Direct closure of an asymptomatic right coronary sinus of Valsalva aneurysm.

A 52-year-old man was referred for evaluation of palpitation. Transthoracic echocardiography revealed an extracardiac aneurysm of the right coronary sinus of Valsalva, and normal anatomy of the aortic valve with no regurgitation. Three-dimensional computed tomography confirmed the aneurysm with a diameter of 21 × 13.7 mm arising from the right coronary sinus of Valsalva under the right coronary artery. Surgical repair was performed without changing the normal anatomy of the aortic valve, preserving the right coronary ostium. Intraoperative and postoperative echocardiography showed complete closure of the aneurysm with normal functioning of the aortic valve.

Mechanical compliance and immunological compatibility of fixative-free decellularized/cryopreserved human pericardium.

BACKGROUND: The pericardial tissue is commonly used to produce bio-prosthetic cardiac valves and patches in cardiac surgery. The procedures adopted to prepare this tissue consist in treatment with aldehydes, which do not prevent post-graft tissue calcification due to incomplete xeno-antigens removal. The adoption of fixative-free decellularization protocols has been therefore suggested to overcome this limitation. Although promising, the decellularized pericardium has not yet used in clinics, due to the absence of proofs indicating that the decellularization and cryopreservation procedures can effectively preserve the mechanical properties and the immunologic compatibility of the tissue. PRINCIPAL FINDINGS: The aim of the present work was to validate a procedure to prepare decellularized/cryopreserved human pericardium which may be implemented into cardiovascular homograft tissue Banks. The method employed to decellularize the tissue completely removed the cells without affecting ECM structure; furthermore, uniaxial tensile loading tests revealed an equivalent resistance of the decellularized tissue to strain, before and after the cryopreservation, in comparison with the fresh tissue. Finally, immunological compatibility, showed a minimized host immune cells invasion and low levels of systemic inflammation, as assessed by tissue transplantation into immune-competent mice. CONCLUSIONS: Our results indicate, for the first time, that fixative-free decellularized pericardium from cadaveric tissue donors can be banked according to Tissue Repository-approved procedures without compromising its mechanical properties and immunological tolerance. This tissue can be therefore treated as a safe homograft for cardiac surgery.

Pulmonary valve papillary fibroelastoma: management of an unusual, tricky pathology.

Papillary fibroelastomas are rare benign tumours of the endocardium, accounting for the most common primary valvular tumours of the heart. They typically originate from left-sided heart valves, whereas pulmonary valve involvement is anecdotal. They rarely cause valvular dysfunction, but they can cause turbulent flow and thrombus formation with consequent cerebral, retinal, coronary and pulmonary embolic disease and obstruction. We present here the case of a 56-year old man who was referred to our institution with an accidental finding, at transthoracic echocardiogram, of a mobile, pedunculated mass on the pulmonary valve, confirmed at cardiac magnetic resonance. He underwent surgical removal of the mass through median sternotomy with complete sparing of the valve. The postoperative course was unremarkable. Histopathological examination confirmed that the mass was a papillary fibroelastoma.

Resection and end-to-end anastomosis for ascending aortic aneurysms associated with a bicuspid valve: case reports.

Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement with a tubular graft because the aortic wall is claimed to be genetically pathological. We describe 9 cases in which patients with an ascending aortic aneurysm and an associated diseased bicuspid valve underwent aneurysmal resection and end-to-end anastomosis. This technique permitted us to remove the entire aneurysmal wall, avoiding graft interposition.