Anticoagulation is essential for patients with mechanical heart valves; however, its management in peri operative period could be a dilemma. Frequently, bridging therapy is applied in this situation to prevent thromboembolic events. The risk and benefit of this strategy is not completely clarified. Furthermore, it become more complex if haemorrhagic complication was associated especially intracerebral localization. In lacking of data supporting a specific treatment strategy, The management of these patients often poses a significant challenge to balance between providing increasing bleeding events and providing ischemic complication. We report a case report of using bridging therapy in patient with mechanical valve in periprocedural cardiac resynchronization surgery complicated by hemorrhagic cerebral hematoma, through which we will discuss the therapeutic modalities of this patients in the light of studies and consensus of learned societies.

PVL is the flow of blood through a track between the native cardiac tissue and the implanted valve and it can complicate mitral and aortic valves replacement. Patients with PVL may experience varying clinical repercussion from absence of symptoms to congestive heart failure and /or significant hemolysis with hemolytic anemia. PVLs are more frequently diagnosed by Transesophageal echocardiography than transthoracic echocardiography due to its ability to detect minute jets of regurgitated blood. Reoperation for closure of PVL is associated with high mortality. Transcatheter closure is less invasive and can be used in high-risk patients. We present a case of a 67-year-old woman with a history of Aortic and mitral Valves replacement who developed hemolytic anemia and haemoglobinurea. The patient was managed initially conservatively but later underwent redo valve surgery after exclusion of other causes of hemolytic anemia. Post operatively her level of hemoglobin and her urine routine examination were normal.

Schönlein-Henoch purpura is a non-thrombocytopenic systemic vasculitis of small-caliber vessels due to immune complexes. We report the case of an adult 30 year old man admitted for a generalized edematous syndrome with purpuric lesions in the 2 lower limbs revealing a dilated cardiomyopathy whose etiological assessment was in favor of a Schönlein-Henoch purpura with cardiac, renal, dermatological involvement. The diagnosis was difficult to establish given the clinical polymorphism. Also, management was complicated given the multifocal involvement. The treatment was based on corticosteroid therapy and rituximab but the evolution was, unfortunately, not satisfactory.

Aorto-mitral discontinuity is uncommun complication of infective endocarditis. In the reported case, images were produced using transthoracic echocardiograms and transesophageal echocardiograms. The latter revealed aorto-mitral discontinuity and a perforated aortic valve aneurysm of the anterior leaflet. These additional examinations may assist in the planning of surgical procedures usually including double valve replacement in addition to aortic root replacement/repair.