No abstract

Mitral valve prosthetic replacement carries high mortality rates by modern standards, and mitral bioprostheses are particularly prone to degeneration. Bioprosthetic replacement may be technically difficult when there is calcification of the tissue ingrowth, strut incorporation, or valve-to-annulus size mismatch at the primary operation. A "valve-in-valve" technique is described where the mechanical prosthesis is implanted in the bioprosthetic annulus in order to avoid such difficulties. The results in the first eight patients are presented, showing post-operative Doppler-derived transvalvar mean gradients between 3.9 mmHg and 7.5 mmHg, and estimated valve areas between 1.9 cm2 and 3.5 cm2. All patients are alive at between 20 and 30 months (mean 23.6 months) after operation, they are without serious post-operative morbidity and are in functional class I or II (NYHA classification).

Left subclavian artery aneurysm with an aneurysm of the aberrant right subclavian artery is a rare condition with a reported incidence of 0.13% to 1%. We report the successful surgical correction of both conditions in a 34-year-old man.

Multiple tuberculous aneurysms of the thoracoabdominal aorta extending to the aortic bifurcation. Central MessageMultiple tuberculous mycotic aneurysms of the thoracoabdominal aorta involving the aortic arch are rare. We report the case of an 18year-old man with this condition who was treated successfully.

Transcatheter Aortic Valve Implantation (TAVI) is a well-described treatment for symptomatic calcific severe aortic stenosis. However, TAVI technology is being increasingly used around the world to treat selected cases of severe aortic regurgitation (AR). One of the main limitations of using TAVI technology for AR is the lack of calcification, which is common in such cases. This makes anchoring of a TAVI prosthesis to the aortic annulus difficult and risks displacement or embolization. However, with the availability of recapturable and repositionable TAVI technologies, these limitations have been overcome to a large extent. This is the first Corevalve Evolut R device that was used in India and the first TAVI to treat AR in India.