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Am J Case Rep. 2025 Jun 30;26:e947068. doi: 10.12659/AJCR.947068.

ABSTRACT

BACKGROUND Renal ectopia (RE) is a congenital malformation in which one or both kidneys fail to reach their normal anatomical position. Most cases are asymptomatic, but they can occasionally lead to complications. This case report presents the incidental finding of a pelvic ectopic kidney during a pre-transcatheter aortic valve replacement (TAVR) evaluation, showing the importance of recognizing anatomical variations in surgical planning for vascular access. CASE REPORT A 68-year-old man undergoing evaluation for severe symptomatic aortic stenosis was incidentally found to have a left pelvic kidney on computed tomography (CT) angiography. The CT scan revealed a dual arterial supply, with one artery entering the kidney medially and an accessory artery wrapping laterally around the kidney, which may have contributed to the failure of its ascent during embryological development. He had no urinary symptoms, and renal function was normal, so no further intervention was required. The identification of this vascular anomaly emphasizes the need for proper preoperative imaging to avoid complications. CONCLUSIONS Recognizing anatomical variations like renal ectopia can help optimize complex vascular procedure planning and prevent complications. Additionally, this case highlights the association between multiple renal arteries and renal ectopia, suggesting further research is needed to understand these correlations.

PMID:40587412 | DOI:10.12659/AJCR.947068

Ann Afr Med. 2025 Jun 30. doi: 10.4103/aam.aam_244_24. Online ahead of print.

ABSTRACT

The thoracic duct is susceptible to damage from a variety of surgical operations, including esophagectomy, lung resection, and mediastinal or aortic surgery, because of its anatomical placement. Lymphatic leaks are known as chylothorax, which is a common complication of coronary artery bypass grafting. However, In congenital cardiac surgeries, the incidence of chylothorax ranges from 2.5% to 4.7%, while in esophageal procedures, it is 0.4%-4%. There have been a few reports of a chylous lymphatic leak following coronary bypass surgery. In this case report, we would like to present the anesthetic management of a chyle leak that developed a couple of days following triple coronary arterial bypass surgery, which was successfully managed with suprainguinal fascia iliaca compartment block for the embolization of the lymphatic duct.

PMID:40587160 | DOI:10.4103/aam.aam_244_24

Multimed Man Cardiothorac Surg. 2025 Jun 30;2025. doi: 10.1510/mmcts.2025.060.

ABSTRACT

Coronary artery aneurysms are exceedingly rare and are most often discovered incidentally. Rupture of such aneurysms is even more uncommon. In this case report, we describe an 82-year-old patient who presented with sudden-onset chest pain and was diagnosed with a fissurating aneurysm of the right coronary artery. The aneurysm was associated with a congenital abnormality of the coronary venous sinus return. The patient underwent emergency surgery. Given her advanced age, the surgical strategy focused solely on addressing the imminent risk of rupture. A 10-mm Gore-Tex graft was implanted because direct suture repair or vein grafting was deemed unsuitable. The patient recovered well postoperatively and was given dual antiplatelet therapy. At nine months of follow-up, she remains asymptomatic, with no recurrence of chest pain.

PMID:40586769 | DOI:10.1510/mmcts.2025.060

Oxf Med Case Reports. 2025 Jun 27;2025(6):omaf074. doi: 10.1093/omcr/omaf074. eCollection 2025 Jun.

ABSTRACT

Cystic hygroma is a rare congenital anomaly typically observed in newborns, with cases in adults being exceptionally rare. In adults, these lesions often remain asymptomatic and present unique challenges owing to the absence of established treatment protocols. This report describes a 23-year-old male with a large pulmonary cystic hygroma manifesting as progressive chest discomfort, breathing difficulties, and systemic symptoms. Diagnostic imaging revealed an extensive cystic structure within the mediastinal-pulmonary region, which was managed surgically via cystotomy. Histopathological analysis confirmed the diagnosis, and the patient experienced a complete recovery with no recurrence during follow-up. This case highlights the need for standardized guidelines in the management of pulmonary cystic hygromas and emphasizes the importance of including cystic hygroma in the differential diagnosis of pulmonary masses in adults. Further studies are essential to optimize therapeutic approaches and enhance outcomes for adult patients with this rare condition.

PMID:40585459 | PMC:PMC12202292 | DOI:10.1093/omcr/omaf074

Medicine (Baltimore). 2025 Jun 27;104(26):e43019. doi: 10.1097/MD.0000000000043019.

ABSTRACT

Studies into the mechanisms of cardiopulmonary bypass-associated acute lung injury have not presented breakthroughs for many years, resulting in the stagnation of management strategies and clinical medicine measures. This is a key factor affecting the prognoses of open-heart surgery patients. Future studies should focus on key targets of inflammation, such as neutrophils, macrophages, and the glycocalyx cell coat, and further explore advanced technologies, such as gene editing and single-cell sequencing, to reveal the underlying mechanisms of cardiopulmonary bypass-associated acute lung injury and to find effective prevention and treatment strategies.

PMID:40587734 | PMC:PMC12212844 | DOI:10.1097/MD.0000000000043019

Inflamm Res. 2025 Jun 30;74(1):99. doi: 10.1007/s00011-025-02058-9.

ABSTRACT

BACKGROUND: Treatment effects of anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in coronary artery disease (CAD) had conflicting results. The study aims to evaluate efficacy and safety outcomes of treatments inhibiting this pathway.

METHODS: Cochrane Library, Embase, Pubmed, and ClinicalTrials.gov were searched for randomized controlled trials evaluating therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in CAD patients. Relative risks (RR) with 95% confidence intervals (CI) were calculated.

RESULTS: 32 studies and 37,056 individuals were included. Anti-inflammatory therapies inhibiting the pathway reduced the risks of myocardial infarction (MI) (RR 0.85, 95% CI 0.78-0.93) and coronary revascularization (RR 0.80, 95% CI 0.74-0.86), with no benefits in major adverse cardiovascular events (MACE), heart failure (HF), stroke, cardiovascular or all-cause mortality. Colchicine reduced the risks of MACE, MI, and coronary revascularization. IL-1 inhibitors reduced the risks of coronary revascularization, with potential benefits in MI and HF. Increased risks of infections, gastrointestinal adverse effects, and injection site reactions were found. Meta-regression analysis demonstrated that post-treatment hsCRP/CRP was correlated with MACE (p < 0.001) and MI (p = 0.048) and post-treatment IL-6 was associated with MI (p = 0.033).

CONCLUSION: Anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway had satisfying safety profiles and were beneficial in preventing MI and coronary revascularization in CAD patients despite no benefits in stroke, cardiovascular, or all-cause mortality.

PMID:40583093 | PMC:PMC12206679 | DOI:10.1007/s00011-025-02058-9

Med Princ Pract. 2025 Jun 27:1-16. doi: 10.1159/000547099. Online ahead of print.

ABSTRACT

OBJECTIVES: This meta-analysis compared the efficacy and safety of drug coated balloon (DCB) angioplasty with drug eluting stent (DES) for the treatment of de novo coronary artery disease.

METHODS: Following PRISMA guidelines, we conducted a systematic search of major databases, including Cochrane, MEDLINE, Embase and clinicaltrials.gov, to identify eligible randomized controlled trials (RCTs) comparing DCB and DES. Mantel-Haenszel model was used for dichotomous outcomes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model using RevMan software.

RESULTS: Thirteen RCTs with a total of 4,686 patients were included. The analysis found no significant differences between DCB and DES for all-cause mortality (RR: 1.11, 95% CI: 0.81-1.53, p = 0.51) or myocardial infarction (RR: 0.80, 95% CI: 0.56-1.15, p = 0.23). Similarly, no significant differences were observed for cardiac death (RR: 1.33, 95% CI: 0.86-2.05, p = 0.19), target lesion revascularization (RR: 1.19, 95% CI: 0.64-2.21, p = 0.59), or target vessel revascularization (RR: 1.34, 95% CI: 0.79-2.28, p = 0.28).

CONCLUSION: This meta-analysis demonstrates comparable efficacy and safety outcomes for DCBs and DES in the treatment of de novo coronary artery disease. While DCBs offer a viable alternative, particularly for high-risk patients or those unsuitable for prolonged dual antiplatelet therapy, further large-scale studies are warranted to strengthen these findings and refine clinical recommendations.

PMID:40582348 | DOI:10.1159/000547099

J Control Release. 2025 Jun 27:113989. doi: 10.1016/j.jconrel.2025.113989. Online ahead of print.

ABSTRACT

Extracellular vesicles (EVs) derived from stem cells have shown therapeutic benefits in myocardial injury. However, the challenges in their large-scale production and elusive molecular mechanisms underlying their therapeutic effects have been hindering their clinical translation. Here, in a mouse model of myocardial ischemia-reperfusion, EVs isolated from human adipose tissue and EV-like nanovesicles fabricated with adipose stem cells (ADSCs) via a membrane extrusion approach, termed ADSC-derived nanovesicles (ADSC-CDNs), exhibited comparable cardioprotective effects, validating this EV-mimetic strategy. CDNs generated from the human monocytic cell line U937 similarly conferred protection, whereas those from HEK293 cells did not, highlighting the importance of cell source for therapeutic efficacy. microRNA profiling identified miR-24-3p as a predominant therapeutic cargo in ADSC EVs and ADSC-CDNs. This microRNA upregulates the cytoprotective transcription factor Nrf2, thereby suppressing cardiomyocyte apoptosis. Functional assays also confirmed that miR-24-3p was a key component mediating the cardioprotective effects of those nanovesicles. Importantly, this study introduces a cell-source-dependent, scalable, and high-yield production platform for ADSC-CDNs that preserves molecular cargo profile of the parent cells, ensuring consistent therapeutic content. This EV-mimetic platform is technically feasible and clinically translatable, demonstrating reproducible efficacy in both acute injury and post-infarction recovery phases. Taken together, the defined microRNA cargo and the robust vesicle production strategy highlight the translational potential of ADSC-CDNs as an off-the-shelf cardioprotective therapy.

PMID:40582645 | DOI:10.1016/j.jconrel.2025.113989

Biochem Biophys Res Commun. 2025 Jun 25;777:152235. doi: 10.1016/j.bbrc.2025.152235. Online ahead of print.

ABSTRACT

BACKGROUND: Environmental pollution, particularly noise exposure, may contribute to the development and progression of cardiovascular disorders by triggering oxidative stress and inflammatory pathways. This study evaluated the protective effects of benfotiamine (BFT) supplementation and moderate-intensity continuous training (MICT), alone or in combination, against noise-induced cardiac damage in male mice.

METHODS AND RESULTS: Eight-week-old mice (n = 8/group) were divided into six groups: control, noise-exposed (Noise) subjected to 100 dB (dB), noise + moderate-intensity continuous exercise training (MICT), noise + BFT group (200 mg/kg/day), noise + MICT + BFT, and noise + N-acetylcysteine (NAC) groups. Noise exposure and other treatments were administered over four weeks. Histopathological changes, oxidative stress parameters, and the gene expression of inflammatory markers were evaluated. Noise exposure markedly increased cardiac ROS, NO, MDA, and protein carbonyl content, while significantly decreasing GSH and FRAP levels (all p < 0.001 vs. control). Treatment with BFT or MICT partially restored redox balance, whereas combined BFT + MICT treatment produced more pronounced improvements (e.g.

, MDA: 9.91 ± 4.45; GSH: 101.2 ± 20.1 μM). Inflammatory markers IL-6, TNF-α, IL-1β, and NF-κB were upregulated by noise and significantly attenuated by all interventions, with the greatest reduction observed in the combined group. Histological analysis confirmed that the combined therapy more effectively preserved myocardial architecture compared to monotherapies.

CONCLUSION: Our findings suggest that BFT's antioxidant and anti-inflammatory properties, in combination with MICT as a non-pharmacological approach, may protect against noise-induced cardiovascular problems. BFT and MICT mitigate noise-induced cardiac injury via antioxidant and anti-inflammatory mechanisms, with additive benefits evident in the combined treatment group.

PMID:40582321 | DOI:10.1016/j.bbrc.2025.152235

Med Sci Monit. 2025 Jun 16;31:e947831. doi: 10.12659/MSM.947831.

ABSTRACT

BACKGROUND Acute coronary syndrome (ACS) is a prevalent cardiovascular disease with persistent risks of myocardial under-perfusion and adverse events after percutaneous coronary intervention (PCI). The combination of tirofiban and cilostazol has shown potential efficacy, but clinical validation remains limited. This study evaluated the effects of tirofiban combined with cilostazol on cardiac function recovery and prognosis in elderly ACS patients after PCI. MATERIAL AND METHODS This study included 80 elderly ACS patients treated between April 2020 and April 2022. Patients were assigned to the control group (n=40), receiving aspirin and clopidogrel, or the observation group (n=40), receiving tirofiban and cilostazol after PCI. We assessed cardiac function, myocardial markers, serum inflammatory factors, platelet aggregation rate, platelet count (PLT), quality-of-life scores, and the incidence of major adverse cardiovascular events (MACE). RESULTS The treatment effectiveness was 97.50% in the observation group versus 80.00% in the control group. One month after PCI, the observation group had lower left ventricular end-diastolic diameter and left ventricular end-systolic diameter and higher left ventricular ejection fraction. Inflammatory markers (IL-6, hs-CRP, TNF-alpha), platelet aggregation rate, and PLT levels were significantly decreased. Myocardial markers (CK-MB, hs-cTnT) were elevated at 24 hours but improved by 1 month. Quality-of-life scores improved significantly, and MACE incidence was lower in the observation group. CONCLUSIONS Tirofiban combined with cilostazol enhances cardiac function, reduces inflammation, platelet aggregation, and myocardial injury, and improves prognosis in elderly ACS patients after PCI.

PMID:40581838 | PMC:PMC12180374 | DOI:10.12659/MSM.947831

Transplant Proc. 2025 Jun 28:S0041-1345(25)00282-9. doi: 10.1016/j.transproceed.2025.05.020. Online ahead of print.

ABSTRACT

This study examines takotsubo cardiomyopathy (TTS) following liver transplantation (LT). Out of 739 LT patients from 2018 to 2024, 76 developed cardiac dysfunction, with 6 cases of TTS, all male. TTS incidence post-LT was 0.8%, with alcoholic cirrhosis as the main diagnosis. TTS occurred a median of 2 days post-LT, highlighting early complications. High catecholamine levels were noted in 1 case. The study stresses the need for differential diagnosis of TTS in post-LT cardiac dysfunction, especially in alcohol abuse patients, with aggressive treatment including IABP, volume management, and anticoagulation. Echocardiographic assessment post-LT is crucial for TTS detection and management.

PMID:40582931 | DOI:10.1016/j.transproceed.2025.05.020

Blood Rev. 2025 Jun 23:101319. doi: 10.1016/j.blre.2025.101319. Online ahead of print.

ABSTRACT

Anemia is a hallmark of myelodysplastic syndromes/neoplasms (MDS) and most patients with MDS chronically require red blood cell transfusions. Due to the body's inability to excrete excess iron, patients are at increased risk of iron overload, often defined by ferritin levels >1000 ng/mL. Iron overload can cause progressive organ damage from iron deposition in tissues and has been linked to increased mortality. In MDS patients undergoing allogeneic hematopoietic cell transplantation (HCT), iron overload has also been associated with increased non-relapse mortality, decreased overall survival, and a higher incidence of relapse. Prospective and retrospective studies have demonstrated the safety and clinical benefit of iron chelation therapy (ICT) in lower-risk MDS. Despite some common adverse effects associated with ICT, such as renal toxicity and gastro-intestinal symptoms, managing iron levels remains essential in transfusion-dependent MDS patients, and those who are undergoing HCT to optimize pre-transplant conditions, and enhance post-transplant outcomes.

PMID:40582916 | DOI:10.1016/j.blre.2025.101319

Circ J. 2025 Jun 28. doi: 10.1253/circj.CJ-25-0088. Online ahead of print.

ABSTRACT

BACKGROUND: Japan's heart transplantation system is characterized by an extremely long waiting period, which contributes to significant mortality on the waiting list. The current allocation system may maintain favorable post-transplant outcomes at the expense of high-risk patients, particularly those with severe heart failure or complications following left ventricular assist device (LVAD) implantation. To explore an optimal allocation system for Japan, we investigated risk factors for waiting list mortality.

METHODS AND RESULTS: We analyzed 300 patients registered on the heart transplant waiting list at Osaka University between 2014 and 2024. Cox hazard analysis identified age at registration (hazard ratio [HR] 1.023) and congenital heart disease (HR 4.531) as independent risk factors for mortality. In the LVAD cohort (n=244), right heart failure (HR 4.582), stroke associated with systemic infection (HR 5.175), and sudden stroke without preceding infection (HR 3.158) were significant risk factors. Although the HeartMate 3 significantly reduced sudden stroke (P<0.001), it did not improve right heart failure or infection-related stroke. Patients with these complications had significantly lower proportions of time at home with an LVAD (P<0.001).

CONCLUSIONS: Prioritized organ allocation for patients with congenital heart disease, right heart failure, or LVAD-related infections may improve waiting list survival. Reducing hospitalizations in high-risk LVAD patients could also be beneficial from a healthcare economics perspective.

PMID:40582867 | DOI:10.1253/circj.CJ-25-0088

J Heart Lung Transplant. 2025 Jun 27:S1053-2498(25)02064-9. doi: 10.1016/j.healun.2025.06.026. Online ahead of print.

ABSTRACT

Medical assistance in dying (MAiD) provides capable patients with intolerable suffering the option to retain control over the timing and circumstances of their deaths. This case reports the first successful cardiac transplantation after MAiD. A 59-year-old male with end-stage heart failure received a donor heart from a 38-year-old male with ALS who underwent MAiD. The donor heart was retrieved using the TransMedics Organ Care System and successfully transplanted with excellent postoperative function. The recipient's recovery included transient mild rejection and acute kidney injury, both of which resolved with treatment. This case demonstrates the feasibility of cardiac transplantation following MAiD and highlights its potential to expand the donor pool.

PMID:40582651 | DOI:10.1016/j.healun.2025.06.026

Kidney Int. 2025 Jun 27:S0085-2538(25)00491-0. doi: 10.1016/j.kint.2025.06.003. Online ahead of print.

ABSTRACT

INTRODUCTION: C3 glomerulopathy (C3G) and immune-complex membranous proliferative glomerulonephritis (IC-MPGN) are rare disorders that frequently result in kidney failure over the long-term. Presently, there are no disease-specific treatments approved for these disorders, although there is much interest in the therapeutic potential of complement inhibition. However, the limited duration and necessarily small size of controlled trials means there is a need to quantify how well short-term changes in estimated glomerular filtration rate (eGFR) and proteinuria predict the clinically important outcome of kidney failure.

METHODS: We address this using longitudinal data from the UK Registry of Rare Kidney Diseases (RaDaR) involving retrospective and prospective data collection with linkage to hospital laboratories via automated feeds of 371 patients. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression with eGFR slope estimated using linear mixed models.

RESULTS: In a median of 11.0 (inter quartile range 7.4-15.1) years follow-up, 148 patients (40%) reached kidney failure. There was no significant difference in progression to kidney failure between C3G and IC-MPGN groups. Baseline urine protein-creatinine ratio (UPCR), although high, was not associated with kidney failure in either group. Two-year eGFR slope had a modest association with kidney failure. In contrast, both 20%‒50% and 50 mg/mmol reductions in UPCR between 0-12 months were associated with lower kidney failure risk in both groups. Notably, those with a UPCR under 100 mg/mmol at 12 months had a substantially lower risk of kidney failure (hazard ratio 0.10 (95% confidence interval 0.03-0.30).

CONCLUSIONS: Overall, proteinuria a short time after diagnosis is strongly associated with long-term outcomes and a UPCR under 100 mg/mmol at one year is associated with a substantially lower kidney failure risk.

PMID:40582408 | DOI:10.1016/j.kint.2025.06.003

Semin Thorac Cardiovasc Surg. 2025 Jun 27:S1043-0679(25)00092-9. doi: 10.1053/j.semtcvs.2025.04.009. Online ahead of print.

ABSTRACT

Ischemic mitral regurgitation (IMR) is a complex heterogeneous complication following myocardial infarction, characterized by left ventricular (LV) remodeling and subsequent valvular distortion. The primary mechanisms include papillary muscle displacement, mitral leaflet tethering, and impaired coaptation following annular dilatation. IMR is associated with poor prognosis and an increased incidence of heart failure. We reviewed studies on the surgical management of IMR published over the past two decades. While mitral valve repair has been favored for its advantages of low perioperative mortality and LV function preservation, high rates of mitral regurgitation recurrence limit its long-term durability. Regarding repair strategy, apart from restrictive mitral annuloplasty, the adjunctive techniques of papillary muscle relocation, papillary muscle approximation, and leaflet augmentation have been proposed. These approaches aim to address LV remodeling and improve leaflet coaptation by mitigating subvalvular tethering. Moreover, the application of true-size annuloplasty and "functional repair" strategies in IMR patients with enlarged LV emphasizes the need to tailor interventions to patients' LV dimensions and dynamic changes. Accumulating clinical evidence highlights the importance of meticulous patient selection and functional mitral valve repair, which remains a promising approach contingent on enhanced understanding of IMR's pathophysiology and its interplay with LV remodeling. The current review summarizes our patient selection criteria and indications for surgical repair (including the use of adjunctive techniques of subvalvular intervention) or mitral valve replacement.

PMID:40582431 | DOI:10.1053/j.semtcvs.2025.04.009

Can J Cardiol. 2025 Jun 27:S0828-282X(25)00525-2. doi: 10.1016/j.cjca.2025.06.068. Online ahead of print.

ABSTRACT

BACKGROUND: In vitro studies demonstrated that direct oral anticoagulants (DOACs) down-regulate expression of proteins involved in calcification and inflammation. This hypothesis-testing study evaluates whether DOAC therapy is associated with decreased valvular calcification in patients with aortic stenosis (AS), anticoagulated due to concomitant atrial fibrillation (AF).

METHODS: In this case-control study 72 Caucasian patients with isolated severe AS were compared with 53 individuals with AF concomitant to severe AS, treated with DOACs for 28.7±13.8 months. Sixteen valves from AS patients on rivaroxaban (20 mg/day, AS-RIVA) and 20 valves from age-, sex-matched non-anticoagulated individuals with AS were subjected to micro-computed tomography (micro-CT), to estimate valvular calcification ex vivo. Calcium volume (CV), surface volume (SV), CV/SV ratio and trabecular thickness (TbTh) were assessed. Valvular expression of osteopontin, NF-κB, and IL-6 was evaluated by immunostaining.

RESULTS: Micro-CT showed that AS-RIVA patients had lower CV (-62.7%), SV (-46.2%), CV/SV ratio (-35.6%), and maximal TbTh (-21.1%), compared to patients not taking rivaroxaban (all p<0.05). Duration of rivaroxaban use correlated inversely with micro-CT parameters, peak transvalvular velocity, and maximal transvalvular pressure gradient. Decreased valvular expression of osteopontin (-20.4%), NF-κB (-26%), and two-fold lower IL-6 fluorescence intensity were observed in the AS-RIVA group compared to the remainder (all p<0.05). Moreover, osteopontin expression was inversely associated with the duration of rivaroxaban use and positively with micro-CT parameters.

CONCLUSIONS: Long-lasting rivaroxaban use in AS patients was associated with lower aortic valve leaflet calcification, reflected by micro-CT parameters, and osteopontin expression, suggesting a potential impact of rivaroxaban on valvular calcification.

PMID:40582401 | DOI:10.1016/j.cjca.2025.06.068

Cancer Rep (Hoboken). 2025 Jul;8(7):e70268. doi: 10.1002/cnr2.70268.

ABSTRACT

OBJECTIVES: Paediatric patients with abdominal tumours associated with tumour thrombus in the inferior vena cava (IVC) and right atrium are relatively rare in clinical practice. Hence, we summarised the management strategies for anaesthesia and cardiopulmonary bypass (CPB) used during surgical treatment for these conditions through multidisciplinary cooperation.

METHODS: We collected the clinical data of paediatric patients who underwent surgery for tumour thrombus removal via CPB from January 2012 to December 2022 because their abdominal tumours had invaded the IVC and right atrium. We explored the strategies used to manage anaesthesia and CPB, assessed the incidence of intraoperative haemorrhage and arterial blood gas analysis, reported the incidence of blood transfusion and described the postoperative outcome and follow-up.

RESULTS: A total of six paediatric patients underwent surgery under CPB to remove the tumour thrombus. Among them, two patients had nephroblastoma, one had renal clear cell carcinoma and three had hepatoblastoma. The average age of the six patients was 25.8 months. The average operation time was 459.8 min, and the average anaesthesia time was 553.1 min. The average CPB time was 150.3 min, and the average aortic block time was 46.1 min. The average hypothermic circulatory arrest time was 20 min. The average quantity infused was as follows: red blood concentrate (RBC): 5.1 units, cryoprecipitate: 3.2 units, fresh frozen plasma (FFP): 200 mL and platelets (PLTs): 4.2 units. The time of extubation ranged from 4 h to 8 days, and the average time spent in the intensive care unit (ICU) was 6.2 days after surgery. No serious complications occurred during the follow-up period.

CONCLUSIONS: The present retrospective study aims to share our clinical experience with the management strategies of anaesthesia and CPB. Steady induction of anaesthesia, intraoperative massive haemorrhage and critical intraoperative situations are the major challenges in anaesthesia management.

PMID:40582963 | PMC:PMC12206560 | DOI:10.1002/cnr2.70268

Eur Heart J. 2025 Jun 23:ehaf446. doi: 10.1093/eurheartj/ehaf446. Online ahead of print.

NO ABSTRACT

PMID:40581490 | DOI:10.1093/eurheartj/ehaf446

Microvasc Res. 2025 Jun 26:104838. doi: 10.1016/j.mvr.2025.104838. Online ahead of print.

ABSTRACT

OBJECTIVES: We investigated the predictive value of the average microvascular resistance of the three main vessels (3VA-AMR) for the prognosis of patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI).

METHODS: This study was conducted on patients with NSTEMI who underwent PCI between March 1, 2021, and February 28, 2022, at Fujian Medical University Union Hospital. Quantitative flow ratio (QFR) analysis was conducted on all patients' PCI angiography images to assess postoperative QFR and angio-based microvascular resistance (AMR) for three main vessels. All enrolled patients were devided into two groups based on the criteria for coronary microvascular dysfunction (CMD): high 3VA-AMR group and low 3VA-AMR group. The primary outcome was 2-year major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and ischemia-driven revascularization.

RESULTS: A total of 290 patients were included in the final analysis. Compared with the low 3VA-AMR group, the three vessels of high 3VA-AMR group showed lower area stenosis (49.46 ± 13.70 % vs. 52.93 ± 15.43 %，P = 0.001), higher QFR value (0.92 ± 0.05 vs. 0.88 ± 0.09, P < 0.001), and higher AMR value (274.50 [257.33-301.42] mmHg*s/m vs. 208.00 [182.00-231.83] mmHg*s/m, P < 0.001). The incidence of 2-year MACEs was significantly higher in the high 3VA-AMR group than in the low 3VA-AMR group (21.90 % vs. 10.27 %, P = 0.007). Univariate and multivariate Cox regression analyses confirmed that 3VA-AMR was independently associated with 2-year MACEs (HR:1.007, 95 % CI:1.004-1.010, P < 0.001). The Kaplan-Meier method further confirmed the difference in 2-year MACE risk between two groups. Receiver operating characteristic curve analysis showed a significant correlation between 3VA-AMR and MACE (area under the curve: 0.701, P < 0.001).

CONCLUSIONS: 3VA-AMR was an independent risk factor for 2-year MACEs in NSTEMI patients. Compared with target-vessel AMR, 3VA-AMR demonstrated superior predictive value for 2-year MACEs following PCI.

PMID:40581281 | DOI:10.1016/j.mvr.2025.104838