Valvular cardiac surgery

Kyobu Geka. 2025 Sep;78(9):693-696.

ABSTRACT

A 74-year-old woman was diagnosed with obstructive hypertrophic cardiomyopathy and symptoms of heart failure. Transthoracic echocardiography and other imaging examinations revealed an apical-basal muscle bundle caused by a left ventricular outflow tract(LVOT) obstruction. The peak velocity was 6.1 m/s, recorded during the Valsalva maneuver, and mitral regurgitation progressed from trivial to moderate. The course of operative treatment consisted of surgical intervention in the mitral valve. The LVOT revealed an apical-basal muscle bundle, approximately 6 mm in diameter;however, this was excluded. Extended septal myectomy and intraoperative transesophageal echocardiography were performed, the latter to verify the systolic anterior motion of the mitral valve;however, mitral regurgitation was not detected. The post-operative peak velocity improved to 2.5 m/s. In conclusion, surgical treatment of obstructive hypertrophic cardiomyopathy and LVOT obstruction associated with an apical-basal muscle bundle was performed with accurate diagnosis, thus avoiding valvular surgery.

PMID:40998368

Catheter Cardiovasc Interv. 2025 Sep 25. doi: 10.1002/ccd.70213. Online ahead of print.

ABSTRACT

Aortic regurgitation (AR) develops in up to 25%-30% of patients with left ventricular assist device (LVAD). Treatment remains challenging since surgery confers significant peri-operative risk and the lack of valvular calcification renders transfemoral transcatheter aortic valve implantation (TF-TAVI) with non-dedicated devices technically challenging. We present a case series wherein a TF J-Valve system, a dedicated transcatheter heart valve for pure AR, emerges as an alternative treatment for AR in patients with an LVAD. We demonstrate successful deployment even in the presence of challenging anatomy including aortic root thrombus. Technical considerations when performing TF-TAVI in LVAD patients are discussed.

PMID:40995838 | DOI:10.1002/ccd.70213

Int J Surg Case Rep. 2025 Sep 22;136:111963. doi: 10.1016/j.ijscr.2025.111963. Online ahead of print.

ABSTRACT

INTRODUCTION: Laubry-Pezzi syndrome is a rare congenital heart disease characterized by the association of a ventricular septal defect (VSD) and aortic regurgitation (AR) due to valvular prolapse. The natural course of this condition may lead to severe valvular damage and aortic root dilatation, particularly in cases of delayed diagnosis.

PRESENTATION OF CASE: We report two adult cases of Laubry-Pezzi syndrome managed surgically in Benin. The first patient, a 49-year-old man, presented with severe AR, a large subaortic VSD, and an ascending aortic aneurysm. He underwent VSD closure and a mechanical Bentall procedure. Postoperatively, he developed complete atrioventricular block requiring pacemaker implantation, with no further complications over 24 months. The second patient, a 19-year-old man, had severe AR, a 16 mm VSD, and dilated sinus of Valsalva. He underwent VSD closure, mechanical aortic valve replacement, and tricuspid annuloplasty. Recovery was uneventful, with favorable outcomes at the four-month follow-up, and ongoing surveillance is planned.

DISCUSSION: These two cases demonstrate the clinical progression of untreated Laubry-Pezzi syndrome in adults, highlighting challenges related to delayed diagnosis. Despite complex anatomical findings, surgical repair including Bentall and valve replacement was successfully performed in a resource-limited setting. Findings align with global literature in terms of pathology and outcomes, supporting the feasibility of advanced cardiac surgery in sub-Saharan Africa.

CONCLUSION: Early detection and intervention are critical to prevent severe valve and aortic complications in Laubry-Pezzi syndrome. This case report illustrates that, even in low-resource contexts, successful surgical outcomes are achievable through adapted techniques and interdisciplinary collaboration.

PMID:40992295 | PMC:PMC12494551 | DOI:10.1016/j.ijscr.2025.111963

PLoS One. 2025 Sep 24;20(9):e0328954. doi: 10.1371/journal.pone.0328954. eCollection 2025.

ABSTRACT

BACKGROUND: Chronic postsurgical pain (CPSP) after cardiac surgery is significant. Despite the known association between acute pain and CPSP, advanced pain management strategies have not reduced its incidence. Preventing CPSP requires optimizing acute pain control and disrupting central sensitization. The side effects and risks associated with chronic use of current opioid-based cardiac anesthesia necessitate the adoption of multimodal analgesia. Regional anesthesia is a promising alternative, though existing techniques in cardiac surgery have notable limitations. The intertransverse process block (ITPB) is a novel regional technique that offers potential somatic and visceral analgesia. Recent studies demonstrate consistent local anesthetic spread to the intercostal, paravertebral, and epidural spaces, suggesting broader pain control. ITPB may provide a simpler, safer approach in cardiac surgery, reducing the risks of pleural puncture and bleeding. We hypothesize that ITPB will improve quality of recovery, pain control, and health-related quality of life, thereby mitigating chronic postsurgical pain.

METHODS: This is a single-center, randomized, double-blinded, placebo-controlled trial with intention-to-treat analysis. Elective patients awaiting coronary artery bypass grafting, with or without valvular repair or replacement, will be recruited. Ninety-six participants will be randomly assigned to either ITPB or control group. The ITPB group will receive bilateral ITPBs with 20 ml 0.25% levobupivacaine on each side at the T4-5 level under ultrasound guidance, administered before anesthesia induction. Sham blocks, with equal volume of normal saline, will be performed in the control group. The primary outcome is the quality of recovery, assessed using the 15-item Quality of Recovery questionnaire, at 24 hours after tracheal extubation. Secondary outcomes include Numerical Rating Scale pain scores, patient satisfaction, and opioid consumption within 72 hours post-extubation, duration of mechanical ventilation, length of stay in the ICU and hospital, and opioid-related side effects. The incidence of CPSP at 3, 6, and 12 months will be measured, along with pain interference via the Brief Pain Inventory and the Short-Form McGill Questionnaire-2.

DISCUSSION: Current pain management strategies often rely heavily on opioids, which can have significant side effects and may not adequately address chronic postsurgical pain. This study investigates the efficacy of the intertransverse process block, a novel regional anesthesia technique, in reducing both acute and chronic postsurgical pain in cardiac surgery. Randomized controlled trials on intertransverse process block in cardiac surgery are limited. The results of this study will help define the role of intertransverse process block on the recovery process, and generate vital preliminary data on its potential long-term benefits in reducing chronic postsurgical pain in cardiac surgical population.

CLINICAL TRIAL REGISTRATION: This trial has been prospectively registered at clinicaltrials.gov: NCT06946290.

PMID:40991544 | PMC:PMC12459764 | DOI:10.1371/journal.pone.0328954

Cardiovasc Res. 2025 Sep 24:cvaf159. doi: 10.1093/cvr/cvaf159. Online ahead of print.

ABSTRACT

AIMS: Calcific aortic valve disease (CAVD) is becoming more prevalent with the population ageing; however, there is currently no medical therapy available. During early lipid deposition, low-density lipoprotein (LDL) mediates chronic inflammation and accelerates calcification progression. However, the mechanism still needs to be further explored.

METHODS AND RESULTS: The study identified the transcription factor FOXS in human valvular interstitial cells (VICs) as a pivotal regulator in aortic valve calcification. Bulk RNA-seq and qRT-PCR analysis were conducted to establish that FOXS1 is induced by oxidized LDL (oxLDL) in VICs. To elucidate the role of FOXS1 in osteogenic differentiation, small interfering RNA and recombinant adenovirus were utilized to modulate FOXS1 expression in VICs. High-fat diet (HFD)-fed Apoe-/-Foxs1-/- mice served as an in vivo model to investigate the role of FOXS1 in aortic valve calcification. Analysis from bulk RNA-seq, qRT-PCR, and western blot indicated significant activation of FOXS1 by oxLDL in VICs, with silencing of FOXS1 inhibiting oxLDL-induced osteogenic differentiation. Deletion of FOXS1 markedly reduced aortic valve calcification in HFD-fed Apoe-/- mice, as shown by decreased calcium deposition in the aortic valve leaflets. RNA-seq and chromatin immunoprecipitation sequencing were performed to reveal the regulatory mechanisms of FOXS1, uncovering direct interactions with the promoter of BSCL2, which subsequently inhibits the expression of ABCA1 and ABCG1 via the PPARγ/LXRα axis. The study demonstrated that FOXS1 mediates VICs' cholesterol transport dysfunction through BSCL2, ABCA1, and ABCG1 using Bodipy-cholesterol and showed that intracellular cholesterol accumulation can activate the NLRP3 inflammasome, promoting osteogenic differentiation of VICs. Additionally, it was found that IMM-H007 and recombinant BSCL2 could reduce aortic valve calcification both in vitro and in vivo.

CONCLUSION: We identified that an oxLDL-induced transcription factor FOXS1 inhibits ABCA1 and ABCG1 expression via the BSCL2/PPARγ/LXRα axis and promotes cholesterol transport dysfunction and the activation of NLRP3 inflammasome in VICs, thereby accelerating the progression of CAVD.

PMID:40990096 | DOI:10.1093/cvr/cvaf159

Front Cardiovasc Med. 2025 Sep 8;12:1567533. doi: 10.3389/fcvm.2025.1567533. eCollection 2025.

ABSTRACT

BACKGROUND: Fast-track extubation is a key component of the interdisciplinary treatment concept Enhanced Recovery After Surgery (ERAS). In preparation for implementing ERAS as a comprehensive approach, we aimed to analyze the current state of fast-track extubation in the operating room, focusing on Minimally Invasive Cardiac Surgery (MICS). Specifically, we assessed the potential benefits of immediate on-table extubation compared to extubation within six hours after the completion of MICS.

METHODS: During a 4-year period from 2019-2023, a total of n = 146 patients underwent MICS at our institution. Surgical aspects were retrospectively analysed along with patients' risk profiles and relevant comorbidities. After 1:1 best neighbor propensity score matching, patients who were admitted to intensive care unit intubated but were extubated within six hours after surgery (fast-track, FT) were compared to those who were extubated in the operating room (extubation in tabula, EIT). The primary endpoint was fast-track failure (FTF), a composite of setbacks in the postoperative course: revision surgery, re-intubation, and readmission to ICU or intermediate care unit (IMC).

RESULTS: Patients had a median age of 61 years (IQR: 51.3-67.8) and were predominantly male (76.7%). The primary study endpoint occurred in 20.0% of all matched patients (FT: 26.7%, EIT: 13.3%; p = 0.289). FT patients had longer cardiopulmonary bypass times [FT 165.0 min (146.5-217.5); EIT 158.5 min (128.0-189.5); p = 0.047], but the duration of surgery was comparable. Additionally, the average length of hospital stay did not differ. A multivariate analysis was conducted and identified preoperative atrial fibrillation and intraoperative hypothermia as predictive risk factors for FTF.

CONCLUSIONS: According to our retrospective single-center analysis, extubation in the operating room is feasible and safe even outside of a structured ERAS program. However, as itself it does not impact the further hospital stay, if there is no action thereafter, e.g., same day physiotherapy.

PMID:40989110 | PMC:PMC12450875 | DOI:10.3389/fcvm.2025.1567533

West Afr J Med. 2025 Apr 30;42(4):330-335.

ABSTRACT

BACKGROUND AND OBJECTIVES: Aortic valve stenosis (AoS) is the most common valvular pathology in the elderly, many of whom are ineligible or high-risk for surgery due to comorbidities. Transcatheter Aortic Valve Implantation (TAVI) was developed as a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe AoS. Its efficacy was first demonstrated in the landmark PARTNER trial, which compared TAVI to medical therapy in ineligible SAVR patients. Subsequent studies have validated its use in intermediate and low-risk groups. Despite its growing adoption, there has yet to be a report of a successful TAVI procedure in West Africa.

METHODS: The procedure involved transcatheter aortic valve implantation using radial and femoral arterial access. A 14Fr Python sheath was introduced after vessel dilation, and the valve was crimped and positioned in the aortic annulus under fluoroscopic guidance. Serial aortograms confirmed accurate placement, and haemostasis was achieved using a Proglide suture, protamine administration, and manual pressure. The patient was transferred to the ICU post-procedure for monitoring.

RESULTS: The patient's post-procedure imaging showed a well-seated valve with trivial central aortic regurgitation, no paravalvular leak, and an insignificant gradient of 12.25 mmHg. The patient remained stable, resumed anticoagulation, and was discharged with a follow-up scheduled in one week.

CONCLUSIONS: This case report details the successful prosthetic aortic valve implantation in an 83-year-old high-risk surgical candidate with hypertension and bilateral knee replacements. It marks a significant step toward adopting less invasive valvular heart disease management approaches in the region.

PMID:40987259

Eur J Neurol. 2025 Sep;32(9):e70365. doi: 10.1111/ene.70365.

ABSTRACT

BACKGROUND: Patients with non-valvular atrial fibrillation (AF) who experience an ischemic stroke despite oral anticoagulation (OAC) are at particularly high risk of recurrence, with a reported annualized ischemic stroke rate of 5.3%-8.9%. The optimal strategy for secondary prevention in these patients remains unknown.

METHODS: We reviewed all percutaneous left atrial appendage closures (LAAC) attempted in AF patients experiencing an ischemic stroke under OAC and who were prospectively collected in four European centers. All index strokes were categorized by an experienced neurologist to exclude patients with non-cardioembolic etiology or insufficient OAC. The primary endpoint was a recurrent ischemic stroke at 2 years after the procedure. Secondary endpoints included procedure-related complications and 2-year death.

RESULTS: Of 2234 patients submitted to LAAC procedure, 95 had a cardioembolic breakthrough stroke. LAAC procedures were performed at a mean of 4 months after the breakthrough stroke. The main antithrombotic therapy at discharge (83%) and at the latest follow-up (79%) consisted of OAC. At the median follow-up of 713 days, the primary endpoint occurred in 4 patients (4%). Procedure-related complications were rare (1%) whereas death occurred in 5% of patients.

CONCLUSION: LAAC procedures were safe and feasible in patients with cardioembolic breakthrough stroke. Recurrent stroke rates were lower than those reported in previous studies with OAC continuation after breakthrough stroke, suggesting a potential additive protection by LAAC on top of OAC. Results from ongoing randomized trials are required to validate our findings.

PMID:40985135 | PMC:PMC12455140 | DOI:10.1111/ene.70365

Med Sci (Basel). 2025 Sep 10;13(3):185. doi: 10.3390/medsci13030185.

ABSTRACT

Background: Mitral valve prolapse is a common valvular heart disorder, usually associated with a benign prognosis in the absence of significant mitral regurgitation. However, a subset of patients is at increased risk for complex ventricular arrhythmias and sudden cardiac death. Identifying these high-risk individuals remains a major clinical challenge. Case Summary: We present the case of a 71-year-old female patient with recurrent syncopal episodes, a strong family history of sudden cardiac death, and complex ventricular ectopy. Multimodality imaging revealed bileaflet mitral valve prolapse, severe mitral regurgitation, mitral annular disjunction, and the Pickelhaube sign, with no evidence of myocardial fibrosis on cardiac magnetic resonance imaging. The patient underwent minimally invasive mitral valve repair and received an implantable cardioverter-defibrillator for primary prevention of sudden cardiac death. Follow-up revealed significant reverse cardiac remodeling, marked reduction in arrhythmic burden, and restoration of mitral valve function. Family screening identified mitral annular disjunction in both of her daughters, who were asymptomatic and without arrhythmias. Discussion: Mitral annular disjunction has emerged as a potentially arrhythmogenic substrate, especially in patients with familial clustering, raising the possibility of a genetic predisposition. Risk stratification remains difficult, as no individual clinical, electrocardiographic, or imaging marker has demonstrated consistent predictive value. Surgical correction of mitral valve prolapse with associated mitral annular disjunction may lead to a reduction in arrhythmic risk and promote favorable structural remodeling. Conclusions: This case-based review emphasizes the importance of advanced imaging techniques in the identification and management of high-risk mitral valve prolapse phenotypes. Early surgical intervention and close arrhythmic surveillance may improve outcomes, although further research is necessary to define risk assessment tools and explore the genetic background of arrhythmogenic mitral valve disease.

PMID:40981183 | PMC:PMC12452400 | DOI:10.3390/medsci13030185

Eur Heart J Case Rep. 2025 Sep 6;9(9):ytaf441. doi: 10.1093/ehjcr/ytaf441. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Frequent premature ventricular contractions (PVCs) and valvular dysfunction are established contributors to worsening heart failure.

CASE SUMMARY: We present a 67-year-old male with dilated cardiomyopathy, severe aortic regurgitation, and unifocal left ventricle-originated PVCs (37.8% burden) refractory to guideline-directed medical therapy and cardiac devices. Due to high surgical risk, a combined transapical transcatheter aortic valve implantation and PVC ablation was performed. Postoperatively, PVCs were eliminated, left ventricular ejection fraction improved from 35% to 55%, and cardiac dimensions normalized significantly.

DISCUSSION: This case highlights the feasibility of a single apical approach for addressing both valvular and arrhythmic pathologies in high-risk patients, offering a novel strategy to mitigate heart failure progression.

PMID:40977933 | PMC:PMC12448879 | DOI:10.1093/ehjcr/ytaf441

Physiol Rep. 2025 Sep;13(18):e70544. doi: 10.14814/phy2.70544.

ABSTRACT

Chronic kidney disease (CKD) and valvular heart disease (VHD) frequently coexist and are associated with a significant increase in morbidity and mortality. Their interplay is complex and multifactorial, involving shared pathophysiological mechanisms such as chronic inflammation, mineral and bone disorder, vascular and valvular calcification, and neurohormonal activation. These factors contribute to a bidirectional relationship in which each condition can exacerbate the progression and clinical consequences of the other. This review provides a comprehensive synthesis of the current evidence on the epidemiology, pathogenesis, and clinical impact of the CKD-VHD association. Special attention is given to the mechanisms underlying valvular calcification in the uremic milieu, the diagnostic challenges posed by overlapping symptoms, and the prognostic implications of valvular disease in patients with impaired renal function. Furthermore, this paper critically examines the available therapeutic options, including medical management, surgical and transcatheter interventions, and their outcomes in CKD patients. Given the limited evidence from randomized controlled trials in this population, our work also identifies key knowledge gaps and highlights future research directions, advocating for multidisciplinary approaches and tailored strategies. A better understanding of this cardio-renal interaction is crucial to optimize clinical decision-making and improve patient outcomes.

PMID:40976977 | PMC:PMC12451019 | DOI:10.14814/phy2.70544

Radiologia (Engl Ed). 2025 Sep-Oct;67(5):101601. doi: 10.1016/j.rxeng.2025.101601. Epub 2025 Aug 5.

ABSTRACT

Valvular heart disease is a condition with increasing prevalence. Although the current treatment of choice is still valve repair or replacement surgery, percutaneous treatment techniques are valid alternatives for selected patients. Various non-invasive imaging techniques are currently available which can provide the information needed to select appropriate patients, planning procedures and techniques. This article reviews the usefulness of cardiac CT to assess patients who are candidates for percutaneous treatment of common valvular diseases. It also reviews the image acquisition protocol and its role in the pre-procedural study, as well as in the detection of the most common complications.

PMID:40975560 | DOI:10.1016/j.rxeng.2025.101601

JACC Case Rep. 2025 Sep 17;30(28):105094. doi: 10.1016/j.jaccas.2025.105094.

ABSTRACT

BACKGROUND: The LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction) procedure is an innovative transcatheter technique designed to prevent left ventricular outflow tract obstruction during transcatheter mitral valve interventions.

CASE SUMMARY: A 14-year-old male patient with a history of infective endocarditis, previously treated with surgical aortic valve replacement and mitral annuloplasty, presented with severe mitral regurgitation and decompensated heart failure. Owing to prohibitive surgical risk, a transcatheter mitral valve-in-ring replacement (TMViR) was performed with adjunctive LAMPOON to prevent left ventricular outflow tract obstruction. This is to our knowledge the first reported pediatric case of TMViR facilitated by LAMPOON. The procedure was technically successful, and the patient recovered without major complications.

DISCUSSION: This case highlights a novel application of LAMPOON in the pediatric population. Given the absence of surgical options, this approach offers a life-saving, minimally invasive alternative and expands the role of structural interventions in children with complex valvular disease.

TAKE-HOME MESSAGES: LAMPOON can enable safe TMViR in high-risk pediatric patients. Successful outcomes require careful planning, imaging, and multidisciplinary coordination.

PMID:40973330 | PMC:PMC12478498 | DOI:10.1016/j.jaccas.2025.105094

Front Immunol. 2025 Sep 3;16:1652294. doi: 10.3389/fimmu.2025.1652294. eCollection 2025.

ABSTRACT

INTRODUCTION: Currently, chronic immune rejection of bioprosthetic heart valves (BHVs) is considered among the key players in the development of structural valve degeneration (SVD). However, the relative contribution of leukocyte infiltration and cyclic mechanical loading into the SVD in bioprosthetic mitral valves (BMVs) and bioprosthetic tricuspid valves (BTVs, experiencing lower hemodynamic load due to the right heart's pressure environment) remains unclear.

METHODS: Here we performed an investigation of BMVs and BTVs which have been pairwise-excised from 4 patients during the BHV replacement because of BMV failure. The amount of valvular calcification was measured by multislice computed tomography and quantified using Pydicom script. Immune cell infiltration and lipid deposition in sectioned leaflets were evaluated by hematoxylin and eosin and Oil Red O staining, respectively; the semi-quantitative analysis of whole slide images was conducted by QuPath and Fiji software. In addition, we conducted an ultrastructural examination of BHVs by backscattered scanning electron microscopy after epoxy resin embedding (EM-BSEM technique).

RESULTS AND DISCUSSION: All BMVs had a significant extent of lipid deposition, hemorrhages, and tears, which eventually led to its mechanical incompetence. Strikingly, BMVs had less amount of immune cell infiltration as compared with BTVs. These results indicate that mechanical fatigue prevails over immune cell infiltration in driving the development of SVD.

PMID:40969748 | PMC:PMC12440782 | DOI:10.3389/fimmu.2025.1652294

Braz J Cardiovasc Surg. 2025 Sep 1;40(5):e20240370. doi: 10.21470/1678-9741-2024-0370.

ABSTRACT

INTRODUCTION: Conventional surgical approaches for aortic root aneurysms, including valved grafts and valve-sparing techniques, present inherent limitations such as the requirement for anticoagulation and the potential for late reoperation. Personalized External Aortic Root Support (PEARS), utilizing the ExoVasc® implant, represents a novel approach that aims to overcome these limitations.

METHODS: This report presents the initial clinical experience with the ExoVasc® PEARS implant in the Americas, encompassing 10 patients (six males, age range 30 - 52 years, mean age 37.8 years) diagnosed with aortic root aneurysms. Indications for PEARS included Marfan syndrome (eight patients, including one reoperation), bicuspid aortic valve (two patients, including one with anomalous coronary artery), and associated valvular dysfunction. Cardiopulmonary bypass was utilized in four cases.

RESULTS: No major adverse postoperative events were observed. Postoperative recovery was generally uneventful, with minor complications, including pericarditis and atrial fibrillation, successfully managed with medical therapy. Aortic dimensions remained stable at 30-day and one-year follow-ups.

CONCLUSION: This initial experience demonstrates the feasibility, safety, and efficacy of the PEARS technique for the treatment of aortic root aneurysms. Potential advantages over traditional approaches include the possibility for off-pump procedures, reduced risk of aortic valve dysfunction, shorter hospital stays, and elimination of the need for long-term anticoagulation therapy. Further investigation is warranted to evaluate the long-term durability and clinical outcomes of this innovative approach.

PMID:40961275 | PMC:PMC12443440 | DOI:10.21470/1678-9741-2024-0370

JACC Basic Transl Sci. 2025 Sep 16;10(10):101324. doi: 10.1016/j.jacbts.2025.101324. Online ahead of print.

ABSTRACT

Although the prevalence of aortic regurgitation (AR), which causes eccentric remodeling and valvular heart disease (VHD), is increasing, suitable animal research models remain lacking. To address this issue, we established the first efficient, real-time visualized minimally invasive aortic regurgitation surgery mouse model by performing echocardiography-guided aortic valve tear using a modified insulin needle. The clinically relevant features of this AR model were verified by multimodal analysis, and feature genes closely associated with AR-induced VHD were obtained by time series analysis in conjunction with weighted gene co-expression network analysis. The results may provide comprehensive insights into the mechanistic study and potential therapeutic targets of AR-induced VHD.

PMID:40956257 | PMC:PMC12481893 | DOI:10.1016/j.jacbts.2025.101324

J Gastrointest Oncol. 2025 Aug 30;16(4):1756-1762. doi: 10.21037/jgo-2025-26. Epub 2025 Aug 8.

ABSTRACT

BACKGROUND: Carcinoid syndrome (CS) is a rare complication of neuroendocrine tumors (NETs). Characterized by cutaneous flushing, diarrhea, abdominal pain, and long-term risk for valvular heart disease, these components occur in a fraction of patients with advanced disease. Early recognition through history taking, physical and laboratory examination, and clinical imaging is paramount to successful management.

CASE DESCRIPTION: We report a case of CS in a 21-year-old male patient found to have a metastatic gastrointestinal, well differentiated (Ki67 <3%) NET. The patient presented with cutaneous flushing, diarrhea, abdominal pain, dyspnea, ascites, and peripheral edema. On imaging, he was found to have a massive left pleural effusion, innumerable enhancing hepatic lesions, mesenteric lymphadenopathy, and large-volume ascites. Cardiac imaging further showed severe tricuspid regurgitation and right heart failure. Biopsy of the enhancing hepatic lesions showed a grade 1 NET of gastrointestinal origin. Urine testing revealed markedly high serotonin metabolites. The patient was started on somatostatin analogues, which resulted in improved control of diarrhea and flushing. Thoracoscopic surgery improved pleural effusion accumulation, and recurrent abdominal ascites was treated with paracentesis when necessary. He was also referred to cardiothoracic surgery tricuspid valve replacement surgery.

CONCLUSIONS: Our case illustrates the classic characteristics of CS as well as valvular heart disease supported by clinical imaging of the syndrome's involvement of multiple organ systems. These findings are important for physicians to recognize as early recognition of CS can lower the risk of long-term complications of carcinoid heart disease. Additionally, patients with limited access to healthcare may be at risk of later CS presentation.

PMID:40950358 | PMC:PMC12432937 | DOI:10.21037/jgo-2025-26

J Coll Physicians Surg Pak. 2025 Sep;35(9):1083-1087. doi: 10.29271/jcpsp.2025.09.1083.

ABSTRACT

OBJECTIVE: To investigate the incidence of postoperative atrial fibrillation (POAF) in patients following isolated coronary artery bypass grafting (CABG), evaluate its impact on mortality and morbidity, and analyse demographic and comorbid variables associated with its onset.

STUDY DESIGN: Observational cohort study. Place and Duration of the Study: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkiye, from June 2020 to December 2022.

METHODOLOGY: Patients who underwent isolated CABG were included in the study. Those diagnosed with valvular heart disease on echocardiography were excluded, as were those with a history of atrial fibrillation (AF).

RESULTS: Statistical analysis was conducted on data from 489 patients. Among the demographic factors examined, only age (p = 0.021) exhibited a significant correlation with the development of POAF. Chronic renal disease (p = 0.044) and reduced glomerular filtration rate (GFR) levels (p = 0.020) were significantly associated with POAF. Regarding perioperative factors, cardiopulmonary bypass (CPB) duration (p = 0.104) was not significantly related to POAF, whereas prolonged cross-clamp time was (p = 0.009). POAF was associated with postoperative complications, including acute kidney damage (p = 0.002), extended intubation (p = 0.003), infection (p <0.001), the need for intra-aortic balloon pump (IABP) or inotropic support (p = 0.004), and mortality (p = 0.001).

CONCLUSION: POAF is a common complication after isolated CABG and is significantly associated with advanced age, reduced GFR, chronic kidney disease, and prolonged cross-clamp time. Its occurrence is associated with increased postoperative morbidity and mortality. These findings emphasise the importance of perioperative risk factors in predicting adverse outcomes.

KEY WORDS: Atrial fibrillation, Coronary artery bypass, Acute kidney injury, Mortality, Morbidity, Intra-aortic balloon pumping.

PMID:40948152 | DOI:10.29271/jcpsp.2025.09.1083

Int J Stroke. 2025 Sep 13:17474930251381131. doi: 10.1177/17474930251381131. Online ahead of print.

ABSTRACT

BACKGROUND: Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Cardioembolic sources account for a significant proportion of these events, necessitating accurate identification of underlying structural heart abnormalities. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCTA) has emerged as a potential alternative, offering non-invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi.

OBJECTIVE: This study aimed to evaluate the diagnostic yield of CCTA compared to TTE and TEE in detecting high-risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular thrombus, and ulcerated aortic plaques, in patients with ischemic stroke.

METHODS: We conducted a retrospective, single-center cohort study at Mayo Clinic, Rochester, MN, including 426 ischemic stroke patients who underwent CCTA within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCTA, TTE, and TEE in detecting structural cardiac sources of embolism.

RESULTS: The overall diagnostic yield of CCTA for detecting high-risk cardioaortic sources was 15.5%. Specifically, CCTA identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCTA demonstrated a higher yield than TTE (16.0% vs. 3.5%, P<0.001) and a comparable yield to TEE (25.3% vs. 20.7%, P=0.47) in detecting these sources.

CONCLUSIONS: CCTA proved to be a viable option for identifying high-risk structural sources of cardioembolism in ischemic stroke patients. Its non-invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCTA in this context.

PMID:40944425 | DOI:10.1177/17474930251381131

J Physiol. 2025 Sep 12. doi: 10.1113/JP288649. Online ahead of print.

ABSTRACT

The heart functions within a complex system that adapts its function to alterations in loading via several mechanisms. For example, the baroreflex is a feedback loop that modulates the heart's function on a beat-to-beat basis to control arterial pressure. On the other hand, cardiac growth is an adaptive process that occurs over weeks or months in response to changes in left ventricular loading. In this study, we investigate the impact of a baroreflex feedback loop on left ventricular growth in simulations of valve disease. To achieve this, we integrated the effects of a baroreflex feedback loop and a growth algorithm into a beating multiscale finite element model of the left ventricle. Our integrated model replicated clinical measures of left ventricular growth in two types of valvular diseases - aortic stenosis and mitral regurgitation - at two different levels of severity for each case. Furthermore, our results showed that incorporating the effects of baroreflex control in simulations of left ventricular growth not only led to more realistic haemodynamics, but also impacted the magnitude of growth. Finally, our results suggest that the regulation of Ca2+ dynamics by the baroreflex is a crucial mechanism in adapting the myocardial cell in response to altered loading due to aortic stenosis and mitral regurgitation. KEY POINTS: The heart adapts its function in response to alterations in loading via short-term and long-term mechanisms. These mechanisms are essential for maintaining proper blood pressure in the vasculature (baroreflex) and homeostasis in the heart (ventricular growth). In this study, we investigate the impact of a baroreflex feedback loop on left ventricular growth in finite element simulations of valve disease. We showed that incorporating the effects of baroreflex control and ventricular growth not only led to more realistic haemodynamics, but also impacted the magnitude of growth. Our results suggest that the regulation of Ca2⁺ dynamics by the baroreflex is a crucial mechanism in adapting the myocardial cell in response to altered ventricular loading.

PMID:40938767 | DOI:10.1113/JP288649