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Histidine–tryptophan–ketoglutarate (HTK) cardioplegia is one of the most widely used methods of cardioplegia. This solution is hyponatremic compared to blood, and the rapid infusion of a substantial volume of hyponatremic solution will result in a notable reduction in serum natrium (Na) levels. The aim of this study was to analyze changes in serum Na concentration following HTK cardioplegia infusion in aortic valve surgery, and to investigate the association between hyponatremia and postoperative outcomes in patients who underwent aortic valve replacement surgery. This retrospective study involved 302 patients who underwent aortic valve replacement surgery between June 2023 and June 2024 at the Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania. Based on their preoperative serum Na levels, the patients were divided into a low Na group (Na < 136 mEq/l) and a normal/high Na group (Na ≥136 mEq/l). Outcomes measured were operative short-term mortality, as well as in-hospital postoperative complications such as neurological impairment, surgical reintervention, new onset atrial fibrillation (AFib), and sustained ventricular fibrillation (VF) or ventricular tachycardia (VT). Before surgery, the mean Na concentration was 134.0 ± 1.3 mmol/l in the low Na group and 140.5 ± 3.2 mmol/l in the normal/high Na group. After surgery, the mean Na concentration decreased to 134.5 ± 3.4 mmol/l in the low Na group and to 135.5 ± 8.1 mmol/l in the normal/high Na group. Logistic regression analysis of the outcomes showed a significant association between low preoperative Na concentrations and surgical reintervention for hemorrhagic cause, being a risk factor (OR = 3.65; 95%CI 1.18–11.34; p = 0.025). The 7-day mortality was 7.6% in the low Na group vs. 1.1% in the normal/high Na group, and 30-day mortality was 10.9% in the low Na group vs. 1.6% in the normal/high Na group. We found a significant association between low preoperative Na levels and 7-day mortality (OR = 7.40; 95% CI 1.57–34.90; p = 0.011), as well as low preoperative Na levels and 30-day mortality (OR =7.36; 95% CI 2.05–26.42; p = 0.002). Our findings suggest that the occurrence of complications is primarily associated with preoperative rather than postoperative hyponatremia, even when there are minor deviations from the normal range. [ABSTRACT FROM AUTHOR]

Aortic valve replacement is a safe therapy that can reverse cardiac remodeling and increase cardiac contractility, improve symptoms and quality of life. We presented a case of a 35-year-old male patient admitted to the Emergency Institute for Cardiovascular Disease and Transplantation of Târgu Mureș, Romania, due to severe aortic stenosis with severely depressed ejection fraction, left atrial myxome and a history of deep vein thrombosis and pulmonary thromboembolism. He underwent excision of the aortic valve and replacement with a mechanical prosthesis, excision of left atrial myxoma and tricuspid annuloplasty. The postoperative evolution was favourable with a significant recovery of the left ventricular systolic function and regression of cardiac symptomatology. This case was particular due to the rapid progression of the aortic pathology with the reduction of cardiac (systolic) function in a relatively short time as well as the occurrence of the thromboembolic event unrelated to the left atrial myxoma and rather associated with the background of cardiac failure with low cardiac output. [ABSTRACT FROM AUTHOR]

Background: Bicuspid aortic valve is the most common congenital heart defect with an estimated prevalence of 0.5-2% in the general population. It is often associated with progressive aortic valve disease (stenosis or regurgitation) and accute thoracic aortic aneurysm and dissection. A suggestive genetic role for TBX20 and NOTCH1 genes in bicuspid aortic valve and thoracic aortic aneurysms etiology underlines the importance of this transcription factors in cardiovascular disease and also indicate a strong genetic component to the development of this malformation. Objectives: Our objective is to present a case of bicuspid aortic valve- related aortopathy in two brothers treated with Bentall procedure. Material and methods: We present the casses of two 44 and 49 years old male brothers who are diagnosed with bicuspid aortic valve and ascending aortic aneurysm, presenting at the objective exam: chest pain, cough, DISPNHEA, asthenia, fatigue, sweating. Presurgical echocardiographic examination revealed an ascending aortic aneurysm and significant aortic valve regurgitation with a normal global contractility. without any other comorbidities. Angiocardiographic examination discovered ascending aortic aneurysm (of 52 mm, respectively 53 mm) and also dilated aortic annulus (of 24 mm respectively 25mm) requiring surgical replacement of the aortic root for both of them. These modifications led to surgical replacement of aortic valve and ascending aorta with mechanical valvular conduit and coronary arteries reimplantation, surgically known as Bentall procedure. Results: Postsurgical echocardiographic examination confirms a good postoperative status of the patients: normalfunctional valvular prothesiss with conserved global contractility which demonstrates adequate coronary perfusion. Conclusion: This case of the two brothers is a very rare example of familial aggregation by bicuspid aortic valve related aortophaty. Bentall procedure is the gold standard surgery in treatment of aortic root pathology which prevents severe complications related to this pathology: dissection and rupture. This procedure improves the quality of life by blurring the symptoms. The bicuspid aortic valve, known as a defect with high heritability, should be strongly investigated for screening to all the patiens and families with this malformation being associated with serious long-term health risks. [ABSTRACT FROM AUTHOR]

Background: Aortic stenosis is the valvulopathy with the highest incidence, having congenital (frequently bicuspid valve) or degenerative etiology. Objective: The purpose of this paper is to present a case of severe cardiac dysfunction due to the aortic stenosis, in which the surgical benefit is impressive, even if the optimal moment has been exceeded. Material and methods: We present a case of a 39 years old male, with bicuspid aortic valve and moderate aortic stenosis, periodically investigated by cardiologists, without indication of surgery at that time who had a sudden decompensation of the clinical status. He had severe fatigue, dyspnea and a thrombophlebitic episode in the lower left limb. The patient was hospitalized in the Cardiovascular Surgery Clinic of the Institute, where we highlighted severe aortic stenosis, severe tricuspid insufficiency, a tumor in the left atrium and severe dysfunction of the left ventricle (EF 30%). Chest CT scan revealed multiple peripheral pulmonary infarctions, probably in the context of the thrombophlebitis. Blood tests revealed liver dysfunction due to the severe tricuspid insufficiency and also the presence of hepatic B virus, undiscovered until then. We practiced aortic valve replacement, tricuspid annuloplasty and myxoma excision from the left atrium. Results: Postoperative, the evolution was favorable, with increasing in the performance of the heart contractility (up to NYHA I, EF 45%), the decrease of the hepatic dysfunction, the improvement of the clinical status and the quality of the patient's life. Conclusions: The replacement of the aortic valve should be performed before the onset of cardiac dysfunction. It may also be beneficial in selected cases, for patients with decompensated stages of the disease, but with good myocardial function in the first decades of life. [ABSTRACT FROM AUTHOR]