Search Results (264)

Background/Objectives: Artificial intelligence (AI) is increasingly proposed to improve surgical planning, guidance, and postoperative surveillance. Yet many promising applications remain disconnected from the full surgical pathway and the feasible limitations of clinical deployment. In contrast to prior reviews that primarily catalog AI use cases, this review combines the literature to define the translational pathway—from label design through staged validation to workflow integration—required for clinically deployable computed tomography (CT)-based surgical AI. CT and particularly computed tomography angiography (CTA) are especially usable sources for surgical AI because they provide a standardized three-dimensional anatomic model that is already embedded in many clinical workflows. In autologous breast reconstruction, deep inferior epigastric perforator (DIEP) flap CTA offers an unusually strong model system: the anatomy is discrete, surgeon decisions are actionable, and downstream operative and postoperative outcomes are measurable. These characteristics make DIEP reconstruction suitable not only for technical model development, but also for exacting testing of how CT-based AI should be annotated, validated, displayed, and governed. Methods: This focused narrative review combines evidence across the surgical workflow, spanning preoperative planning and risk stratification, intraoperative support, and postoperative monitoring. Reporting standards, implementation frameworks, governance, and regulatory sources were also considered when directly relevant to clinical deployment. Results: Across the available literature on breast reconstruction with the DIEP flap, preoperative CTA has been associated with reductions in operative time of approximately 54–76 min in individual studies. Semi-automated perforator mapping can reduce review time from 2 to 3 h to approximately 30 min. Intraoperative extended-reality tools and surgeon-facing navigation systems illustrate the importance of the ‘last mile’ of translation, while postoperative monitoring models show how imaging-linked data can support a closed-loop learning system. Across these stages, recurring limits include target mismatch, weak external validation, protocol variability, inconsistent reporting, limited subgroup analysis, and inadequate integration of economic and governance considerations. Conclusions: We argue that the next important step is not a generic autonomous model, but a clinically deployable DIEP-CTA-AI program. The practical blueprint proposed here is staged: structured anatomical labels, separate imaging, surgeons’ decisions, and outcome reference standards, dense intermediate endpoints, retrospective and external validation, reader studies, prospective silent deployment, and workflow-impact assessment. If implemented in this way, DIEP flap CTA can serve as a practical blueprint for CT-based AI translation in surgery more broadly. Full article

Dental implant placement has evolved from conventional freehand techniques toward digitally guided workflows integrating cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and dynamic navigation systems. Although guided surgery improves positional accuracy, its clinical relevance compared with freehand placement remains debated. This narrative review, based on a systematic and structured literature search following predefined selection criteria, analyzes studies published between 2000 and 2025 comparing guided and freehand implant placement regarding accuracy, survival, complications, biological outcomes, and workflow efficiency. Searches of PubMed/MEDLINE, Embase, and Web of Science identified 40 eligible human clinical studies for qualitative synthesis. Guided placement consistently demonstrated greater positional accuracy, with angular deviations of approximately 2–4° versus 5–9° for freehand placement and linear deviations reduced by about 1 mm. Nevertheless, implant survival rates were high and comparable for both techniques, generally exceeding 95% across short- and medium-term follow-up. Overall complication rates were low; guided approaches reduced anatomical risk and improved prosthetic predictability in complex or multi-implant cases, while freehand placement allowed greater intraoperative flexibility and tactile feedback, potentially optimizing primary stability in variable bone conditions. Marginal bone loss and peri-implant tissue outcomes were similar between approaches. Guided workflows required additional planning time and costs but enhanced reproducibility in complex rehabilitations. Guided and freehand implant placement should therefore be considered complementary strategies, with optimal outcomes depending on case selection, surgical expertise, and the balanced integration of digital technologies into contemporary implant practice. Full article

Background: Cage subsidence (CS) is among the main complications after oblique lumbar interbody fusion (OLIF) and may lead to the failure of indirect decompression. Accurate preoperative bone quality assessment is critical for risk stratification, yet the optimal imaging modality and diagnostic threshold remain unclear. Objectives: This study aimed to determine a quantitative computed tomography (QCT)-derived volumetric bone mineral density (vBMD) threshold for predicting CS after OLIF with posterior fixation. Methods: Patients undergoing OLIF with posterior fixation between July 2017 and March 2020 were retrospectively enrolled. Preoperative vBMD was measured using QCT as the average L2–L4 trabecular volumetric BMD. CS was defined as a loss of more than 2 mm of disk height on sagittal midline CT views between 3 days postoperatively and the last follow-up. Clinical and radiographic parameters including gender, age, body mass index, vBMD, number of operative levels, cage dimensions, disk height, segmental lordosis, intraoperative endplate injury, and fusion status were analyzed. Results: 86 patients (107 operative levels) with a mean follow-up of 20.6 months were included; 25 levels (23.4%) developed CS. Multivariate logistic regression identified vBMD (p < 0.001; OR 0.947; 95% CI 0.923–0.972) and intraoperative endplate injury (p = 0.031; OR 3.640; 95% CI 1.125–11.776) as independent risk factors. The area under the receiver operating characteristic curve (AUC) for vBMD was 0.847 (95% CI, 0.762–0.932), with an optimal threshold of 83.0 mg/cm³ (sensitivity 84.0%, specificity 76.8%). This threshold closely aligns with the American College of Radiology QCT criterion for osteoporosis (80 mg/cm³); however, given that it was derived from a single-center retrospective cohort, external validation in multi-center studies is warranted before broad clinical adoption. Fusion rates differed significantly between CS and non-CS groups (84.0% vs. 96.3%, p = 0.029). Conclusions: QCT-derived vBMD provides a phantom-calibrated, protocol-standardized metric for preoperative risk stratification of cage subsidence after OLIF. Full article

A 13-year-old, spayed female Maltese dog presented with acute collapse and profound lethargy of approximately 1 h duration. On admission, the dog was in hypovolemic shock, with severe hypotension, marked pallor, tachycardia, and hemoperitoneum identified by focused abdominal ultrasonography. Ultrasonography also revealed a ruptured hemorrhagic mass in the right retroperitoneal space. Because the patient was hemodynamically unstable and ongoing life-threatening hemorrhage was suspected, preoperative computed tomography was considered unsafe, and emergency exploratory laparotomy was performed following transfusion-based resuscitative stabilization. Intraoperatively, the lesion was found to involve the right kidney and caudate hepatic lobe. En bloc resection, including right nephrectomy, partial hepatectomy, and excision of the retroperitoneal-associated mass, was completed while preserving the right adrenal gland and adjacent major vasculature. Histopathologic and immunohistochemical evaluation supported a diagnosis of solid-pattern hemangiosarcoma, although a single primary site of origin could not be definitively assigned. The dog recovered without major perioperative complications, was discharged in stable condition, and maintained good quality of life for approximately 1 year; however, late clinical decline suspicious for recurrence or progression was not objectively confirmed. This case highlights the practical utility of focused ultrasonography, rapid surgical decision-making, and carefully planned en bloc resection for emergency hemorrhage control in a dog when advanced imaging was considered unsafe. Full article

Background: Traditional intraoperative sizing for sutureless aortic valves, such as the Corcym Perceval Plus (CPP), often relies on subjective tactile feedback, which can lead to excessive over-sizing. Significant over-sizing is associated with complications like increased trans-prosthetic gradients, valve thrombosis, and conduction disturbances requiring permanent pacemakers. This study aims to develop an AI-driven predictive recommendation system using Multidetector Computed Tomography (MDCT) data to optimize valve sizing and improve patient outcomes. Methods: Data were collected from 380 consecutive patients who underwent aortic valve replacement with a CPP prosthesis between 2011 and 2026. Two machine learning models were trained using preoperative MDCT features, including annular area, perimeter, and diameters. The first model predicted “normal” clinical labels, while the second used “penalized” labels adjusted for postoperative hemodynamic performance to discourage over-sizing. The dataset was split into training (80%) and testing (20%) subsets. Results: The mean patient age was 77.6 years. The model using normal labels achieved an overall accuracy of 91.84% (68.75% on the test set). The penalized label model showed improved performance with an overall accuracy of 92.89% (72.16% on the test set). MDCT provided highly reproducible objective metrics superior to echocardiography for calculating optimal sizing. Conclusions: The AI-driven recommendation system proves to be a reliable and reproducible tool for preoperative planning. By transitioning from subjective tactile assessment to predictive modeling, surgeons can better select valve sizes that minimize complications, particularly in minimally invasive approaches. Full article

Background/Objectives: Intraoperative cone-beam computed tomography (CBCT) can detect residual fragments (RFs) during percutaneous nephrolithotomy (PCNL), enabling immediate removal and improving stone-free status. However, CBCT requires a hybrid operating room (OR), which is often limited in availability. This study explores patient and stone characteristics associated with CBCT eligibility and develops an exploratory treatment-selection model estimating stone-free probabilities conditional on CBCT use. Methods: We performed a retrospective study of a previously conducted randomized controlled trial evaluating intraoperative CBCT during PCNL in a tertiary care center. We compared CBCT-eligible cases versus ineligible cases, and cases achieving grade C (≤4 mm) stone-free status versus those with RFs. A multivariate exploratory treatment-selection model was developed using the strongest potential predictors of stone-free status. Internal validation was performed using bootstrapping. The model was also assessed for predicting grade A (0 mm) stone-free status. Results: The only significant difference between CBCT-eligible (n = 160) and ineligible (n = 60) cases was stone composition (p = 0.022). The final model included intraoperative CBCT (p = 0.003), stone size (p = 0.024), and composition (p = 0.044). Model-based estimates suggested smaller differences in predicted stone-free probabilities with CBCT in solitary stones. The AUC was 0.81 (95% CI: 0.73–0.88) for grade C and 0.75 for grade A (95% CI: 0.67–0.82) outcomes. Internal validation demonstrated moderate optimism, indicating potential overfitting. Conclusions: This exploratory treatment-selection model estimates conditional stone-free probabilities with and without CBCT. The findings suggest variation in expected benefit across stone characteristics but should be considered hypothesis-generating. The model is not intended for clinical decision-making and requires external validation before implementation. Full article

Background: Rare appendicular pathologies (RAP) are uncommon clinical entities with important diagnostic and therapeutic implications. These conditions frequently mimic acute appendicitis, yet they may require different operative strategies and, in selected cases, oncological management. Methods: We performed a retrospective cohort study including all patients who underwent surgery with the intention of performing an appendectomy at the First Surgical Clinic, Emergency County University Hospital of Cluj-Napoca, between 2018 and 2021. During this interval, 330 appendectomies were performed. Patients with a histopathological diagnosis of RAP were included. Clinical, imaging, surgical, histopathological, postoperative, and follow-up data were analyzed, with particular attention to the preoperative diagnostic work-up and imaging-based suspicion of rare appendicular pathology. Results: Ten patients (3.03%) were diagnosed with RAP, including low-grade appendiceal mucinous neoplasm (LAMN; n = 5), mucinous cystadenoma (n = 2), appendiceal adenocarcinoma (n = 1), appendicular diverticulum (n = 1), and stump appendicitis (n = 1). Computed tomography was the main diagnostic modality, particularly in patients with atypical presentation or suspicion of complicated or neoplastic appendiceal disease, while magnetic resonance imaging and colonoscopy provided additional information in selected cases. Preoperative suspicion of a rare or neoplastic appendiceal pathology was achieved in 70% of patients. Laparoscopic appendectomy was performed in 6 patients, open appendectomy in 1 patient, open ileocecal resection in 1 patient, open right hemicolectomy in 1 patient, and laparoscopic right hemicolectomy in 1 patient. Histopathological examination confirmed the diagnosis in all cases. Immediate postoperative outcomes were favorable, without perioperative mortality or major complications; during follow-up, the patient with adenocarcinoma required oncological treatment and resection of a local recurrence 1 year after surgery. Conclusions: RAP represent a small but clinically significant subset of appendiceal disease. Structured preoperative imaging, intraoperative recognition of atypical findings, and an individualized surgical strategy are essential for optimal outcomes and appropriate oncological management. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a novel vessel preparation device for patients with peripheral artery disease undergoing angioplasty. The IVL catheter includes an integrated balloon, which emits high pressure and transient sonic waves. The release of shockwaves results in cracking of intimal and medial calcium within the vessel wall improving lumen patency. Objectives: The aim of this prospective observational cohort study is to evaluate the morphological and imaging changes in atherosclerotic plaque in patients with PAD undergoing IVL as a vessel preparation technique, followed by angioplasty with drug-coated balloon (DCB) or stent placement if required. Secondary endpoint is to evaluate the efficacy of IVL in the perfusion of the lower extremities, by calculating the ankle–brachial index (ABI) and toe–brachial index (TBI) post-angioplasty, as well as adverse events within 30 days. Methods: Consecutive adult (≥18 years of age) patients with symptomatic femoropopliteal artery disease selected to undergo IVL will be included in the study. Computed tomography angiography (CTA) of the lower limbs will be performed pre- and postoperatively. Intraoperatively, an intravascular ultrasound (IVUS) will be used before and immediately post-angioplasty, for real-time evaluation of the morphological and quantitative changes in the atherosclerotic plaque. All participants will be clinically re-evaluated in 30 days postoperatively and a color Duplex ultrasound of the lower extremity arteries will be performed. The perfusion of the peripheral arteries will be assessed using ABI and TBI post-procedurally. Outcomes: The primary outcome is the quantitative assessment of changes in plaque morphology and volume within the index target lesion, based on pre- and post-procedural computed tomography angiography using TeraRecon™ (Durham, NC, USA) plaque analysis module, reflecting plaque modification and redistribution, in the context of IVL-based vessel preparation. Secondary outcomes include improvement of peripheral arterial perfusion and freedom from clinically driven target lesion revascularization (CD-TLR) and major adverse events. Full article

Background: Coronary artery bypass grafting is the optimal revascularization strategy for patients with complex multivessel coronary artery disease. However, saphenous vein grafts are associated with high failure rates and donor site morbidity. Off-the-shelf tissue-engineered vascular grafts offer a potential solution for patients lacking suitable autologous vessels. Here, we report the first successful clinical implant of an acellular Tissue-Engineered Vessel (TEV) for coronary artery bypass grafting in Europe. Methods: A 73-year-old male with two-vessel disease and no suitable autologous vein underwent on-pump coronary artery bypass grafting using the left internal mammary artery to the left anterior descending artery and a 4 mm TEV to the right coronary artery. Results: Implant procedure followed standard surgical techniques, sutures and duration. The conduit handling was comparable to native vessels. Intraoperative flow measurements demonstrated excellent graft performance (TEV: 110 mL/min, Pulsatility Index 1.0). Postoperative recovery was uneventful. One-month computed tomography coronary angiography confirmed graft patency. Discussion: This case demonstrates the feasibility of using a bioengineered conduit for coronary revascularization in patients without suitable autologous grafts. If these findings are confirmed in larger trials, bioengineered vessels could expand surgical revascularization to patients without suitable autologous conduits and fundamentally alter conduit selection strategy in CABG. Conclusions: This first-in-Europe clinical implant demonstrates that an off-the-shelf acellular tissue-engineered vessel can meet the procedural, hemodynamics, and patency requirements of coronary artery bypass. These proof-of-concept results support progression to prospective multi-center evaluation. Full article

Artificial intelligence (AI) is increasingly transforming spine surgery, with expanding applications in diagnostics, intraoperative imaging, and surgical navigation. As the field advances toward greater precision and safety, machine learning (ML) and deep learning technologies are being integrated to augment surgeon expertise and optimize operative workflows. In particular, AI-driven innovations in image acquisition and navigation are reshaping intraoperative decision-making and technical execution. This narrative review provides an overview of AI applications relevant to intraoperative imaging and navigation in spine surgery. We begin by defining key concepts in AI, ML, and deep learning and briefly outline the historical evolution of AI within spine practice. We then examine current capabilities in image recognition and automated pathology detection, emphasizing their clinical relevance. Given the central role of imaging accuracy in modern navigation-assisted procedures, we review conventional acquisition platforms, including intraoperative computed tomography (CT) systems (e.g., O-arm, GE, Airo), surface-based registration to preoperative CT (Stryker, Medtronic), and optical surface mapping technologies (e.g., 7D Surgical). Emerging AI-optimized advancements are subsequently discussed, including low-dose intraoperative CT protocols, expanded scan windows, metal artifact reduction algorithms, integration of 2D fluoroscopy with preoperative CT datasets, and 3D reconstruction derived from 2D imaging. These developments aim to improve image quality, reduce radiation exposure, and enhance navigational accuracy. By synthesizing current evidence and technological progress, this review highlights how AI-enhanced imaging systems are redefining intraoperative spine surgery and shaping the future of precision-based care. The primary purpose of this review is to outline the applications of AI and its potential for perioperative and intraoperative optimization, including radiation exposure reduction, workflow streamlining, preoperative planning, robot-assisted surgery, and navigation. The secondary purpose is to define AI, machine learning, and deep learning within the medical context, describe image and pathology recognition, and provide a historical overview of AI in orthopedic spine surgery. Full article

Management of unstable upper lumbar fractures with corpectomy and posterior fixation is technically demanding, and conventional workflows may require intraoperative repositioning, increasing operative complexity. Lateral mini-open upper lumbar corpectomy (LMULC) paired with robotic-assisted (RA) posterior percutaneous pedicle screw fixation (PPPSF) can be performed in a single position to facilitate ventral spinal decompression and stabilization in the anatomically constrained upper lumbar spine. In this study, we describe the operative technique and report four illustrative cases of unstable L1 or L2 fractures treated with single-position LMULC, RA-PPPSF, and short-segment fusion. Clinical, radiological, intraoperative variables and postoperative outcomes were evaluated. The mean age was 52.3 ± 17.7 years. The median operation time was 314 min (range 268–361 min); the median estimated blood loss (EBL) was 225 mL (range 100–400 mL). The median preoperative kyphosis was 10.15° (range 8.4–14.6°), the median postoperative kyphosis measured 6.65° (range 1.7–10.8°) and the median correction achieved was 3.5° (range −2.4–12.9°). The median visual analog scale (VAS) pain score reduced from 7 (range 7–9) preoperatively to 4.5 (range 2–6) postoperatively at discharge. At a median follow-up of 12 months (range 6–15 months), all patients had uncomplicated recoveries, demonstrated solid fusion on imaging, and reported favorable MacNab outcomes. Single-position LMULC with RA-PPPSF was technically feasible in this preliminary illustrative series and resulted in favorable clinical and radiographic outcomes. However, further studies in larger cohorts are warranted to help confirm these findings and better define the potential advantages and limitations of this technique. Full article

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

Background/Objectives: Accurate preoperative assessment of renal tumor complexity is essential for surgical planning and for predicting perioperative outcomes after partial nephrectomy (PN). RENAL and PADUA nephrometry scores, traditionally derived from two-dimensional (2D) computed tomography (CT) imaging, are widely used to quantify renal tumor complexity and surgical risk. However, the introduction of hyperaccuracy three-dimensional (HA3D) models has enabled enhanced anatomical visualization, potentially improving the assessment of surgical difficulty and the prediction of postoperative complications. The aim of this study was to compare conventional CT-based RENAL and PADUA scores with HA3D-derived nephrometry scores in predicting perioperative complications in patients undergoing robot-assisted or laparoscopic PN. Methods: A total of 17 consecutive patients with intermediate- or high-complexity category renal tumors (RENAL ≥ 7) and moderate- or high-risk category tumors (PADUA ≥ 8) were prospectively enrolled. Preoperative demographic and clinical parameters, as well as intraoperative and postoperative data, were prospectively collected. Tumor characteristics were evaluated using both CT-based RENAL and PADUA scoring systems and HA3D nephrometry reconstruction. Associations between nephrometry scores and perioperative outcomes were assessed using Spearman’s correlation. Predictive performance for postoperative complications and early chronic kidney disease (CKD) was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 41% and 35% of cases were downgraded according to three-dimensional (3D) RENAL and PADUA complexity–risk category assessment, respectively. Operative time demonstrated a moderate correlation with 3D RENAL (ρ = 0.57) and 3D PADUA (ρ = 0.49) scores. ROC curve analysis demonstrated numerical differences in area under the curve (AUC) values between 3D- and 2D-based nephrometry scores in predicting overall complications (RENAL: 0.61 vs. 0.54; PADUA: 0.69 vs. 0.46). 3D RENAL score demonstrated numerically higher AUC values for early postoperative CKD compared with 2D RENAL score (AUC: 0.72 vs. 0.67). Conclusions: HA3D-based nephrometry scores were associated with enhanced anatomical visualization, frequent downgrading of tumor complexity–risk categories, and numerical differences in predictive performance for postoperative complications and early renal functional decline compared with conventional CT-based scores. These findings suggest a potential role for HA3D modeling in preoperative planning for PN. However, given the limited sample size, these observations should be interpreted as exploratory and hypothesis-generating, and warrant validation in larger multicenter cohorts. Full article

Background and Clinical Significance: Needle fracture during inferior alveolar nerve block is a rare complication, but it can nevertheless result in serious complications, especially when the fragment migrates into deep anatomical spaces like the pterygomandibular region. Accurate localization and safe retrieval are vital in preventing infection, chronic pain, neurovascular injury, and long-term functional impairment. Case Presentation: We present a case of a 27-year-old patient who had a fractured needle fragment from a local anesthetic procedure retained in the left pterygomandibular space. Cone beam computed tomography (CBCT) was carried out to verify the presence of the metallic foreign body and to define its exact three-dimensional position in relation to adjacent bone and soft tissue landmarks. The approach was transoral, and the surgery was done under general anesthesia. During the surgery C-arm fluoroscopy was used to help guide localization and retrieval, along with the help of radiopaque reference markers to assist in determining the trajectory. The fragment was removed without any issue. After the surgery, the patient’s condition improved well, and he showed no signs of functional deficits. Conclusions: The management of broken needle fragments in the pterygomandibular space can be safely and effectively done using a combination of preoperative CBCT and intraoperative C-arm guidance. This technique allows for exact location determination, minimizes unnecessary dissection of the tissue, and will make the surgery safer in complicated areas. Full article

Background and Clinical Significance: Subvalvular aortic stenosis (SAS) is the second most common form of aortic stenosis after valvular disease and predominantly affects male patients. It is frequently associated with other congenital cardiac anomalies, such as ventricular septal defect, and is rarely diagnosed during infancy. Instead, SAS typically manifests during childhood or adulthood as a progressive left ventricular outflow tract obstruction, leading to left ventricular hypertrophy and, in many cases, aortic regurgitation. Case Presentation: The first patient was a 61-year-old man presenting with progressive dyspnea, in whom echocardiography revealed severe subaortic stenosis and computed tomography demonstrated aneurysmal dilatation of the ascending aorta. Intraoperatively, the aortic valve was found to be dystrophic with mixed stenotic and regurgitant disease; therefore, subaortic membrane resection, mechanical aortic valve replacement, and ascending aortic replacement with a synthetic graft were performed. The second patient was a 31-year-old man with exertional dyspnea and a discrete subaortic membrane associated with mild ascending aortic dilatation. Surgical treatment consisted of complete membrane resection and aortic valve repair, while the ascending aorta was preserved. Both patients had an uneventful postoperative course and were discharged on the fourth postoperative day. At 3-month follow-up, both were asymptomatic, in normal sinus rhythm, and demonstrated satisfactory echocardiographic findings without residual left ventricular outflow tract obstruction. Conclusions: Surgical intervention remains the definitive treatment for subvalvular aortic stenosis when clinically indicated. Concomitant cardiac or aortic pathology should be addressed during the same procedure to optimize outcomes. When performed with meticulous technique and appropriate patient selection, surgical correction is associated with excellent early recovery and favorable mid-term results, although long-term follow-up remains essential due to the risk of recurrence. Full article