Novel technique of sutureless pulmonic valve replacement for quadricuspid pulmonic valve with huge pulmonary artery aneurysm

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Identification of Distinct Subgroups in Moderately Severe Rheumatic Mitral Stenosis Using Data-Driven Phenotyping of Longitudinal Hemodynamic Progression

Background Rheumatic mitral stenosis is a significant cause of valvular heart disease. Pulmonary arterial systolic pressure (PASP) reflects the hemodynamic consequences of mitral stenosis and is used to determine treatment strategies. However, PASP progression and expected outcomes based on PASP changes in patients with moderately severe mitral stenosis remain unclear. Methods and Results A total of 436 patients with moderately severe rheumatic mitral stenosis (valve area 1.0-1.5 cm2) were enrolled. Composite outcomes included all-cause mortality and hospitalization for heart failure. Data-driven phenotyping identified 2 distinct trajectory groups based on PASP progression: rapid (8.7%) and slow (91.3%). Patients in the rapid progression group were older and had more diabetes and atrial fibrillation than those in the slow progression group (all P40 mm Hg was independently associated with allocation to the rapid progression group (odds ratio, 4.95 [95% CI, 2.08-11.99]; P40 mm Hg.ope

Cancer Therapy-Related Cardiac Dysfunction in Patients Treated with a Combination of an Immune Checkpoint Inhibitor and Doxorubicin

Backgrounds: There are scarce data on whether immune checkpoint inhibitors (ICIs) increase the risk of cardiac dysfunction when used with cardiotoxic agents. Thus, we evaluated cardiac dysfunction in patients with sarcoma receiving doxorubicin with or without ICI using echocardiography and left ventricular global longitudinal strain (LVGLS). Methods: A total of 95 patients were included in this study. Echocardiography and LVGLS were evaluated at baseline and follow-up (at 3 and 6 months of chemotherapy) and compared with the doxorubicin (Dox; n = 73) and concomitant ICI with doxorubicin (Dox-ICI; n = 22) groups. Cancer therapy-related cardiac dysfunction (CTRCD) was defined as a left ventricular ejection fraction (LVEF) drop of >10% and LVEF of <50% (definite CTRCD), LVEF drop of >10%, LVEF of ≥50%, and LVGLS relative reduction of >15% (probable CTRCD) at six months. Results: There were no significant differences in age, cumulative dose of doxorubicin, and cardiovascular risk factors between the two groups. At baseline, the LVEF was similar in the Dox and Dox-ICI groups (p = 0.493). In the Dox group, LVEF decreased to 59 ± 6% (Δ -7 ± 1.3%, p < 0.001) and LVGLS decreased from -17.3 ± 3.2% to -15.4 ± 3.2% (Δ -10.1 ± -1.9%, p < 0.001) at six months. In the Dox-ICI group, LVEF decreased to 55 ± 9% (Δ -9 ± 2.1%, p < 0.001), along with a significant decrease in LVGLS (from -18.6 ± 1.9% to -15.3 ± 3.6%, Δ -12.4 ± -2.4%, p < 0.001). Over a median follow-up of 192 days, there were no cases with clinical manifestations of fulminant myocarditis. In the Dox group, definite and probable CTRCD were observed in seven (10.1%) and five (7.4%) patients, respectively. In the Dox-ICI group, definite and probable CTRCD were observed in four (19%) and four (19%) patients, respectively. The total number of patients who developed CTRCD was significantly higher in the Dox-ICI group than in the Dox group (38.1% vs. 17.4%, p = 0.042). Serum troponin-T level was significantly higher in the Dox-ICI group than in the Dox group (53.3 vs. 27.5 pg/mL, p = 0.023). Conclusions: ICIs may increase the risk of CTRCD when used with cardiotoxic agents. CTRCD should be monitored in patients treated with ICIs by cardiac biomarkers and echocardiography, including LV-GLS.ope

Inflammatory pseudotumour originating from congenital double atrial septum

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Right ventricular compression by distended stomach: a rare cause of postprandial dyspnoea

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Risk factors and outcomes with surgical bioprosthetic mitral valve dysfunction

Background: There are insufficient data regarding the risk factors associated with valve dysfunction of bioprosthetic valves in the mitral position This study aimed to investigate the factors associated with bioprosthetic mitral valve (MV) dysfunction (MVD). Methods: A total of 245 patients (age 67.2±11.2 years, 74.9% women) who were followed up for more than 5 years after surgical bioprosthetic MV replacement were analysed in the setting of retrospective study design. MVD was defined as an increased mean gradient of >5 mm Hg with limited leaflet motion and/or newly developed MV regurgitation of at least moderate severity on follow-up echocardiography. The clinical outcome was defined as a composite of cardiovascular mortality, redo MV surgery or intervention and heart failure-related hospitalisations. Results: During a median of 96.0 months (IQR 67.0-125.0 months), bioprosthetic MVD occurred in 66 (27.6%) patients. Factors associated with bioprosthetic MVD detected by multivariate regression analysis were age at surgery (HR 0.98, 95% CI 0.96 to 0.99, p5.5 mm Hg across the bioprosthetic MV early after operation (HR 2.02, 95% CI 1.08 to 3.78, p=0.028) and average haemoglobin level after surgery (HR 0.80, 95% CI 0.67 to 0.96, p=0.015). Patients with bioprosthetic MVD showed significantly poorer clinical outcomes than those without bioprosthetic MVD (log-rank p<0.001). Conclusions: Young age at operation, chronic kidney disease, elevated pressure gradient across the bioprosthetic MV early after surgery and postsurgical anaemia are associated with bioprosthetic MVD. Bioprosthetic MVD is associated with poor clinical outcomes.restrictio