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Transcatheter pulmonary valve replacement (TPVR) has expanded and evolved since its initial commercial approval in the United States in 2010. This study sought to characterize real-world practice, including patient selection, procedural outcomes, complications, and off-label usage. Characteristics and outcomes for patients undergoing balloon-expandable TPVR were collected from the American College of Cardiology National Cardiovascular Data Registry IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry. Between April 2016 and March 2021, 4,513 TPVR procedures were performed in patients with a median age of 19 years, 57% with a Melody (Medtronic Inc) and 43% with a SAPIEN (Edwards Lifesciences) valve. Most implanting centers performed <10 cases annually. One-third of transcatheter pulmonary valve implants were into homograft conduits, one-third were into bioprosthetic valves (BPVs), 25% were in native or patched right ventricular outflow tracts (RVOTs), and 6% were into Contegra (Medtronic Inc) conduits. Over the course of the study period, SAPIEN valve use grew from ∼25% to 60%, in large part because of implants in patients with a native/patched RVOT. Acute success was achieved in 95% of patients (95.7% in homografts, 96.2% in BPVs, 94.2% in native RVOTs, and 95.4% in Contegra conduits). Major adverse events occurred in 2.4% of procedures, more commonly in patients with a homograft (2.9%) or native RVOT (3.4%) than a prior BPV (1.4%; P = 0.004). This study describes novel population data on the use and procedural outcomes of TPVR with balloon-expandable valves. Over time, there has been increasing use of TPVR to treat regurgitant native RVOT anatomy, with the SAPIEN valve more commonly used for this application. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure. Methods: This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay. Results: After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, P <.0001), an increased hospital length of stay by 2.88 days (95% CI: 2.84-2.92 days, P <.0001) and approximately $16 255 increase in cost. Conclusions: Cardiac catheterization was associated with decreased in-hospital mortality, longer length of stay and higher total costs in admissions with heart failure aged 65 years or older. [ABSTRACT FROM AUTHOR]

Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate–high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036–7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08–9.74), while all-cause mortality was 11% (CI 95%, 5.4–19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ≥ 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile. [ABSTRACT FROM AUTHOR]

Right heart failure (RHF) is associated with poor outcomes, especially in patients undergoing left ventricular assist device (LVAD) implantation. The aim of this study was to identify predictors of RHF after LVAD implantation. Of 129 consecutive patients (mean age 56 ± 11 years, 89% male) undergoing LVAD implantation, 34 developed RHF. Compared to patients without RHF, those with RHF required longer invasive mechanical ventilation and had longer intensive care unit and hospital stays (p < 0.01). One-year all-cause mortality was significantly higher in patients with versus without RHF after LVAD implantation (29.4% vs. 1.2%; hazard ratio 35.4; 95% confidence interval 4.5–277; p < 0.001). Mortality was highest in patients with delayed RHF after initial LVAD-only implantation (66.7%). Patients who did versus did not develop RHF had significantly higher baseline pulmonary vascular resistance (PVR; 404 ± 375 vs. 234 ± 162 dyn/s/cm5; p = 0.01). PVR > 250 dyn/s/cm5 was a significant predictor of survival in patients with RHF after LVAD implantation. These data confirm the negative impact of RHF on morbidity and mortality after LVAD implantation. Preoperative PVR > 250 dyn/s/cm5 determined using invasive right heart catheterization was an independent predictor of developing RHF after LVAD implantation, and of subsequent mortality, and could be used for risk stratification in the setting for deciding between single or biventricular support strategy. [ABSTRACT FROM AUTHOR]

Background: Transcatheter atrial septal closures for secundum atrial septal defects (ASD) have demonstrated favorable clinical outcomes. However, the impact of device implantation on the stiffness of the left atrium remains unclear. Method: Patients with secundum ASD undergoing transcatheter closure and follow-up right heart catheterization at six months were included. We investigated the relationship between post-procedural (E/e' ratio)/(LAs strain) ratio, an index of left atrial stiffness, and baseline characteristics, including echocardiographic and hemodynamic parameters. Results: Forty patients were included (median 69 (56, 75) years, 12 men, and pulmonary systemic flow ratio 2.27 (1.96, 2.86)). Trans-catheter ASD closure was successfully performed without any major complications, accompanying a significant reduction in right ventricular to left ventricular size ratio from 1.04 (0.87, 1.13) to 0.74 (0.66, 0.86) (p < 0.01). The (E/e' ratio)/(LAs strain) ratio was markedly elevated the day after the procedure and was further increased 6 months later (before: 0.25 (0.17, 0.34), 1 day later: 0.34 (0.27, 0.50), 6 months later: 0.43 (0.27, 0.76), p < 0.01). The groups with higher (E/e' ratio)/(LAs strain) ratios at 6 months had significantly more severe heart failure conditions including lower cardiac output and higher plasma B-type natriuretic peptides. Conclusions: Patients undergoing transcatheter ASD closure experienced improvement in hemodynamics and clinical symptoms but an elevation in left atrial stiffness post-procedure. The clinical ramifications of this finding, particularly during the longer-term observation period subsequent to ASD closure, warrant further investigation. [ABSTRACT FROM AUTHOR]

Heart failure (HF) has a global prevalence of 1–2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5–10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF. [ABSTRACT FROM AUTHOR]

Background Most neonates with persistent left superior vena cava (PLSVC) have no clinical symptoms or hemodynamic changes, and this anomaly is only found during cardiac catheterization, pacemaker implantation, or central venous catheterization. Electrocardiogram (ECG) localization is helpful for the application of the peripherally inserted central catheter (PICC) technique in neonates with PLSVC. Objective To explore the characteristic waveforms of the P wave when a PICC under ECG localization is applied in neonates with PLSVC. Study Design The observation and management strategies for the P wave changes during catheter insertion (CI) of two neonates with PLSVC admitted to our institution between January and July 2020, who underwent PICC line insertion, were summarized. Results The characteristic P wave changes in two children with a PICC line inserted via the PLSVC were observed. When a wide inverted P wave appeared on ECG, the catheter was immediately withdrawn by 0.5 cm, a bidirectional P wave gradually appeared and then disappeared. After that, the catheter was further withdrawn by 0.5 cm. After catheterization, the optimal position of the PICC was confirmed by X-ray photography and bedside B-ultrasound. The PICC line was removed as scheduled after indwelling for 18 and 29 days, respectively, in the two cases, and no PICC-related complications occurred during indwelling. Conclusion The characteristic P wave changes on ECG during CI provide important clinical reference values for the application of the PICC technique under ECG localization in neonates with PLSVC. Key Points Electrocardiogram localization. Peripherally inserted central catheter. Persistent left superior vena cava. [ABSTRACT FROM AUTHOR]

Background: Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. Methods: We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)−1), middle (≥ 5.9–8.02 mm.(m/s)−1), and high (≥ 8.03 mm.(m/s)−1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. Results: Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872–0.985], p < 0.05). Kaplan–Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)−1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. Conclusion: The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest. [ABSTRACT FROM AUTHOR]

This article discusses the use of transjugular liver biopsy (TJLB) as a technique for monitoring liver disease in patients with Fontan palliation and congenital heart defects (CHD). The study involved four patients with Fontan circulation and three patients with CHD who underwent TJLB during routine cardiac catheterization. The procedures were successful with no complications, and the samples obtained were suitable for histopathological assessment. The authors conclude that TJLB is a safe and efficient method for obtaining liver specimens in these patient populations and should be considered as a standard approach in their follow-up care. [Extracted from the article]

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The coexistence of bicuspid aortic valve disease and coronary artery disease is well‐established, but the identification of cardiac amyloidosis in this population has surged with advancing imaging techniques, introducing complexities in patient management. This case report emphasizes the pivotal role of multimodality imaging in accurately diagnosing three concurrent pathologies. [ABSTRACT FROM AUTHOR]

BACKGROUND This study was conducted to assess the contribution of MDCT (Multi-Detector Computed Tomography) contrast-enhanced coronary angiography to the clinical classification of benign and malignant coronary artery variations and abnormalities. METHODS This was a descriptive observational cross-sectional study carried out in a hospital setting among 200 patients who underwent MDCT coronary angiography at Fortis Hospital, Noida, between August 2016 and March 2018. The institutional ethics committee approved the study, and participants' signed informed consent was acquired. RESULTS Of the 200 patients in our investigation, 76 had variants, accounting for 38% of the cohort. These variants included variations in the dominance pattern (20%), conus branch variants (3%), SA nodal branch variants (0.5%), and ramus intermedius variants (14.5%). In terms of origin and course anomalies, LAD (Left Anterior Descending) and LCX (Left Circumflex Artery) have different origins and there is no LMCA (Left Main Coronary Artery). Two individuals in our sample had ectopic LMCA at the level of the sino-tubular junction and above the junction with the retroarterial and interarterial courses, while one patient had missing LMCA. Two percent of the population had an anomalous origin from the opposite coronary sinus (n = 1). CONCLUSION With MDCT coronary angiography, coronary artery variations and anomalies are most accurately detected. With MDCT angiography, a number of malignant anomalies that are challenging to diagnose by ICA can be quickly found. When a patient is having interventional procedures like cardiac catheterization, coronary angioplasty, and stenting, having prior knowledge of various defects is helpful. [ABSTRACT FROM AUTHOR]

The occupational risk to interventional cardiologists related to using X-rays in the catheterisation laboratory (cath lab) includes a range of radiation-induced effects. The primary concern is the possibility of developing head and neck malignancies. A literature review of reports on developing head and neck malignancies among interventional cardiologists was conducted. Several individual cases of head and neck malignancies have been reported, predominantly on the left side. However, these studies do not have a sufficient sample size to generalise the results. Based on the available reports, it is concluded that head and neck malignancies are unlikely to constitute an occupational risk for interventional cardiologists. More research is required to establish whether head and neck malignancies are more prevalent among interventional cardiologists. [ABSTRACT FROM AUTHOR]

A 5 years old, Shar Pei intact female, presented with lethargy, progressive weight loss, pale mucous membrane and severe dehydration (7-10%). The patient was diagnosed with acute on chronic renal disease (ACKD), polycystic kidney disease (PKD) and non-regenerative anemia and was referred for hemodialysis. A central venous catheter was placed under light sedation. During central venous catheterization, the cardiac rhythm was monitored by ECG. A key factor for a favorable outcome of the procedure is to understand the correlation between central venous catheterization and cardiac electrical activity. ECG monitoring goal was to observe alterations in P-wave morphology, which reflects atrial depolarization, during central venous catheterization. By monitoring the P-wave variations with extensive care is possible to observe the valuable cardiovascular dynamics in the context of central venous catheterization, aiding clinicians in optimizing patient care and safety of the procedure. [ABSTRACT FROM AUTHOR]

Background: ModulHeart (Puzzle Medical Devices Inc) is a novel percutaneous flow entrainment pump anchored in the descending aorta. The current study evaluates the hemodynamic effect of ModulHeart support and its impact on cerebral, myocardial, and renal blood flow. Methods: ModulHeart was implanted in the descending aorta of four healthy calves. A ramp protocol (2000 RPM increments) was performed with the pump operating at five different speeds from 14 000 to 22 000 RPM. For each speed, pressures proximal and distal to the pump, and right heart catheterization measurements were recorded. Stable‐isotope labeled microspheres were injected in the left ventricle to evaluate organ perfusion. Results: Thermodilution cardiac output increased by 23% at 22 000 RPM. Greater pump speeds resulted in greater pump gradients, up to 10 mm Hg in mean arterial pressure at 22 000 RPM, without significant reduction of proximal perfusion pressures. Arterial pulse pressure remained stable at all speeds. ModulHeart was not associated with a reduction in cerebral or myocardial blood flow at any speed. Renal cortical and medullary blood flow increased by up to 50% and 40%, respectively. Conclusion: The ModulHeart device implanted in the descending aorta of healthy calves resulted in significant arterial pressure gradients and preserved pulse pressure. Greater pump speeds translated into greater increases in renal blood flow, with no decrease in cerebral or myocardial perfusion. [ABSTRACT FROM AUTHOR]

Transcatheter sinus venosus defect (SVD) closure with covered stents is emerging as an alternative to surgery. An adequate anchor zone in the superior vena cava is mandatory for the stability of the covered stent to prevent caudal embolization. There is a potential risk of innominate vein occlusion by the fabric of the covered stent in patients with a very short superior caval vein. Three among a total of 105 patients who underwent SVD closure at our institution developed innominate vein occlusion. Predisposing anatomical factors, identification and management of occluded innominate vein, and follow-up outcomes are discussed. [ABSTRACT FROM AUTHOR]

Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs. [ABSTRACT FROM AUTHOR]

Severe tricuspid regurgitation (TR) is a common pathology in the daily practice of a cardiologist. This disease entity is associated with significant morbidity and mortality if left untreated. Classically, surgical repair or replacement were the only therapeutic options present and were often not performed due to high postprocedural mortality. Transcatheter tricuspid valve intervention has emerged as a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. In this review, we will provide an overview of transcatheter edge-to-edge repair of TR using the TriClip device (Abbott, Santa Clara, CA, USA). [ABSTRACT FROM AUTHOR]

The United States (US) Food and Drug Administration (FDA) has issued multiple statements and guidelines since 2015 on the topic of thyroid function testing in babies and children through 3 years old after receiving iodinated contrast media for medical imaging exams. In April 2023, the FDA adjusted this recommendation to target babies and young children younger than 4 years of age who have a history of prematurity, very low birth weight, or underlying conditions which affect thyroid gland function, largely in response to solid arguments from expert statements from the American College of Radiology (ACR) which is endorsed by the Society for Pediatric Radiology (SPR), Pediatric Endocrinology Society (PES), and the Society for Cardiovascular Angiography & Intervention (SCAI). Herein we describe our approach and development of a clinical care guideline along with the steps necessary for implementation of the plan including alterations in ordering exams requiring iodinated contrast media, automatic triggering of lab orders, reporting, and follow-up, to address the 2022 FDA guidance statement to monitor thyroid function in children after receiving iodinated contrast media. The newly implemented clinical care guideline at Ann and Robert H. Lurie Children's Hospital of Chicago remains applicable following the 2023 updated recommendation from the FDA. We will track patients less than 3 months of age who undergo thyroid function testing following computed tomography (CT), interventional radiology, and cardiac catheterization exams for which an iodinated contrast media is administered as a clinical care quality initiative. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is often present in patients presenting for kidney transplant listing. While PH can complicate kidney transplantation (KTx), it can be managed with multidisciplinary management that includes both the transplant center and pulmonary hypertension center, or with experts both pre- and post-transplant. This review summarizes the approach and management of PH in KTx candidates and recipients, along with expected outcomes and controversies surrounding arteriovenous fistula and graft management. [ABSTRACT FROM AUTHOR]

Aims: Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized, there is limited data on this combined application in adult congenital heart disease (ACHD) patients undergoing electrophysiological (EP) procedures. We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients undergoing EP procedures. Methods and Results: The population of ACHD patients undergoing transfemoral EP procedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed. During the study period, femoral access (left/right, arterial/venous) was performed under real-time ultrasound guidance. At the end of the procedure, a single Z-stitch was performed at the puncture site. We evaluated the incidence of in-hospital complications associated with femoral access puncture in this population. Among 101 patients who had a total of 147 previous ipsilateral vascular punctures (mean 1.5 per person), 100 patients underwent successful femoral vascular access for EP procedures. The median age of the patients was 47 ± 15 years and 34 (34%) were male. Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses (mean 3 punctures per person). No patient developed vascular puncture relevant inguinal hematoma, pseudo aneurysm, arteriovenous fistula, venous or arterial thrombosis. Conclusion: In ACHD patients undergoing EP procedures, optimal femoral access management can be achieved with ultrasound-guided puncture and postprocedural Z-stitch hemostasis. [ABSTRACT FROM AUTHOR]

We describe a 63-year-old male who appears to have undergone an early form of the arterial switch operation for D-transposition of the great arteries performed in the mid-1960s. We review the clinical and imaging data that support our conclusion. He had a diagnostic cardiac catheterization which demonstrated severe pulmonary hypertension responsive to epoprostenol and oxygen. Our case may represent one example of the experimental surgical work done prior to Dr. Adibe Jatene's description of the first successful arterial switch performed in 1975. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a possible complication of connective tissue diseases (CTDs), especially systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). It is defined by an elevation of the mean pulmonary arterial pressure above 20 mmHg documented during a right heart catheterization (RHC). Due to their multiorgan involvement, CTDs can induce PH by several mechanisms, that are sometimes intricated: pulmonary vasculopathy (group 1) affecting arterioles (pulmonary arterial hypertension, PAH) and possibly venules (pulmonary veno-occlusive-like disease), left-heart disease (group 2), chronic lung disease (group 3) and/or chronic thromboembolic PH (group 4). PH suspicion is often raised by clinical manifestations (dyspnea, fatigue), echocardiographic data (increased peak tricuspid regurgitation velocity), isolated decrease in DLCO in pulmonary function tests, and/or unexplained elevation of BNP/NT-proBNP. Its formal diagnosis always requires a hemodynamic confirmation by RHC. Strategies for PH screening and RHC referral have been extensively investigated for SSc-PAH but data are lacking in other CTDs. Therapeutic management of PH depends of the underlying mechanism(s): PAH-approved therapies in group 1 PH (with possible use of immunosuppressants, especially in case of SLE or MCTD); management of an underlying left-heart disease in group 2 PH; management of an underlying chronic lung disease in group 3 PH; anticoagulation, pulmonary endartectomy, PAH-approved therapies and/or balloon pulmonary angioplasty in group 4 PH. Regular follow-up is mandatory in all CTD-PH patients. [ABSTRACT FROM AUTHOR]

Inhaled nitric oxide (iNO) is a potent and selective pulmonary vasodilator with a safety concern due to rebound pulmonary hypertension (PH) associated with its withdrawal. We report short‐term pulsed iNO in patients with severe pulmonary arterial hypertension (PAH) and nonoperable chronic thromboembolic PH (nCTEPH). This is a retrospective analysis of 33 patients: 22 with PAH and 11 with nCTEPH. We assessed hemodynamic, echocardiographic, and other noninvasive variables to evaluate safety and efficacy of iNO. We performed an iNO withdrawal test during right heart catheterization and after 3 days of iNO treatment. iNO significantly improved all variables examined in 22 patients with PAH and 11 with nCTEPH. Two patterns of response were observed after sudden iNO withdrawal. Twenty‐nine patients (88%) showed minimal hemodynamic, oxygenation and clinical changes. Four patients (12%) had a reduction in cardiac index ≥20% and PaO2 ≥ 5%, three patients did not show clinical deterioration, and one patient developed hemodynamic collapse that needed iNO administration. This retrospective study suggests that short‐term iNO improves hemodynamics and clinical conditions in some patients with PAH an nCTPEH. However, pulsed iNO withdrawal PH rebound could be a serious concern in these patients. Given the lack of evidence, we do not recommend the use of pulsed iNO in the treatment of patients with chronic PH. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a rare subgroup of pulmonary hypertension (PH). Claims and administrative databases can be particularly important for research in rare diseases; however, there is a lack of validated algorithms to identify PAH patients using administrative codes. We aimed to measure the accuracy of code‐based PAH algorithms against the true clinical diagnosis by right heart catheterization (RHC). This study evaluated algorithms in patients who were recorded in two linkable data assets: the Stanford Healthcare administrative electronic health record database and the Stanford Vera Moulton Wall Center clinical PH database (which records each patient's RHC diagnosis). We assessed the sensitivity and specificity achieved by 16 algorithms (six published). In total, 720 PH patients with linked data available were included and 558 (78%) of these were PAH patients. Algorithms consisting solely of a P(A)H‐specific diagnostic code classed all or almost all PH patients as PAH (sensitivity >97%, specificity <12%) while multicomponent algorithms with well‐defined temporal sequences of procedure, diagnosis and treatment codes achieved a better balance of sensitivity and specificity. Specificity increased and sensitivity decreased with increasing algorithm complexity. The best‐performing algorithms, in terms of fewest misclassified patients, included multiple components (e.g., PH diagnosis, PAH treatment, continuous enrollment for ≥6 months before and ≥12 months following index date) and achieved sensitivities and specificities of around 95% and 38%, respectively. Our findings help researchers tailor their choice and design of code‐based PAH algorithms to their research question and demonstrate the importance of including well‐defined temporal components in the algorithms. [ABSTRACT FROM AUTHOR]

Chronic thromboembolic pulmonary disease (CTEPD) is characterized by organized nonresolving thrombi in pulmonary arteries (PA). In CTEPD with pulmonary hypertension (PH), chronic thromboembolic PH (CTEPH), early wave reflection results in abnormalities of pulsatile afterload and augmented PA pressures. We hypothesized that exercise during right heart catheterization (RHC) would elicit more frequent elevations of pulsatile vascular afterload than resistive elevations in patients with CTEPD without PH. The interdependent physiology of pulmonary venous and PA hemodynamics was also evaluated. Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty‐five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (p < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance‐compliance time product at rest. The physiological relationship between changes in PA pressures relative to PAWP was disrupted in the ExABN group. In CTEPD without PH, exercise RHC revealed latent pulmonary vascular afterload elevations in 58% of patients with more frequent augmentation of pulsatile than resistive pulmonary vascular afterload. [ABSTRACT FROM AUTHOR]

Right ventricular failure (RVF) is a critical condition that significantly impacts morbidity and mortality in affected patients. This review article aims to provide a comprehensive understanding of RVF by discussing its background, etiology, pathophysiology, clinical presentation, diagnostic studies, medical treatment, and mechanical assistive devices. [ABSTRACT FROM AUTHOR]

BACKGROUND: Maldistribution of pulmonary blood flow in patients with congenital heart disease impacts exertional performance and pulmonary artery growth. Currently, measurement of relative pulmonary perfusion can only be performed outside the catheterization laboratory. We sought to develop a tool for measuring relative lung perfusion using readily available fluoroscopy sequences. METHODS: A retrospective cohort study was conducted on patients with conotruncal anomalies who underwent lung perfusion scans and subsequent cardiac catheterizations between 2011 and 2022. Inclusion criteria were nonselective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer’s SlicerHeart extension to calculate the amount of contrast that entered each lung field from the start of contrast injection and until the onset of levophase. The predicted perfusion distribution was compared with the measured distribution of pulmonary blood flow and evaluated for correlation, accuracy, and bias. RESULTS: In total, 32% (79/249) of screened studies met the inclusion criteria. A strong correlation between the predicted flow split and the measured flow split was found (R²=0.83; P<0.001). The median absolute error was 6%, and 72% of predictions were within 10% of the true value. Bias was not systematically worse at either extreme of the flow distribution. The prediction was found to be more accurate for either smaller and younger patients (age 0–2 years), for right ventricle injections, or when less cranial angulations were used (≤20°). In these cases (n=40), the prediction achieved R²=0.87, median absolute error of 5.5%, and 78% of predictions were within 10% of the true flow. CONCLUSIONS: The current study demonstrates the feasibility of a novel method for measuring relative lung perfusion using conventional angiograms. Real-time measurement of lung perfusion at the catheterization laboratory has the potential to reduce unnecessary testing, associated costs, and radiation exposure. Further optimization and validation is warranted. [ABSTRACT FROM AUTHOR]

Purpose: MR‐guided cardiac catheterization procedures currently use passive tracking approaches to follow a gadolinium‐filled catheter balloon during catheter navigation. This requires frequent manual tracking and repositioning of the imaging slice during navigation. In this study, a novel framework for automatic real‐time catheter tracking during MR‐guided cardiac catheterization is presented. Methods: The proposed framework includes two imaging modes (Calibration and Runtime). The sequence starts in Calibration mode, in which the 3D catheter coordinates are determined using a stack of 10–20 contiguous saturated slices combined with real‐time image processing. The sequence then automatically switches to Runtime mode, where three contiguous slices (acquired with partial saturation), initially centered on the catheter balloon using the Calibration feedback, are acquired continuously. The 3D catheter balloon coordinates are estimated in real time from each Runtime slice stack using image processing. Each Runtime stack is repositioned to maintain the catheter balloon in the central slice based on the prior Runtime feedback. The sequence switches back to Calibration mode if the catheter is not detected. This framework was evaluated in a heart phantom and 3 patients undergoing MR‐guided cardiac catheterization. Catheter detection accuracy and rate of catheter visibility were evaluated. Results: The automatic detection accuracy for the catheter balloon during the Calibration/Runtime mode was 100%/95% in phantom and 100%/97 ± 3% in patients. During Runtime, the catheter was visible in 82% and 98 ± 2% of the real‐time measurements in the phantom and patients, respectively. Conclusion: The proposed framework enabled real‐time continuous automatic tracking of a gadolinium‐filled catheter balloon during MR‐guided cardiac catheterization. [ABSTRACT FROM AUTHOR]

Objectives: Transposition of great arteries (TGA) is a common cause of cyanotic newborns. There is an atrioventricular concordance with ventriculoarterial discordance. This parallel circulation is incompatible with life unless communication exists for the inter-circulatory mixing of blood. Balloon atrial septostomy (BAS) is a percutaneously performed interventional procedure in catheterization laboratory, usually in patients with TGAintact ventricular septum (IVS) to ensure admixture of oxygenated and deoxygenated blood thus improving systemic oxygen delivery, to achieve hemodynamic stability before the definitive procedure (Arterial switch operation), and to determine the risk of intraprocedural complications in neonates undergoing balloon atrial septostomy. Material and Methods: This is a retrospective observational study, which included neonatal patients during a single year. All the data were collected from the medical record section of the hospital. Results: We included 17 neonates with TGA transferred to our center for definite treatment. Six cases were done under sedation and 11 under general anesthesia. The mean age at the time of BAS was 4.8 days. Procedurerelated complications occurred in 41% of patients. In one of the cases, difficult airway management made the periprocedural course daunting. Complications included intraprocedural balloon rupture (1 case), transient atrial arrhythmia (4 cases), hypotension (1 case), and pericardial tamponade due to left atrial wall puncture (1 case). Conclusion: BAS is a safe and effective palliative procedure for TGA-IVS, with good immediate results in our institution. Maintaining cardiorespiratory stability, prevention of respiratory depression in a spontaneously breathing neonate, and maintenance of normothermia in the cold temperature of the catheterization laboratory, with eternal vigilance, forms the cornerstone of a successful neonatal outcome. [ABSTRACT FROM AUTHOR]

Right heart catheterisation is a useful technique to diagnose - Pulmonary artery hypertension (PAHT), differentiate constrictive/restrictive physiology, and to monitor vasodilator treatment outcomes in PAHT. Helpful to assess and quantify intracardiac shunts. To assess the hemodynamics and fluid management after surgical procedures, myocardial infarction with complications, cardiac failure, and cardiogenic shock. It is a very useful method for pre cardiac transplant evaluation, to assess cardiac transplant recipients' surveillance status. Pre and post procedure evaluation of left ventricular assist devices (LVAD). [ABSTRACT FROM AUTHOR]

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Background: In aortic stenosis (AS), left ventricular hypertrophy (LVH) is the response to pressure overload and represents the substrate for a maladaptive cascade, the so‐called AS‐related cardiac damage. We hypothesized that in AS patients electrocardiogram (ECG) LVH not only predicts echocardiography LVH but also other noninvasive and invasive markers of cardiac damage and prognosis after aortic valve replacement (AVR). Methods: In 279 patients with severe AS undergoing ECG, echocardiography, and cardiac catheterization before AVR, the Sokolow‐Lyon index, the Cornell product, the Romhilt‐Estes score, and the Peguero‐Lo Presti score were assessed. Results: The mean left ventricular mass index was 109 ± 34 g/m2, and 131 (47%) patients had echocardiography LVH. The areas under the receiver operator characteristics curve (AUC) for the Sokolow‐Lyon index, the Cornell product, the Romhilt‐Estes score, and the Peguero‐Lo Presti score for the prediction of echocardiography LVH were 0.59, 0.70, 0.63, and 0.65. The Peguero‐Lo Presti score had the numerically greatest AUC for the prediction of left ventricular end‐diastolic pressure >15 mmHg, mean pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance >3 Wood units, mean right atrial pressure >14 mmHg, and stroke volume index <31 mL/m2. After a median follow‐up of 1365 (interquartile range: 931–1851) days after AVR only the Peguero‐Lo Presti score was significantly associated with all‐cause mortality [hazard ratio: 1.24 (95% confidence interval: 1.01–1.54); per 1 mV increase; p =.045]. Conclusions: Among severe AS patients, the Peguero‐Lo Presti score is associated with abnormalities in cardiac structure including LVH, invasive measures of cardiac damage, and long‐term mortality after AVR. [ABSTRACT FROM AUTHOR]

Aims While transthoracic echocardiography (TTE) assessment of left ventricular end-diastolic pressure (LVEDP) is critically important, the current paradigm is subject to error and indeterminate classification. Recently, peak left atrial strain (LAS) was found to be associated with LVEDP. We aimed to test the hypothesis that integration of the entire LAS time curve into a single parameter could improve the accuracy of peak LAS in the noninvasive assessment of LVEDP with TTE. Methods and results We retrospectively identified 294 patients who underwent left heart catheterization and TTE within 24 h. LAS curves were trained using machine learning (100 patients) to detect LVEDP ≥ 15 mmHg, yielding the novel parameter LAS index (LASi). The accuracy of LASi was subsequently validated (194 patients), side by side with peak LAS and ASE/EACVI guidelines, against invasive filling pressures. Within the validation cohort, invasive LVEDP was elevated in 116 (59.8%) patients. The overall accuracy of LASi, peak LAS, and American Society of Echocardiography/European Association for Cardiovascular Imaging (ASE/EACVI) algorithm was 79, 75, and 76%, respectively (excluding 37 patients with indeterminate diastolic function by ASE/EACVI guidelines). When the number of LASi indeterminates (defined by near-zero LASi values) was matched to the ASE/EACVI guidelines (n = 37), the accuracy of LASi improved to 87%. Importantly, among the 37 patients with ASE/EACVI-indeterminate diastolic function, LASi had an accuracy of 81%, compared with 76% for peak LAS. Conclusion LASi allows the detection of elevated LVEDP using invasive measurements as a reference, at least as accurately as peak LAS and current diastolic function guideline algorithm, with the advantage of no indeterminate classifications in patients with measurable LAS. [ABSTRACT FROM AUTHOR]

Aims To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. Methods and results We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75–88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10–0.78, P = 0.016). Conclusion LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure. [ABSTRACT FROM AUTHOR]

Background Patients undergoing cardiac catheterization are ordered to take nothing by mouth after midnight before their procedure with no evidence to support this practice. Objective To identify best practice for fasting requirements before cardiac catheterization through comparative evaluation in a prospective randomized controlled study. Methods The study included a convenience sample of 197 patients undergoing elective cardiac catheterization in a progressive inpatient cardiac unit at a regional heart institute in the midwestern United States. The patients were randomized into 2 groups. Patients in the hearthealthy diet group could eat a specified diet with low-acid options until the scheduled procedure. Patients in the fasting group were restricted to nothing by mouth after midnight except for sips of water with medications until the scheduled procedure. Outcome measures included patient-reported satisfaction and complications. Results Compared with patients in the fasting group, those in the heart-healthy diet group had significantly more satisfaction with the preprocedural diet. Patients in the heart-healthy diet group had less thirst and hunger before and after the procedure. No patients experienced pneumonia, aspiration, intubation, or hypoglycemia after the procedure. Fatigue, glucose level, gastrointestinal issues, and loading dose of antiplatelet medication did not differ between the groups. Conclusions Allowing patients to eat before elective cardiac catheterization posed no safety risk and benefited patient satisfaction and overall care. The results of this study may help identify best practice for allowing patients to eat before elective procedures using conscious sedation. [ABSTRACT FROM AUTHOR]

Background: Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. This study aimed to evaluate cBP differences between patients with and without obesity, identify cBP determinants, and evaluate the accuracy of the algorithm Antares for non-invasive cBP estimation. Methods: A total of 190 patients (25% female; 39% with BMI ≥30kg/m2; age: 67±12 years) undergoing elective cardiac catheterization were included. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device with integrated Antares algorithm. Results: No significant cBP differences were found between obese and non-obese patients. However, females, especially those with obesity, had higher systolic cBP compared to males (P<0.05). Multiple regression analysis showed that brachial mean arterial pressure, pulse pressure, BMI, and heart rate predicted cBP significantly (adjusted R2 = 0.82, P<0.001). Estimated cBP correlated strongly with invasive cBP for systolic, mean arterial, and diastolic cBP (r = 0.74–0.93, P<0.001) and demonstrated excellent accuracy (mean difference <5 and SD <8 mmHg). Conclusions: This study discovered no significant difference in cBP between obese and non-obese patients. However, it revealed higher cBP values in women, especially those with obesity, which requires further investigation. Additionally, the study highlights Antares' effectiveness in non-invasively determining cBP in obese individuals. This could improve the diagnosis and treatment of hypertension in this special patient population. [ABSTRACT FROM AUTHOR]

Thanks to advancements in percutaneous cardiac interventions, an expanding patient population now qualifies for treatment through percutaneous endovascular procedures. High-risk interventions far exceed coronary interventions and include transcatheter aortic valve replacement, endovascular management of acute pulmonary embolism and ventricular tachycardia ablation. Given the frequent impairment of ventricular function in these patients, frequently deteriorating during percutaneous interventions, it is hypothesized that mechanical ventricular support may improve periprocedural survival and subsequently patient outcome. In this narrative review, we aimed to provide the relevant evidence found for the clinical use of percutaneous mechanical circulatory support (pMCS). We searched the Pubmed database for articles related to pMCS and to pMCS and invasive cath lab procedures. The articles and their references were evaluated for relevance. We provide an overview of the clinically relevant evidence for intra-aortic balloon pump, Impella, TandemHeart and ECMO and their role as pMCS in high-risk percutaneous coronary intervention, transcatheter valvular procedures, ablations and high-risk pulmonary embolism. We found that the right choice of periprocedural pMCS could provide a solution for the hemodynamic challenges during these procedures. However, to enhance the understanding of the safety and effectiveness of pMCS devices in an often high-risk population, more randomized research is needed. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Patent foramen ovale is an important part of fetal circulation, allowing the oxygenated blood from the umbilical cord to bypass the lungs. Patent foramen ovale usually close after birth due to the sudden change of the hemodynamics associated with the expansion of the lungs; however, they are known to persist in about 25% of the total population. One of their rare manifestations is platypnea-orthodeoxia syndrome, which presents as dyspnea upon assuming an upright position that improves upon recumbency. It is accompanied by hypoxemia. Case Report: We report a case of a 63-year-old man known to have systemic lupus erythematosus and positive anti-phospholipid antibodies. He had no prior thrombotic events, was admitted with symptoms of SARS-COV2 infection, and developed symptoms of platypnea-orthodeoxia syndrome during his hospitalization. Further evaluation by transthoracic echocardiography revealed he had patent foramen ovale with a right-to-left shunt, which was treated successfully with percutaneous device closure. Conclusions: Platypnea-orthodeoxia syndrome can be associated with various cardiac defects, resulting in right-to-left shunts and other non-cardiac pathologies such as pulmonary arteriovenous malformations, lung parenchymal diseases, and hepatopulmonary syndrome. In cases of cardiac right-to-left shunts, contrast-enhanced transthoracic echocardiography can effectively diagnose platypnea-orthodeoxia syndrome, and percutaneous closure has been shown to be an efficacious treatment option in alleviating the symptoms. This case report highlights the necessity of actively exploring the possibility of a patent foramen ovale with right-to-left shunting in patients exhibiting platypnea-orthodeoxia syndrome symptoms, while considering other potential etiologies. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of the study was to assess whether a recent SARS-CoV-2 infection could by itself be a risk or prognostic factor for ST-segment elevation myocardial infarction (STEMI). Method: An observational study in unvaccinat-ed patients with STEMI confirmed by cardiac catheterization was conducted. A recent or concurrent SARS-CoV-2 infection was identified by the presence of serum IgG against the nucleocapsid protein, or a positive polymerase chain reaction test on naso-pharyngeal swabs. Baseline cardiovascular risk factors, clinical STEMI severity, main catheterization findings, and occurrence of major adverse cardiovascular events (MACE) during hospitalization were compared between study subgroups. Results: Of a total of 89 patients recruited, 14 (16%) had a recent SARS-CoV-2 infection. Patients with STEMI and recent SARS-CoV-2 infection had a markedly lower frequency of high blood pressure (21% vs. 55%; p = 0.03) as well as a tendency to have fewer co-morbidities. Regarding the clinical presentation, there were no differences in the severity of the STEMI. Furthermore, the main findings during cardiac catheterization including the atherosclerotic burden and the number of vessels affected, as well as the occurrence of MACE during follow-up, were not significantly different between the groups. Conclusions: A recent SARS-CoV-2 infection appears to facilitate the triggering of STEMI, as these patients have fewer traditional cardiovascular risk factors than their uninfected counterparts. However, this does not seem to affect the clinical presentation or the in-hospital course of STEMI patients. [ABSTRACT FROM AUTHOR]

Background: It has been shown that the increase in volume and pressure in the right heart chambers increases liver congestion and liver stiffness. The Albumin-Bilirubin (ALBI) score is a useful and easy-to-use score for objectively assessing liver function. There is no information in the literature regarding the changes in ALBI scores in patients undergoing right heart catheterization(RHC). Objectives: The aim of our study is to investigate the changes in ALBI score and its clinical impact in patients undergoing RHC. Methods: Of the 156 analyzed patients, 20 were excluded. Correlation and regression analysis between ALBI and RHC data was performed on the remaining 136 patients who underwent RHC. The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI= (log10 bilirubin [umol/L] * 0.66) + (albumin [g/L] * -0.085). Results: Of these 136 patients included in the study, the mean age was 45.8±17.2 years, 85 of them (62.5 %) were women, and their body mass index was 27.2±5.9 kg/m2 (Table 1, Table 2). Linear regression analysis was performed for parameters significantly associated with ALBI in univariate and multivariate analysis. As a result of this analysis, mixed venous oxygen saturation [(r= -0.362 p<0.003), (B= -0.345, p=0.089)], mean pulmonary arterial pressure [(r=0.288, p=0.017), (B=0.192, p=0.167))], mean pulmonary capillary wedge pressure [(r=0.526, p<0.001), (B=0.191, p=0.206)], mean right atrial pressure [(B=0.668, p <0.001), (B=0.530, p=0.001))], and cardiac index [(r= -0.384, p=0.002), (B= - 0.293, p=0.064)] were found to be associated with ALBI. In multivariate linear regression analysis, the ALBI score was independently associated with mean right atrial pressure. A mean right atrial pressure greater than 6 mmHg as measured by RHC was associated with increased ALBI scores (cut-off = - 3.53) with a sensitivity of 69.1% and a specificity of 88% (area under the ROC curve = 0.818, 95% CI 0.726-0.909, p<0.001) (Figure 1). Conclusions: ALBI score was independently associated with mean mean right atrial pressure. The ALBI score could be a simple, evidence-based, objective, and discriminatory method to evaluate liver function and gain insight into right atrial pressure in patients with cardiac problems that may affect right heart hemodynamics. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a pathophysiological manifestation of a heterogeneous group of diseases characterized by abnormally elevated pulmonary arterial pressures diagnosed on right heart catheterization. The 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines for the diagnosis and treatment of PH provides a new hemodynamic definition to define PH by lowering the threshold of the mean pulmonary artery pressure (mPAP) to 20 mm Hg. Precapillary PH is thus now defined as a mPAP >20 mm Hg together with a normal pulmonary artery wedge pressure (<15 mm Hg) and an increased pulmonary vascular resistance (>2 Wood Units). The ESC/ERS 2022 Guidelines also introduce a revised clinical classification of PH while retaining its previous distinction between the five groups according to the underlying pathophysiology. [ABSTRACT FROM AUTHOR]

Objective: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients. Methods: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two‐dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three‐dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated. Results: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR‐derived volumes and RVEF (r =.91, r =.79, r =.64; p <.0001 for each, respectively). Among other parameters, RV fractional area change (r =.439; p <.001) and RV free wall longitudinal strain (RVFW‐LS) (r = −.34; p <.05) correlated moderately with CMR‐RVEF, whereas tricuspid annulus S' velocity (r =.29; p <.05) and tricuspid annular systolic plane excursion (r =.27; p <.05) correlated weakly with CMR‐RVEF. Additionally, 3D‐RVEF and RVFW‐LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p =.04 and −15.5 ± 3.1 vs. −17.5 ± 3, p =.03, respectively). Conclusion: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW‐LS and 3D‐RVEF in these patients. [ABSTRACT FROM AUTHOR]

Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. All the patients ultimately underwent TAVI. The intervention was successful in all cases, without ≥ moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 ± 12.55 mL/min; after multi-modality imaging: 26.76 ± 11.51 mL/min; post-TAVI at discharge: 29.84 ± 13.98 mL/min; p = 0.3 all). The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction. [ABSTRACT FROM AUTHOR]

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. [ABSTRACT FROM AUTHOR]

Percutaneous carotid access (PCA) in infants has been reported in small multicenter cohorts, case reports and wider studies over the last 20 years. Compare outcomes after implementation of a systematic approach to PCA in a single center including an imaging follow-up protocol. Retrospective case–control study of PCA at Children's Hospital Colorado was performed from January 2013 to December 2022. Seventy-four patients underwent 82 PCAs for cardiac catheterization. The median age (range) was 14 days (1–359), and weight was 3.25-kg (1.9–7.9). Median sheath size was 4-Fr (3.3–6). Seventy-seven interventions performed included PDA stenting, aortic valvoplasty, BTT shunt stenting, and coarctation stenting. Vascular access was performed using a modified 21 g butterfly needle. A protocolized approach was implemented in 2020 reversing the patient head-to-toe orientation on the catheterization table, maintaining intubation and sedation for 4-h during recovery and routine use of a specific vascular ultrasound protocol. Following these changes, time to access significantly improved with no major complications. Before 2020, two access related complications occurred. One requiring surgical vascular repair and one occlusive thrombus. A significant increase in sheath time in post-era was associated with increased case complexity. Longer sheath times were not associated with increased risk of vessel injury or thrombus. No neurological insults were reported. Our experience confirms that PCA is safe and achievable with preserved vessel patency regardless of patient weight or sheath size. A protocolized planning, recovery, and follow-up regimen is recommended to establish safe practice and identify and treat complications as necessary. [ABSTRACT FROM AUTHOR]

Safety and acute outcomes for patients who need catheterization shortly after congenital cardiac surgery has been established; literature on mid-term outcomes is lacking. We sought to evaluate the mid-term outcomes of patients who undergo early postoperative cardiac catheterization. This is a retrospective cohort study of patients who underwent cardiac catheterization within 6 weeks of congenital cardiac surgery with longitudinal follow-up and assessment of mid-term outcomes. Multivariable analysis was utilized to relate variables of interest to outcomes. 99 patients underwent cardiac catheterizations within 6 weeks of cardiac surgery between January 2008 and September 2016. Forty-six (45.5%) interventional procedures were performed at a median age of 41 days (IQR 21–192) and a median weight of 3.9 kg (3.3–6.6). During a median follow-up duration of 4.24 years (1.6–5.6) in study survivors, 61% of patients remained free from the primary endpoint (death and/or transplant). Sixty-nine patients (69.7%) underwent an unplanned surgical or catheter procedure. Renal failure at catheterization (OR 280.5, p 0.0199), inotropic medication at catheterization (OR 14.8, p 0.002), and younger age were all significantly associated with meeting the primary endpoint. Patients requiring surgical intervention as an initial additional intervention underwent more unplanned re-interventions, while patients who survived to hospital discharge demonstrated favorable mortality, though with frequent need for re-intervention. In patients requiring early postoperative cardiac catheterization, renal failure, younger age, and need for inotropic support at catheterization are significantly associated with meeting the primary endpoint. [ABSTRACT FROM AUTHOR]

We devised a scoring system to identify patients with systemic sclerosis (SSc) at risk for pulmonary hypertension (PH) and predict all-cause mortality. Using 7 variables obtained via pulmonary function testing, echocardiography, and computed tomographic chest imaging, we applied the score to a retrospective cohort of 117 patients with SSc. There were 60 (51.3%) who were diagnosed with PH by right heart catheterization. Using a scoring threshold ≥ 0, our decision tool predicted PH with a sensitivity, specificity, and accuracy of 0.87 (95% CI 0.75, 0.94), 0.74 (95% CI 0.60, 0.84), and 0.80 (95% CI 0.72, 0.87), respectively. When adjusted for age at PH diagnosis, sex, and receipt of pulmonary arterial vasodilators, each one-point score increase was associated with an adjusted HR of 1.19 (95% CI 1.05, 1.34) for all-cause mortality. With further validation in external cohorts, our simplified clinical decision tool may better streamline earlier detection of PH in SSc. [ABSTRACT FROM AUTHOR]