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Cardiac blood cysts (BCs) are rare benign cardiac masses. This study aimed to summarize the clinical and echocardiographic characteristics and clinical outcomes of patients with BCs.This retrospective study enrolled patients diagnosed with BC between 2009 and 2021 at a single center in China. Their clinical and echocardiographic characteristics, management, and outcomes at follow-up are summarized.The study population comprised 26 patients with BCs with a mean age of 40 ± 19 years (median, 42 years; range, 27-56 years). The cohort was predominantly male (16, 62%). Twenty-two (81%) patients were symptomatic: dyspnea or exertional dyspnea (11, 42%) and palpitations (6, 23%) were the most frequent symptoms. Most cysts appeared as single round, oval, or lobulated anechoic masses, measuring 4-30 mm (mean, 18 mm). Half of the BCs (13, 50%) were pedunculated and mobile, and the others swung with the movement of the valve. The mitral valve (13, 50%) was the most common site of occurrence, followed by the tricuspid valve (6, 23%), right atrium (4, 15%), and aortic valve (3, 12%). Contrast echocardiography, which was performed for two patients, revealed a closed cyst without bubbles. Five cases were complicated by left ventricular outflow tract obstruction and six by valve prolapse. Eighteen patients underwent surgery, and one received antiplatelet therapy. Cardiovascular or cerebrovascular events did not occur in any patient during the follow-up period.Cardiac BCs are most commonly attached to the atrioventricular valve. Echocardiography is considered to be the most useful imaging modality for assessing BC. The management of patients with BC should be individualized based on the symptoms and associated complications.

ObjectivePreclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH).MethodsBetween July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66–92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8–23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially.ResultsAfter CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1–5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2and room-air resting SatO2 decreased by 6.2±1.9% (pConclusionThe interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory.Trial registration numberNCT03554330.

The aim of the present study was to investigate the mitral annulus (MA) geometry and dynamic motion changes in patients with aortic regurgitation (AR) before and after aortic valve replacement (AVR). Moreover, the difference in the effect of the type of prosthetic aortic valve on MA was compared.Prospective observational study.Cardiac operating room at a single hospital.Eighty-two patients with isolated moderate-to-severe AR who underwent AVR. Forty patients with normal valves were enrolled as controls.None.The MA geometry and dynamic motion throughout the cardiac cycle were evaluated semiautomatically by three-dimensional transesophageal echocardiography. The severity of functional mitral regurgitation was intraoperatively evaluated. All patients were divided into 2 groups depending on the type of prosthetic valve (mechanical valve and bioprosthetic valve groups). Before AVR, compared with the control group without AR, the AR group demonstrated larger MA dimensions and the MA geometry was flatter. The contraction fraction of the MA area, perimeter, and height during the whole cardiac cycle were larger in the AR group (p0.05 for all). After AVR, most MA geometric and dynamic parameters decreased and functional mitral regurgitation also improved. In the postoperative subset analyses, the mechanical valve group showed a larger contraction fraction of the MA area and perimeter than the bioprosthetic valve group (p0.05 for both).The MA geometry and dynamic motion changed markedly in patients with AR. These spatial and dynamic changes were restored to a certain extent after surgical correction of the aortic valve. However, the effects produced by mechanical and bioprosthetic valves on MA were different.

To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p 0.0001) but equivalent (p 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).

Background: High-resolution optical coherence tomography can detect in situ thrombi within patent foramen ovale (PFO), which can become a dangerous embolic source. This study aimed to investigate the frequency and size of in situ thrombus within PFO using optical coherence tomography. Methods: The cross-sectional study was conducted at Fuwai Hospital (Beijing, China) between 2020 and 2021. From 528 consecutive patients with PFO, 117 (age, 34.33 [SD, 11.30] years) without known vascular risk factors were included; according to PFO-related symptoms, they were divided into the stroke (n=43, including 5 patients with transient ischemic attack), migraine (n=49) and asymptomatic (n=25) groups. Optical coherence tomography was used to evaluate in situ thrombi and abnormal endocardium within PFO. Univariable analysis and a logistic model were used to evaluate the association between stroke and in situ thrombus; age, sex, body mass index, and antithrombotic therapy were included as covariates. Results: Antithrombotic therapy was used more frequently in the stroke group than in the migraine group (76.7% versus 12.2%; P P P =0.199), maximum thrombus diameter (0.35 [0.20–0.46] versus 0.21 [0–0.68] mm; P =0.597), or total thrombus volume (0.02 [0.01–0.05] versus 0.01 [0–0.05] mm 3 ; P =0.386). Additionally, in situ thrombus was significantly associated with stroke risk (odds ratio, 4.59 [95% CI, 1.26–16.69]). Abnormal endocardium within PFO occurred in patients with in situ thrombi (71.9%) but not in those without. During optical coherence tomography examination, migraine occurred in 2 patients with in situ thrombi. Conclusions: The frequency of in situ thrombus was extremely high in stroke and migraine groups, while none of the asymptomatic individuals presented with an in situ thrombus. In situ thrombus formation may play a role in patients with PFO-associated stroke or migraines and have therapeutic implications. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04686253.

OBJECTIVES The purpose of this study was to review the outcomes of surgical treatment in patients with aorto-left ventricular tunnel and to investigate what kind of patient cohort is more likely to have adverse events. METHODS Twenty-one patients with a median age of 6.58 [interquartile range (IQR) 4.17–24.50] years who received surgical treatment of aorto-left ventricular tunnel from March 2002 to December 2019 were reviewed. The median follow-up time was 64.50 (IQR 25.15–120.50) months. Clinical characteristics, surgical methods and follow-up outcomes were summarized in separate groups of patients with or without preoperative aortic valve (AoV) issues. Composite adverse events were defined as death or requirement of reoperation. Time-related analysis of freedom from death and requirement of reoperation was performed with the Kaplan–Meier method. RESULTS The average tunnel size was 8.68 (standard deviation: 3.62) mm. The most common and the most important associated lesions were AoV lesions. Tunnels in 20 patients were closed with direct sutures or a patch. For 1 patient with an irreparable AoV, the tunnel was cut open simultaneously with aortic valve replacement and aortic root plasty. In the group of patients with preoperative AoV issues, 4 patients received aortic valve replacement with mechanical prosthetic valves and 6 patients received aortic valvuloplasty repair. The follow-up outcomes differed significantly between groups (the incidence of death was 15.38% and the incidence of requiring a reoperation was 46.15% in patients with preoperative AoV issues). In the group without preoperative AoV issues, there were no deaths and no reoperations (Fisher’s exact test; P = 0.018). The probability of freedom from death and of the requirement for reoperation between the 2 groups was not significantly different (log-rank, P = 0.09). Overall, the estimated probability of freedom from death and requirement of reoperation was 77.30% (standard error: 10.20%) [95% confidence interval (CI): 49.53–91.00] at 5 years, 67.64% (standard error: 12.70%) (95% CI: 36.71–85.84) at 10 years. CONCLUSIONS Patients with aorto-left ventricular tunnel with preoperative AoV issues are more prone to die or to require a reoperation. In contrast, patients without preoperative AoV issues can be free from death or reoperation for a longer period of time. Patients with preoperative AoV issues need much stricter postoperative long-term echocardiographic follow-up.

A 9-year-old girl was admitted to the hospital because of exertional dyspnea, intermittent fever and fatigue, and inappetence for 3 months. She did not have chills or night sweats and had not lost weight. She was in mild respiratory distress with a respiratory rate of 34 breaths/min and a heart rate of 100 bpm that was regular in rhythm. Her blood pressure was 94/62 mm Hg. Cardiac auscultation revealed a distinct early diastolic click followed by a grade 2/5 diastolic decrescendo murmur at the apex that was variable in character with postural changes. Chest x-ray, posterior-anterior view, showed that the cardiothoracic ratio was increased. A high density was noted behind heart. The left lateral view showed an enlarged left atrium and abnormally high density at the region of lower left pulmonary hilar (Figure 1). Figure 1. Chest x-ray. A , Posterior-anterior view showed that the cardiothoracic ratio was increased, and a high density was noted behind the heart (arrow). B , Left lateral view showed an enlarged left atrium and an abnormally high density (arrow) at the region of the lower left pulmonary hilar. The ECG showed sinus rhythm, left atrium enlargement demonstrated by bifid P wave with >40 milliseconds between the 2 peaks and a total P-wave duration of >110 milliseconds in lead II. A biphasic P wave was seen with a terminal negative portion that was >40 milliseconds in duration and …

Objectives To evaluate the alterations of peripheral arterial structures and stiffness in patients suffering from symptomatic lower extremity arterial disease (PAD), as well as the factors correlated with femoral arterial stiffness. Methods Thirty-one patients with lower extremity PAD and 34 age- and sex-matched control subjects were enrolled in this study. The intima-media thickness (IMT), diameter and two parameters of arterial stiffness (β, pulse wave velocity (PWVβ)) were measured by displaying the longitudinal view of the common carotid arteries and common femoral arteries by using the technology of QIMT and QAS. The left ventricular ejection fraction was measured in order to exclude subjects with systolic dysfunction. These parameters were compared between these two groups. Univariable and multivariable analysis were carried out to evaluate the factors correlated with femoral arterial stiffness. Results 1. The SBP, PP, smoking packyear and smoking extent (non-smoker, smoker with 2. The IMT (μm) of the left common carotid artery (LCCA) was significantly increased in the PAD group ((727.29±136.51):(649.12±123.32), p 3. The stiffness indices β, PWVβ of LCCA and PWVβ of RCCA were significantly higher ((LCCA_β (14.60±8.91):(10.35±2.48), LCCA_PWVβ (9.43±3.08):(7.93±1.16), RCCA_PWVβ (8.82±1.92):(7.75±1.42), p 0.05) in the PAD group than those in the control group. β and PWVβ of LCFA and RCFA were significantly higher in the PAD group (LCFA_β (27.59±20.55): (16.35±10.83), LCFA_PWVβ (13.50±6.19):(9.46±3.40), RCFA_β (27.93±28.90): (12.22±6.53), RCFA_PWVβ (12.54±6.05):(8.49±2.52), p 4. Univariable analysis showed that the femoral mβ was correlated with femoral mIMT, SBP, PP, smoking amount and smoking extent (r=0.50, 0.46, 0.47, 0.29, 0.33, p Conclusions Patients with symptomatic lower extremity PAD have carotid and femoral remodelling as well as higher arterial stiffness. The alterations are more prominent in femoral arteries. The stiffened femoral arteries are due to atherosclerosis of the artery, higher blood pressure and smoking status.