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To produce a high quality article for physicians that reviews the current literature pertaining to NOAC's, in particular, their use in clinical practice, known drug interactions and side effect profile. Medline, Cochrane and PubMed databases were searched for the most recent and clinically sound articles pertaining apixaban, rivaroxaban and dabigatran. Researchers found the trials for each of these NOAC's to be sound and have results that can be translated into clinical practice.

Artificial intelligence (AI) is an overarching term that encompasses a set of computational approaches which are trained through generalised learning to autonomously execute specific tasks. AI is a rapidly expanding field in medicine. In particular cardiology, with its high reliance on numerical patient data in decision making, has great potential to benefit from AI. Types of AI, including neural networks and computer vision can dramatically change the day-to-day workflow of cardiologists, primarily through integration in diagnostic imaging modalities, peri-procedural planning, electronic health record analysis and patient monitoring. Health care systems will undoubtedly become more automated and shift to more AI driven methods to improve efficiency and reduce cost. Patients in the end will benefit from these changes with improved diagnostic accuracy, better tailored treatments resulting in a greater quality and quantity of life. In this article we will describe some of the fundamental principles underlying AI that physicians should have an understanding of, along with current clinical applications. This article is protected by copyright. All rights reserved.

Aortic stenosis (AS) of moderate or greater severity has an estimated prevalence of 5% in people older than 65 years. Survival is poor after onset of symptoms, and surgical aortic valve replacement was the gold-standard treatment for decades. However, more than one-third of patients with symptomatic AS were untreated due to high surgical risk, exposing a clinical need for a less invasive therapy for aortic valve stenosis. The PARTNER trials were pivotal in presenting robust evidence for the safety, feasibility, and efficacy of transcatheter aortic valve replacement in the management of AS and paved the way for clinical use worldwide.

Moderate or severe aortic regurgitation (AR) occurs in 0.5% of the population and typically peaks in the fourth to sixth decade of life. A significant proportion of patients have prohibitive surgical risk and are therefore treated medically with pharmacological management of heart failure and no definitive treatment of the underlying valvular pathology. Transcatheter aortic valve replacement (TAVR) has been used in an off-label setting to treat AR to attempt to reduce mortality and improve quality of life with varying levels of success. New-generation TAVR devices currently used in AS have demonstrated safety and feasibility when used in patients with AR. Novel TAVR devices dedicated for use in AR are being developed and early studies demonstrate promising results. Ongoing studies with larger clinical trials and novel methods of device anchoring are required, which if positive, will in turn lead to commercial approval and reimbursement, eventually making TAVR ready for use in AR.

A 36-year-old female underwent left lower lobectomy with left atrial and left upper pulmonary vein (LUPV) reconstruction with a bovine pericardial patch for an intrathoracic pheochromocytoma. Postoperatively, she developed shortness of breath and transesophageal echocardiography demonstrated LUPV stenosis with increased velocities. Computed tomography angiogram of the chest revealed LUPV stenosis at the left atrium ostium with an area of 39 mm2. Under angiographic and echocardiographic guidance, a 10 × 19 mm Omnilink Elite uncovered stent was deployed in the LUPV ostia. While reported following left atrial ablation, pulmonary vein stenting can be successful in a pulmonary vein surgically reconstructed with bovine pericardium.

Mitral regurgitation (MR) is a valvular heart disease associated with significant morbidity and mortality. Transcatheter mitral valve intervention (TMVI) repairs or replaces the mitral valve through small arterial and venous entry sites and so avoids risks associated with open heart surgery. Transcatheter devices targeting components of the mitral apparatus are being developed to repair or replace it. Numerous challenges remain including developing more adaptable devices and correction of multiple components of the mitral annulus to attain durable results. The mitral valve apparatus is a complex structure and understanding of the mechanisms of MR is essential in the development of TMVI. There will likely be a complementary role between surgery and TMVI in the near future.

Background Three-dimensional (3D) printing of cardiac fistulae allows for immediate understanding of their complex courses and anatomical relations. Models can be used to improve patient understanding, enhance the consenting process, facilitate communication between multidisciplinary staff at heart team meetings, and help plan surgical or percutaneous interventions. Case summary We report four cases where 3D printed models were used as an adjunct with traditional measures in treating patients with complex cardiac fistulae. Discussion In our cases, overall patient understanding was improved, staff at heart team meetings were more aware of anatomical anomalies and perioperatively planning saw adjustments made that may have ultimately benefited patient outcome. Our cases highlight the additional benefit that 3D printed models can play when treating patients with complex cardiac fistulae.

Coronary artery disease (CAD) is the leading single cause of death in Australia affecting around 1.4 million people. Coronary computed tomography angiography has an established role in the assessment of patients with low to intermediate pretest probability for CAD who have chest pain and is typically used with the aim to rule out significant coronary artery stenosis. Use was initially limited because of concerns over radiation exposure, a Medicare rebate restricted to specialist referrals and an absence of data supporting its use as an alternative to functional testing in patients with chest pain. Recent advances in scanner technology and image sequencing, along with data from randomised control trials, have addressed these issues and indicate that coronary computed tomography angiography will play a greater role in the assessment of CAD in the coming years.

Right heart catheterisation (RHC) is a minimally invasive procedure that provides direct haemodynamic measurement of intracardiac and pulmonary pressures. It is the gold standard investigation for the diagnosis and management of pulmonary hypertension. This article will describe how to perform right heart catheterisation, indications and contraindications.

Purpose: To present a position statement from the Hematology/Oncology Pharmacy Association (HOPA) that pertains to dose rounding of biologic and cytotoxic anticancer agents. Methods: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to examine the safety and value of dose rounding of biologic and cytotoxic anticancer agents. Primary literature that describes methods for dose rounding, with clinical or economic data, were analyzed. Relevant pharmacokinetic characteristics and aspects of product formulation were considered. Issues for institutional application were addressed. Results: Rounding of biologic and cytotoxic agents within 10% of the ordered dose is designated as acceptable for routine clinical care. Dose changes ≤ 10% are not expected to reduce the safety or effectiveness of therapy. The rounding amount—10%—is rational in the context of standard dose adjustments for patient tolerance and tumor response (≥ 20%), clinical trial deficiency criteria (> 10%), and the influence of interpatient pharmacokinetic variability. HOPA supports the use of the same threshold for dose rounding of anticancer drugs as that used for palliative and curative therapy. Potential exceptions to dose rounding are discussed. Conclusion: Dose rounding reduces waste and health care costs. HOPA recommends that each institution develop its own dose-rounding policy that addresses biologic and cytotoxic agents. Institutional guidelines for dose rounding of anticancer agents, including criteria for automatic dose rounding, the allowable percentage, and institutional processes for operationalizing and documenting dose rounding, should be determined by collaborative stakeholder consensus. Exceptions to dose rounding should be determined a priori. Additional studies that evaluate the impact of dose rounding on patient outcome are warranted.

Mitral regurgitation (MR) is a valvular heart disease associated with significant morbidity and mortality. Transcatheter mitral valve intervention (TMVI) repairs or replaces the mitral valve through small arterial and venous entry sites and so avoids risks associated with open heart surgery. Transcatheter devices targeting components of the mitral apparatus are being developed to repair or replace it. Numerous challenges remain including developing more adaptable devices and correction of multiple components of the mitral annulus to attain durable results. The mitral valve apparatus is a complex structure and understanding of the mechanisms of MR is essential in the development of TMVI. There will likely be a complementary role between surgery and TMVI in the near future.

A 66-year-old female with a history of hypertension presented for an elective transthoracic ultrasound. The study revealed normal left and right ventricular size and function and an echogenic band running along a normally sized left atrium. Subsequently a transesophageal echocardiogram (TEE) was organised which revealed a thin partial membrane arising from the roof of the left atrium (LA) and extending across to the interatrial septum (IAS) ( Fig. 1A, B, C and D ). Colour Doppler imaging revealed unidirectional, laminar flow through the membrane ( Fig. 1E and F). The remainder of the study was unremarkable, with normal left and right ventricular function and absent valvular pathology.

Background Transcatheter pulmonary valve implantation (TPVI) with the Melody® transcatheter pulmonary valve (TPV) has demonstrated good haemodynamic and clinical outcomes in the treatment of right ventricular outflow tract (RVOT) conduit dysfunction in patients with repaired congenital heart disease CHD. We present the first Australian single centre experience of patients treated with Melody TPV. Method A prospective, observational registry was developed to monitor clinical and haemodynamic outcomes in patients with RVOT dysfunction treated with the Melody TPV (Medtronic Inc, Minneapolis, United States). Results Seventeen patients underwent TPVI with Melody TPV at The Prince Charles Hospital between January 2009 and February 2016 with a median (range) age of 34 (R: 15–60). Fifteen (88%) were NYHA Class 2 dyspnoea and 11 (59%) had corrected Tetralogy of Fallot. Indication for TPVI was stenosis in eight (47%), regurgitation in two (12%) and mixed dysfunction in seven (41%). Device implantation was successful in all patients. Peak RVOT gradient was significantly reduced and there was no significant regurgitation post procedure. There was one (6%) major procedural adverse event and two (12%) major adverse events at last recorded follow-up. There were no patient deaths. Follow-up cardiac magnetic resonance imaging revealed a significant reduction in indexed right ventricular end diastolic volume. Conclusion This study confirms the safety and effectiveness of TPVI with Melody TPV for RVOT dysfunction in repaired CHD.

We report a case of a man in his 40s presented to the emergency department twice, 1 month apart, with severe ischaemic sounding chest pain within 1 h of smoking marijuana on both occasions. He had elevated serial biomarkers and ischaemic electrocardiogram changes. His coronary angiograms on both episodes were entirely normal along with normal echocardiogram. This potentially suggests a coronary vasospasm as an underlying mechanism for these non-ST elevation myocardial infarctions. This should alert clinicians and the public alike to this potential risk of cannabis use.

Here, we describe a case of a successful percutaneous insertion of a transcatheter 29 mm Edwards Sapien XT valve into a tricuspid valve in a patient with repaired tetralogy of fallot. Similar procedures have been performed with the Edwards Sapien valve and Melody valves; however, this is the first case described in the literature of an Edwards Sapien valve used in a patient with Tetralogy of Fallot. With procedural safety being demonstrated, this case illustrates an important alternative treatment option for patients with congenital heart disease. Although long-term data is required to compare its efficacy with surgically replaced valves, percutaneous procedures can serve as a delay to surgical valve replacement which over a patients’ lifetime with congenital heart disease, can minimise the amount of invasive surgeries and potential complications.

Prasugrel and ticagrelor are two new antiplatelet agents being used in the management of acute coronary syndromes. The number of patients in the community managed on these medications is growing, and thus, it is essential that general practitioners have a good understanding of these agents and their evidence-based applications.The pharmacokinetic and pharmacodynamic properties of common and new antiplatelet agents will be reviewed, along with the evidence supporting their use. Safety and side effect profiles will be discussed, and some common general practice case scenarios presented.Aspirin is still the mainstay of therapy in patients with acute coronary syndromes. The addition of clopidogrel, prasugrel or ticagrelor can reduce morbidity and mortality in selected patients. Patient factors including bleeding risk, renal function and time since coronary stent insertion must be reviewed before these agents are initiated and before making any changes to the medication regimen.