Intraluminal aortic clamping has been achieved until now by means of a sophisticated device consisting of a three-lumen catheter named Endoclamp, which allows at the same time occlusion of the aorta, antegrade delivering of cardioplegia, and venting through the aortic root. This tool has shown important advantages allowing aortic occlusion and perfusate delivering without a direct contact with ascending aorta reducing meanwhile the risk of traumatic and/or iatrogenic injuries. Recently, a new device (Intraclude catheter) with the same characteristics and properties has been proposed and introduced in clinical practice. The aim of this paper is to investigate the differences between Endoclamp and Intraclude catheters and to analyze the advantages advocated by this new device for intraluminal aortic occlusion since it is noticeable as these new technological tools are gaining more and more attractiveness due to their appraised clinical efficacy.

BackgroundPapillary fibroelastoma is the third most common primary benign tumor with an incidence of up to 0.33% in autopsy series; it accounts for approximately 75% of all cardiac valvular tumors.Case presentationWe describe a rare case of a 28-Year-old man that while playing football, had a sudden onset of neurological deficit: aphasia, right hemiparesis and right facial numbness. Transthoracic echocardiography (TTE) showed a 10x10 mm mass attached to the anterior mitral valve leaflet. The patient was treated surgically for the prevention of further embolic complications. Histologic examination of the resected mass revealed a papillary fibroelastoma. It is the third most frequent primary cardiac tumor, after myxoma and fibroma, and the most common primary tumor of heart valves. Despite the benign nature of this tumor, it carries very high risk of embolic complications. The successful complete resection of the papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.ConclusionsDifferential diagnosis of cardiac masses requires clinical informations, laboratory tests, blood cultures and appropriate use of imaging modalities. Papillary fibroelastoma is a potential cause of embolic stroke in the young. The prompt surgical excision of papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.

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MitraClip system has been recently introduced in clinical practice for percutaneous mitral valve repair in selected patients. In the case of early or late detachment of the device dedicated tools, either with percutaneous or surgical approach, have been developed. We describe a novel technique to atraumatically remove the MitraClip.

Background: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the surgical risk in redo surgery. The objective of our retrospective observational study is to assess the results of cardiac reoperations in patients with mitral valve disease approached trough a 5-7 cm right mini-thoracotomy. Methods: From February 2017 to December 2019, 65 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary bypass (CPB) was started by cannulation of the femoral and jugular vein and femoral artery or alternatively right axillary artery. Patients enrolled had a mean age of 66.6±11.5 years.Patients were divided into three groups based on the procedure adopted: external aortic cross-clamp (EAC), EndoAortic balloon occlusion (EABO) and ventricular fibrillation (VF). Major complications were evaluated and compared with a propensity matched population of patients undergoing elective isolated mitral valve surgery via right minithoracotomy (MVS). Results: The average time between last operation and reoperation was 7.1±3.4 years. Fourteen patients (21%) underwent mitral valve repair and 51 patients (78%) underwent mitral valve replacement; 9 patients (14%) received tricuspid valve surgery. There was no statistically significant difference in CPB time between the groups. 7 patients (11%) had a postoperative renal failure, 5 patients (8%) underwent surgical reopening for bleeding; incidence of post-operative stroke and pace-maker implantation was 3% for both. No deaths were registered during in-hospital stay and at 30-days echocardiographic control all patients respect the criterions of device success according with MVARC. Propensity matched patients of group redo had a longer CPB time (100.8±42.7 versus 72.8±16.7 min, P<0.001) and cross-clamp time (71.9±30.7 versus 59±10.7 min, P<0.001) respect to first operation mitral valve surgery patients.Conclusions: Minimally invasive mitral valve redo surgery is a safe procedure. Less invasive techniques in redo surgery could minimize morbidity and mortality without prolonging the duration of CPB.

We present a case of double aortic arch with a predominant right and a double arterial duct detected by echocardiogram in a 28-week gestation foetus. The first evaluation revealed that both arches were perfused; the 1-month postnatal echocardiogram showed the closure of both arterial ducts and the partial obliteration of the left aortic arch between the left subclavian artery and the dorsal aorta. In our case, the postnatal obliteration of the left arch in a double aortic arch was probably due to the closure of the left-sided arterial duct.

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Background And Aim: Reoperative mitral valve surgery is burdened by a greater technical difficulty and a higher complications rate respect to first operation. When in a heart centre minimally invasive surgery has become routine, the application of this to reoperations may represent the way to greatly reduce the surgical risk. The objective of the study is to assess results within the last year of technically difficult reoperations in 10pts with mitral valve disease approached trough a 5–7 cm right mini-thoracotomy with direct cross clamping. Methods: Cardiopulmonary bypass was installed by cannulation of femoral vein (internal jugular vein in case of tricuspid concomitant surgery) and axillary or femoral artery. Aorta was partially isolated and directly cross-clamped by the same incision. Results: Patients enrolled had a median age 68 years (IQR I-III 61–75). Median time between last operation and reoperation was 7 years (IQR I-III 4–11): 1 patient underwent mitral valve repair, 9 patients to mitral valve replacement and 3 of these also received tricuspid annuloplasty. Median Euroscore I was 8.5 (IQR I-III 6.1–12). Median cross-clamp time was 68 min (IQR I-III 51–86) and median cardiopulmonary bypass time was 88 min (IQR I-III 68.8–119). 1 patient had a postoperative renal failure requiring CVVH and 1 patient underwent surgical reoperation for bleeding. There were no deaths at 30day follow-up. Conclusions: Direct aortic cross-clamping in minimally invasive mitral valve surgery reoperations is a safe procedure. The use of less invasive techniques in reoperations may minimize morbidity and mortality, without prolonging duration of cardiopulmonary bypass.