Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era ( less then  1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.In industrialized countries, the most common etiology of mitral regurgitation (MR) is degenerative mitral valve (MV) disease. The natural history of severe degenerative MR is poor. However, its appropriate and timely correction is associated with a life expectancy similar to that of the normal population. Surgical MV repair is the gold-standard treatment. This review will focus on the most recent evidence with a specific emphasis on surgical indications, timing of treatment, contemporary surgical techniques, Heart Teams, and Centers of Excellence.Rheumatic valve repair although complex but with better understanding of mitral complex and dynamics, successful rate of mitral repair is enhanced and promising.Many retrospective series have been reported on the outcomes of tracheal resection for adenoid cystic carcinoma. However, demonstration on techniques of surgery and ventilatory management during the procedure are rare. We, herewith demonstrate a surgical video, wherein a distal tracheal resection was performed through right posterolateral thoracotomy.Left main coronary artery disease (LMCAD) has low incidence but foreshadow a high prognostic risk merely due to the myocardial territory it supplies. Coronary artery bypass grafting (CABG) has been the standard of treatment for LMCAD. Recently, two major trials-NOBEL and EXCEL-with contradicting results have been published. I will not wade into the accusations of malfeasance, but the bottom line is that, superiority of percutaneous coronary interventions (PCI) to CABG is yet to be proved. Heart-team approach has been discussed in every aspect, but in real-world scenario, to what extent, and in what manner the same is practised, remains a question. We need an objective type of heart-team approach than a subjective heart-team approach.Benign extra-gonadal germ cell tumors, known as teratoma or dermoid cysts, are commonly found in the anterior mediastinum in association with the thymic gland. This association is due to their common site of embryological origins, from the third and the fourth pharyngeal pouches. Since it is not unusual to find normal thymic tissue in the neck, germ cell tumors arising from here will present as a cervical tumor. We submit the typical images of one such tumor in a young adult. Intraoperatively, the tumor was well encapsulated and was connected to the mediastinal thymus by a long pedicle of thymic tissue. It was not related to the thyroid gland unlike a primary cervical teratoma. We present these typical images of a mediastinal dermoid in this unusual cervical location. The differential diagnoses to be considered clinically are primary cervical teratomas, thyroid tumors, lymph nodal pathologies, and branchial cyst.This is a case of a young man who underwent preoperative computed tomography evaluation for sinus venosus type of atrial septal defect, and was found to have associated chronic constrictive pericarditis. Association of these two entities is rare and changes the management approach.The Nordic-Baltic-British left main revascularization trial (NOBLE) is a prospective, randomized, multicentre, non-inferiority trial comparing percutaneous coronary angioplasty (PCI) with coronary artery bypass grafting (CABG) for revascularization of patients with unprotected left main coronary artery (LMCA) stenosis. The primary outcome was a combined endpoint of all-cause mortality, stroke, non-procedural myocardial infarction and repeat revascularization. CABG was found to be superior to PCI with respect to the 5-year MACCE rates (28% vs. 19%) with a hazard ratio (HR) of 1.58 (95% CI 1.24-2.01). All-cause mortality rates were similar, but PCI was associated with increased occurrence of non-procedural myocardial infarction (p = 0.0002) and repeat revascularization (p = 0.0009). There was no difference in the stroke rates (p = 0.11) at 5 years. Currently, European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization assign a class 1A recommendation to PCI in patients with unprotected LMCA stenosis with a SYNTAX score less then  23. The findings of the NOBLE trial challenge this premise.A combination of tetralogy of Fallot with diaphragmatic hernia represents a very rare entity. We present a case of 18-month-old child presenting late with cyanosis and respiratory distress. Chest X-ray and computed tomography angiography showed tetralogy of Fallot with small left pulmonary artery with right lung aplasia with congenital diaphragmatic hernia with liver and bowel loops in right chest cavity. The patient was managed with central shunt on cardiopulmonary bypass and was discharged uneventfully.Congenitally corrected transposition of the great arteries (CCTGAs) is a condition, which includes atrioventricular and ventriculoarterial discordant connections along with ventricular septal defect (VSD), pulmonary stenosis (PS), or pulmonary atresia (PA). Without treatment, progressive systemic ventricular failure begins, which is followed by sudden cardiac death by the fourth or fifth decade. We report a case of a 4-year-old with CCTGA, VSD, and PS operated by Senning procedure and pulmonary root translocation (PRT) with uneventful postoperative recovery. PRT overcomes problems with the right ventricle to the pulmonary artery conduit and maintains pulmonary valve function and growth capacity. Our initial experience with PRT in CCTGA indicates that it is a feasible surgical alternative for such patients.Pseudocoarctation of the aorta (PCOA) is a rare anomaly of the aortic arch and its presentation is often an incidental finding. We present the case of a 66-year-old patient with a history of high blood pressure, who was admitted for surgical management of bicuspid aortic valve disease with severe insufficiency and who was incidentally detected to have a PCOA. It was decided to manage the latter conservatively and go ahead with surgical aortic valve replacement, to address the problem that led to his admission to the hospital. The patient had a favorable postoperative course and was discharged in a stable condition with an advice for periodic follow-up as out-patient consultations.This case report is a description of an uncommon delayed presentation of penetrating trauma of lower limb with history of inciting event being 45 years ago, as there are only 4 such reported cases in the literature. A 65-year-old male presented with progressive enlargement of swelling over the anterior aspect of the right thigh with difficulty in walking due to mechanical effects and paraesthesia in the affected limb. Clinical signs of a large lump in the right anteromedial thigh with no pulsations were present. Computerised tomographic angiography revealed the presence of a superficial femoral artery pseudoaneurysm. The open surgical management involved resection of the pseudoaneurysm and autologous vein patch angioplasty. The rarity of incidence and paucity of physical signs suggest that a high index of suspicion, careful clinical review and radiological investigation is indispensable to diagnose and treat this condition.The extension of aortic dissection into common carotid arteries can cause thrombus formation in false lumen. This may result in perioperative cerebral malperfusion and stroke. At present there are no specific management guidelines in this situation. We report our experience of operative and non-operative management of thrombosis of carotid arteries in type A acute aortic dissection in 3 patients.The presence of interatrial communication is considered obligatory in total anomalous pulmonary venous connection (TAPVC). Even a restriction in this communication leads to obstructive TAPVC. We report a rare case of obstructed supracardiac TAPVC with the absence of interatrial communication and with multiple ventricle septal defects (VSDs) in a 3-month-old child.We report a case of a 24-year-old man who had an exploratory laparotomy 3 years earlier for a penetrating hypogastric wound. He presented with congestive heart failure that had progressed over the past 4 months. Transthoracic echocardiography and computed tomography (CT) angiography of the aorta demonstrated a wide arteriovenous fistula between the right common iliac artery and the iliocaval confluence, resulting in the dilatation of the inferior vena cava and of the right heart chambers. The patient was treated by surgical ligation of the right common iliac artery above and below the fistula in conjunction with aortoiliac bypass, thus excluding the shunt.Coronary sinus rupture (CSR) is a rare operative complication, and a standard procedure for its treatment has not been established. We report successful repair of a CSR in a 68-year-old man who underwent total arch replacement for type A acute aortic dissection. CSR was caused by the coronary sinus cannulation for retrograde cardioplegia and was detected during cardiopulmonary bypass weaning. We applied an elastomeric sealant with a bovine pericardium patch on the beating heart. After manual compression for 2 min, complete hemostasis was achieved. A clampless and sutureless hemostasis for repairing coronary sinus rupture is a simple, fast, and effective technique.Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. We report a case of large posterior mid-ventricular rupture following mitral valve replacement, which was successfully treated by a patch repair and autotransplantation.Submitral aneurysm is a congenital outpouching of the left ventricular wall invariably occurring adjacent to the posterior leaflet of the mitral valve. It usually presents with heart failure symptoms. We report a case of a 59-year-old gentleman with a posterolateral submitral aneurysm who underwent aneurysm patch repair and mitral valve repair. Good knowledge about the interrelationship between the aneurysmal sac and mitral valve was obtained enabling proper surgical repair.