Valvular cardiac surgery

Front Cardiovasc Med. 2025 May 30;12:1455947. doi: 10.3389/fcvm.2025.1455947. eCollection 2025.

ABSTRACT

Cardiac papillary fibroelastomas (PFEs) are the most common benign cardiac tumors and are typically solitary. PFEs affecting both sides of the heart are exceptionally rare, with only four cases reported in the literature. Herein, we report a case of a 63-year-old male presenting with signs and symptoms of embolic strokes and an embolism in the coronary arteries. An echocardiogram showed multiple masses on both the mitral and tricuspid valve leaflets. Because of the risk of embolism, he underwent successful valve-sparing surgical resection without complications. The follow-up echocardiogram at 6 months showed no recurrence and competence of both the mitral and tricuspid valves with minimal regurgitation.

PMID:40520929 | PMC:PMC12163016 | DOI:10.3389/fcvm.2025.1455947

Cureus. 2025 May 15;17(5):e84146. doi: 10.7759/cureus.84146. eCollection 2025 May.

ABSTRACT

Caseous mitral annular calcification (CMAC), a rare variant of mitral annular calcification (MAC), predominantly affects older adults. CMAC represents a very small fraction of MAC, and it features a necrotic core with peripheral calcifications, mimicking neoplasms. Multimodal imaging is essential for diagnosis. We present a case of an 86-year-old hypertensive male patient who presented with exertional dyspnea. Transthoracic echocardiography revealed severe left ventricular hypertrophy, a left cardiac mass, and severe MAC. Cardiac MRI confirmed CMAC (12×14 mm calcified mass). He was managed medically and surveilled with serial echocardiograms. While asymptomatic cases may regress, complications (emboli, valve dysfunction) warrant surgery. Advanced imaging prevents misdiagnosis, guiding intervention. CMAC necessitates multimodal imaging for accurate diagnosis. Conservative management with serial monitoring is appropriate in asymptomatic patients, underscoring the importance of clinician awareness to mitigate complications. Early recognition ensures optimal outcomes in these rarer etiologies.

PMID:40519475 | PMC:PMC12166507 | DOI:10.7759/cureus.84146

Heart Rhythm. 2025 Jun 12:S1547-5271(25)02550-0. doi: 10.1016/j.hrthm.2025.06.004. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence following catheter ablation (CA) on HF is not well understood.

OBJECTIVE: We sought to examine the clinical outcomes and hospitalisation patterns in AF HFrEF patients following CA.

METHODS: This multicentre study reports the re-admission outcomes for patients with AF and HFrEF (LVEF≤40%) following CA.

RESULTS: 231 patients (60.5±11.1years, 37 females, mean LVEF 30.7±7.1%, persistent AF 87.9%) with AF and HFrEF underwent CA. At 3.0 years follow-up, recurrent AF occurred in 120 (51.9%) and complete LV systolic recovery (LVEF≥50%) in 125 (54%) patients. There were 366 hospitalisations amongst 123 patients: 240 cardiac and 126 non-cardiac. Arrhythmia related hospitalisations occurred in 179: 151 recurrent atrial arrhythmia without HF, 4 AF with HF, 3 supraventricular tachycardia and 21 ventricular arrhythmia. Other cardiac hospitalisations (61) included: HF without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3) and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery post ablation (OR=1.32, 95% CI=1.11-12.55 P=0.03), persistent AF versus paroxysmal AF recurrence (OR=1.76, 95% CI=1.21-27.72 P=0.03), ischemic cardiomyopathy (OR=3.62, 95% CI=1.16-11.30 P=0.02), and furosemide use (OR=4.96, 95% CI=1.55-15.91 P<0.01) were associated with future HF hospitalisation.

CONCLUSION: After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF and HF, but more commonly present with HF without AF, or AF without HF.

PMID:40516777 | DOI:10.1016/j.hrthm.2025.06.004

JACC Case Rep. 2025 Jun 11;30(14):103675. doi: 10.1016/j.jaccas.2025.103675.

ABSTRACT

Pituitary apoplexy is a clinical syndrome caused by hemorrhage or infarction of the pituitary gland and has been described as a rare complication of cardiac surgery. Management of this complication after mechanical valve replacement is complex, given the need for postoperative anticoagulation and potential neurosurgical resection. This paper presents a case of pituitary apoplexy identified after mechanical root and ascending hemiarch replacement and describes our clinical decision making around anticoagulation selection and optimal surgical timing. The patient underwent successful resection on postoperative day 9 and did not have any major bleeding or valvular thromboembolic complications. Multidisciplinary collaboration was critical to his favorable outcome.

PMID:40514113 | DOI:10.1016/j.jaccas.2025.103675

Chest. 2025 Jun;167(6):e195-e199. doi: 10.1016/j.chest.2025.01.021.

ABSTRACT

A 54-year-old woman with a history of recurrent exertional dyspnea for 5 years was admitted for evaluation. Six months prior, she noted a worsening of her symptoms, with progressive physical activity limitation caused by exertional fatigue and dyspnea (climbing 2 to 3 flights of stairs). She also experienced palpitations, with an estimated heart rate that ranged from 120 to 150 beats per minute. The patient denied chest pain, hemoptysis, or other notable symptoms. Notably, the patient underwent surgical repair of an atrial septal defect more than 20 years earlier, with a good postoperative recovery. Regular postoperative echocardiograms revealed no residual shunt, no valvular abnormalities, and no pulmonary hypertension. The patient had no history of smoking, drug abuse, or alcohol consumption.

PMID:40506133 | DOI:10.1016/j.chest.2025.01.021

Heart Lung. 2025 Jun 10;74:1-11. doi: 10.1016/j.hrtlng.2025.05.016. Online ahead of print.

ABSTRACT

BACKGROUND: An increasing number of studies have recently suggested a relationship between sleep duration and cardiovascular disease (CVD). However, a correlation between the two has not been studied.

OBJECTIVE: The aim of this study was to investigate a correlation between sleep duration and CVD.

METHODS: This study is based on summary data from genome-wide association studies (GWAS), across various races, regarding sleep duration and 12 major cardiovascular diseases. We utilized two-sample Mendelian randomization (MR), a method specifically designed to analyze correlation, to investigate whether sleep duration directly affects risk of developing CVD. Our primary analysis used the inverse variance weighting (IVW) method to examine the effect of sleep duration on multiple cardiovascular conditions. Additionally, we employed maximum likelihood, MR-Egger regression, weighted median, and weighted mode methods to ensure the robustness of our findings.

RESULTS: This study revealed a correlation between over-sleeping and three cardiovascular conditions (valvular heart disease, myocardial infarction, and heart failure) with significant negative correlations (P < 0.05). No significant correlation was found with the remaining nine cardiovascular conditions (P > 0.05). Furthermore, we found that under-sleeping had a correlation with four cardiovascular conditions (non-ischemic cardiomyopathy, cardiac arrhythmias, valvular heart disease, and atrial fibrillation) with significant positive correlations (P < 0.05) butnot with the remaining eight cardiovascular conditions (P > 0.05).

CONCLUSION: Over-sleeping was negatively correlated with several cardiovascular diseases, whereas under-sleeping was positively correlated with others, suggesting that lack of sleep may increase the risk of certain cardiovascular conditions.

PMID:40499503 | DOI:10.1016/j.hrtlng.2025.05.016

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf191. doi: 10.1093/ejcts/ezaf191.

ABSTRACT

OBJECTIVES: Aortic stenosis (AS) and mitral regurgitation (MR) are rare in heart transplant (HTx) recipients, but their incidence increases with extended post-transplant survival. This study assesses the safety, efficacy and outcomes of transcatheter interventions in this high-risk population.

METHODS: An institutional series of HTx patients undergoing a transcatheter aortic valve implant (TAVI) or mitral transcatheter edge-to-edge repair (M-TEER) from March 2015 through April 2024 was analysed retrospectively. Both elective cases and patients in cardiac decompensation/cardiogenic shock were included. There were no exclusion criteria. Primary outcomes were echocardiographic allograft function and Valve Academic Research Consortium 3 (VARC-3)/Mitral Valve Academic Research Consortium (MVARC) success and safety composite end points. Secondary outcomes included symptom change, complications and survival.

RESULTS: A total of 15 consecutive patients were included in the analysis. Nine patients underwent TAVI and 6 had M-TEER. The median age was 56 years, with a median of 17 years from HTx to valve intervention. A total of 46.7% (7/15) of the procedures were considered urgent/emergency. Improvements were noted in the left ventricular ejection fraction, systolic pulmonary artery pressure and tissue Doppler peak contraction velocity. The VARC-3/MVARC technical success was 100%; device success for TAVI was 93.3% and 83.3% for M-TEER. VARC-3 early safety was 66.7% for TAVI, and MVARC procedural success was 83.3% for M-TEER; 86.7% showed improved functional status. Median survival was 800 days.

CONCLUSIONS: TAVI and M-TEER were feasible and efficient in improving echocardiographic allograft function. Elective procedures were associated with a median survival of over 2 years. Survival outcomes varied based on procedure urgency. Close monitoring of AS/MR seems crucial in HTx patients, with timely intervention prior to decompensation/shock. Further multicentre studies are needed to establish management guidelines for AS/MR in HTx recipients.

PMID:40498548 | DOI:10.1093/ejcts/ezaf191

Am J Med Genet A. 2025 Jun 9:e64148. doi: 10.1002/ajmg.a.64148. Online ahead of print.

ABSTRACT

Cardiac involvement in Gaucher disease (GD) is an uncommon feature, most often associated with the homozygous Asp448His (D409H) variant in GBA1 and typically presents with valvular and pericardial calcifications or myocardial infiltration. To date, approximately 132 individuals with this cardiovascular phenotype (GDIIIc) have been reported, with limited representation from the Middle East. This study reports the first cohort from Kuwait, involving five individuals from three unrelated Middle Eastern families, all with molecularly confirmed homozygous Asp448His variants. All individuals demonstrated early-onset cardiac valvular disease requiring surgical intervention, in addition to organomegaly, skeletal manifestations, and neurological symptoms. Despite corrective surgeries, four individuals died, with only one adult female currently alive and stable. Remarkably, this surviving patient is the first reported individual with GDIIIc to have successfully conceived and delivered a healthy child prior to her diagnosis, initiation of enzyme replacement therapy, or cardiac surgery. She later developed a broad spectrum of neuropsychiatric symptoms, including phobias, hallucinations, obsessive thoughts, anxiety, and delusions of persecution, as well as resting tremors and dysphagia. Brain MRI revealed granular ependymitis and cerebral microbleeds-neuroradiological features not previously described in GDIIIc-making her case uniquely informative. These findings broaden the phenotypic spectrum of GDIIIc and highlight the importance of recognizing cardiac and neuropsychiatric manifestations in individuals with the Asp448His variant. Early identification and multidisciplinary management may improve outcomes in this ultra-rare but severe disease.

PMID:40491257 | DOI:10.1002/ajmg.a.64148

Rev Cardiovasc Med. 2025 May 8;26(5):28173. doi: 10.31083/RCM28173. eCollection 2025 May.

ABSTRACT

Once considered the "forgotten valve and ventricle", the tricuspid valve and right ventricle are now recognized as critical structures with significant clinical and prognostic implications. Growing evidence has highlighted that tricuspid regurgitation (TR) and right heart failure are not merely secondary phenomena that resolve following the treatment of left-sided heart disease. Instead, TR and right heart failure contribute to adverse outcomes and increased mortality if left untreated. This paradigm shift has fueled extensive clinical research, leading to a deeper understanding of the pathophysiology of TR and right ventricular (RV) dysfunction. Additionally, advancements in cardiovascular imaging have facilitated early detection, risk stratification, and innovative therapeutic approaches for TR and right heart failure. This article explores the evolving landscape of tricuspid valve disease, emphasizing the importance of early recognition and the role of emerging imaging technologies in improving patient outcomes. Thanks to progress in imaging technology, especially echocardiography, as well as cardiac magnetic resonance and cardiac computer tomography, enhanced studies can be conducted on the tricuspid valve pathology to delineate the various mechanisms involved in TR and RV dysfunction and offer patients a tailored medical, as well as surgical and transcatheter therapies. These unparalleled technological advances would not be possible without the hard work of physicians, scientists, surgeons, interventional cardiologists, and echocardiographers worldwide, despite the many challenges they experience daily and in every procedure. Many patients with TR present at an advanced stage of disease progression, often with severe regurgitation and clinical manifestations associated with poor outcomes. Additionally, a significant proportion of these patients have either undergone previous open-heart surgery for left-sided valvular disease or are considered high-risk surgical candidates due to multiple comorbid conditions. In recent years, transcatheter therapy has emerged as a viable alternative for this high-risk population, offering a less invasive option for those previously deemed "inoperable". This breakthrough has transformed the therapeutic landscape for valvular heart disease, particularly for TR, providing new hope and improved outcomes for patients who were once left with limited treatment options.

PMID:40475749 | PMC:PMC12135663 | DOI:10.31083/RCM28173

Prehosp Emerg Care. 2025 Jun 23:1-6. doi: 10.1080/10903127.2025.2517154. Online ahead of print.

ABSTRACT

This case report highlights the importance of prehospital point-of-care ultrasound (POCUS) when acute aortic dissection is suspected. At 2:09 pm the local emergency medical services (EMS) received a call from a small town in Lombardy, Italy, reporting that a 54-years-old man had collapsed while lifting weights in a fitness club. Response teams found him lying on the floor, fully responsive and very pale; he was a lean man, with no allergies, no home therapy and no significant past medical history. He had had a transient facial paralysis and complained of dizziness and mild chest discomfort. During physical examination he became suddenly hypotensive (60/30 mmHg). The electrocardiogram showed a sinus rhythm, 80 beats per minute (bpm) and unaltered T wave and ST segment. The POCUS showed a dilated aortic root with intimal flap and small pericardial effusion. A diagnosis of Type A acute aortic dissection was made on the spot. The EMS dispatch center identified the closest hospital with available cardiothoracic surgery and provided a full report of the patient's condition, diagnosis and initial treatment. At 3:10 pm, the patient entered the emergency room and a rapid transthoracic ultrasound confirming the diagnosis was performed in the presence of the cardiac anesthetist and cardiothoracic surgeon. The patient was agitated, tachycardic (110 bpm) and hypotensive (50/30 mmHg). Upon stabilization with intravenous norepinephrine and fluids, a computed tomographic angiogram was performed demonstrating a Stanford Type A aortic dissection with intimal flap starting from the bulb/valvular plane and extending to the origin of supra-aortic trunks down to the left common iliac artery. At 4.00 pm the patient was ready for surgery; he underwent successful ascending aorta replacement with a regular postoperative course and no signs of neurological damage. On post-operative day eight he was referred to an inpatient cardiac rehabilitation facility and later discharged home. At prehospital level, POCUS is feasible and may provide key diagnostic findings in some threatening medical (non-trauma-related) conditions that are normally diagnosticated only once the patient has reached the hospital. In addition, this report highlights a perfect interaction between out-of-hospital medical personnel, dispatch center and in-hospital multidisciplinary health staff.

PMID:40472335 | DOI:10.1080/10903127.2025.2517154

Eur Heart J. 2025 Jun 5:ehaf363. doi: 10.1093/eurheartj/ehaf363. Online ahead of print.

NO ABSTRACT

PMID:40471673 | DOI:10.1093/eurheartj/ehaf363

J Am Heart Assoc. 2025 Jun 17;14(12):e040150. doi: 10.1161/JAHA.124.040150. Epub 2025 Jun 5.

ABSTRACT

BACKGROUND: Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.

METHODS: Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.

RESULTS: Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; P<0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; P<0.01). This difference persisted over 5 years (P<0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; P<0.001). This trend continued over 5 years (P<0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; P<0.01).

CONCLUSIONS: Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.

PMID:40470661 | DOI:10.1161/JAHA.124.040150

J Med Case Rep. 2025 Jun 4;19(1):265. doi: 10.1186/s13256-025-05292-1.

ABSTRACT

BACKGROUND: Mitral blood cyst with atrial septal aneurysm is a unique instance of rare occurrence in medical literature. It is crucial for the discipline of cardiology to address the special difficulties that come with diagnosing and treating these two diseases together. The goal of this case report is to provide a comprehensive overview of the clinical presentation, diagnostic challenges, and treatment strategies for this uncommon cardiac disease in a resource-limited setting.

CASE PRESENTATION: This is a case involving a 50-year-old Ethiopian female patient referred to our hospital for cardiac evaluation. She presented with intermittent palpitation to a nearby health center, which was diagnosed as rheumatic heart disease, for which she was on intramuscular benzathine penicillin injection on a monthly basis. Otherwise, she had no history suggestive of acute rheumatic fever and no chest pain, body swelling, orthopnea, or paroxysmal nocturnal dyspnea, historically or on current presentation. Evaluations revealed that her chest was clear and resonant with good air entry, and flat jugular venous pressure, but she had a grade III pansystolic murmur best heard at the apex that radiates to the left axilla. No other pertinent physical examination findings were discovered. Echocardiographic evaluation revealed a tiny cyst at the apex of posterior mitral valve leaflet with interatrial septal bulging into the right atrium.

CONCLUSION: Cardiac blood cysts are an uncommon congenital cardiac condition that can lead to stroke and other potentially fatal consequences, especially if they are situated on the mitral valve. With improved specialists and low-risk procedures, surgical removal is advised. Given the patient's state, a proper diagnosis was therefore essential to provide her with accessible management options in this setting while she waits for a definitive surgical treatment in case the need arises.

PMID:40468408 | PMC:PMC12139344 | DOI:10.1186/s13256-025-05292-1

J Cardiothorac Surg. 2025 Jun 4;20(1):259. doi: 10.1186/s13019-025-03493-9.

ABSTRACT

BACKGROUND: There is no solid evidence on the clinical benefits of blood cardioplegia or Custodiol™ in procedures other than coronary artery bypass grafting. We aimed to compare mortality and the risk of major cardiovascular events in patients undergoing valve or aortic surgery.

METHODS: This retrospective single-center study included patients who underwent valve or ascending aortic surgery between 2016 and 2024. The sample was divided based on the type of cardioplegia for myocardial protection: Custodiol™ or blood cardioplegia. The comparison of outcomes between the two groups was adjusted using propensity score.

RESULTS: 2909 patients were included, with 1426 (49%) receiving Custodiol™. In a propensity score-matched analysis that included 930 pairs, we observed higher perioperative mortality in the blood cardioplegia group (5.3% vs. 2.9%, p = 0.014) and worse long-term survival (p = 0.004). In an IPTW analysis, we confirmed significant differences in favor of Custodiol™ for early mortality (-2.2%, 95% CI -4; -0.4), long-term mortality (2.6 years, 95% CI 2.1; 3.2), and renal failure (-4.7%, 95% CI -7.9; -1.6), and low cardiac output syndrome requiring mechanical circulatory support (-2.2%, 95% CI -3.6;-0.9), but a higher siks of postoperative denovo atrial fibrillation (6.8%, 95% CI 2.5;11).

CONCLUSIONS: In this retrospective study including patients undergoing on-pump valve and aortic surgery, Custodiol™ compared to blood cardioplegia was associated with lower short- and medium-term mortality, although no robust evidence was found for differences in other clinical events.

PMID:40468334 | PMC:PMC12135263 | DOI:10.1186/s13019-025-03493-9

Curr Cardiol Rev. 2025 Jun 3. doi: 10.2174/011573403X353597250515051547. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to assess the association of renal impairment (RI) severity on short and mid-term outcomes in patients undergoing cardiac surgery for infective endocarditis (IE).

METHODS: Patients undergoing cardiac surgery for IE between January 2010 and October 2022 were included. They were stratified based on preoperative renal function into four groups: Normal (N: Creatinine clearance (CrCl) >85mL/min), moderate RI (M: CrCl 51-85mL/min), severe RI (S: CrCl ≤50mL/min), and haemodialysis-dependent (H). Each group was compared with group N. Survival analysis was performed using Kaplan-Meier curves.

RESULTS: A total of 487 patients (N: 198; M: 154; S: 96; H: 39) were included. Mean age 55.92 ± 14.60 years, 375 (77%) males. Groups M, S, and H vs N demonstrated more atrial fibrillation [17 (11.0%), 20 (20.8%), 6 (15.4%) vs 8 (4.0%); p<0.05]. Groups S and H vs. N had increased incidence of left ventricular ejection fraction <50% [43 (44.8%), 22 (56.4%) vs 43 (21.7%); p<0.001] and preoperative cardiogenic shock [16 (16.7%), 13 (33.3%) vs 9 (4.5%); p<0.001]. The need for postoperative haemodialysis was 21 (13.6%) in M and 23 (23.0%) in S vs. 13 (6.6%) in N (p<0.05). In-hospital mortality was 13 (8.4%), 21 (21.9%), and 11 (28.2%) vs. 12 (6.1%) (p=0.388, <0.001, <0.001), and mortality at a mean of 69.1months was 49 (31.8%), 46 (46.9%), 30 (76.9%) vs. 49 (24.7%) (p=0.142, <0.001, <0.001) in groups M, S, H vs. N, respectively.

CONCLUSIONS: The incidence of renal impairment in patients with IE undergoing surgery remains high. Early and mid-term outcomes of those with severe RI and haemodialysis dependence are significantly worse.

PMID:40464179 | DOI:10.2174/011573403X353597250515051547

Open Forum Infect Dis. 2025 May 12;12(6):ofaf287. doi: 10.1093/ofid/ofaf287. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: The 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) guideline included Enterococcus faecalis as a typical infective endocarditis (IE) organism irrespective of the primary source and setting of infection. Universal echocardiogram for E. faecalis bacteremia is resource-intensive. Our aim was to develop a risk score that can be applied at the time of bacteremia.

METHODS: We conducted a retrospective cohort study utilizing a territory-wide electronic database and included all inpatients (age ≥18) between 2009 and 2019 who had at least 1 blood culture positive for E. faecalis. A multistep machine learning algorithm was employed to generate the risk score.

RESULTS: A total of 2535 distinct E. faecalis bacteremia episodes were analyzed. The percentage of IE was 3.39% (86/2535). The Machine Learning-derived Enterococcus faecalis Infective Endocarditis Risk (MEFIER) score was developed based on history of valvular heart disease (28 points), history of congenital heart disease (14 points), presence of cardiac implantable electronic device (12 points), age (≥18 to <43 years: 3 points; ≥43 to <65 years: 6 points), male gender (2 points), community onset (11 points), and abnormal levels of hemoglobin (16 points), albumin (3 points), and platelets (1 point). With a threshold of ≥32 indicating high risk for IE, the MEFIER score demonstrated an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.72-0.88) and a negative predictive value of 0.98 (95% CI, 0.97-0.99).

CONCLUSIONS: The MEFIER score is a unique tool to stratify IE patients with E. faecalis bacteremia, boasting a negative predictive value of 98%, to guide use of echocardiography in these patients.

PMID:40463831 | PMC:PMC12131156 | DOI:10.1093/ofid/ofaf287

J Tehran Heart Cent. 2024 Oct;19(4):283-288. doi: 10.18502/jthc.v19i4.17615.

ABSTRACT

Mixed atrial septal defects (ASDs) involving inferior vena cava (IVC)-type sinus venosus and secundum types and mixed partial anomalous pulmonary, systemic, and hepatic venous drainage are rare. We describe a 3-year-old acyanotic boy who presented with a large mixed inferior sinus venosus and secundum-type ASD. He exhibited an abnormal connection between the right upper pulmonary vein and the right atrium. Additionally, the IVC and a hepatic vein drained abnormally into the left atrium. The patient also had valvular and supravalvular pulmonary stenosis, as well as a small patent ductus arteriosus. The ASD was surgically closed using a pericardial patch, positioned lower than usual to reroute the IVC and hepatic vein flow into the right atrium. The surgery was successful, with no residual lesions or complications. The patient recovered without issues and was discharged smoothly. At the 6-month follow-up, the child's cardiac examination and oxygen saturation were normal. Furthermore, echocardiography confirmed normal drainage of the systemic and hepatic veins into the right atrium.

PMID:40454352 | PMC:PMC12126196 | DOI:10.18502/jthc.v19i4.17615

Catheter Cardiovasc Interv. 2025 Jun 2. doi: 10.1002/ccd.31579. Online ahead of print.

ABSTRACT

BACKGROUND: Behcet's, a systemic autoimmune vasculitis, often leads to cardiovascular complications sunch as valvular damage and aortic root pseudoaneurysms. Concurrent involvement of all four cardiac valves is exceptionally rare, posing significant surgical challenges due to tissue fraagility, inflammatory destruction, and high reoperation risks.

OBJECTIVE: To describe a tailored surgical strategy for quadruple replacement in a Behcet's syndrome patient with extensive valvular lesions, aortic root pseudoaneurysm, and prior mechanical valve failure, emphasizing techniques to address anatomical complexity and enable future transcatheter interventions.

METHODS: A 51-year-old female with Behcet's syndrome and prior aortic/pulmonary valve replacements underwent reoperation for aortic root pseudoaneurysm, paravalvular leaks, severe mitral/tricuspid regurgitation, and pulmonary valve thrombosis. Key techniques include three parts, firstly, radical debridement of necrotic tissue and annular enlargement (aortic: 20-25mm; mitral: 25-29mm). Second, modified "chimney" Commando-Bentall hybrid procedure with a tongue-shaped vascular path to reconstruct the aorto-mitral curtain and reinforce the aortic root. Third, "Sandwich" technique for aortic root reconstruction to minimize paravalvular leakage.

RESULTS: The surgery was successful, with uneventful recovery and discharge on postoperative day 30. Six-month follow-up confirmed patient survival, stable valve function, and no recurrent leaks. Dual annular enlargement facilitated larger protheses, reducing patient-prothesis mismatch and preserving options for future transcatheter valve im plantation (TAVI).

CONCLUSIONS: This cases highlights the feasibility of combining annular enlargement, root reinforcement, and bioprosthetic valve replacement in Behcet's syndrome with pan-valvular involvement. The hybrid chimney-Bentall technique and meticulous root reconstruction address inflammatory tissue vulnerability while enabling future minimally invasive interventions. This approach optimizes immediate outcomes and long-term durability in complex autoimmune-associated valvulopathies.

PMID:40452468 | DOI:10.1002/ccd.31579

J Am Soc Echocardiogr. 2025 May 30:S0894-7317(25)00273-1. doi: 10.1016/j.echo.2025.05.013. Online ahead of print.

ABSTRACT

Carcinoid heart disease (CaHD) is a complication that occurs in patients with metastatic neuroendocrine tumors (usually to the liver) and carcinoid syndrome. Hormonal release causes endocardial thickening, typically affecting right-sided cardiac valves. Symptomatic patients with CaHD have a poor prognosis, and management of valvular heart disease is complicated by metastasis and other associated conditions and carries a higher risk than management of other acquired valve disease. Clinical and biomarker assessment are used for screening and echocardiography is the diagnostic imaging backbone used for identification of CaHD, as well as grading of severity of valvular lesions and associated chamber dysfunction. Echocardiography is critical in the evaluation for surgical intervention, as well as in guiding surgery and postoperative surveillance. This article reviews in detail applications of echocardiography in patients with CaHD.

PMID:40451471 | DOI:10.1016/j.echo.2025.05.013

Int J Cardiol. 2025 Oct 1;436:133428. doi: 10.1016/j.ijcard.2025.133428. Epub 2025 May 28.

ABSTRACT

BACKGROUND: The self-expanding aortic valve prosthesis ACURATE neo2 features an extended external sealing skirt aiming to reduce postprocedural paravalvular leak (PVL). There is limited knowledge if PVL can be further reduced by dedicated implantation techniques. We aim to examine predictors of PVL after implantation of the ACURATE neo2 with focus on implantation technique.

METHODS: Patients undergoing ACURATE neo2 transcatheter aortic valve replacement (TAVR) at 3 centers were included in a retrospective registry. Patients were analyzed in 2 groups: PVL none/trace and PVL ≥ mild.

RESULTS: A total of 901 patients (mean age 81 ± 6 years, 57 % women) were included. On echocardiography before discharge, PVL was graded as none/trace, mild and moderate in 599 (67 %), 291 (32 %) and 6 (1 %), respectively. Implantation depth (OR 0.93 per mm, 95 % CI 0.88-0.99, p = 0.032) and commissural misalignment (>45°; OR 9.6, 95 % CI 1.9-48.6, p = 0.006) significantly predicted PVL ≥ mild. Other, non-modifiable predictors for PVL included LVOT calcification severity (OR 1.98, 95 % CI 1.24-3.16, p = 0.002), larger sinotubular junction diameter and sinus of valsalva diameter (OR 1.08 per mm, 95 % CI 1.02-1.13, p = 0.004 and OR 1.07 per mm, 95 % CI 1.04-1.12, p = 0.003, respectively).

CONCLUSIONS: A high implantation and commissural misalignment were associated with PVL ≥ mild after implantation of the ACURATE neo2. These findings may help to guide implantation technique and further improve clinical outcomes.

PMID:40446851 | DOI:10.1016/j.ijcard.2025.133428