We present the case of a 44-year-old gentleman, hospitalized in Interventional cardiology department with retrosternal pain. Percutaneous coronary investigation(PCI) was performed demonstrating bilateral ostial coronary artery stenosis with moderate aortic regurgitation. The patient was transferred in our department for urgent surgery. Cardiac surgery procedure was performed including: double coronary artery bypass grafting (CABG) combined with aortic valve replacement(AVR) with mechanical valve. The Venereal Disease Research Laboratory test (VDRL) and Treponema pallidum Haemagglutination(TPHA) test were done on admission – both of them being positive. Those results confirmed tertiary cardiovascular syphilis. The patient was discharged on POD 12, and was transferred to Dermatology and sexually transmitted diseases(STD) department for further antibiotic therapy concerning the syphilis infection.

We present a case of 29-year-old-woman diagnosed with severe coarctation of the aorta 15mm distal to the left subclavian artery. The patient was admitted in our institution, computed tomohraphy(CT) scan was performed - confirming the diagnosis. After heart team meeting discussion, decision was taken for surgical correction as the best option for the case. Cardiac surgery procedure was performed including: resection of coarctation segment and aortic prosthesis interposition using left heart bypass for optimum spinal cord and visceral organs protection. The patient was discharged on postoperative day 7 on drug therpapy with antiplatelet and dual antihypertensive therapy with β-blocker and calcium channel blocker: Aspirine, Metoprolol and Lercanidipine. At late follow-up examination one year after the surgical correction the patient was normotensive at rest, as well as after treadmill stress test using the standart Bruce protocol. Despite the established good cardiac prophylaxis on newborns, sometimes this disease can remain undiagnosed until adulthood when the complications are starting to present.

A 23-year-old woman in her 29th gestation week of pregnancy was admitted in Obstetrics and Gynaecology Department with symptoms of fever, dyspnea and shortness of breath. The blood test examinations showed significant leukocytosis and elevated c-reactive protein levels. Transthoracic(TT) echocardiography was performed showing severe mitral valve regurgitation with posterior cusp destruction confirming the diagnosis of infective endocarditis. The condition of the patient significantly deteriorated, and she was urgently transferred to the Cardiovascular Surgery Department for an emergent surgical treatment. She was admitted in the Intensive Care Unit with clinical signs of severe septic shock and severe left heart insufficiency. A consultation of gynaecologist was performed and fetal death in utero from fetal ultrasonography was diagnosed. A decision for an emergent simultaneous operation was taken. During the anesthesia induction the patient developed severe circulatory shock needing a cardiopulmonary resuscitation which restored the spontaneous circulation after one minute. At first, before heparinization sectio parva was performed confirming the diagnosis of fetal death. During the cardiac operation after the cardiopulmonary bypass(CPB) institution, mitral valve replacement and inspection of the tricuspid valve was performed. The CPB was discontinued with three catecholamine support. In the postoperative period she was febrile with severe multiple organ system failure(MOSF) manifestation, generalized single tonic-clonic seizure and in the following hours three seizures with focal onset(muscle contractions in the right facial half) were observed. On the postoperative day(POD) 2 she developed clinical signs of blue discoloration of the distal phalanx of the left foot. Doppler ultrasound examination showed subtle pulsations on the left dorsal pedal artery. Ultrahemofiltration with antiseptic filter was performed for cytokine removal. In the following days the condition of the patient improved. She was extubated on POD 4, transferred to the post-operative department on POD 7 and discharged on POD 23. Despite advances in medicine, the treatment of the infective endocarditis is associated with high mortality and complication rates. Multidisciplinary collaboration is crucial for achieving the best outcome.

The cardiopulmonary bypass, or heart-lung machine is one of the biggest medical inventions in the mid -20th century and the advances in cardiac surgery would not have been possible without this contrivance. Nevertheless it is not without its share of side-effects, with post-perfusion acute lung injury being among one of the most severe and life-threatening complications. We report a case of 65-year-old female patient diagnosed with left main and three-vessel coronary artery disease and admitted for an elective coronary artery bypass grafting(CABG). Triple bypass grafting procedure was performed. After weaning from bypass, the patient developed severe pulmonary edema with calculated Murray score of 4 points suggesting ECMO(extracorporeal membrane oxygenation) as the only salvage procedure. Peripheral venoarterial ECMO was implanted. After 5 days the mechanical support was withdrawn with full pulmonary recovery. Innovative cardiopulmonary bypass circuit and techniques, lung-protective mechanical ventilation strategies, ECMO etc. are amid possibilities to avoid this potentially lethal complication.

Coronary artery aneurysm is not a common diagnosis, and those of the left main coronary artery(LMCA) are extremely rare with an incidence of 0.1% of patients undergoing percutaneous coronary intervention(PCI). We report a case of 68-year-old male patient, hospitalized in interventional cardiology department with a retrosternal pain, where PCI was performed revealing a saccular aneurysm of the LMCA. Computed tomography(CT) scan confirmed the diagnosis of isolated coronary artery aneurysm 15mm distal to the orifice of the LMCA. Cardiac surgery procedure was performed including: double coronary artery bypass grafting(CABG), occlusion of the LMCA orifice combined with distal occlusion of the aneurysm. The postoperative course was uneventful and the patient was discharged on postoperative day 6 without any remarks. Even though the etiology of the aneurysm was not fully investigated, it was suspected to be a congenital one.