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Asian Cardiovasc Thorac Ann. 2025 Jun 12:2184923251350362. doi: 10.1177/02184923251350362. Online ahead of print.

ABSTRACT

BackgroundValve-sparing repair for tetralogy of Fallot is challenging in patients with hypoplastic pulmonary valves. Recently, we adopted transannular incision and delamination. This study evaluates its feasibility for right ventricular outflow relief, valve function, and growth.MethodsWe retrospectively reviewed records of patients with tetralogy of Fallot or Fallot-type double-outlet right ventricle who underwent intracardiac repair from October 2013 to December 2020.ResultsTwenty-six patients were enrolled. Two patients who underwent the Rastelli procedure were excluded, leaving 24 for evaluation. Eleven underwent valve-sparing repair, eight underwent valve-preserving repair with transannular delamination, and five underwent the transannular patch procedure. The median age and weight at surgery were 11.7 months (1.9-40.2 months) and 7.6 kg (3.7-12.7 kg). No patients died or required reintervention for pulmonary valve stenosis or regurgitation during a median follow-up of 42.5 months (4.6-72.1 months). In the delamination group, the mean preoperative pulmonary valve z-score was -2.1 ± 1.0, improving significantly to 0.2 ± 0.8. Pulmonary regurgitation was mild in six of eight patients, while two with the smallest preoperative annulus developed moderate regurgitation. Despite no significant difference in the preoperative pulmonary valve annulus between the delamination and transannular patch groups, the delamination group had significantly lower postoperative pulmonary valve regurgitation, while no significant difference in stenosis.ConclusionsValve-preserving repair using the transannular delamination technique is feasible in patients with tetralogy of Fallot, reducing pulmonary regurgitation and avoiding transannular patch use. Long-term data with more patients are required to show the utility of this approach.

PMID:40509787 | DOI:10.1177/02184923251350362

J Clin Med. 2025 Jun 3;14(11):3955. doi: 10.3390/jcm14113955.

ABSTRACT

Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), hypoplastic aortic arch (HAA), and hypoplastic left heart syndrome (HLHS) predominate. Tissue patches are applied in pediatric cardiovascular surgery for the repair of congenital aortic defects as a filling material to replenish missing tissue or as a substitute material for the complete reconstruction of the vascular wall along the course of the vessel. This retrospective single-center study aimed to present the safety and feasibility of extracellular matrix (ECM) biological scaffolds in pediatric aortic surgery. Patients and methods: There were 26 patients (17 newborns and nine children), who underwent surgical procedures in the Department of Pediatric Cardiac Surgery (Poznań, Poland) between 2023 and 2024. The patients' population was divided into two subgroups according to the hemodynamic nature of the primary diagnosis of the congenital heart defect and the performed pediatric cardiovascular surgery. The first group included 18 (72%) patients after aortic arch repair for interrupted aortic arch and/or hypoplastic aortic arch, while the second group included seven (28%) patients after aortopulmonary anastomosis. In the first group, patches were used to reconstruct the aortic arch by forming an artificial arch with three separate patches sewn together, primarily addressing the hypoplastic or interrupted segments. In the second group, patches were applied to augment the anastomosis site between the pulmonary trunk and the aortic arch, specifically at the connection points in procedures, such as the Damus-Kaye-Stansel or Norwood procedures. The analysis was based on data acquired from the national cardiac surgery registry. Results: The overall mortality in the presented group was 15%. All procedures were performed using median sternotomy with a cardiopulmonary bypass. The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) median times were 144 (107-176) and 53 (33-79) min, respectively. There were two (8%) cases performed in deep hypothermic circulatory arrest (DHCA). The median postoperative stay in the intensive care unit (ICU) was 284 (208-542) h. The median mechanical ventilation time was 226 (103-344) h, including 31% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3-596.3) days, showed no evidence of patch-related complications such as restenosis, aneurysmal dilation, or calcification in surviving patients. One patient required reintervention on the same day due to a significantly narrow ascending aorta, unrelated to patch failure. No histological data from explanted patches were available, as no patches were removed during the study period. The median (Q1-Q3) hospitalization time was 21 (16-43) days. Conclusions: ProxiCor® biological patches derived from the extracellular matrix can be safely used in pediatric patients with congenital aortic arch disease. Long-term follow-up is necessary to confirm the durability and growth potential of these patches, particularly regarding their resistance to calcification and dilation.

PMID:40507716 | PMC:PMC12155669 | DOI:10.3390/jcm14113955

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

J Clin Med. 2025 Jun 5;14(11):4011. doi: 10.3390/jcm14114011.

ABSTRACT

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.

PMID:40507773 | PMC:PMC12155902 | DOI:10.3390/jcm14114011

J Clin Med. 2025 May 28;14(11):3786. doi: 10.3390/jcm14113786.

ABSTRACT

Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae plane block (ESPB) in adult patients undergoing MICS. Methods: In this prospective, single-center, double-blind, randomized, non-inferiority trial, 40 adult patients scheduled for MICS were allocated to receive either ESPB (n = 20) or a combination of IPB + SAPB (n = 20) prior to surgical incision. All patients received standardized anesthesia. Pain was assessed using the Critical-Care Pain Observation Tool (CPOT) during intubation and the Numerical Rating Scale (NRS) at 6-48 h postoperatively, following extubation. The primary outcome was the NRS score at 24 h. A non-inferiority margin of 2 NRS points was pre-specified, and non-inferiority was evaluated using between-group differences with 95% confidence intervals. Opioid consumption was recorded via PCA fentanyl and rescue analgesics, converted to morphine milligram equivalents (MMEs). Secondary outcomes included extubation time and postoperative nausea and vomiting (PONV). Results: Median 24 h NRS was 3.0 (0-5.0) in the ESPB group and 2.5 (0-5.0) in the IPB + SAPB group. The between-group difference remained within the predefined two-point margin (95% CI: -0.8 to 1.2). Opioid consumption (p = 0.394), extubation time, and PONV incidence were comparable (all p > 0.05). No block-related complications occurred. Conclusions: IPB + SAPB was non-inferior to ESPB for postoperative analgesia in MICS. Despite requiring two injections, it remains an effective alternative. Larger trials are needed to confirm these findings.

PMID:40507548 | PMC:PMC12156317 | DOI:10.3390/jcm14113786

J Clin Med. 2025 May 26;14(11):3711. doi: 10.3390/jcm14113711.

ABSTRACT

Background/Objectives: Remifentanil and dexmedetomidine are widely used agents for pain management during general anesthesia. Adropin acts as a regulator of endothelial function by affecting nitric oxide bioavailability and various hemodynamic factors, including blood flow, vascular dilatation, and mean arterial pressure. We aimed to evaluate the effects of remifentanil and dexmedetomidine on adropin and eNOS levels and hemodynamic parameters in patients undergoing unilateral single-level lumbar microdiscectomy under controlled hypotension. Methods: This study included 40 patients who underwent lumbar microdiscectomy and were randomly assigned to two groups: 20 patients received remifentanil, and 20 received dexmedetomidine. Hemodynamic parameters, preoperative and postoperative VAS scores, and intraoperative blood loss were recorded. Adropin and eNOS mRNA levels were measured with RT-qPCR at three time points: preoperative (T1), intraoperative (T2), and postoperative (T3). Adropin protein levels were evaluated using ELISA. Results: The remifentanil and dexmedetomidine groups had similar heart rate, arterial pressure, intraoperative blood loss, surgery time, and VAS scores. The extubation time was longer with remifentanil. Adropin mRNA level was higher in remifentanil at all time points. At T2, the eNOS mRNA level was higher in the remifentanil group. In the dexmedetomidine group, adropin mRNA levels decreased at T2 compared to T1. Adropin protein levels were higher in the remifentanil group at T2 and T3. In the dexmedetomidine group, serum adropin levels decreased at T3 compared to those at T1. Preoperative VAS scores in patients receiving both remifentanil and dexmedetomidine were higher than postoperative VAS scores. No significant correlation was observed between VAS scores and adropin levels or between intraoperative blood loss and adropin protein levels. Conclusions: Both drugs demonstrated similar effects on the hemodynamics of the patients, and adropin levels were not associated with the VAS score and intraoperative blood loss. These findings suggest that dexmedetomidine mediates vasodilation through adropin-independent mechanisms, while remifentanil may provide more favorable surgical conditions through adropin in patients undergoing unilateral single-level lumbar microdiscectomy.

PMID:40507473 | PMC:PMC12156445 | DOI:10.3390/jcm14113711

Diagnostics (Basel). 2025 May 31;15(11):1404. doi: 10.3390/diagnostics15111404.

ABSTRACT

Background: Hypotension is a common adverse event after the induction of general anesthesia and may lead to serious complications. The Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio is an echocardiographic parameter reflecting right ventricular (RV) function and pulmonary circulation. This study aimed to evaluate the predictive value of the TAPSE/PASP ratio for hypotension after general anesthesia induction. Methods: This prospective observational study included 79 patients with no known cardiac disease who were scheduled for elective surgery and classified as having a physical status of I-III according to the American Society of Anesthesiologists (ASA). TAPSE, PASP, and RV function were assessed using transthoracic echocardiography (TTE) within 5-30 min before surgery, and their hemodynamic changes after general anesthesia induction were recorded. Results: Data analysis revealed a significant association between the TAPSE/PASP ratio and the occurrence of hypotension following the induction of general anesthesia (p < 0.001). In addition, a cut-off value of ≤1.98 was determined for predicting hypotension, which demonstrated a sensitivity of 72.5% and a specificity of 64.1% (AUC = 0.733, 95% CI: 0.621-0.826, p < 0.001). Conclusions: The TAPSE/PASP ratio is a potential predictor of hypotension following the induction of general anesthesia. Further studies are required to validate its predictive accuracy and clinical utility in perioperative hemodynamic management.

PMID:40506977 | PMC:PMC12154500 | DOI:10.3390/diagnostics15111404

J Clin Lipidol. 2025 Apr 10:S1933-2874(25)00269-7. doi: 10.1016/j.jacl.2025.04.191. Online ahead of print.

ABSTRACT

BACKGROUND: The temporal changes in carotid plaque progression (PP) and its association with cardiovascular events are not well understood.

OBJECTIVE: This study aimed to evaluate the factors affecting short-term carotid PP and its relation to cardiovascular events.

METHODS: A total of 650 patients who underwent serial carotid ultrasonography over a period of at least 12 months were enrolled and analyzed. The study population was stratified into 2 groups: those with carotid PP (n = 304) and those without PP (n = 346). PP was defined as an increase of plaque number or a ≥20% increase in total plaque thickness compared to previous ultrasonography. The primary endpoint was a 4-year incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, coronary revascularization, or stroke.

RESULTS: Among all patients, the initial mean plaque thickness and number were 6.0 ± 6.7 mm and 2.7 ± 2.7, respectively. Upon follow-up, the PP rate was 46.7%, plaque regression was 16.5%, and no change was observed in 36.8%. The incidence of MACE over 4 years was significantly higher in the PP group (26.6%) compared to the no-PP group (13.0%), with a hazard ratio (HR) of 2.19 (95% CI, 1.52-3.15; P < .001). Independent predictors of MACE included age, chronic kidney disease, coronary artery disease, previous stroke, and PP (HR, 2.05; 95% CI, 1.42-2.95; P < .001). Age (HR, 1.02; 95% CI, 1.00-1.03; P = .038) and coronary artery disease (HR, 1.42; 95% CI, 1.04-1.95; P =.030) were independent predictors of PP.

CONCLUSION: Older age and coronary artery disease tended to increase the likelihood of PP during short-term follow-up, which was significantly associated with cardiovascular events.

PMID:40506269 | DOI:10.1016/j.jacl.2025.04.191

Stem Cell Rev Rep. 2025 Jun 12. doi: 10.1007/s12015-025-10910-y. Online ahead of print.

ABSTRACT

Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.

PMID:40504481 | DOI:10.1007/s12015-025-10910-y

Eur Heart J Open. 2025 Jun 11;5(3):oeaf057. doi: 10.1093/ehjopen/oeaf057. eCollection 2025 May.

ABSTRACT

AIMS: In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.

OBJECTIVES: We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.

METHODS AND RESULTS: All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators' visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction P > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).

CONCLUSION: In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.

PMID:40503340 | PMC:PMC12152305 | DOI:10.1093/ehjopen/oeaf057

Stem Cell Rev Rep. 2025 Jun 12. doi: 10.1007/s12015-025-10910-y. Online ahead of print.

ABSTRACT

Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.

PMID:40504481 | DOI:10.1007/s12015-025-10910-y

Am J Physiol Heart Circ Physiol. 2025 Jun 12. doi: 10.1152/ajpheart.00105.2025. Online ahead of print.

ABSTRACT

The hemodynamics of Fontan pathophysiology and the effects of pulmonary vasodilator therapy are insufficiently understood. The aim was to evaluate hemodynamic responses to dobutamine induced stress and the effect of concomitant acute pulmonary vasodilation testing (APV) in patients with a Fontan circulation to identify hemodynamic phenotypes. Sixteen adult patients undergoing cardiac catheterization for clinical indication were included. Hemodynamic phenotyping was performed during baseline, dobutamine induced stress and concomitant APV (inhaled nitric-oxide with FIO2 1.0). Pulmonary vascular disease (PVD) was defined by pulmonary vascular resistance (PVR)>2Wood units or pulmonary artery pressure/pulmonary blood flow-slope (mPAP/Qp)>3mmHg/L/min. Patients were assigned to Group-A without PVD (N=8) or Group-B with PVD (N=8 mPAP/Qp>3 with N=3 PVR>2). For the total group; median cardiac output (Qs) was 5.2L/min and increased to 7.3L/min with dobutamine (p=0.005) without further change with APV (p=0.255). However, subgroup-analysis revealed that during dobutamine the increase in Qs occurred only in Group-A (+3.5L/min, p=0.012), and Qs decreased APV(-1.3L/min, p=0.0036). In contrast, in group-B Qs did not change with dobutamine (p=0.236), nor with APV (p=0.327). However, in contrast to group-A (p=0.889), in group-B Qp increased with APV(+1.3L/min, p=0.017) while the mPAP/Qp-slope improved significantly (6.2 to 1mmHg/L/min, p=0.017). Suggesting that APV improved Qp and oxygenation in patients with PVD, but had negative effects in those without PVD. This study shows that hemodynamic response to dobutamine induced stress and APV differs in patients with a Fontan circulation depending on the presence of pulmonary vascular disease. Hemodynamic phenotyping with sophisticated identification of pulmonary vascular disease potentially allows for patient-tailored treatment.

PMID:40506093 | DOI:10.1152/ajpheart.00105.2025

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6):e24.00343. doi: 10.5435/JAAOSGlobal-D-24-00343. eCollection 2025 Jun 1.

ABSTRACT

A healthy 15-year-old male athlete presented with upper thoracic congenital kyphoscoliosis, causing notable pain and limiting participation in competitive sports. In addition to mid and low back pain related to sagittal profile, the patient also expressed concerns regarding shape of his back from the compensatory thoracolumbar lordosis relative to his desired physical activities. Imaging demonstrated an abnormal fusion segment from T4-T8 with hemivertebrae at T6 and T7. After failing conservative management, the patient underwent T2-L2 posterior spinal fusion with posterior column osteotomies, successfully restoring sagittal alignment and allowing a return to high-impact sports. Unfavorable symptoms associated with abnormal sagittal spinal alignment should be considered even in a stable, nonprogressive deformity. Sagittal correction with posterior spinal instrumented fusion can effectively restore sagittal posture and function in athletes with congenital kyphoscoliosis associated with a sweeping and symptomatic thoracolumbar lordosis, altering the natural history of the deformity and improving quality of life.

PMID:40505129 | PMC:PMC12168692 | DOI:10.5435/JAAOSGlobal-D-24-00343

Int Wound J. 2025 Jun;22(6):e70710. doi: 10.1111/iwj.70710.

ABSTRACT

The primary aim of this study was to evaluate the impact of the polyhexamethylene biguanide (PHMB) care bundle on the occurrence rates of surgical site infections (SSIs) in paediatric and neonatal cardiac surgery, addressing a critical gap in paediatric-specific infection prevention protocols. A retrospective cohort study included patients under 18 years old who underwent cardiac surgery at IRCCS Policlinico San Donato. Cohort A (n = 117) received the PHMB care bundle from April to December 2023, while Cohort B (n = 801) received conventional care from September 2020 to March 2023. The 1:1 propensity score matching was used to balance covariates between cohorts, resulting in two comparable cohorts (Cohort A = 114 patients and Cohort B = 112). The study found a significant reduction in SSIs among patients receiving the PHMB care bundle compared with those receiving conventional care (1.8% vs. 7.1%, p = 0.048). The comprehensive nature of the PHMB care bundle, including educational programs, preoperative and postoperative antimicrobial treatments, and consistent application of best practices, was instrumental in achieving these outcomes. Implementing antimicrobial care bundles could significantly reduce SSIs in paediatric cardiac surgery. Future research is needed to refine the tested bundle with prospective approaches.

PMID:40503594 | PMC:PMC12159764 | DOI:10.1111/iwj.70710

Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2689-2692. doi: 10.1007/s12070-025-05563-9. Epub 2025 May 22.

ABSTRACT

Drug induced sleep endoscopy (DISE) is an accepted diagnostic tool to pinpoint sites of dynamic obstruction in sleep apnoea. However, the challenges increase manifold in a child with Poland's syndrome (PS), a congenital condition characterised by hypoplasia or agenesis of thoracic musculoskeletal elements, with rare limb anomalies. There are numerous risks associated with anaesthesia, including difficulties with ventilation and the potential for malignant hyperthermia. We describe a case of a child with Poland's syndrome, with sleep disordered breathing. The patient was taken up for DISE-guided surgery. To our best knowledge, this is the first case of Poland's syndrome described with respect to DISE in literature. We discuss the case and our experience - both surgical and anaesthesia related Poland's syndrome.

PMID:40503156 | PMC:PMC12149053 | DOI:10.1007/s12070-025-05563-9

Eur Heart J Case Rep. 2025 May 28;9(6):ytaf270. doi: 10.1093/ehjcr/ytaf270. eCollection 2025 Jun.

NO ABSTRACT

PMID:40502811 | PMC:PMC12152536 | DOI:10.1093/ehjcr/ytaf270

Eur Heart J Case Rep. 2025 May 24;9(6):ytaf267. doi: 10.1093/ehjcr/ytaf267. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Infective endocarditis on a patent ductus arteriosus (PDA) is a rare but serious condition that can lead to life-threatening complications, such as mycotic aneurysms. We report a case of endocarditis on a PDA, complicated by multiple mycotic aneurysms, including a partially ruptured aneurysm of the pulmonary artery (PA) trunk.

CASE SUMMARY: A 20-year-old female presented with progressive dyspnoea, worsening over 48 h, accompanied by fever. Echocardiography revealed a large pericardial effusion with cardiac tamponade, necessitating the drainage of 500 mL of haemorrhagic fluid. Imaging studies revealed a false aneurysm of the PA trunk, with contrast extravasation into the pericardial space. Blood cultures and pericardial fluid cultures were positive for Staphylococcus aureus. Emergency surgery involved resection of the aneurysm, ligation of the PDA, and pericardial drainage. The patient recovered after 4 weeks of intravenous antibiotics and was discharged with good clinical and biological outcomes.

CONCLUSION: This case illustrates the importance of early diagnosis and management of infective endocarditis associated with congenital heart defects, as the delay can result in severe complications such as aneurysm rupture.

PMID:40502810 | PMC:PMC12152474 | DOI:10.1093/ehjcr/ytaf267

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

J Am Heart Assoc. 2025 Jun 17;14(12):e039663. doi: 10.1161/JAHA.124.039663. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting (CABG) has been associated with reduced mortality, myocardial infarction, and repeat revascularization compared with percutaneous coronary intervention (PCI) for patients with 3-vessel coronary artery disease (CAD) and diabetes. The majority of previous studies have been limited to follow-up of <10 years. Herein, we compared CABG and PCI in patients with 3-vessel coronary artery disease and diabetes with a maximum long-term follow-up of 14 years.

METHODS: Patients with diabetes and 3-vessel coronary artery disease but without ST-segment-elevation myocardial infarction who underwent coronary angiography followed by CABG or PCI from 2009 to 2018 were included in this study. The primary outcome was mortality, and the secondary outcomes included myocardial infarction, stroke, or repeat revascularization. Outcomes were adjusted for age, sex, and clinical comorbidities.

RESULTS: A total of 1210 patients underwent PCI (median follow-up, 9.1 years) while 477 underwent CABG (median follow-up, 8.1 years). Patients who underwent CABG were less likely to experience mortality (49.6% versus 57.6%, P=0.003, adjusted hazard ratio [aHR], 0.75 [95% CI, 0.61-0.91]), myocardial infarction (15.6% versus 28.1%, P<0.001, aHR, 0.45 [95% CI, 0.33-0.61]), or require repeat revascularization (7.7% versus 26.9%, P<0.001, aHR, 0.21 [95% CI, 0.14-0.30]) at longest follow-up. Risk of rehospitalization (82.6% versus 83.4%, P=0.656) and stroke (11.6% versus 12.2%, P=0.794) did not significantly differ between groups.

CONCLUSIONS: In this study, we describe one of the longest follow-up periods for patients with diabetes and 3-vessel coronary artery disease who underwent CABG or PCI and confirmed that the shorter-term benefits seen in randomized trials do translate into longer-term reductions in risk of death, myocardial infarction, or repeat revascularization.

PMID:40497515 | DOI:10.1161/JAHA.124.039663

J Am Heart Assoc. 2025 Jun 17;14(12):e040526. doi: 10.1161/JAHA.124.040526. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.

METHODS: We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023. Primary outcomes were in-hospital mortality and major bleeding; secondary end points included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis initiation. Subgroup analyses were conducted by age, sex, race, AMI type, revascularization status, and extent of coronary disease. We used the NCDR validated risk model for multivariable adjustment.

RESULTS: PAD was present in 36 274 patients with AMI (7.4%). In-hospital mortality was significantly higher in patients with PAD compared with those without (8.23% versus 4.87%; adjusted odds ratio [aOR], 1.25 [95% CI, 1.19-1.31]). Increased mortality persisted across age groups (<65 years: aOR, 1.42; ≥65 years: aOR, 1.18) and AMI type (non-ST-segment-elevation MI: aOR, 1.14; ST-segment-elevation MI: aOR, 1.46), with significant interactions by both age and AMI type. Among revascularized patients, mortality was elevated in those with PAD (aOR, 1.49). PAD was associated with increased rates of major bleeding (aOR, 1.23), particularly among revascularized patients (aOR, 1.31), as well as cardiac arrest, shock, heart failure, stroke, and new dialysis.

CONCLUSIONS: PAD was independently associated with markedly worse in-hospital outcomes in AMI, highlighting the need for risk mitigation strategies in this high-risk population.

PMID:40497502 | DOI:10.1161/JAHA.124.040526