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Introduction: Cyanotic congenital heart diseases are among the most serious anomalies among newborns. A rare type of this condition is direct communication between the right pulmonary artery and left atrium, which presents mostly in adolescence and adulthood. Large shunts, however, should be corrected as soon as possible, considering their potential to cause congestive heart failure. Case Presentation: Two 2- and 13-year-old patients with this pathologic communication complained of exertional dyspnea and central cyanosis. Their physical exams were prominent, with a low oxygen saturation level. The diagnostic modalities used, electrocardiogram, chest X-ray, echocardiogram, CT scan, and selective angiography of the pulmonary arteries, showed right-to-left abnormal blood flow through the right pulmonary artery and left atrium shunt. Finally, both patients were treated successfully by a transcatheter occluder without any complications or follow-up complaints. Discussion: The right pulmonary artery and left atrium abnormal congenital connections are rare causes of central cyanosis, mostly present with exertional dyspnea and cyanosis during adolescence or early adulthood. Transthoracic echocardiography, contrast-enhanced CT scans, and angiography of the pulmonary arteries make the diagnosis. The treatment has emerged during the last two decades, shifting from surgical treatment for severe cases to interventional percutaneous strategies, leaving the surgery for cases with no appropriate location for the application of interventional therapy. Conclusion: Considering the potentially life-threatening complications of the untreated right pulmonary artery and left atrium fistulas, such as thromboembolic events, early diagnosis is crucial. However, treating these patients is not always straightforward, and strategies should be selected based on the connecting fistula's anatomical features, location, size, and tortuosity. Although endovascular treatment is the preferred option, some patients need to be treated with surgical procedures due to their structural characteristics. [ABSTRACT FROM AUTHOR]

Coronary arterial fistulas are rare. They may occur between the coronary arteries themselves or with neighboring large vascular structures. There are congenital or acquired causes in the etiology. Symptoms may vary according to the severity of the shunt. Treatment can be performed with endovascular or surgical procedures. In this study, we report a case of fistula between the pulmonary artery and the right coronary artery and between the pulmonary artery and the left anterior descending coronary artery. It was interesting that the patient had a fistula in two different coronary arteries despite no history of intervention. The fistula was closed by coil embolization two years ago. However, coronary angiography performed after the resumption of his complaints showed that the fistula tract was open. We would like to share the radiologic images and successful surgery of the patient. [ABSTRACT FROM AUTHOR]

High-flow priapism is an uncommon condition typically resulting from penile or perineal trauma, due to laceration of cavernosal artery. We present a case of 24-year-old male who presented with post-traumatic painless priapism. Ultrasound showed hematoma with arterio-cavernosal fistula. On CT Angiogram, the cavernosal artery was seen arising from accessory pudendal artery, which arose from inferior epigastric artery (IEA), branch of external iliac artery (EIA). Catheter angiogram of EIA showed fistulous communication at the base of the penis from a branch of IEA. Selective embolisation of the artery was done using 33% glue (n-butyl cyanoacrylate). Post embolisation, no residual filling of the fistula and partial detumescence of penis was noted. Transarterial embolisation is usually preferred as first line of management in high-flow fistulous priapisms. [ABSTRACT FROM AUTHOR]

High-flow priapism (HFP) during childhood is a very rare condition. Low-flow priapism (LFP) is an urological emergency, but HFP is not. Thus, it is important to make a differential diagnosis between LFP and HFP. The Piesis Maneuver can be used as a physical examination for differential diagnosis between LFP and HFP, as well as to roughly locate the arteriocavernosal fistula in childhood HFPs. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 60-year-old female with a coronary arterio-pulmonary fistula, emphasizing the use of minimally invasive small-incision off-pump ligation monitored by transesophageal echocardiography (TEE). The surgical approach, performed without cardiopulmonary bypass, demonstrated successful ligation of the fistula with TEE providing real-time monitoring and evaluation of the surgery's efficacy, highlighting the safety of this method for treating coronary artery fistulas.

A 52‐year‐old female never‐smoker with an abnormal shadow in the right lung detected on radiography was referred to our institution. Contrast‐enhanced computed tomography revealed an irregular nodule in the upper lobe of the right lung, suggestive of a pulmonary vascular abnormality. Angiography revealed a direct communication between the right internal mammary artery (IMA) and the right upper lobe pulmonary artery branches, with dilated and tortuous vascular proliferation. As multiple branch arteries were seen flowing into the upper lobe from the IMA, transcatheter selective embolization of these vessels and right upper lobectomy by video‐assisted thoracoscopic surgery were performed. Contrary to the clinical diagnosis, the pathological finding was a pulmonary adenocarcinoma of the right upper lobe. Additional lymph node dissection was performed later. We report an extremely rare and unprecedented case of pulmonary adenocarcinoma fed by the right IMA, with a literature review. [ABSTRACT FROM AUTHOR]

This study aimed to report on complication management in a 58-year-old woman referred for transjugular biopsy for the evaluation of unknown liver disease. After an initial uneventful biopsy procedure, the patient complained of severe upper abdominal pain. Laboratory tests revealed increasing liver enzymes. Imaging studies depicted an iatrogenic pseudoaneurysm associated with an arterio-biliary fistula originating from the right peripheral hepatic artery. Angiography and percutaneous transarterial superselective embolotherapy was performed by means of a microcatheter and microvascular plug. Precise device positioning allowed for successful closure of the bleeding site without compromising the hepatic vasculature. [ABSTRACT FROM AUTHOR]

Transthoracic and transesophageal imaging of a 30‐year‐old patient who presented with palpitations and shortness of breath revealed flow from the aorta to the right atrium. An aortic‐right atrial fistula, which is a rare anomaly, was evaluated. As there was no acquired cause, it was considered a congenital defect. Due to the patient's being symptomatic, a percutaneous closure was performed with the Amplatzer Duct Occluder II device. [ABSTRACT FROM AUTHOR]

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively. [ABSTRACT FROM AUTHOR]

Coronary artery fistula (CAF) is a rare congenital anomaly with a reported incidence of 0.2%–0.6%. There is a wide variation in the clinical presentation depending on the size and the site of the fistula. Transcatheter closure is currently the treatment of choice in these patients. We report a case of CAF with an unusually large fistulous sac within the interventricular septum. The fistula had connections with all the three major coronary arteries, namely, left anterior descending (LAD), left circumflex , and right coronary arteries but did not have any exit resulting in to and fro movement of blood within the sac and the feeding vessels. The patient was managed successfully by transcatheter coil embolization. [ABSTRACT FROM AUTHOR]

Background Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle. Case summary We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary–left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD–LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up. Discussion Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization. [ABSTRACT FROM AUTHOR]

Background: The vital signs reflect the physiological state of patients in various clinical conditions. The purpose of this study was to compare the effects of cold compress and Xyla-P cream on hemodynamical changes during venipuncture in hemodialysis patients. Methods and Material: In this clinical trial study, 50 patients under hemodialysis were selected by simple random sampling. The patients were then randomly assigned to either Xyla-P cream, cold compress or placebo groups. The vital signs (blood pressure and pulse) were measured upon two intermittent hemodialysis sessions before and after venipuncture. Data were analyzed using repeated measures analysis of variance. Results: The mean alternation in systolic blood pressure was significantly different comparing the placebo and cold compress groups before and after intervention (p<0.001). However, the difference was not significant between the Xyla-P cream group and either placebo (p=0.402) or ice compress (p=0.698) groups. The difference of the mean diastolic blood pressure was significant comparing the placebo group with either the Xyla-P cream group (p=0.003) or cold compress group (p<0.001) before and after intervention. In addition, there was a significant difference in the mean number of heartbeats comparing the control group with either the Xyla-P cream group (p<0.001) or cold compress group (p<0.001) before and after the intervention. Conclusions: Considering the beneficial effects of ice compress and the Xyla-P cream on reduction of cardiovascular parameters, it is recommended to use these methods in hemodialysis patients during venipuncture. [ABSTRACT FROM AUTHOR]

Objectives: To identify the risk factors causing misdiagnosis by echocardiography and missed diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Materials and Methods: Echocardiographic results of 16 patients with ALCAPA confirmed by surgery in Union Hospital, Wuhan, were analyzed retrospectively. The influencing factors leading to echocardiographic misdiagnosis were analyzed from the aspects of confusing image characteristics, special pathological anatomy of the left coronary artery (LCA), and operators' working years. Results: Echocardiography diagnosed 11 cases with an accuracy rate of 68.8%. Five cases were misdiagnosed, three cases as endocardial fibroelastosis, one case as mitral prolapse with severe insufficiency, and one case as coronary‐pulmonary artery fistula. Display rate of the specific echocardiographic features for confirmed group and misdiagnosed group was statistically significantly different（P =.014）. But the working years of the operator for confirmed group and misdiagnosed group were not statistically significantly different（P =.267）. Some special pathological anatomy and pathophysiological features could be also the cause of misdiagnosis. Conclusions: Echocardiography is the first diagnostic choice of the ALCAPA in China. It is essential for the operator to have the knowledge, diagnostic awareness, and proficiency in manipulation in the accurate interpretation of echocardiography results. [ABSTRACT FROM AUTHOR]

Background The persistent trigeminal artery (PTA) is an adult carotid-basilar anastomosis with debated pathologic aspects, such as its association with brain aneurysms. True trigeminal artery aneurysms are rare vascular anomalies, reported in a few case reports. Objective To report our experience with a ruptured trigeminal artery aneurysm and to provide a systematic review of the literature in order to analyse potential links between the anatomic configuration of the PTA and PTA aneurysm (PTAA) type, and implications of each PTAA type for the diagnostic and therapeutic approach. Methods We reviewed the medical literature on trigeminal artery aneurysms according to the PRISMA guidelines. Population characteristics, aneurysms features, and PTA type and side were assessed. Results 40 previously published cases of PTAAs were included in the analysis. The mean age of subjects was 55 years, with a strong female predominance (77%). Four PTAAs were accidentally discovered, while 16 caused compressive symptoms and 20 were ruptured. Successful endovascular treatment was performed in 62% of cases. Conclusions PTAAs are rare vascular anomalies, underdiagnosed in the presence of a trigemino-cavernous fistula. Parent vessel occlusion seems to be the best therapeutic option for ruptured or symptomatic unruptured PTAAs in Saltzman type II and III PTAs. Patency of the parent vessel is the main target in Saltzman type I PTA. [ABSTRACT FROM AUTHOR]

Abstract Coronary artery fistulas are rare cardiac conditions which constitute a subgroup of anomalies of the coronary arteries. Though majority are asymptomatic, they may be associated with high prevalence of late symptoms and complications. Accurate identification of the fistulas, their hemodynamic significance and associated conditions generally influence management strategies. Dual source computed tomographic evaluation is valuable in delineating its precise morphology with identification and characterization of associated anomalies, thereby assisting in mapping the ideal treatment option. Highlights • Coronary artery fistulas are rare group of termination anomalies. • Identification and delineation is important for advocating appropriate therapy. • Dual source CT delineates its precise morphology and identifies associated anomalies. • Thus, dual source CT assists in mapping the ideal treatment option. [ABSTRACT FROM AUTHOR]

Cases of coronary to pulmonary artery fistula are seen in patients of pulmonary atresia with ventricular septal defect (VSD). These fistulas are rarely seen in patients of Tetralogy of Fallot (TOF). In this case report, we have presented ICU management of a postoperative case of TOF, with missed diagnosis of left main coronary artery (LMCA) to main pulmonary artery (MPA) fistula. [ABSTRACT FROM AUTHOR]

Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing STsegment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients. [ABSTRACT FROM AUTHOR]

Purpose: Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG).Materials and Methods: We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT.Results: MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs.Conclusions: Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs.Level Of Evidence: Level 3, local non-random sample. [ABSTRACT FROM AUTHOR]

Traumatic vessel perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). A rare consequence of this complication is a coronary-cameral fistula. The management of this condition is not well elucidated. Herein, we present such a case of symptomatic left anterior descending to the right ventricle (LAD-RV) fistula which was treated with coil embolization. [ABSTRACT FROM AUTHOR]

Background: Mutations in the LMNA gene are a common cause (6–8%) of dilated cardiomyopathy (DCM) leading to heart failure, a growing health care problem worldwide. The premature aging disease Hutchinson-Gilford syndrome (HGPS) is also caused by defined mutations in the LMNA gene resulting in activation of a cryptic splice donor site leading to a defective truncated prelamin A protein called progerin. Low levels of progerin are expressed in healthy individuals associated with ageing. Here, we aimed to address the role of progerin in dilated cardiomyopathy. Methods and results: mRNA expression of progerin was analyzed in heart tissue of DCM (n = 15) and non-failing hearts (n = 10) as control and in blood samples from patients with DCM (n = 56) and healthy controls (n = 10). Sequencing confirmed the expression of progerin mRNA in the human heart. Progerin mRNA levels derived from DCM hearts were significantly upregulated compared to controls (1.27 ± 0.42 vs. 0.81 ± 0.24; p = 0.005). In contrast, progerin mRNA levels in whole blood cells were not significantly different in DCM patients compared to controls. Linear regression analyses revealed that progerin mRNA in the heart is significantly negatively correlated to ejection fraction (r = -0.567, p = 0.003) and positively correlated to left ventricular enddiastolic diameter (r = 0.551, p = 0.004) but not with age of the heart per se. Progerin mRNA levels were not influenced by inflammation in DCM hearts. Immunohistochemistry and Immunofluorescence analysis confirmed increased expression of progerin protein in cell nuclei of DCM hearts associated with increased TUNEL+ apoptotic cells. Conclusion: Our data suggest that progerin is upregulated in human DCM hearts and strongly correlates with left ventricular remodeling. Progerin might be involved in progression of heart failure and myocardial aging. [ABSTRACT FROM AUTHOR]

Branch pulmonary artery stenosis is one of the most common complications late after the arterial switch operation. The pathophysiology of stenosis in these circumstances is very different to that encountered in with normally related great vessels. The LeCompte manoeuvre leaves the pulmonary arteries straddled and stretched over the aortic root which contributing significantly to the degree of stenosis encountered. Unilateral branch pulmonary artery stenosis rarely leads to significant symptoms in young patients with biventricular repairs; however, significant discrepancies in the split flows between right and left lung may place the patient in an unfavourable physiological position as they move in to middle age. Balloon expandable stent implantation distorts the anatomical arrangement of the LeCompte and is associated with negative interactions with the often dilated aortic root. We present three cases of the use of flexible self-expanding stents to improve the physiological flow distributions to each lung whilst hopefully decreasing the risk of erosion and perforation or fistula formation related to the pulmonary artery. All three patients had uncomplicated procedures with significant improvements in vessel diameter and flow distribution noted on follow-up MRI scans. This is the first report of the use of self-expanding stents in the context of branch pulmonary artery stenosis after the LeCompte manoeuvre. Theoretically and based on our early experience, this technique provides potential safety advantages over the use of more traditional balloon expandable stents. [ABSTRACT FROM AUTHOR]

An undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor levels is an acknowledged obstacle to CVD prevention. In this paper, we present the hypothesis that the vasculature's robustness against risk factor load will complement conventional risk factor models as a novel stratifier of risk. Figuratively speaking, mortality risk prediction without robustness scoring is akin to predicting the breaking risk of a lake's ice sheet considering load only while disregarding the sheet's bearing strength. Taking the cue from systems biology, which defines robustness as the ability to maintain function against internal and external challenges, we develop a robustness score from the physical parameters that comprehensively quantitate cardiovascular function. We derive the functional parameters using a recently introduced novel system, VascAssist 2 (iSYMED GmbH, Butzbach, Germany). VascAssist 2 (VA) applies the electronic-hydraulic analogy to a digital model of the arterial tree, replicating non-invasively acquired pule pressure waves by modulating the electronic equivalents of the physical parameters that describe in vivo arterial hemodynamics. As the latter is also subject to aging-associated degeneration which (a) progresses at inter-individually different rates, and which (b) affects the biomarker-mortality association, we express the robustness score as a correction factor to calendar age (CA), the dominant risk factor in all CVD risk factor models. We then propose a method for the validation of the score against known time-to-event data in reference populations. Our conceptualization of robustness implies that risk factor-challenged individuals with low robustness scores will face preferential elimination from the population resulting in a significant robustness-CA correlation in this strata absent in the unchallenged stratum. Hence, we also present an outline of a cross-sectional study design suitable to test this hypothesis. We finally discuss the objections that may validly be raised against our robustness hypothesis, and how available evidence encourages us to refute these objections. [ABSTRACT FROM AUTHOR]

A case study is present in which a A 29-year-old pregnant woman suffering from diabetes was diagnosed with congenital defect known as coronary artery fistula (CAF). It notes that the fetal echocardiography revealed dilated left coronary artery. The article mentions the delivery of a female infant through cesarean section and that the infant was detected patent ductus arteriosus (PDA). The case also mentions the surgery of the fistula and PDA.

Objective To find evidence of autonomic imbalance and present the heart rate variability (HRV) parameters that reflect the severity of paroxysmal sympathetic hyperactivity (PSH) in children with acquired brain injury (ABI). Methods Thirteen children with ABI were enrolled and age- and sex-matched children with cerebral palsy were selected as the control group (n=13). The following HRV parameters were calculated: time-domain indices including the mean heart rate, standard deviation of all average R-R intervals (SDNN), root mean square of the successive differences (RMSSD), physical stress index (PSI), approximate entropy (ApEn); successive R-R interval difference (SRD), and frequency domain indices including total power (TP), high frequency (HF), low frequency (LF), normalized HF, normalized LF, and LF/HF ratio. Results There were significant differences between the ABI and control groups in the mean heart rate, RMSSD, PSI and all indices of the frequency domain analysis. The mean heart rate, PSI, normalized LF, and LF/HF ratio increased in the ABI group. The presence of PSH symptoms in the ABI group demonstrated a statistically significant decline of the SDNN, TP, ln TP. Conclusion The differences in the HRV parameters and presence of PSH symptoms are noted among ABI children compared to an age- and sex-matched control group with cerebral palsy. Within the ABI group, the presence of PSH symptoms influenced the parameters of HRV such as SDNN, TP and ln TP. [ABSTRACT FROM AUTHOR]

We present the first case of an arteriovenous fistula after an all-inside anterior cruciate ligament (ACL) reconstruction. A seventeen-year-old boy had an uneventful ACL reconstruction. Four weeks after surgery, the patient was seen with a pulsating swelling at the lateral distal upper leg. Vascular consultation led to the diagnosis of pseudoaneurysm and arteriovenous fistula of the lateral superior genicular artery. Most likely, fistula is caused by the stab incision for preparation of the femoral tunnel, and no anatomical cause was found. The clinical presentation, previous cases of arteriovenous fistula after arthroscopic ACL reconstruction, possible causes, and management are discussed. [ABSTRACT FROM AUTHOR]

In cases of pulmonary atresia with ventricular septal defect ( PA- VSD), coronary-pulmonary arterial fistula ( CPAF) as the main source of pulmonary blood supply is extremely rare. These fistulae may arise from the left coronary artery, right coronary artery, or a single coronary artery. Fistulae from a single coronary artery are unusual. We are reporting a case of PA- VSD with single coronary artery and CPAF as the main source of pulmonary supply in addition to two major aortopulmonary collateral arteries ( MAPCAS). Successful surgical correction with VSD closure and right ventricle ( RV) to the pulmonary artery ( PA) conduit was made. [ABSTRACT FROM AUTHOR]

Spinal vascular malformations are uncommon yet important spinal pathologies commonly classified in congenital and acquired lesions. Spinal lipomas consist of three subtypes: intramedullary lipomas, lipomyelo(meningo)celes and lipomas of the filum. Although the association of spinal arteriovenous malformations (AVM) with other congenital anomalies is well known, the coexistence of dural arteriovenous fistulas (AVF) and tethered spinal cord is exceptionally rare and only eight cases have been reported. We present two cases from our institution and speculate on the possible origin of such a rare but insidious association. We review the current literature with a focus on possible pitfalls in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

We report a case of tentorial dural arteriovenous fistula (DAVF) with a severe intracranial hemorrhage occurring after Onyx embolization. A 40-year-old man presented with an asymptomatic tentorial DAVF on angiography. Transarterial embolization with Onyx was performed via the middle meningeal artery, and the cast filled the fistula itself and its proximal draining vein. Postoperative angiography confirmed complete occlusion of the DAVF. A computed tomography scan performed immediately after the procedure demonstrated an acute subdural hematoma with the temporal hemorrhage. Emergency craniotomy revealed continuous arterial bleeding from a viable glomus-like vascular structure around the proximal part of the embolized draining vein, fed by a pial artery arising from the posterior cerebral artery. Pathologic findings suggested diagnosis of vascular malformation extending into the subdural space. Tentorial DAVFs can extend to the subdural space along their drainage route, and may be involved in severe hemorrhagic complications of curative endovascular treatment using Onyx, particularly those with pial arterial supply. [ABSTRACT FROM AUTHOR]

Background: While journals and reporting guidelines recommend the presentation of confidence intervals, many authors adhere strictly to statistically significant testing. Our objective was to determine what proportions of not statistically significant (NSS) cardiovascular trials include potentially clinically meaningful effects in primary outcomes and if these are associated with authors' conclusions.Methods: Cardiovascular studies published in six high-impact journals between 1 January 2010 and 31 December 2014 were identified via PubMed. Two independent reviewers selected trials with major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death) as primary outcomes and extracted data on trial characteristics, quality, and primary outcome. Potentially clinically meaningful effects were defined broadly as a relative risk point estimate ≤0.94 (based on the effects of ezetimibe) and/or a lower confidence interval ≤0.75 (based on the effects of statins).Results: We identified 127 randomized trial comparisons from 3200 articles. The primary outcomes were statistically significant (SS) favoring treatment in 21% (27/127), NSS in 72% (92/127), and SS favoring control in 6% (8/127). In 61% of NSS trials (56/92), the point estimate and/or lower confidence interval included potentially meaningful effects. Both point estimate and confidence interval included potentially meaningful effects in 67% of trials (12/18) in which authors' concluded that treatment was superior, in 28% (16/58) with a neutral conclusion, and in 6% (1/16) in which authors' concluded that control was superior. In a sensitivity analysis, 26% of NSS trials would include potential meaningful effects with relative risk thresholds of point estimate ≤0.85 and/or a lower confidence interval ≤0.65.Conclusions: Point estimates and/or confidence intervals included potentially clinically meaningful effects in up to 61% of NSS cardiovascular trials. Authors' conclusions often reflect potentially meaningful results of NSS cardiovascular trials. Given the frequency of potentially clinical meaningful effects in NSS trials, authors should be encouraged to continue to look beyond significance testing to a broader interpretation of trial results. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). Materials and Methods: We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Results: Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. Conclusion: MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning. [ABSTRACT FROM AUTHOR]

This present study was applied on shovelnose ray fish (Glaucostegus Typus) to the anatomical features of gills and its vascular networks (arterio-arterial pathway) within the gill . Twleve fresh specimens were used by applying the intravascular injection technique with red colored latex or Urographin to study the gill vasculature. Fish gills consisted of five pairs of gill arches, opened externally by five branchial slits; each arch supported by a double row of gill filaments along its lateral convex border except the 1st arch had one posterior row. The gill arches were supported by a complete interbranchial septum. The arterioarterial (respiratory) pathway consists of the afferent, the lamellar, the filamental and the efferent segments of the branchial arteries. [ABSTRACT FROM AUTHOR]

A coronary-pulmonary artery fistula with giant aneurysmal dilatation is an extremely rare clinical constellation. The natural course of this disease and the incidence of complications are unknown. Hence, optimal treatment, particularly in asymptomatic patients, is still a matter of debate. Here we report a case of a 71-year-old asymptomatic woman with a diastolic murmur. Comprehensive cardiovascular assessments including cardiac computed tomography and invasive coronary angiography revealed a coronary-pulmonary artery fistula with giant aneurysmal dilatation. The patient was managed conservatively and has now been followed up for 5 years without any events. [ABSTRACT FROM AUTHOR]

Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery. [ABSTRACT FROM AUTHOR]

It has long been held as conventional wisdom that urogenital fistulae in low-income and middle-income countries are almost exclusively of obstetric aetiology, related to prolonged neglected obstructed labour, whereas those seen in high-income countries are largely iatrogenic in nature. There is, however, a growing perception amongst those working in the field that an increasing proportion of urogenital fistulae in low-income and middle-income countries may be iatrogenic, resulting from caesarean section. Recent studies suggest that adverse patterns of care may also be emerging in high-income countries; an increase in the risk of both vesicovaginal and ureterovaginal fistulae following hysterectomy has been reported, concurrently with the reduction in overall use of the procedure. These apparent secular trends are discussed in the context of evolution of practice, teaching and training in obstetrics and gynaecology. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients. The most favourable effects of lifestyle changes on success of rhythm control have been demonstrated in obese patients with AF. Differences in genotype may also play an important role. Common gene variants have been associated with recurrence of AF after electrical cardioversion, antiarrhythmic drug therapy and catheter ablation. Therefore, both phenotyping and genotyping may become useful for patient selection in the future. Beside the choice of rate or rhythm control, and type of rhythm control, prevention of complications associated with AF may also differ depending on genotype and phenotype. Efficacy of stroke prevention has been well established, but bleeding remains a clinically relevant problem. Risk stratification is still cumbersome, especially in low-risk patients and in those with a high bleeding risk. The decision whether to start anticoagulation (and if so which type of anticoagulant) or, alternatively, to implant an occlusion device of the left atrial appendage may also be improved by genotyping and phenotyping. In this review, we will summarize new insights into the roles of phenotype and genotype in generating more tailored treatment strategies in patients with AF and discuss several patient-tailored treatment options. [ABSTRACT FROM AUTHOR]

We describe the repair of an acute aorto-pulmonary artery fistula in a 82-year-old patient with a ruptured aortic arch aneurysm using a frozen elephant trunk technique. [ABSTRACT FROM AUTHOR]

In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's). [ABSTRACT FROM AUTHOR]

A 68-year-old male patient presented with chief complaints of chest pain and dyspnea on exertion. On physical examination, his pulse was regular at 82 bpm and blood pressure was 140/80 mmHg. Resting electrocardiography (ECG) was within normal limit and chest X-ray also did not reveal any significant abnormality. Routine blood investigations were unremarkable; transthoracic echocardiography also did not show any significant abnormality. Catheter coronary angiography revealed severe triple vessel disease and showed possibility of coronary artery fistula. Computed tomography (CT) coronary angiography showed three aberrant branches arising from right and left coronary arteries forming a sac which subsequently opened into the main pulmonary artery. [ABSTRACT FROM AUTHOR]

Left atrial myxoma is the common benign tumor of heart. Coronary arteries may supply these tumor. Considering the vascular nature of the tumor, acquired coronary cameral fistula(CCF) can be a possibility postexcision of the left atrial myxoma. Here, we discuss a case of 53-year-old female patient, who developed acquired CCF, following excision of the tumor and the role of transesophageal echocardiography intraoperatively in diagnosis. [ABSTRACT FROM AUTHOR]

Background: Coronary artery fistula and single coronary artery are two different rare congenital anomalies. The cases with co-existed the two anomalies are more rare. To the best of our knowledge with literature review, the coronary artery fistula between single right coronary artery and right pulmonary artery has not been previously reported.Case Presentation: In the present article, we report a Chinese patient (a 8-month-old male) who presented cyanosis when cried and heart murmur. The cardiac angiography confirmed coronary artery fistula between single coronary artery arising from the right aortic sinus and right pulmonary artery. Furthermore, the right pulmonary artery was interrupted with main pulmonary artery and the pulmonary blood supplied by single right coronary artery. Following the surgical procedure, the anomalous fistula vessel was cut and sutured. The right pulmonary artery was reconstructed to connect with main pulmonary artery. The patient had an uneventful postoperative course and discharged. Then we reviewed the related literature with Medline and Pubmed databases for further details.Conclusion: We believe our patient is the very particular case about coronary artery fistula combined with single coronary artery, and it is first reported with our literature review. As other coronary anomalies, coronary or aortic root angiography is the gold standard method for the diagnosis. Furthermore, early surgery is an optimal treatment in our case. [ABSTRACT FROM AUTHOR]

Background Emerging studies have assessed the association between secondhand smoke (SHS) exposure and cardiovascular disease (CVD) as well as all-cause mortality. However, findings were not consistent due to the heterogeneity of study characteristics. Methods PubMed and Embase were searched through May 2014 for prospective cohort and case–control studies investigating the associations of SHS exposure in never smokers with all-cause mortality and the risk of CVD. The main analysis was performed in studies using self-reported SHS exposure and secondary analysis was performed in studies using objectively measured SHS exposure. Summary estimates were calculated using random-effects models. Results Twenty-three prospective and 17 case–control studies were included. The pooled relative risks (RR) for never smokers exposed to SHS in comparison with those unexposed were 1.18 [95% confidence interval (CI): 1.10–1.27] for all-cause mortality (12 studies), and 1.23 (1.16–1.31) for CVD (38 studies). The association of SHS exposure with CVD was markedly stronger among studies conducted in China (RR = 1.65, 95% CI 1.27–2.13) than that in the US (RR = 1.09, 95% CI 1.03–1.16). Studies using objectively measured SHS exposure demonstrated a slightly higher risk for CVD compared with those using self-reported SHS exposure. Conclusions Exposure to SHS significantly increased the risk for all-cause mortality and CVD. The risk associated with SHS exposure was large in China while the risk was only modest in the US. Studies using objectively measured SHS exposure may yield a higher risk of CVD than those using self-reported SHS exposure. [ABSTRACT FROM AUTHOR]

Acute onset of digital ischemia and infarction is an unusual complication in patients undergoing hemodialysis. This is a report of a patient on regular hemodialysis who presented with acute distal extremity ischemia, progressing to digital infarction and on evaluation was found to have thrombosis of brachial arteriovenous fistula with embolization to the distal arteries causing digital artery occlusion. [ABSTRACT FROM AUTHOR]

The reconstruction of vascular access in patients with kidney allograft failure is a challenging problem. A case of a 62-year-old man with transplanted kidney insufficiency is described. The patient was initially dialyzed with a wrist radial-cephalic arteriovenous fistula. In the post-transplantation period, the enormously dilated venous part of the anastomosis was ligated and the part of the vein suspected of being the source of bacteremia was excised. The man was referred to our department due to kidney allograft failure for vascular access creation. During preoperative assessment, we unexpectedly found a soft thrill on the forearm. Doppler ultrasound confirmed fistula patency, although the blood supply was not sufficient to perform dialysis. Angiography showed the blood flow from the radial artery to the cephalic vein, through a complicated vessel system consisting of inter alia a dilated vein of the subcutaneous venous network. We successfully used this vein as the vascular access outflow for fistula recreation. In conclusion, making use of veins of the subcutaneous venous network of the forearm for creation of a native fistula should be considered in selected cases. [ABSTRACT FROM AUTHOR]

Oats ( Avena sativa L.) were revaluated in recent years as a promising crop for improving the nutritional quality of foods, due to their richness in many bioactive compounds, including phenols. These plant secondary metabolites are useful as radical scavenging, and also possess positive biochemical effects against cardiovascular diseases, cancer growth and age-related diseases. Twenty oat cultivars were analyzed for their soluble phenol content (SPC, ranging 0.78–1.09 g GAE /kg d.m.) and total antioxidant capacity (TAC, ranging 13.99–18.84 mmol TE/kg d.m.). In another experiment, the kinetics of SPC accumulation and TAC in the immature grains of five oat cultivars revealed a marked decrease of both parameters (−48.9% and −72.1%, respectively) from ten days after anthesis to maturity. These results could suggest a possible use of immature oat grains in human nutrition, as it was already proposed for other cereals. [ABSTRACT FROM AUTHOR]