Shone complex is a rare congenital cardiovascular anomaly characterized by multiple left-sided obstructive lesions. Adult presentation is uncommon and may result in atypical clinical manifestations, particularly when complicated by infective endocarditis. Coarctation of the aorta-associated infective endocarditis is especially rare and carries significant clinical risk. We report a 25-year-old male with partial Shone complex consisting of a parachute mitral valve, mitral stenosis, and coarctation of the aorta. The patient presented with persistent high-grade fever and was diagnosed with methicillin-sensitive Staphylococcus aureus infective endocarditis based on positive blood cultures. Transthoracic and transesophageal echocardiography revealed obstructive left-sided lesions, mitral valve pathology, and moderate aortic regurgitation. Positron emission tomography demonstrated intense hypermetabolic activity at the coarctation site, consistent with active infection and confirming a saccular aneurysm. The patient underwent prolonged intravenous cefazolin therapy followed by surgical repair. The early postoperative course was stable; however, seven months later he re-presented with recurrent fever. Repeat imaging demonstrated graft infection, vegetation on the prosthetic material, and a perforated mitral leaflet. A second course of intravenous antibiotics (cefazolin and rifampicin) was administered, followed by long-term suppressive oral therapy. Subsequent follow-up showed persistent moderate-to-severe mitral regurgitation with stable postoperative anatomy. This case highlights a rare adult manifestation of partial Shone complex complicated by coarctation of the aorta-site methicillin-sensitive Staphylococcus aureus infection, saccular aneurysm formation, and recurrent graft-associated infective endocarditis. The clinical course underscores the importance of vigilant multimodality imaging, early multidisciplinary evaluation, and long-term follow-up in adults with complex CHD, particularly when infectious complications are present.

Shone complex is a group of coexisting obstructive left-sided cardiac lesions with variable presentation and severity. There are limited data regarding long-term outcomes of patients with Shone complex given the rarity of the condition. Late-onset (outside the postoperative period) complete heart block (CHB) has not typically been associated with Shone and is not well described in the literature. In this case series, we retrospectively analyzed 3 clinical cases of patients with Shone complex, aged 31 to 59 years, who developed late heart block. The primary objective of the case series was to identify any associated characteristics among the three Shone complex patients who developed late CHB.

• Supravalvular AS is a rare finding in Shone complex (SC). • Despite absence of MS, common complications of SC developed. • Frequent reevaluation via echocardiography is key in detection and management. [Figure: see text]

Coronary artery fistulas (CAFs) are rare anomalies that can cause ischemia, arrhythmias, and sudden cardiac death. Conventional closure techniques often fail in anatomically complex cases. We present the first-in-human use of a customized, partially covered G-Armor pulmonary artery (PA) stent to manage a left main-to-right pulmonary artery fistula in a patient with Shone complex. The intervention was planned using a three-dimensionally printed model, allowing precise stent customization to avoid obstruction of key pulmonary branches. This case shows the feasibility of using customized endovascular devices to address complex CAFs in high-risk patients. The intervention improved antegrade coronary perfusion and clinical outcomes. To the best of our knowledge, this is the first reported case of a customized partially covered PA stent for CAF management. In anatomically complex and high-risk CAFs, customized stenting offers a viable solution when conventional therapies fail.

Shone complex is a rare and underrecognized congenital heart disease involving four obstructive lesions of the left heart. This report presents a rare case of incomplete Shone complex, along with other associated anomalies, requires an extensive clinical workup for accurate diagnosis and appropriate surgical planning.