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Transcatheter correction of sinus venosus defects (SVD) with covered stent has recently emerged, with promising results, as an alternative to surgery. Our aim was to assess the feasibility and diagnostic value of 4D flow MRI in patients who underwent transcatheter repair of SVD. Since may 2023, we scanned 16 patients who underwent transcatheter repair of SVD with cardiac magnetic resonance (CMR) including a 4D Flow MR sequence, using a 1.5T magnet. For all patients, balanced steady-state free precession (bSSFP) cine images were obtained for evaluation of left and right ventricle (RV) volumes and function. Coronal ECG-gated 4D flow MR sequences were performed, with complete thoracic coverage. Global objective was, by a visual and quantitative analysis, to detect abnormal flow patterns and location of persistent shunts (PS). Pulmonary-to-systemic flow ratios (Qp/Qs) and RV end-diastolic volume indexed (RVEDVi) were also measured. CMR and 4D Flow MR were feasible and assessed global success of the procedure in all 16 patients. RVEDVi decreased in all patients. Average Qp/Qs was 1.24 (± 0.33), with RVEDVi of 77 mL/m2 (± 21). Qp/Qs measured by catheterization, 4D Flow MR and RV/LV stroke volume ratio were well correlated. Twelve out of 16 patients (75%) had no significant PS with Qp/Qs < 1.5, including 8 patients without any PS at all. Four patients showed significant shunting with Qp/Qs > 1.5. PS visual analysis provided valuable insights into the understanding and the mechanism analysis of the PS. We demonstrated the feasibility of 4D Flow MRI in all patients who had undergone transcatheter correction of SVD. 4D flow MRI accurately identified PS with comprehensive visualization of their location and mechanism, providing valuable information for their follow-up and to further discuss reintervention. Qp/Qs ratio assessment using 4D Flow data showed good correlation compared to other functional measurements. [ABSTRACT FROM AUTHOR]

Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults. This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort. A prospective, single-center cohort study included 2,253 consecutive patients (median age 28 years; children: n = 865, 38.4%) who underwent transcatheter ASD closure with the Amplatzer Septal Occluder (ASO; Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago, USA) from May 1998 to December 2021. Peri-procedural data associated with major adverse events were investigated retrospectively. The mean ASD diameter, as measured by transthoracic echocardiography, was 18 mm. About 8.9% of patients had an ASD size-to-body surface area (BSA) ratio of ≥ 20 mm/m2. Deficient rims (< 5 mm) were identified in 27.9% of patients, with retroaortic rim deficiency in 22.7% and inferior rim deficiency in 0.9%. The median ASO diameter was 24 mm, with a procedural success rate of 98.2%. ASD/BSA ≥ 20 mm/m2 was associated with procedural failure, while age and weight were not. Major peri-procedural adverse events occurred in 31 patients (1.4%), with 19 device embolizations and 2 cardiac erosions. No peri-procedural deaths were reported. Multivariate analysis showed that deficiency of the inferior vena cava rim and an ASD size/BS ratio ≥ 20 mm/m2 were significantly associated with major adverse events (P = 0.002 and P = 0.035, respectively) (Fig. 1). Transcatheter osASD closure using ASO is safe and effective in a large spectrum population with low rate of peri-procedural adverse events and favorable short-term outcomes. ASD size-to-body surface area ratio (≥ 20 mm/m2) and inferior rim deficiency are key morphological risk markers for major adverse events following this procedure. [ABSTRACT FROM AUTHOR]

Percutaneous treatment of para-prosthetic valve leaks (PVL) is an alternative to redo surgery. Based on the clinical case of an unusual aortic para-prosthetic leak closure (PVLc), are presented successively the diagnostic difficulties of PVL, the modalities of therapeutic choice, the main technical steps of PVLc followed by a review of results and complications., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de lien d'intérêt avec cet article., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Hereditary transthyretin (ATTRv) p.Val142Ile (V122I) mutation is the most common inherited cause of cardiac amyloidosis and little is known about the phenotype and outcome of the rare homozygotic genotype. This study aimed to compare phenotypic characteristics and outcomes between heterozygous and homozygous patients with ATTRv V122I amyloidosis., Material and Methods: This monocentric, observational, retrospective study conducted at the French National Referral Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil), described clinical, electrocardiographic, cardiac imaging features and prognostic data for patients with ATTRv V122I amyloidosis., Results: Among 185 ATTRv V122I patients identified, 161 were heterozygous and 24 were homozygous. The homozygous frequency was 13%. Onset occured significantly earlier in the homozygotes compared to heterozygotes with earlier median age at diagnosis (67[63-71] years vs 76[70-79] years, p  < .001), age at first cardiac symptom (66[61-71] years vs 74[68-78] years, p  < .001) and age at first extracardiac symptom (59[52-70] years vs 69[62-75] years, p  = .003). Homozygous ATTRv V122I was also associated with greater disease burden with earlier events (death, transplant or hospitalisation for acute heart failure) compared with heterozygotes (71[67-74] vs 78[76-79] years, p  = .018)., Conclusion: This rare, homozygous V122I cohort confirmed the earlier age of onset, death and cardiac events in this population.

Background: Screening for silent coronary artery disease in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of coronary artery disease., Methods: The aim of this study was to investigate the incremental value of resting left ventricular (LV) global longitudinal strain (GLS) for the prediction of positive results on stress (exercise or dobutamine) transthoracic echocardiography in 273 consecutive asymptomatic high-risk patients with DM. Positive results on stress transthoracic echocardiography were defined as stress-induced LV wall motion abnormalities (new or worsening preexisting abnormalities)., Results: Compared with patients with negative stress results, those with positive stress results (n = 28 [10%]) more frequently had cardiovascular risk factors, complications of DM, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus, and worse resting LV GLS (-16.7 ± 2.9% vs -19.0 ± 1.9%, P < .001). On multivariable logistic regression analysis, DM duration > 10 years, diabetic retinopathy, LV hypertrophy, and impaired LV GLS (odds ratio, 1.39 [95% CI, 1.14-1.70] per percentage increase; odds ratio, 5.16 [95% CI, 1.96-13.59] for LV GLS worse than -18%) were independently associated with positive results on stress transthoracic echocardiography. The area under the curve to predict positive results was 0.74 for LV GLS with a cutoff of -18.0% (sensitivity 68%, specificity 78%). The area under the curve of the multivariable model to predict test results was improved by the addition of LV GLS (P < .001), with a bias-corrected area under the curve after bootstrapping of 0.842 [95% CI, 0.753-0.893]., Conclusions: The present findings show that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from coronary artery disease screening., (Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Takotsubo syndrome (TTS) is a reversible cardiomyopathy. Little is known regarding its basal form and possible complications., Case Summary: A 31-year-old woman with no medical history was hospitalized for attempted suicide by ingestion of cocaine, benzodiazepine, and methadone. Initially, the patient received intensive care for coma and bradypnoea. After naloxone administration, the neurological situation improved, but the patient developed acute pulmonary oedema. Transthoracic echocardiography (TTE) revealed left ventricular systolic dysfunction with the basal wall's akinesia associated with moderate to severe restrictive mitral regurgitation. Global longitudinal strain (GLS) was impaired mainly in the basal segments. A coronary computed tomography ruled out coronary artery disease. Symptoms improved quickly under diuretic treatment. Transthoracic echocardiography at Day 6 showed improved basal wall contraction, with a left ventricular ejection fraction (LVEF) of 50% and moderate mitral regurgitation. TTE at Day 30 confirmed the diagnosis of myocardial infarction with non-obstructive coronary arteries related to a basal TTS after complete recovery of the LVEF, normalization of the wall motion and GLS, and the absence of residual mitral regurgitation., Discussion: We report a case of acute pulmonary oedema due to basal TTS complicated by severe transient mitral regurgitation associated with moderate left ventricular dysfunction. Measuring strain by speckle-tracking can be useful to diagnose and monitor this entity. The use of coronary computed tomography is informative in young patients to rule-out coronary artery disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)