Background. Redo operation for failed tricuspid bioprosthetic valves is associated with high morbidity and mortality. Transcatheter tricuspid valve-in-valve implantation has become an acceptable option for high-risk patients with a failed tricuspid bioprosthesis. We present a case of successful tricuspid valve-in-valve implantation using a J-valve in a failed tricuspid bioprosthesis position. Case Summary. A 48-year-old male, who had a failed tricuspid bioprosthesis, presented with right-side heart failure, right-to-left shunting at the atrial level, severe dyspnea, cyanosis, peripheral edema, hepatauxe, and ascites. After the interdisciplinary assessment, we successfully performed transcatheter tricuspid valve-in-valve implantation with the J-valve system. At 34-month postoperative follow-up, the patient had no symptoms of heart failure and the echocardiogram showed good valve position and well hemodynamic status. Conclusions. This case demonstrated that the J-valve system may be a new option for high-risk patients with a failed tricuspid bioprosthetic valve.

Background and Aims: Bicuspid aortic valve (BAV) related aortopathy has been a controversial issue in the past few years. Most of the researches focused on BAV with dilated ascending aorta after aortic valve replacement (AVR), but there were limited documents of patients with the normal-sized proximal aorta. We retrospectively analyzed the clinical data of patients undergoing AVR in our institution and evaluated the progression of the unreplaced ascending aorta in a relatively long term follow-up. Methods: In our institution, 165 patients were consecutively recruited from July 2004 to December 2017. Detailed perioperative information and follow-up data were comprehensively collected and quantitatively analyzed. Results: 48 patients (29.1%) had BAV, while TAV was found in 117 patients. A significant difference was observed in diameters of ascending aorta at baseline between BAV and TAV group (37.5 ±4.2mm vs 35.1 ±4.4mm; p=0.001). The overall survival rates were 89% and 95.8% at 10 years postoperatively in BAV versus TAV group (Plog rank=0.138). Only 1 patient suffered an aortic dissection and underwent proximal aortic surgery. No difference in the progression of ascending aorta (0.8±4.7mm vs 0.6±3.5mm, p=0.821) was observed. The diameter of ascending aorta at baseline was a significant predictor of progression in ascending aorta. Conclusions: BAV patients with a normal-sized ascending aorta have a considerable low incidence of late adverse aortic events after AVR. Meanwhile, the progression of the unreplaced ascending aorta in BAV patients is not different from that in TAV patients.

Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft. After 3 months of follow-up, it was found that the radial artery graft was occluded. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.