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In cardiac surgery, aortic diseases represent an important chapter, and include treatments from the aortic valve to the descending aorta. The infra-diaphragmatic abdominal aorta, generally and historically, is the domain of vascular surgery. Despite the excellent and consolidated results obtained in the treatment of thoracic aortic disease, surgical mortality and morbidity are still relevant, also due to the presence of older patients with more extensive and complex aortic disease. In the last decades, the better knowledge of the aortic issues and the availability of new grafts have resulted in an important evolution of the management, both at the aortic valve and vessel level, with use of transcatheter grafts (transcatheter aortic valve implantation and thoracic endovascular aortic repair). The evidence of the right indications and the long-term results will determine the real usefulness and effectiveness of these "new" procedures and their role as safe and definitive aortic therapies.

Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the left ventricular free wall, the ventricular septum and the papillary muscle, but also the right ventricular free wall and more rarely the atrium. This complication is responsible for 10-15% of in-hospital deaths after ST-elevation myocardial infarction. Advanced age, female sex, first infarction and hypertension (in the acute phase of infarction) are the most important risk factors for cardiac rupture. It occurs typically between 4 and 7 days after the infarction but it may also develop within the first 24-48h, particularly in patients undergoing fibrinolytic therapy and in cardiac patients with the following characteristics: 1) recent coronary artery occlusion, 2) transmural necrosis, 3) poor collateral circulation, and 4) minimal or absent myocardial fibrosis. Cardiac rupture should be suspected when sudden or rapidly progressive hemodynamic deterioration occurs. After prompt diagnosis and stabilization, the patient can be operated. The high mortality rate between 5 and 14 days post-infarction justifies the urgency of surgical repair, which includes infartectomy and the employment of a Dacron patch and biological glues. Also percutaneous strategies have recently been used in patients with high surgical risk. The most frequently performed surgical techniques for the treatment of cardiac rupture are described below. By now early diagnosis and surgical treatment are crucial for successful outcome.

Left ventricular rupture is the most frequent cause of death following myocardial infarction after ventricular arrhytmias and cardiogenic shock. Under these circumstances, only a prompt diagnosis and urgent surgical treatment can be lifesaving. A review of the literature is made and a simple surgical technique with GRF glue application is presented.

A 65 year old patient underwent surgery for mitral and aortic valves replacement. Four months later, a type I left ventricular rupture with pseudoaneurysm was discovered. The formation and surgical reparation are described.