe mitral stenosis. The patient had undergone aortic and mitral valve replacements. Conclusions: This rare case is a near complete form of Shone complex associated with patent ductus arteriosus.It is emphasized that when any form of left heart obstruction is encountered we should meticulously look for other associated lesions.

Isolated right bundle branch block is a common finding in the general population. It may be associated with variations in detailed coronary anatomy characteristics. The aim of this study was to investigate the coronary anatomy in patients with isolated right bundle branch block and to compare that with normal individuals.In this case-control study we investigated the coronary anatomy by reviewing angiographic films in two groups of normal coronary artery patients: patients with right bundle branch block (RBBB) (n = 92) and those with normal electrocardiograms (n = 184).There was no significant difference between the two groups in terms of diminutive left anterior descending artery, dominancy, number of obtuse marginal artery, diagonal, acute marginal artery, the position of the first septal versus diagonal branch, presence of ramus artery, and size of left main artery. The number of septal branches was higher in the case group (p-value0.001). Origination of the atrioventricular node artery from the right circulatory system was more common in both groups but cases showed more tendency to follow this pattern (p-value = 0.021). The frequency of the normal conus branch was higher in the cases versus controls (p-value = 0.009).Coronary anatomy characteristics are somewhat different in subjects with RBBB compared to normal individuals.