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Background: Fever can occur after acute myocardial infarction (MI). The influence of body temperature (BT) after hospital arrival on patients with acute MI has rarely been investigated. Methods: Patients who were diagnosed with acute MI in the emergency department (ED) of a tertiary teaching hospital between 1 January 2020 and 31 December 2020 were enrolled. Based on the tympanic temperature obtained at the ED triage, patients were categorized into normothermic (35.5°C-37.5°C), hypothermic (< 35.5°C), or hyperthermic (> 37.5°C) groups. The primary outcome was in-hospital cardiac arrest (IHCA), while the secondary outcomes were adverse events. Statistical significance was set at p < 0.05. Results: There were 440 enrollees; significant differences were found among the normothermic (n = 369, 83.9%), hypothermic (n = 27, 6.1%), and hyperthermic (n = 44, 10.0%) groups in the triage respiratory rate (median [IQR]) (20.0 [4.0] cycles/min versus 20.0 [4.0] versus 20.0 [7.5], p = 0.009), triage heart rate (88.0 [29.0] beats/min versus 82.0 [28.0] versus 102.5 [30.5], p < 0.001), presence of ST-elevation MI (42.0% versus 66.7% versus 31.8%, p = 0.014), need for cardiac catheterization (87.3% versus 85.2% versus 72.7%, p = 0.034), initial troponin T level (165.9 [565.2] ng/L versus 49.1 [202.0] versus 318.8 [2002.0], p = 0.002), peak troponin T level (343.8 [1405.9] ng/L versus 218.7 [2318.2] versus 832.0 [2640.8], p = 0.003), length of ICU stay (2.0 [3.0] days versus 3.0 [8.0] versus 3.0 [9.5], p = 0.006), length of hospital stay (4.0 [4.5] days versus 6.0 [15.0] versus 10.5 [10.8], p < 0.001), and infection during hospitalization (19.8% versus 29.6% versus 63.6%, p < 0.001) but not in IHCA (7.6% versus 14.8% versus 11.4%, p = 0.323) or any adverse events (50.9% versus 48.1% versus 63.6%, p = 0.258). Multivariable analysis showed no significant association of triage BT with IHCA or any major complication. Conclusion: Triage BT did not show a significant association with IHCA or adverse events in patients with acute MI. However, triage BT could be associated with different clinical presentations and should warrant further investigation. [ABSTRACT FROM AUTHOR]

Aims: Transcatheter aortic valve replacement (TAVR) has become the standard of care for selected patients with severe aortic stenosis. Multidetector computed tomography (MDCT) and transoesophageal 2D/3D (two‐dimensional/three‐dimensional) echocardiography (ECHO) are used for aortic annulus (AA) sizing. The aim of this study was to compare the accuracy of AA sizing by ECHO versus MDCT for Edwards Sapien balloon expandable valve in a single center. Methods and results: Data from 145 consecutive patients with TAVR (Sapien XT or Sapien S3) were analyzed retrospectively. A total of 139 (96%) patients had favorable outcomes after TAVR (at most mild aortic regurgitation and only one valve implanted). The 3D ECHO AA area and area‐derived diameter were smaller than the corresponding MDCT parameters (464 ± 99 vs. 479 ± 88 mm2, p <.001, and 24.2 ± 2.7 vs. 25.0 ± 5.5 mm, p =.002, respectively). The 2D ECHO annulus measurement was smaller than both the MDCT and 3D ECHO area‐derived diameters (22.6 ± 2.9 vs. 25.0 ± 5.5 mm, p =.013, and 22.6 ± 2.9 vs. 24.2 ± 2.7 mm, p <.001, respectively) but larger than the minor axis diameter of the AA derived from MDCT and 3D ECHO by multiplanar reconstruction (p <.001). The 3D ECHO circumference‐derived diameter was also smaller than the MDCT circumference‐derived diameter (24.3 ± 2.5 vs. 25.0 ± 2.3, p =.007). The sphericity index by 3D ECHO was smaller than that by MDCT (1.2 ±.1 vs. 1.3 ±.1, p <.001). In up to 1/3 of the patients, 3D ECHO measurements would have predicted different (generally smaller) valve size than was the valve size implanted with favorable result. The concordance of the implanted valve size with the recommended size based on preprocedural MDCT and 3D ECHO AA area was 79.4% versus 61% (p =.001), and for the area‐derived diameter, the concordance was 80.1% versus 61.7% (p =.001). 2D ECHO diameter concordance was similar to MDCT (78.7%). Conclusions: 3D ECHO AA measurements are smaller than MDCT measurements. If 3D ECHO‐based parameters alone are used to size the Edwards Sapien balloon expandable valve, then the selected valve size would have been smaller than the valve size implanted with favorable result in 1/3 of the patients. MDCT preprocedural TAVR assessment should be the preferred method over 3D ECHO in routine clinical practice to determine Edwards Sapien valve size. [ABSTRACT FROM AUTHOR]

Pacer wire induced tricuspid regurgitation is not well‐understood. The mechanisms behind pacer wired induced tricuspid regurgitation have not been clearly defined. This clinical vignette sets to identify different technical mechanisms behind cardiac lead induced tricuspid regurgitation to help optimize cardiac lead implantation strategies for future device implantation. [ABSTRACT FROM AUTHOR]

Introduction. Coronary artery aneurysms (CAAs) are rare disorders, especially the left main CAA. In the literature, there are several reported cases with CAAs, various localization, size, clinical presentation, and way of treatment. There is no unique consensus about the most adequate treatment for these patients; however, surgery is still preferable, although there are some new experiences of percutaneous treatment. The decision is made for each patient individually. We report a case of giant left main CAA, with acute coronary syndrome and heart failure presentation, surgically treated. Case report. A 66-year-old female patient was admitted to the emergency department of our clinic due to chest pain and dyspnea. Acute non-STelevation segment myocardial infarction (STEMI) of anterolateral localization was diagnosed (creatine kinase max 1,111 U/L, troponin T 3.754 ng/mL), complicated with acute heart failure. Heart catheterization and coronary angiography revealed a giant saccular, 3.5 × 3.5 mm left main CAA full with thrombi, compressing the proximal segments of the left anterior descending and circumflex artery. Conclusion. Giant left main CAAs are rare pathologic findings, and there are no established principles for treatment. Although the percutaneous way of treatment is now available in selected cases, the surgical approach is still preferred for these patients. [ABSTRACT FROM AUTHOR]

Introduction: A 52‐year‐old woman presented with a complex ventricular arrhythmia in an intraoperative context, during kyphoplasty for an osteoporotic fracture of a lumbar vertebra. The subject showed no indications of a previous cardiovascular condition. Methods and Results: Causes of arrhythmias associated with the procedure were excluded. Due to her positive family history for dilated cardiomyopathy, upcoming thoughts were made for unmasking a previous asymptomatic cardiomyopathy. Nevertheless, an intracardiac cement embolism was diagnosed and, finally, the patient underwent an open‐heart surgery with successful removal of the cardiac cement. Νo new arrhythmia recorded during follow up. Conclusion: To the best of our knowledge, this is the first reported case of ventricular arrhythmogenic presentation of a cardiac cement embolus after a KP procedure. [ABSTRACT FROM AUTHOR]

Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary embolism. CTEPH also may present without prior VTE history, which can contribute to its underrecognition. The true incidence of CTEPH is unclear, but is estimated to be approximately 3% after acute pulmonary embolism. V ˙ / Q ˙ scintigraphy is the best screening test for CTEPH, with CT scan imaging and other advanced imaging methods now playing a larger role in disease detection and confirmation. Perfusion defects on V ˙ / Q ˙ scintigraphy in the setting of pulmonary hypertension are suggestive of CTEPH, but pulmonary angiography and right heart catheterization are required for confirmation and treatment planning. CTEPH potentially is curative with pulmonary thromboendarterectomy surgery, with mortality rates of approximately 2% at expert centers. Advances in operative techniques are allowing more distal endarterectomies to be performed successfully with favorable outcomes. However, more than one-third of patients may be considered inoperable. Although these patients previously had minimal therapeutic options, effective treatments now are available with pharmacotherapy and balloon pulmonary angioplasty. Diagnosis of CTEPH should be considered in all patients with suspicion of pulmonary hypertension. Treatments for CTEPH have advanced with improvements in outcomes for both operable and inoperable patients. Therapy should be tailored based on multidisciplinary team evaluation to ensure optimal treatment response. [ABSTRACT FROM AUTHOR]

Background : Developmental pulmonary vein pulmonary vein stenosis in the setting of prematurity is a rare and poorly understood condition. Diagnosis can be challenging in the setting of chronic lung disease of prematurity. High-resolution non-contrast chest computed tomography (CT) is the conventional method of evaluating neonates for potential structural changes contributing to severe lung dysfunction and pulmonary hypertension but may miss pulmonary venous stenosis due to the absence of contrast and potential overlap in findings between developmental pulmonary vein pulmonary vein stenosis and lung disease of prematurity. Objective: To describe the parenchymal changes of pediatric patients with both prematurity and pulmonary vein stenosis, correlate them with venous disease and to describe the phenotypes associated with this disease. Materials and methods: A 5-year retrospective review of chest CT angiography (CTA) imaging in patients with catheterization-confirmed pulmonary vein stenosis was performed to identify pediatric patients (< 18 years) who had a history of prematurity (< 35 weeks gestation). Demographic and clinical data associated with each patient were collected, and the patients' CTAs were re-reviewed to evaluate pulmonary veins and parenchyma. Patients with post-operative pulmonary vein stenosis and those with congenital heart disease were excluded. Data was analyzed and correlated for descriptive purposes. Results: A total of 17 patients met the inclusion criteria (12 female, 5 male). All had pulmonary hypertension. There was no correlation between mild, moderate, and severe grades of bronchopulmonary dysplasia and the degree of pulmonary vein stenosis. There was a median of 2 (range 1–4) diseased pulmonary veins per patient. In total, 41% of the diseased pulmonary veins were atretic. The right upper and left upper lobe pulmonary veins were the most frequently diseased (n = 13/17, 35%, n = 10/17, 27%, respectively). Focal ground glass opacification, interlobular septal thickening, and hilar soft tissue enlargement were always associated with the atresia of an ipsilateral vein. Conclusion: Recognition of the focal parenchymal changes that imply pulmonary vein stenosis, rather than chronic lung disease of prematurity changes, may improve the detection of a potentially treatable source of pulmonary hypertension, particularly where nonangiographic studies result in a limited direct venous assessment. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) is an important complication of interstitial lung disease (ILD), as its development confers a poor prognosis. There are no specific recommendations for methods of assessment for PH in ILD populations. Aims: To determine current assessment practices for PH in an Australian ILD centre. Methods: In the Austin Health ILD database, 162 consecutive patients with idiopathic pulmonary fibrosis or connective tissue disease‐associated ILD were identified and retrospectively evaluated for methods of PH assessment with transthoracic echocardiography (TTE), serum N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and right heart catheterisation (RHC) in relation to patient demographic and physiological parameters. Results: The median follow‐up was 30 (14.4–56.4) months. At baseline, vital capacity was 80.0 ± 18.4% predicted, and diffusing capacity for carbon monoxide was 59.6 ± 15.2% predicted. Evaluation for PH was performed in 147 (90.7%) patients, among whom 105 (64.8%) had TTE performed at least once. At the initial TTE, 33.7% patients had high probability of PH, defined as RVSP >40 mmHg + RAp and/or right ventricular dysfunction. At the time of the most recent TTE, these criteria were met in 45 (52.3%) patients. Elevated serum NT‐proBNP levels during the first year were observed in 47 (38.8%) patients. Only 14 (8.6%) patients had RHC. Conclusion: Our institutional PH assessment practice in ILD demonstrates a substantial prevalence of probable PH at baseline. As new therapies emerge for the treatment of PH in ILD, well‐defined screening practices are important in this population for early identification and optimal management. [ABSTRACT FROM AUTHOR]

To evaluate short-term procedural outcomes and safety for infants < 2.5 kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5 kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0 kg (range 0.7–2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume. [ABSTRACT FROM AUTHOR]

We investigated the hemodynamic parameters of pediatric PDA patients and focused on the influence of PDA size on pulmonary arterial pressure and the prevalence of pulmonary hypertension. A total of 52 patients aged between 2 months and 20 years who received transcatheter closure of a PDA from January 2018 to June 2022 in our institution were retrospectively recruited. Their hemodynamic parameters collected both by echocardiography and by cardiac catheterization were analyzed to delineate the influence of PDA size on the pulmonary vascular system. The echocardiographic-based ductal size and indexed PDA size were 1.93 mm (1.15–6 mm) and 4.05 mm/m2 (2.03–25.47 mm/m2), respectively. The pulmonary artery pressure measured was 20.83 mmHg (8–45 mmHg). We found a positive correlation between indexed PDA size and mean pulmonary arterial pressure (mPAP) (Pearson correlation coefficient = 0.47, p < 0.001). A subgroup analysis showed that 28 patients (53.8%) developed pulmonary hypertension (PH) (defined as mPAP > 20 mmHg). The median age of the PH group was 1.02 years [range: 0.19–8.64], which was significantly younger than the non-PH group's median age of 3.43 years [range: 0.42–19.96] (p = 0.001). The indexed PDA size for the PH group, 4.69 mm/m2, was significantly higher than that of the non-PH group, 3.2 mm/m2 (p = 0.004). The major risk factor for patients with PH was the PDA/BSA index, with an OR of 2.181 (95% CI, 1.224–3.887). Our demographic data showed younger patients with a higher PDA/BSA index are more likely to develop pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Up to one third of patients with pulmonary atresia with intact ventricular septum (PA-IVS) will have inadequate anterograde coronary blood flow and rely on fistulous connections from the right ventricle (RV) for myocardial perfusion, known as RV-dependent coronary circulation (RVDCC). Historically, identification of the extent of ventriculocoronary connections and coronary stenosis has required invasive imaging with cardiac catheterization and angiography. Cardiac computed tomography (CCT) potentially provides a less invasive imaging option for therapeutic planning in this group of patients. We describe six neonates with PA-IVS who underwent both CCT and cardiac catheterization at our institution prior to any surgical or transcatheter intervention between 2009 and 2019. Imaging was concerning for RVDCC in all six patients. The average tricuspid Z-score was − 4.19 (2.1 to − 5.34). Two patients underwent cardiac transplantation and two patients underwent ductal stenting. The overall mortality rate was 50%. CCT findings closely mirrored the findings of invasive cardiac catheterization and identified important morphological variations. The average radiation exposure (DLP) per CCT was (10.5 mGy cm, range 6–20). Technological improvements in CCT have enabled adequate visualization of coronary anomalies in children with comparable accuracy to cardiac catheterization, but considerably less radiation exposure. However, diagnosis of RVDCC requires direct right ventricular angiography. Therefore, the potential benefit of obtaining a CCT prior to catheterization for infants with PA-IVS is the ability to risk stratify, assist with procedural planning, and improve family counseling. [ABSTRACT FROM AUTHOR]

Background and objectives: Catheterization laboratories in hospitals and clinics employ imaging technology to diagnose blockages in the heart's arteries and chambers and treat patients accordingly. The procedure room is staffed by technicians. Investment in technology, clinical acumen, and the price of a cath lab. Every operation should have the best possible outcome by improving its application, quality of care, and adherence to established standards. Patient satisfaction is measured, and the structure, method of care, radiation safety, policies, and procedures of the catheterization laboratory at Vydehi Medical College & Research Centre (VIMS & RC) Hospital are compared to recommended standards. Methods: This study is a prospective research conducted to review the current structure, policies, and protocols, and retrospective data is collected to evaluate the facility's use between August 2021 to July 2022. In order to gauge parental contentment and pinpoint problem spots for quality enhancement, a survey technique based on a structured questionnaire is employed. Result: There are two cardiac catheterization laboratories at VIMS&RC, however only one is currently operational. There is not enough of the required standard equipment in the unit. Quality of care may be jeopardised because current radiation and infection control policies and processes fall short of recommended best practises. Throughout the time period of the study, an average daily census was 4.01. Eighty parents responded to the poll, and the total satisfaction rate was 73%. Conclusion: The research showed that the quality of the infrastructure, procedures, and guidelines did not meet the benchmarks set out by the experts. The customer satisfaction study highlighted the need for enhanced waiting room communication, information, and facilities. Improving the building and its associated rules and regulations will increase productivity there. This would guarantee progress towards superior medical treatment. [ABSTRACT FROM AUTHOR]

PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information. [ABSTRACT FROM AUTHOR]

Introduction Pulmonary endarterectomy (PEA) remains the preferred and potentially curative option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to report the results of PEA for CTEPH in a tertiary center in Tabriz, Iran. Methods We analyzed the results of 42 CTEPH patients undergoing PEA, who were enrolled in the Tabriz University of Medical Sciences (TUMS-CTEPH) from January 2016 to October 2020. The main outcome measures included the New York Heart Association (NYHA) functional classification, the 6-Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity, and mortality. Results There was a significant improvement in the NYHA function class (2.6 ± 0.5 vs 1.1 ± 0.34), mean pulmonary arterial pressure (47.1 ± 13 vs 27.9 ± 8 mm Hg), cardiac output (4.3 ± 1.06 vs 5.9 ± 1.2 L/min), and pulmonary vascular resistance (709.4 ± 297.5 vs 214 ± 77 dyn s/cm5). Fifteen patients (35%) developed complications. The most common complication (10 [23%]) was reperfusion injury. Also, postsurgical mortality was 4% during hospital admission and 1-year follow-up. Conclusion This is the first single-center report of PEA from Iran. Post-PEA and 1-year survival were acceptable as a referral center. PEA can be performed safe with low mortality. Greater awareness of PEA and patients' access to experienced CTEPH centers are important issues. [ABSTRACT FROM AUTHOR]

The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains a challenge. There are three methods proposed as diagnostic tools. H2FPEF score was determined by six weighted clinical characteristics and echocardiographic variables. Heart Failure Association (HFA)‐PEFF algorithm consists of various functional and morphological variables as well as natriuretic peptides. SVI/S′ is a novel echocardiographic parameter calculated by stroke volume index and mitral annulus systolic peak velocity. This study aimed to compare the three approaches in patients with suspected HFpEF. Patients referred to right heart catheterization for suspected HFpEF were classified into low‐, intermediate‐ and high‐likelihood groups according to H2FPEF or HFA‐PEFF scores. A diagnosis of HFpEF was confirmed by pulmonary capillary wedge pressure (PCWP) of ≥15 mm Hg according to the guidelines. In result, a total of 128 patients were included. Of these, 71 patients with PCWP ≥15 mm Hg and 57 patients with PCWP <15 mm Hg. Moderate correlations were observed between H2FPEF score, HFA‐PEFF score, SVI/S′ and PCWP. The area under curve of SVI/S′ was 0.82 for diagnosis of HFpEF, compared with 0.67 for H2FPEF score and 0.75 for HFA‐PEFF score by receiver‐operating characteristics analysis. Combining SVI/S′ with diagnostic scores showed higher Youden index and accuracy than each score alone. Kaplan–Meier analysis reported that the high‐likelihood group showed poorer outcomes regardless the method used for diagnosis. Among the contemporary tools for identifying HFpEF in this study, the combination of SVI/S′ with risk scores showed best diagnostic ability. Each of the strategies can determine rehospitalisation because of heart failure. [ABSTRACT FROM AUTHOR]

Ionizing radiation (IR) exposures have increased exponentially in recent years due to the rise in diagnostic and therapeutic interventions. A number of small-scale studies investigated the long-term effect of IR on health workers or immediate effects of IR on patients undergoing catheterization procedures; however, the long-term impact of multiple cardiac catheterizations on DNA damage on a patient population is not known. In this study, the effects of IR on DNA damage, based on micronuclei (MN) frequency and 8-hydroxy-2′-deoxyguanosine (8-OHdG) as markers in peripheral lymphocytes, were evaluated in patients who previously underwent multiple cardiac catheterization procedures. Moreover, genetic polymorphisms in genes PARP1 Val762Ala, OGG1 Ser326Cys, and APE1 Asn148Glu as a measure of sensitivity to radiation exposure were also investigated in the same patient population. The patients who underwent ≥ 3 cardiac catheterization procedures revealed higher DNA injury in comparison to the patients who underwent ≤ 2 procedures, documented with the presence of higher level of MN frequency (6.4 ± 4.8 vs. 9.1 ± 4.3, p = 0.002) and elevated serum 8-OHdG levels (33.7 ± 3.8 ng/mL vs. 17.4 ± 1.9 ng/mL, p = 0.001). Besides, OGG1 Ser326Cys and APE1 Asn148Glu heterozygous and homozygous polymorphic types, which are related with DNA repair mechanisms, were significantly associated with MN frequency levels (p = 0.006 for heterozygous and p = 0.001 for homozygous with respect to OGG1 Ser326Cys, p = 0.007 for heterozygous and p = 0.001 for homozygous with respect to APE1 Asn148Glu). There was no significant difference in terms of PARP1 Val762Ala gene polymorphism between two groups. [ABSTRACT FROM AUTHOR]

We are presenting a 35‐year‐old woman with past medical history of disseminated leiomyomatosis who presented with heart failure symptoms and was found to have post‐capillary pulmonary hypertension and high cardiac output state in right heart catheterization secondary to a huge pelvic arterio‐venous fistula. [ABSTRACT FROM AUTHOR]

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Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Interventional treatment of restrictive atrial septal defects in complex heart disease is considered state-of-the-art therapy up to date. Nevertheless, dedicated balloons are lacking so far, as several products have been withdrawn from the market. We report on off-label use of a balloon embolectomy catheter used successfully in a preterm patient and discuss whether this device might be used in other patients as well as it seems to be promising due to its shape and versatility. [ABSTRACT FROM AUTHOR]

Background: Over the past three decades, Transradial-Access (TRA) has revolutionized cardiac catheterization, demonstrating superior safety and outcomes compared to other access points. The European Society of Cardiology has now endorsed TRA as a viable alternative to traditional methods. Challenges during TRA can arise despite its success, making a comprehensive assessment of forearm artery anatomy essential. Forearm artery angiography (FA) has emerged as a valuable tool to improve procedural success and reduce complications. In this study, we retrospectively analyze the impact of FA on a diverse patient population, aiming to enhance TRA's effectiveness and safety in cardiac catheterization procedures in Bangladesh. Aim of the study: This study investigates the potential for enhanced success rates of Coronary Angiography and Percutaneous Coronary Intervention (PCI) by utilizing Standardized Forearm Angiography in a diverse patient population. Methods: This is a prospective comparative study, a total of 480 patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2022 to December 2022. Result: In this prospective study, 480 patients were analyzed, and various characteristics of the study population were examined. The average age of patients was 71.4 years, 71% male and 29% female. The study focused on forearm artery access, with 54.17% having right forearm access and 45.83% left forearm access. The most common access type for left forearm artery access was the distal radial artery, while the proximal radial artery dominated right forearm access. Arterial hypertension was the most prevalent variable, followed by diabetes mellitus and active smoking. The most common clinical indication for medical procedures was "Suspected CAD or chronic coronary syndrome." Etiological factors leading to medical conditions were also analyzed, with "Failure to achieve arterial puncture or introduce arterial sheath" being the most common factor, followed by "Kinking" and "Atherosclerotic occlusion." Conclusion: The retrospective analysis showcased promising results, indicating that standardized forearm angiography may lead to enhanced success rates in coronary angiography and PCI among a diverse patient population. This non-invasive approach could offer improved diagnostic accuracy and procedural outcomes, warranting further investigation and consideration for broader clinical implementation. [ABSTRACT FROM AUTHOR]

Introduction: We describe an unusual case of atrial tachycardia (AT) emanating from the left atrial appendage body (LAA), successfully treated by chemical ablation. Methods: A 66‐year‐old patient with cardiac amyloidosis and history of persistent atrial fibrillation ablation presented poorly tolerated AT with 1:1 atrioventricular nodal conduction at 135/min, despite amiodarone therapy. Three‐dimensional mapping suggested a reentrant AT from the anterior aspect of the left LAA. Results: The tachycardia could not be terminated with radiofrequency ablation. The LAA vein was then selectively catheterized and infused with Ethanol, resulting in immediate termination of tachycardia, without LAA isolation. No recurrence occurred at 12 months. Conclusion: Atrial tachycardias emanating from the LAA that are resistant to radiofrequency ablation may respond to chemical ablation of the LAA vein. [ABSTRACT FROM AUTHOR]

Background: The remote dielectric sensing (ReDS) system is a recently introduced non-invasive technology used to easily estimate the degree of lung fluid volume without any expert techniques. In the previous literature, ReDS values had a moderate correlation with invasively measured pulmonary artery wedge pressure (PAWP), the gold standard for representing left heart preload. Considering the mechanism of ReDS technology, ReDS values may be inappropriately elevated in the presence of pleural effusion (PE), and the ability of the ReDS system to estimate PAWP may decrease in such a situation. Methods: In-hospital patients with cardiovascular diseases underwent computed tomography, and the presence of pleural effusion (PE) was evaluated. The measurement of ReDS values using the ReDS system and the measurement of PAWP using invasive right heart catheterization were also performed simultaneously. The impact of the presence of PE on the relationship between the ReDS values and PAWP was evaluated. Results: A total of 59 patients (79 years, 30 male) were included. The median ReDS value was 25% (IQR: 22%, 30%) and the median PAWP level was 13 (IQR: 10, 18) mmHg. Of these patients, 11 had PE. PAWP was not significantly different between the two groups, whereas the ReDS values in the PE group were significantly higher than in the no-PE group. The impact of the presence of PE on the ReDS values was significant, with a beta value of 6.61 (95% confidence interval: 4.80–8.42, p < 0.001) upon adjusting for the levels of PAWP. Conclusions: We should pay attention to interpreting ReDS values when assessing the degree of pulmonary congestion in patients with PE, because ReDS values may be inappropriately elevated in this cohort. [ABSTRACT FROM AUTHOR]

Diastolic stiffness coefficient (β) and end‐diastolic elastance (Eed) are ventricular‐specific diastolic parameters. However, the diastolic function of right ventricle had not been investigated sufficiently due to the lack of established evaluation method. We evaluated the validity of these parameters calculated using only data of right heart catheterization (RHC) and assessed it in patients with restrictive cardiomyopathy (RCM) and cardiac amyloidosis. We retrospectively analyzed 46 patients with heart failure who underwent RHC within 10 days of cardiac magnetic resonance (CMR). Right ventricular end‐diastolic volume and end‐systolic volume were calculated using only RHC data, which were found to be finely correlated with those obtained from CMR. β and Eed calculated by this method were also significantly correlated with those derived from conventional method using CMR. By this method, β and Eed were significantly higher in RCM with amyloidosis group than dilated cardiomyopathy group. In addition, the β and Eed calculated by our method were finely correlated with E/A ratio on echocardiography. We established an easy method to estimate β and Eed of right ventricle from only RHC. The method finely demonstrated right ventricular diastolic dysfunction in patients with RCM and amyloidosis. [ABSTRACT FROM AUTHOR]

Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized that hemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinical features and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients who underwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVR index (SVRI) ≥ 20; B, CI < 3, SVRI ≥ 20; C, CI ≥ 3, SVRI < 20; and D, CI < 3, SVRI < 20. The primary outcome was freedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart trans- plant, and death. Clinical and hemodynamic variables and freedom from the endpoint were compared between the hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients were included. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. All the patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascular resistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category D had a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category D were outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamic profiling. [ABSTRACT FROM AUTHOR]

Aims To assess the effects of bed rest duration on short-term complications following transfemoral catheterization. Methods and results A systematic search was carried out in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, Scopus, SciELO and in five registries of grey literature. Randomized controlled trials and quasi-experimental studies comparing different durations of bed rest after transfemoral catheterization were included. Primary outcomes were haematoma and bleeding near the access site. Secondary outcomes were arteriovenous fistula, pseudoaneurysm, back pain, general patient discomfort and urinary discomfort. Study findings were summarized using a network meta-analysis (NMA). Twenty-eight studies and 9217 participants were included (mean age 60.4 years). In NMA, bed rest duration was not consistently associated with either primary outcome, and this was confirmed in sensitivity analyses. There was no evidence of associations with secondary outcomes, except for two effects related to back pain. A bed rest duration of 2–2.9 h was associated with lower risk of back pain [risk ratio (RR) 0.33, 95% confidence interval (CI) 0.17–0.62] and a duration over 12 h with greater risk of back pain (RR 1.94, 95% CI 1.16–3.24), when compared with the 4–5.9 h interval. Post hoc analysis revealed an increased risk of back pain per hour of bed rest (RR 1.08, 95% CI 1.04–1.11). Conclusion A short bed rest was not associated with complications in patients undergoing transfemoral catheterization; the greater the duration of bed rest, the more likely the patients were to experience back pain. Ambulation as early as 2 h after transfemoral catheterization can be safely implemented. Registration PROSPERO: CRD42014014222. [ABSTRACT FROM AUTHOR]

Heart failure with preserved ejection fraction (HFpEF) is now the most common cause of pulmonary hypertension (PH), and the diagnosis of HFpEF should be considered in any patient with a preserved left ventricular systolic function being evaluated for PH. Accurately diagnosing HFpEF as compared with pulmonary arterial hypertension has critical treatment implications, given the vastly different treatment options available, and can be accurately guided using exercise right heart catheterization. In this review, the diagnostic approach and treatment implications of PH in patients at risk for HFpEF will be discussed. [ABSTRACT FROM AUTHOR]

Pulmonary tumor thrombotic microangiopathy (PTTM) is an underrecognized cause of pulmonary hypertension and fulminant right ventricle failure. It is associated with a high mortality due to delay in diagnosis. We present two cases of PTTM, both diagnosed postmortem, highlighting the importance of timely identification and initiation of treatment for this nearfatal condition. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) results in increased morbidity and mortality in patients with interstitial lung disease (ILD). Early recognition of PH in this population is essential for planning diagnostic testing, initiating therapy, and evaluating for lung transplantation. The previously developed PH-ILD Detection tool has significant potential in the evaluation and treatment of ILD patients; the aim of this study was to validate the tool in an independent, multicenter cohort of patients. We conducted a retrospective review of prospectively collected data from 161 ILD patients. Patients were stratified into low- (n = 78, 48.4%), intermediate- (n = 54, 33.5%), and high-risk (n = 29, 18.0%) groups based on the score obtained with the tool. Intermediate- and high-risk patients underwent follow-up echocardiogram (TTE); 49.4% (n = 41) had an abnormal TTE suggestive of underlying PH. These patients underwent right heart catheterization; PH-ILD was diagnosed in 73.2% (n = 30) of these cases. The PH-ILD Detection tool has a sensitivity of 93.3%, specificity of 90.9%, and area-under-the-curve of 0.921 for diagnosing PH in ILD patients, validating the findings from the original study and establishing the tool as a fundamental resource for early recognition of PH in ILD patients. [ABSTRACT FROM AUTHOR]

• Pediatric cardiac catheterization, which is performed by accessing the femoral vessel, requires immobilization and bed rest for 4 to 6 h to prevent postprocedure vascular complications. • Studies in adults suggest that after use of the same access site, the immobilization time can be safely reduced to 1.5–2 h after catheterization. • There were no significant hemostatic complications after 2 h of bed rest following pediatric catheterization; therefore, 2 h of bed rest was as safe as 4 h of bed rest. Pediatric cardiac catheterization, which is performed by accessing the femoral vessel, requires immobilization and bed rest for 4–6 h to prevent vascular complications. Studies in adults suggest that the immobilization time for the same access can be safely reduced to approximately 2 h after catheterization. However, it is unclear whether bed-rest time can be safely decreased after catheterization in children. To assess the effects of bed-rest duration on bleeding, vascular complications, pain level, and the use of additional sedatives after transfemoral cardiac catheterization in children with congenital heart disease. This study was an open-label, randomized, controlled, posttest-only design, including 86 children who underwent cardiac catheterization. Children were allocated to receive either 2 h of bed rest (n = 42) in the experimental group or 4 h of bed rest (n = 42) in the control group following catheterization. The mean age of children was 3.93 (±3.82) years in the experimental group and 5.63 (±3.97) years in the control group. There was no difference in site bleeding incidence (P = 0.214), vascular complication score (P = 0.082), pain level (P = 0.445), or additional sedation use (P = 1.000) between the two groups. There were no significant hemostatic complications after 2 h of bed rest following pediatric catheterization; therefore, 2 h of bed rest was as safe as 4 h of bed rest. (Trial registration: KCT0007737). [ABSTRACT FROM AUTHOR]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recognition and evaluation of structural heart disease has become more common in clinical practice and will continue to grow as the population ages. With the growing availability of surgical and transcatheter interventional options, appropriate evaluation and patient selection for therapy is required. While echocardiography can frequently provide the required anatomic and hemodynamic information required to guide therapeutic decisions, there remains subsets of patients in which noninvasive testing yields inconclusive results prompting the need for invasive hemodynamics. This article reviews the indications and strengths of invasive hemodynamics in a variety of structural heart diseases. We describe the utilization and benefits of continuous hemodynamics during transcatheter interventions and review the prognostic information that can be gleaned from changes in hemodynamics after intervention. The advancement of transcatheter therapies for structural heart disease has sparked a renewed interest in the utilization of invasive hemodynamics. Continued growth and accessibility of comprehensive hemodynamics for clinical practice will rely on clinicians to continually review, refine, and develop procedural techniques beyond the current training standards in order to further advance the field. [ABSTRACT FROM AUTHOR]

Background: Back pain is frequently reported following cardiac catheterization. This is mainly due to the prolonged bed rest prescribed post-cardiac catheterization, ranging from 3 to 6 h (Masoudi et al.,2017). Objectives: To determine the effect of change position and back massage on physiological parameters for patients with back pain post-cardiac catheterization. Methodology: A quasi-experimental design was conducted on patients divided into two study groups. A non-probability (homogenous purposive sample) of (90) patients is included in the present study (30 patients for the study group1,30 patients for study group 2 and 30 patients for the comparison group) where study group 1 received the change position protocol and study group 2 received the change position and back massage. All patients are post-cardiac catheterization and have back pain. Results: Improvement in physiological parameters for patients with back pain in study groups compared with those participants in the comparison group and between the pre-test and three readings of the post-test in the study groups. Conclusion: Implementing the change position and back massage for patients post-cardiac catheterization who have back pain is an effective approach to improve physiological parameters. Recommendations: Future studies should be conducted to determine the effectiveness of the intervention strategy on improving physiological parameters, particularly back pain in combination with other interventions to compare current study's impact with another intervention method for patients with back pain post-cardiac catheterization. [ABSTRACT FROM AUTHOR]

Background: Percutaneous coronary intervention (PCI) is one of the cardiac catheterization procedures used to diagnose and treat coronary artery disease(CAD). It may lead to local vascular complications after the removal of the femoral arterial sheath, which may contribute to morbidity and mortality, and increase the patient's length of stay and hospital costs. Objectives: The present study aimed to determine the effect of direct cold compress for femoral arterial sheath removal on reduction of local vascular complications in patients after PCI. Methodology: A randomized controlled trial, post-test only was conducted on patients in the present study. A non-probability (homogenous purposive sample) of (90) patients are involved after PCI (45 patients for the experimental group and 45 patients for the control group). The experimental group exposed to direct cold bag compression for removing the femoral arterial sheath removal. While, the control group exposed for usual nursing care provided for patients in CCU. The study was conducted at Al-Najaf AL Ashraf City/ AL-Najaf Center for Cardiac Surgery and Cardiac Catheterization. The local vascular complications involved in the present study for both groups are hematoma, bleeding and ecchymosis. Results: The study results indicated that there is a reduction in local vascular complications (hematoma, bleeding, and ecchymosis) for patients after femoral arterial sheath removal in the experimental group compared with those patients in the control group. Conclusion: The present study has been concluded that the using of direct cold bag compress for removing the femoral arterial sheath in patients after PCI is an effective approach in reduction of local vascular complications compared with the control group. Recommends: Based on the results of the present study, the researcher suggests the direct cold bag compress for femoral arterial sheath removal as a nursing intervention to reduce local vascular complications (hematoma, bleeding, and ecchymosis) for patients after PCI. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims To assess whether intraprocedural transesophageal echocardiographic (TEE)-derived haemodynamic parameters predict outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR). Methods and results This is a single-centre, retrospective analysis encompassing 458 (IQR, 104–1035) days of follow-up after 926 consecutive patients [481 (52%) with functional MR] referred to an isolated mitral TEER between 2013 and 2020. Cases without actual clip deployment, or in whom prior mitral procedures had taken place, were excluded. The primary outcome was the combined rate of all-cause mortality or heart failure (HF) hospitalizations. Secondary endpoints included single components of the primary outcome, as well as MR severity at one month and one year following the procedure. A multivariable analysis identified two intraprocedural echocardiographic observations made after clip deployment as independent predictors of the primary outcome: an above mild MR (HR for whole study period 1.49, 95% CI 1.05–2.13, P = 0.026) and a 100% or more increase from baseline in the transmitral mean pressure gradient (TMPG) (HR for whole study period 1.32, 95% CI 1.01–1.72, P = 0.039). Also, MR grade of above mild and the absence of a normal pulmonary venous flow pattern (PVFP) bilaterally were associated with an increased risk for HF hospitalizations and greater-than-mild 1-month MR. No prognostic role was demonstrated for the change in MR severity, the absolute TMPG, or the mere improvement in PVFP. Conclusion Immediate post-TEER MR severity and the relative change in TMPG are predictive of clinical and echocardiographic outcomes following the procedure. [ABSTRACT FROM AUTHOR]

Pediatric patients with congenital heart disease (CHD) often undergo low dose ionizing radiation (LDIR) from cardiac catheterization (CC) for the diagnosis and/or treatment of their disease. Although radiation doses from a single CC are usually low, less is known about the long-term radiation associated cancer risks. We aimed to assess the risk of lympho-hematopoietic malignancies in pediatric CHD patients diagnosed or treated with CC. A French cohort of 17,104 children free of cancer who had undergone a first CC from 01/01/2000 to 31/12/2013, before the age of 16 was set up. The follow-up started at the date of the first recorded CC until the exit date, i.e., the date of death, the date of first cancer diagnosis, the date of the 18th birthday, or the 31/12/2015, whichever occurred first. Poisson regression was used to estimate the LDIR associated cancer risk. The median follow-up was 5.9 years, with 110,335 person-years. There were 22,227 CC procedures, yielding an individual active bone marrow (ABM) mean cumulative dose of 3.0 milligray (mGy). Thirty-eight incident lympho-hematopoietic malignancies were observed. When adjusting for attained age, gender and predisposing factors to cancer status, no increased risk was observed for lympho-hematopoietic malignancies RR/mGy = 1.00 (95% CI: 0.88; 1.10). In summary, the risk of lympho-hematopoietic malignancies and lymphoma was not associated to LDIR in pediatric patients with CHD who undergo CC. Further epidemiological studies with greater statistical power are needed to improve the assessment of the dose-risk relationship. [ABSTRACT FROM AUTHOR]

Exercise pulmonary hypertension (ePH) has three common diagnostic criteria: the mean pulmonary artery pressure (mPAP) > 30 mmHg and total pulmonary resistance (TPR) at peak exercise >3 Wood units ("Joint criteria"), the mPAP/cardiac output (CO) slope of the two-point measurement (ΔmPAP/ΔCO) > 3 mmHg/L/min ("Two-point criteria"), and the mPAP/CO slope of the multi-point data >3 mmHg/L/min ("Multi-point criteria"). We compared the diagnostic efficacy of these criteria, which remain controversial. Following resting right heart catheterization (RHC), all patients underwent exercise RHC (eRHC). The patients were divided into different ePH and non-exercise pulmonary hypertension (nPH) groups according to the above criteria. Joint criteria were used as the reference to compare the other two, namely diagnostic concordance, sensitivity and specificity. We conducted further analysis to determine the correlation between different diagnostic criteria grouping and the clinical severity of PH. Thirty-three patients with mPAP rest ≤ 20 mmHg were enrolled. a) Diagnostic concordance, sensitivity and specificity: compared with Joint criteria, the diagnostic concordances of Two-point criteria and Multi-point criteria were 78.8% (κ = 0.570, P < 0.01) and 90.9% (κ = 0.818, P < 0.01), respectively; the sensitivity of Two-point criteria was high (100%), but the specificity was poor (56.3%); however, Multi-point criteria exhibited higher sensitivity (94.1%) and specificity (87.5%). b) Clinically relevant analysis: a significant difference was observed in several clinical severity indicators between ePH and nPH patients according to Multi-point criteria grouping(all P < 0.05). Multi-point criteria are more clinically relevant and provide better diagnostic efficiency. • Exercise right heart catheterization can be of clinical value in diagnosing exercise pulmonary hypertension. • The linearized multi-point mPAP/CO slope criteria have a better diagnostic performance on exercise pulmonary hypertension. • The linearized multi-point mPAP/CO slope criteria are of more clinically relevance. [ABSTRACT FROM AUTHOR]

There is a lack of knowledge regarding the contribution of central and peripheral factors to the increases in VO2max following sprint‐interval training (SIT). This study investigated the importance of maximal cardiac output (Qmax) in relation to VO2max improvements following SIT and the relative importance of the hypervolemic response on Qmax and VO2max. We also investigated whether systemic O2 extraction increased with SIT as has been previously suggested. Healthy men and women (n = 9) performed 6 weeks of SIT. State‐of‐the‐art measurements: right heart catheterization, carbon monoxide rebreathing and respiratory gas exchange analysis were used to assess Qmax, arterial O2 content (caO2), mixed venous O2 content (cvO2), blood volume (BV) and VO2max before and after the intervention. In order to assess the relative contribution of the hypervolemic response to the increases in VO2max, BV was re‐established to pre‐training levels by phlebotomy. Following the intervention, VO2max, BV and Qmax increased by 11% (P < 0.001), 5.4% (P = 0.013) and 8.8% (P = 0.004), respectively. cvO2 decreased by 12.4% (P = 0.011) and systemic O2 extraction increased by 4.0% (P = 0.009) during the same period, both variables were unaffected by phlebotomy (P = 0.589 and P = 0.548, respectively). After phlebotomy, VO2max and Qmax reverted back to pre‐intervention values (P = 0.064 and P = 0.838, respectively) and were significantly lower compared with post‐intervention (P = 0.016 and P = 0.018, respectively). The decline in VO2max after phlebotomy was linear to the amount of blood removed (P = 0.007, R = −0.82). The causal relationship between BV, Qmax and VO2max shows that the hypervolemic response is a key mediator of the increases in VO2max following SIT. Key points: Sprint‐interval training (SIT) is an exercise model involving supramaximal bouts of exercise interspersed with periods of rest known for its efficiency in improving maximal oxygen uptake (VO2max).In contrast to the commonly accepted view where central haemodynamic adaptations are considered to be the key mediators of increases in VO2max there have been propositions highlighting peripheral adaptations as the main mediators in the context of SIT‐induced changes in VO2max.By combining right heart catheterization, carbon monoxide rebreathing and phlebotomy, this study shows that increases in maximal cardiac output due to the expansion of the total blood volume is a major explanatory factor for the improvement in VO2max following SIT, with a smaller contribution from improved systemic oxygen extraction.The present work not only clarifies a controversy in the field by using state‐of‐the‐art methods, but also encourages future research to investigate regulatory mechanisms that could explain how SIT can lead to improvements in VO2max and maximal cardiac output similar to those that have previously been reported for traditional endurance exercise. [ABSTRACT FROM AUTHOR]

Congenital left atrial appendage ostial stenosis is a very rare congenital cardiac condition. We present the case of an extremely premature infant with congenital left atrial appendage ostial stenosis diagnosed by transthoracic echocardiographic imaging. [ABSTRACT FROM AUTHOR]

Background: In aortic stenosis (AS), estimated glomerular filtration rate (eGFR) is an important prognostic marker but its haemodynamic determinants are unknown. We investigated the correlation between eGFR and invasive haemodynamics and long‐term mortality in AS patients undergoing aortic valve replacement (AVR). Methods: We studied 503 patients [median (interquartile range) age 76 (69–81) years] with AS [indexed aortic valve area.42 (.33–.49) cm2/m2] undergoing cardiac catheterization prior to surgical (72%) or transcatheter (28%) AVR. Serum creatinine was measured on the day before cardiac catheterization for eGFR calculation (CKD‐EPI formula). Results: The median eGFR was 67 (53–82) mL/min/1.73 m2. There were statistically significant correlations between eGFR and mean right atrial pressure (r = −.13; p =.004), mean pulmonary artery pressure (mPAP; r = −.25; p <.001), mean pulmonary artery wedge pressure (r = −.19; p <.001), pulmonary vascular resistance (r = −.21; p <.001), stroke volume index (r =.16; p <.001), extent of coronary artery disease, and mean transvalvular gradient but not indexed aortic valve area. In multivariate linear regression, higher age, lower haemoglobin, lower mean transvalvular gradient (i.e. lower flow), lower diastolic blood pressure, and higher mPAP were independent predictors of lower eGFR. After a median post‐AVR follow‐up of 1348 (948–1885) days mortality was more than two‐fold higher in patients in the first eGFR quartile compared to those in the other three quartiles [hazard ratio 2.18 (95% confidence interval 1.21–3.94); p =.01]. Conclusion: In patients with AS, low eGFR is a marker of an unfavourable haemodynamic constellation as well as important co‐morbidities. This may in part explain the association between low eGFR and increased post‐AVR mortality. [ABSTRACT FROM AUTHOR]

Aims: Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF. Methods and results: Data from 85 patients (aged 69 ± 8 years) who underwent exercise right heart catheterization and echocardiography were retrospectively analysed. All had symptoms of heart failure, left ventricular ejection fraction ≥50% and haemodynamic features of HFpEF. Patients were divided into LA volume index‐based tertiles (≤34 ml/m2, >34 to ≤45 ml/m2, >45 ml/m2). A subgroup analysis was performed in patients with recorded LA global reservoir strain (n = 60), with reduced strain defined as ≤24%. Age, sex, body surface area and left ventricular ejection fraction were similar between volume groups. LA volume was associated with blunted increases in cardiac output with exercise (padjusted <0.001), higher resting mean pulmonary artery pressure (padjusted = 0.003), with similar wedge pressure (padjusted = 1). Pulmonary vascular resistance (PVR) increased with increasing LA volume (padjusted <0.001). Larger LA volumes featured reduced LA strain (padjusted <0.001), with reduced strain associated with reduced PVR–compliance time (0.34 [0.28–0.40] vs. 0.38 [0.33–0.43], p = 0.03). Conclusion: Increasing LA volume may be associated with more advanced pulmonary vascular disease in HFpEF, featuring higher PVR and pulmonary pressures. Reduced LA function, worse at increasing LA volumes, is associated with a disrupted PVR–compliance relationship, further augmenting impaired pulmonary haemodynamics. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary arterial hypertension (IPAH) is an uncommon and severe disease. We report the case of a 7-year-old boy investigated for cardiac murmur and exercise intolerance. Pulmonary hypertension (PH) was suspected at clinical examination and confirmed by echocardiography and cardiac catheterization. This case of pulmonary hypertension was classified as idiopathic given the negative etiological investigation. Vasoreactive testing with oxygen and nitric oxide was negative. Therefore, treatment with sildenafil (1.4 mg/kg/d) and bosentan (3 mg/kg/d) was initiated. This allowed the stabilization of, but not a decrease in, pulmonary artery pressure for the next 5 years, during which the patient's quality of life was significantly reduced. At a later follow-up, the estimated pulmonary pressure was found to have increased and become supra-systemic, with a consequent deterioration in the child's condition. This led to the decision to enter him into a clinical trial that is still ongoing. Idiopathic pulmonary arterial hypertension is a severe disease that can present with non-specific symptoms, such as asthenia and exercise limitation, which are important not to trivialize. The disease is associated with significantly decreased quality of life in affected children and carries a high burden in terms of mortality and morbidity. The current knowledge about IPAH in children is reviewed, with a particular focus on the future prospects for its treatment and the related quality of life of patients. [ABSTRACT FROM AUTHOR]

This is the first report specifically describing outcomes of pediatric patients who underwent cardiac catheterization while on uninterrupted anticoagulation. One hundred forty-four cardiac catheterizations were identified that met inclusion criteria at our institution from 11/2014 to 10/2019. The median age and weight of the patients were 6.3 [0.01–20.9] years and 19.3 [2.1–172.5] kg, respectively. Seventy-eight (54%) catheterizations involved inpatients. The most common cardiac diagnoses among the cohort were single ventricle (n = 41), conotruncal defects (n = 37), and structurally normal heart (n = 16). The most common indications for anticoagulation were arterial/venous thrombus (n = 45), Fontan physiology (n = 32), and mechanical valve thrombus prophylaxis (n = 27). The anticoagulation medications used were warfarin (n = 57), heparin (n = 52), enoxaparin (n = 25), fondaparinux (n = 5), rivaroxaban (n = 2), and both heparin and warfarin (n = 3). Interventions were performed in 96 cases (67%). The median length of the procedure was 122.5 [15–760] minutes, and the median time to achieve hemostasis was 18.0 [range: 5–76, IQR: 13–25] minutes. Adverse events were present in 11 cases (7.6%), and of those only 2 cases (1.4%) were bleeding-related complications. Our single-center data suggest that performing cardiac catheterization on pediatric patients while on uninterrupted anticoagulation is safe and does not substantially increase the risk of bleeding complications based on a cohort of patients that varied in age, size, diagnosis, medical complexity, and type of intervention performed. Patients on warfarin therapy for a mechanical valve are most likely to benefit from this practice, as the ability to continue warfarin therapy avoids the need for bridging and other interruption-related complications. [ABSTRACT FROM AUTHOR]

Background: There is no consensus regarding thromboprophylaxis after Fontan procedure, and novel tools to assess thrombogenicity are needed to establish optimal thromboprophylaxis. The Total Thrombus-formation Analysis System (T-TAS) was developed for the quantitative analysis of thrombus formation using microchips with thrombogenic surfaces. This prospective study evaluated the utility of T-TAS in the assessment of thrombogenicity in pediatric Fontan patients. Methods and Results: The participants included 20 consecutive Fontan patients who underwent cardiac catheterization and 30 healthy controls. Blood samples collected without and with antithrombotic therapy (aspirin or aspirin and warfarin) were used for T-TAS to compute the area under the curve (AUC) in the atheroma (AR10-AUC30) and platelet (PL18-AUC10) chips. A higher AUC indicates higher thrombogenicity. T-TAS values showed that patients in the Fontan group without antithrombotic therapy had lower thrombogenicity than those in the control group [PL18-AUC10, median (interquartile range) 356 (313–394) vs. 408 (392–424); AR10-AUC30, median (interquartile range) 1270 (1178–1351) vs. 1382 (1338–1421)]. Aspirin and warfarin therapies significantly decreased PL18-AUC10 and AR10-AUC30, respectively, compared with those of patients without antithrombotic therapy (P < 0.001 for each comparison). Subgroup analysis divided by low (< 9 mmHg) or high (≥ 9 mmHg) central venous pressure (CVP) showed that CVP affects the reduction in AR10-AUC30 with antithrombotic therapy. Conclusions: T-TAS may be a useful tool for monitoring thrombogenicity and antithrombotic therapy in Fontan patients. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) adaptation is the principal determinant of outcomes in pulmonary arterial hypertension (PAH), however, RV function is challenging to assess. RV responses to hemodynamic stressors are particularly difficult to interrogate without invasive testing. This study sought to identify metabolomic markers of in vivo right ventricular function and exercise performance in PAH. Consecutive subjects with PAH (n = 23) underwent rest and exercise right heart catheterization with multibeat pressure volume loop analysis. Pulmonary arterial blood was collected at rest and during exercise. Mass spectrometry-based targeted metabolomics were performed, and metabolic associations with hemodynamics and comprehensive measures of RV function were determined using sparse partial least squares regression. Metabolite profiles were compared with N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) measurements for accuracy in modeling ventriculo-arterial parameters. Thirteen metabolites changed in abundance with exercise, including metabolites reflecting increased arginine bioavailability, precursors of catecholamine and nucleotide synthesis, and branched-chain amino acids. Higher resting arginine bioavailability predicted more favorable exercise hemodynamics and pressure-flow relationships. Subjects with more severe PAH augmented arginine bioavailability with exercise to a greater extent than subjects with less severe PAH. We identified relationships between kynurenine pathway metabolism and impaired ventriculo-arterial coupling, worse RV diastolic function, lower RV contractility, diminished RV contractility with exercise, and RV dilation with exercise. Metabolite profiles outperformed NT-proBNP in modeling RV contractility, diastolic function, and exercise performance. Specific metabolite profiles correspond to RV functional measurements only obtainable via invasive pressure-volume loop analysis and predict RV responses to exercise. Metabolic profiling may inform discovery of RV functional biomarkers. [ABSTRACT FROM AUTHOR]

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Background: Contrast-induced encephalopathy (CIE) is considered as an uncommon complication following cardiac catheterization. Due to the varied manifestations, CIE has no formal diagnostic criteria. In fact, the incidence of CIE may be greatly underestimated because of the difficulty in its differential diagnosis with other cerebrovascular complications. Thus, making a flow diagram according to patients' clinical symptoms and examinations after cardiac catheterization to help clinicians diagnose CIE is important and needed. Case presentation: In this report, we describe a case of probable CIE in a 66-year-old Chinese man with hypertension who underwent cardiac catheterization with stents placement in the bifurcation lesion, during which 80 ml iopromide contrast was used. About 2 h following the procedure, the patient lost his consciousness suddenly and suffered from a status epilepticus. Malignant arrhythmias were not found through continuous electrocardiogram monitoring, but mild ST-segment elevation was displayed in leads I and aVL. The echocardiography, plasma glucose and electrolyte levels were normal. Emergency re-angiography with percutaneous transluminal coronary angioplasty was performed in the culprit lesion, which involved 60 ml iopromide contrast. However, the patient remained unconsciousness and epilepticus. Non-contrast computed tomography (CT) of the head showed cortical and subarachnoid enhancement as well as prolonged retention of contrast media in the middle cerebral artery. With supportive treatment of intravenous hydration, sedative and dehydrant, the patient recovered 3 h later and finally discharged without any neurological deficits. Conclusions: CIE is an acute reversible encephalopathy induced by contrast media. It is exceptionally challenging to make the diagnosis of CIE following cardiac catheterization since there is a lack of consensus on the definition of CIE. Via this case we reviewed the related literatures, through which a flow diagram of the differential diagnosis and clinical decision making was given, which could help to differentiate CIE from other neurological complications following cardiac catheterization. [ABSTRACT FROM AUTHOR]

The cardiac catheter laboratory, which in many health care facilities falls under the umbrella of perioperative services, generally sits geographically outside the traditional operating suite. Perhaps due in part to this geographical distance, standards that are routinely applied in the operating suite may not be applied in the cardiac catheter laboratory. One such standard is the management of accountable items such as swabs, surgical instruments, sharps and sheaths. Well-known standards and guidelines for managing accountable items recommend mandatory counting and documentation of all accountable items in environments where a surgical item may be left behind; yet, despite this, counting is not mandatory in the cardiac catheter laboratory. The risk of items (or parts thereof) being unintentionally retained during percutaneous procedures, such as those performed in the cardiac catheter laboratory, are low; however, this complication still occurs, with several case studies reporting broken and fragmented surgical instruments and/or equipment being retained in patients following procedures. As the complexity of percutaneous cardiac catheter laboratory cases increases, so does the potential requirement of reversion to open procedures should a serious complication occur; and this, in turn, is known to increase the risk of a surgical item being retained during the subsequent procedure. Performing surgical counts in the cardiac catheter laboratory would improve patient safety during the intra-procedural/intra-operative period by reducing the risk of a surgical item (or parts thereof) being unintentionally left behind, a complication that is likely to result in patient harm. This discussion paper aims to not only highlight the vital importance of performing a full surgical count of all items used during cardiac catheter laboratory procedures but also to advocate for pre- and post-procedural inspection of sheaths, angioplasty balloons, stents and wires to ensure they are intact at the beginning and end of the procedure. These pre- and postprocedural inspections are vitally important, not just in the cardiac catheter laboratory but in all other areas, such as operating suites, endoscopy and interventional radiology, where endovascular devices are used. [ABSTRACT FROM AUTHOR]