This meta-analysis shows that mitral valve repair has good clinical outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve repair should be attempted in those patients in whom sufficient valve tissue is present for reconstruction after all infectious tissue has been resected.

Increasing age and postoperative infection are most strongly associated with POAF. Adoption of enhanced recovery protocols, along with more rigorous monitoring and early treatment of postoperative infection may help reduce POAF and its associated morbidity. Rhythm assessment is crucial to identify persistent AF after discharge, and clinicians should be vigilant for recurrence of AF at follow-up.

We report a case of an incidental finding of an anomalous left circumflex coronary artery arising from the right pulmonary artery that effectuated a ventricular fibrillation cardiac arrest in a woman aged 34 years. This rarity was detected during routine work-up to delineate the cause of this arrhythmia. Our patient had a background of double-outlet right ventricle and a ventricular septal defect, which was repaired with a Dacron patch and a left ventricle patch over to the aorta at age 14 months. Angiographic study at the time of her presentation showed anomalous origin of the left circumflex artery originating from the right pulmonary artery; this was discussed in multispecialty team meeting and surgical intervention was recommended; eventually, surgery was performed with reimplantation of the anomalous circumflex artery into the ascending aorta. We highlight the importance of early angiographic studies in patients with known congenital heart defects and emphasise the optimal strategy of treatment.

Composite mechanical root offers no superiority to composite biological root. There is a significant increase in the perioperative bleeding amongst composite mechanical root cohort. There is a need for further randomized control trail to assess the efficacy of either methods.

Ruptured thoracic duct cysts are an extremely rare occurrence that may arise spontaneously or due to trauma. Surgical treatment is needed to provide a definitive diagnosis, drain the chylothorax and ligate the thoracic duct to prevent reoccurrence. We report the case of a woman with a ruptured thoracic duct cyst presenting with abdominal pain and subsequent tension chylothorax. To the best of our knowledge, this is the first such reported case.

Loeys-Dietz syndrome (LDS) is characterised by a mutation in the transforming growth factor beta receptor, and is strongly associated with aortic aneurysms and rupture. Most cases of LDS present in the second decade of life, with the average life expectancy being 37 years. We report a case of suspected LDS (owing to significant family history of the disorder) that presented in the seventh decade of life. Our patient had aortic root dilation and was initially believed to have Marfan syndrome. However, subsequent tests were negative. On further investigation of her family history, it was revealed that she had a strong positive family history of aortic rupture and aneurysms associated with genetically confirmed atypical LDS. By reporting this case, we aim to highlight the importance of considering inherited connective tissue disorders when a patient presents with aortic aneurysms or dissections associated with a strong family history of aortic pathology. Case historyA 70-year-old woman was referred to her local cardiology centre with a diastolic murmur associated with dyspnoea. She reported no chest pain or fevers. Her past medical history included bronchiectasis, pulmonary embolus and deep vein thrombosis, for which she was on lifelong warfarin. Of particular note, she had a very strong family history of aortic disease and sudden death associated with genetically confirmed Loeys-Dietz syndrome (LDS). Her sister had significant aortic surgery for aortic dissection and her nephew had prophylactic aortic surgery after both had genetic testing that confirmed a diagnosis of LDS. Furthermore, her father's brother and his son had died at young ages from aortic rupture.On examination, the patient was noted to be tall with a long face and long fingers, and had translucent skin. There was no hypermobility and she had a normal palate. Her heart rate was regular at 90bpm. A diastolic murmur was noticed, loudest at the left sternal edge.Transthoracic echocardiography (TTE) showed a normal left ventricle with preserved ejection fraction, a bicuspid aortic valve with mild aortic regurgitation and a dilated aortic root measuring 4.1cm. Annual repeat TTE showed no significant enlargement of the aortic root until 2014, when the aortic root diameter measured 4.6cm. Computed tomography coronary angiography showed no evidence of coronary artery obstruction and carotid Doppler imaging was normal (Fig 1).In 2016 the patient's symptoms deteriorated with sudden onset of worsening dyspnoea and palpitations. She therefore underwent cardiac magnetic resonance imaging, which confirmed an increasingly dilated aortic root of 4.9cm (Fig 2) but there was no evidence of aortic dissection or coarctation. In addition, there was moderate aortic regurgitation. As a result, she was listed for urgent cardiac surgery.Intraoperative findings included a pseudobicuspid aortic valve with fusion of the left and right coronary cusps, and the aortic root was asymmetrically dilated. The patient underwent a mechanical Bentall procedure using a Carbomedic...

Loeys-Dietz syndrome (LDS) is characterised by a mutation in the transforming growth factor beta receptor, and is strongly associated with aortic aneurysms and rupture. Most cases of LDS present in the second decade of life, with the average life expectancy being 37 years. We report a case of suspected LDS (owing to significant family history of the disorder) that presented in the seventh decade of life. Our patient had aortic root dilation and was initially believed to have Marfan syndrome. However, subsequent tests were negative. On further investigation of her family history, it was revealed that she had a strong positive family history of aortic rupture and aneurysms associated with genetically confirmed atypical LDS. By reporting this case, we aim to highlight the importance of considering inherited connective tissue disorders when a patient presents with aortic aneurysms or dissections associated with a strong family history of aortic pathology.

No abstract