Acute Congenital and Acquired Heart Disease

Acute aortic syndrome (AAS) is the modern term that includes aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Both acquired and genetic conditions share a common pathway leading to the breakdown in the integrity of the intima. All mechanisms that weaken the media layers of the aorta will eventually lead to higher wall stress, which can induce aortic dilatation and aneurysm formation, eventually resulting in intramural hemorrhage, aortic dissection, or rupture. In case of type A acute aortic syndromes, the classic aortic arch operation consists in the replacement of the ascending aorta with or without partial arch. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. The best method to protect the brain has demonstrated to be the bilateral antegrade selective cerebral perfusion (ASCP). Acute myocardial infarction (AMI) can result in ischemic, mechanical, arrhythmic, embolic, or inflammatory complications. Ventricular septal rupture, free-wall rupture, and papillary muscle rupture are the most frequents and catastrophic complications that require a prompt surgical intervention. Critical congenital heart defects (cCHD) are causes for acute cardiac failure in the neonate, and despite the progress in cardiothoracic surgery, they remain a principal cause of comorbidity and mortality with a mortality rate up to 25% in the first year of life. For that reason, prenatal diagnosis and initiation of adequate treatment are mandatory.