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Background: Cardiac MRI plays an important role in the diagnosis and follow‐up of patients with congenital heart disease (CHD). Gadolinium‐based contrast agents are often needed to overcome flow‐related and off‐resonance artifacts that can impair the quality of conventional noncontrast 3D imaging. As serial imaging is often required in CHD, the development of robust noncontrast 3D MRI techniques is desirable. Purpose: To assess the clinical utility of noncontrast enhanced magnetization transfer and inversion recovery prepared 3D free‐breathing sequence (MTC‐BOOST) compared to conventional 3D whole heart imaging in patients with CHD. Study type: Prospective, image quality. Population: A total of 27 adult patients (44% female, mean age 30.9 ± 14.8 years) with CHD. Field Strength/Sequence: A 1.5 T; free‐breathing 3D MTC‐BOOST sequence. Assessment: MTC‐BOOST was compared to diaphragmatic navigator‐gated, noncontrast T2 prepared 3D whole‐heart imaging sequence (T2prep‐3DWH) for comparison of vessel dimensions, lumen‐to‐myocardium contrast ratio (CR), and image quality (vessel wall sharpness and presence and type of artifacts) assessed by two experienced cardiologists on a 5‐point scale. Statistical Tests: Mann–Whitney test, paired Wilcoxon signed‐rank test, Bland–Altman plots. P < 0.05 was considered statistically significant. Results: MTC‐BOOST significantly improved image quality and CR of the right‐sided pulmonary veins (PV): (CR: right upper PV 1.06 ± 0.50 vs. 0.58 ± 0.74; right lower PV 1.32 ± 0.38 vs. 0.81 ± 0.73) compared to conventional T2prep‐3DWH imaging where the PVs were not visualized in some cases due to off‐resonance effects. MTC‐BOOST demonstrated resistance to degradation of luminal signal (assessed by CR) secondary to accelerated or turbulent flow conditions. T2prep‐3DWH had higher image quality scores than MTC‐BOOST for the aorta and coronary arteries; however, great vessel dimensions derived from MTC‐BOOST showed excellent agreement with standard T2prep‐3DWH imaging. Data Conclusion: MTC‐BOOST allows for improved contrast‐free imaging of pulmonary veins and regions characterized by accelerated or turbulent blood flow compared to standard T2prep‐3DWH imaging, with excellent agreement of great vessel dimensions. Evidence Level: 1 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

SUMMARY: Within the last century, US Americans have come to humanize dogs and place a greater personal value on them than ever before. In response to this cultural change, some US Christians have begun to use therapy dogs in ministry work. For this exploratory study, six chaplains in a canine ministry share their experiences and beliefs about their use of therapy dogs. Their stories reveal a unique form of human‐animal partnership emergent in contemporary society distinguished by a faith‐based context. The chaplain and ministry dog act together as co‐instruments of God, both being subject and object simultaneously. The dogs occupy an ontologically complex position of being subordinate to humans while also embodying virtues that Christians idealize. This paper focuses on the chaplains' conceptualization of the relationality between themselves, their dogs, and God. Their accounts reveal changing perceptions of what it means to be human vis‐a‐vis our relationship with animals. [multispecies ethnography, dogs, religion, Christianity, ontology] [ABSTRACT FROM AUTHOR]

Management of congenital coronary artery anomalies (CAA) is not standardized due to the variety of conditions included and their rare prevalence. Detection of CAA during myocardial infarction with non‐obstructive coronary arteries (MINOCA) may induce clinicians to address the patient for surgery as CAA is not included in any algorithm1,2 for the management of MINOCA and American Association for Thoracic Surgery evidence‐based guidelines suggest surgical repair for patients with anomalous aortic origin of a coronary artery and symptoms compatible with myocardial ischaemia.3 We present the case of a 35‐year‐old man with an anomalous origin of left coronary artery from right Valsalva sinus with pre‐pulmonic course detected during urgent coronary angiography for suspected myocardial infarction. Stress cardiac magnetic resonance did not show signs of ischaemia at high‐dose dobutamine but did reveal a recent myocarditis. This clinical case highlights the need for accurate risk stratification in CAA especially when confounding clinical scenarios co‐exist. [ABSTRACT FROM AUTHOR]

New Findings: What is the main observation in this case?Ultra‐endurance cycle racing is known to lead to suppressed heart rates as a product of time spent racing. This case report identifies a racer who experienced this phenomenon initially, but then uniquely experienced an overall increase in heart rate late in the race.What insight does it reveal?In this case, unique chronotropic disturbances to heart rate occurred as a result of the many extreme demands of ultra‐endurance racing. Work should now focus on identifying the frequency of this response in other racers and whether the main causes are physiological, environmental or genetic in nature. Participation in ultra‐endurance cycling events, such as the Transcontinental Race, is increasing. These extremely demanding races provide a unique opportunity for field observation of the limits of human endurance physiology and, importantly, when these limits might be exceeded and cross over into pathology. The heart is of special interest in this field, and previous data suggest that 'reverse drift' of heart rate occurs as a product of time and load in races of 24–48 h, whereas transient structural abnormalities have been observed upon completion of running ultramarathons. Here, we report a unique case of a male cyclist racing in the Transcontinental Race over an extended period of 14 days characterized by extreme workloads and a low quantity and quality of sleep. The heart rate response was dynamic over the course of the race and defined by a U‐shaped quadratic relationship. A larger scale study is required to determine the relevance of this information to the ultra‐endurance cycling community. [ABSTRACT FROM AUTHOR]

Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD) newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB), has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN) measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P < 0.01) during CPB and at the end of the surgical procedure. Moreover, ADN showed a flat pattern and no significant differences (P > 0.05) have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations. [ABSTRACT FROM AUTHOR]

Lipoprotein(a) (Lp(a)) is an LDL-like molecule consisting of an apolipoprotein B-100 (apo(B-100)) particle attached by a disulphide bridge to apo(a). Many observations have pointed out that Lp(a) levels may be a risk factor for cardiovascular diseases. Lp(a) inhibits the activation of transforming growth factor (TGF) and contributes to the growth of arterial atherosclerotic lesions by promoting the proliferation of vascular smooth muscle cells and the migration of smooth muscle cells to endothelial cells. Moreover Lp(a) inhibits plasminogen binding to the surfaces of endothelial cells and decreases the activity of fibrin-dependent tissue-type plasminogen activator. Lp(a) may act as a proinflammatory mediator that augments the lesion formation in atherosclerotic plaques. Elevated serum Lp(a) is an independent predictor of coronary artery disease and myocardial infarction. Furthermore, Lp(a) levels should be a marker of restenosis after percutaneous transluminal coronary angioplasty, saphenous vein bypass graft atherosclerosis, and accelerated coronary atherosclerosis of cardiac transplantation. Finally, the possibility that Lp(a) may be a risk factor for ischemic stroke has been assessed in several studies. Recent findings suggest that Lp(a)-loweringtherapy might be beneficial in patients with high Lp(a) levels. A future therapeutic approach could include apheresis in high-risk patients in order to reduce major coronary events. [ABSTRACT FROM AUTHOR]

Background: Perioperative heart failure (HF) in coronary operations is accompanied by a high operative mortality rate. An intra-aortic balloon pump (IABP) is often used to treat this syndrome. The correct timing for IABP insertion after completion of the operation has not yet been investigated. The aim of this study was to investigate the operative mortality in perioperative HF patients who had undergone coronary operations with respect to the early or the late use of IABP. Methods: This is a retrospective study including 7,270 patients who had undergone coronary surgery with or without associated procedures. A population of patients with perioperative HF was extracted and analyzed with respect to the use of drugs, intra-operative or post-operative IABP to treat this condition. Results: A total of 1,051 (14.5%) patients had perioperative HF. The mortality rate in this group was 13.5%. Early (intra-operative) IABP insertion was performed in 123 patients. In contrast, 928 patients were treated with inotropic drugs only, and, of these patients, 59 developed a drug-refractory HF requiring late IABP insertion. Operative mortality was significantly ( P=0.001) higher in patients requiring late (64.4%) vs. early (41.5%) IABP insertion. Independent risk factors for developing a drug-refractory HF were age, pre-operative serum creatinine value and an associated mitral valve procedure. Conclusions: Postponing the use of IABP may be deleterious in patients with drug-refractory HF. In the presence of the three factors independently associated with the risk of a drug-refractory HF, early IABP insertion is suggested. [ABSTRACT FROM AUTHOR]

Background: Thrombocytopenia after cardiac operations is a common event in both adult and pediatric patients. Late thrombocytopenia (LTCP) is a less common event that is still without a well-recognized cause. This study explores the role of heparin-induced thrombocytopenia (HIT) and other factors (complexity of the operation, temperature management, and drug use) in determining LTCP. Methods: We conducted an observational study of 63 consecutive patients aged <36 months operated with or without cardiopulmonary bypass (CPB). LTCP was defined as a platelet count <100,000 cells/μl or <50% of the pre-operative count at any point in time between post-operative days 5 and 10. A diagnostic test for heparin-platelet factor 4 (PF4) antibodies was performed in patients with LTCP. Other pre- and post-operative factors were investigated for their association with LTCP. Results: LTCP occurred in 15 (24%) patients. No patient had positive heparin-PF4 antibodies. The lowest temperature on CPB was an independent predictor of LTCP, with a cut-off value at 29 °C (sensitivity 80%, specificity 70%). Other factors associated with LTCP were prolonged post-operative use of unfractionated heparin and milrinone. LTCP was associated with increased post-operative morbidity. Conclusion: LTCP was related to a combination of factors (operation severity, degree of hypothermia during CPB, prolonged use of unfractionated heparin, and milrinone). The individual contribution of each factor seems difficult to establish. However, the degree of hypothermia during CPB and drug-associated effects were identified. HIT could be excluded in all cases. [ABSTRACT FROM AUTHOR]

Background and Objectives Allogeneic blood products transfusions are associated with an increased morbidity and mortality risk in cardiac surgery. At present, a few transfusion risk scores have been proposed for cardiac surgery patients. The present study is aimed to develop and validate a risk score based on adequate statistical analyses joint with a clinical selection of a limited (five) number of preoperative predictors. Materials and Methods The development series was composed of 8989 consecutive adult patients undergone cardiac surgery. Independent predictors of allogeneic blood transfusions were identified. Subsequently, five predictors were extracted as the most clinically relevant based on the judgement of 30 clinicians dealing with transfusions in cardiac surgery. A predictive score was developed and externally validated on a series of 2371 patients operated in another institution. The score was compared to the other existing scores. Results The following predictors constituted the Transfusion Risk and Clinical Knowledge score: age > 67 years; weight < 60 kg for females and < 85 kg for males preoperative haematocrit; gender – female; and complex surgery. At the external validation, this score demonstrated an acceptable predictive power (area under the curve 0·71) and a good calibration at the Hosmer–Lemeshow test. When compared to the other three existing risk scores, the Transfusion Risk and Clinical Knowledge score had comparable or better predictive power and calibration. Conclusion A simple risk model based on five predictors only has a similar or better accuracy and calibration in predicting the transfusion rate in cardiac surgery than more complex models. [ABSTRACT FROM AUTHOR]

An abstract of the article "Effects of surgical ventricular restoration in patients with post-infarction moderate dilatation of the left ventricle," by M. Di Donato is presented.

An abstract of the article "Left atrium size and left ventricular geometric correlates," by M. Di Donato and colleagues is presented.

An abstract of the article "Time course changes in diastolic function induced by surgical ventricular restoration," by M. Di Donato and colleagues is presented.

An abstract of the article "Left ventricular remodeling following anterior and inferior infarction: differences in LV geometry," by M. Di Donato and colleagues is presented.