Preoperative Assessment of Anomalous Right Coronary Artery Arising from the Main Pulmonary Artery

Anomalous origin of the right coronary artery from the pulmonary artery is a rare condition. Two cases are presented in this paper. One case was treated by ligation and coronary artery bypass. The other was treated by direct reimplantation of the anomalous coronary artery into the aorta

Investigating geographic and temporal genetic variation in the black grouse (Lyrurus tetrix) in the Italian Alps

The black grouse (Lyrurus tetrix) is a Galliform distributed across northern Eurasia, and is a game bird in most EU countries. Although the species is listed as ‘Least Concern’ by the IUCN, populations at the western and southern edges of its range are considered ‘Vulnerable’ due to increasing habitat fragmentation and human disturbance. Between 1995 and 2017, in collaboration with several hunting associations, we collected more than 600 black grouse samples across seven regions of the Italian Alps. Ten microsatellite markers (STRs) and 2442 Single Nucleotide Polymorphisms (SNPs) were analysed in large subsets of the collected data, with the aim of identifying environmental, temporal and anthropic factors that affect the distribution and level of genomic variation. The main factor shaping the genetic distances between populations based on STRs is the geographic distance between them (i.e. isolation-bydistance), but even the populations on the two extremes of our sampling area are very similar (Fst between the two regions = 0.053). SNP data supports the STR analysis. However, isolation-by-resistance methods for the larger STR data set show that both higher altitudes and urban areas inhibit movement of grouse between populations. While temporal analysis of STRs for the Trentino-Alto Adige region showed no significant change in the mean number of alleles and allelic size range between the two time frames studied (e.g. mean number of alleles 1995-1999: 8.8, 2009-2010: 8.2), and the expected heterozygosity was high in both time frames (1995-1999: 0.740, 2009-2010: 0.722). While black grouse population size is reportedly decreasing, our results suggest there is no measurable genetic impact from this trend. Hence this dataset provides a basis for future monitoring of genetic diversity in this charismatic alpine species

Association of Bovine Arch Anatomy With Incident Stroke After Transcatheter Aortic Valve Replacement

BACKGROUND: Acute ischemic stroke complicates 2 % to 3 % of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke. METHODS AND RESULTS: This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022. The aortic arch morphology was determined via a manual review of the pre-TAVR computed tomography images. An a priori approach was used to select the covariates for the following: (1) the logistic regression model assessing the association between a bovine arch and periprocedural stroke (defined as stroke within 7 days after TAVR) and (2) the Cox proportional hazards regression model assessing the association between a bovine arch and long-term stroke after TAVR. A total of 2775 patients were included (59.6 % men, 97.8 % White race, mean ± SD age, 79.3 ± 8.4 years), of whom 495 (17.8 %) had a bovine arch morphology. Fifty-seven patients (1.7 %) experienced a periprocedural stroke. The incidence of acute stroke was significantly higher among patients with a bovine arch compared with those with a nonbovine arch (3.6% versus 1.7%; =0.01). After adjustment, a bovine arch was independently associated with increased periprocedural strokes (adjusted odds ratio, 2.16 [95 % CI, 1.22-3.83]). At a median follow-up of 2.7 years, the overall incidence of post-TAVR stroke was 6.0 % and was significantly higher in patients with a bovine arch even after adjusting for potential confounders (10.5 % versus 5.0 % adjusted hazard ratio, 2.11 [95 % CI, 1.51-2.93], \u3c 0.001). CONCLUSIONS: A bovine arch anatomy is associated with a significantly higher risk of periprocedural and long-term stroke after TAVR

Operative management after transcatheter aortic valve replacement

With broadening applications of transcatheter aortic valve replacement (TAVR) and increasing use in intermediate- and low-risk patients, the incidence of surgical re-interventions after TAVR is growing. Transcatheter heart valves suffer from similar long-term complications as surgical heart valve prostheses that require surgical re-intervention, including endocarditis and structural valve deterioration. Catastrophic periprocedural complications — such as annular or aortic rupture requiring urgent surgical intervention — may also occur during TAVR procedures. This review summarizes the current knowledge on indications, methods, and outcomes of cardiac operations after TAVR, with a focus on how to improve results in a rapidly growing patient population

Predicting postoperative systolic dysfunction in mitral regurgitation: CT vs. echocardiography

IntroductionVolume overload from mitral regurgitation can result in left ventricular systolic dysfunction. To prevent this, it is essential to operate before irreversible dysfunction occurs, but the optimal timing of intervention remains unclear. Current echocardiographic guidelines are based on 2D linear measurement thresholds only. We compared volumetric CT-based and 2D echocardiographic indices of LV size and function as predictors of post-operative systolic dysfunction following mitral repair.MethodsWe retrospectively identified patients with primary mitral valve regurgitation who underwent repair between 2005 and 2021. Several indices of LV size and function measured on preoperative cardiac CT were compared with 2D echocardiography in predicting post-operative LV systolic dysfunction (LVEFecho <50%). Area under the curve (AUC) was the primary metric of predictive performance.ResultsA total of 243 patients were included (mean age 57 ± 12 years; 65 females). The most effective CT-based predictors of post-operative LV systolic dysfunction were ejection fraction [LVEFCT; AUC 0.84 (95% CI: 0.77–0.92)] and LV end systolic volume indexed to body surface area [LVESViCT; AUC 0.88 (0.82–0.95)]. The best echocardiographic predictors were LVEFecho [AUC 0.70 (0.58–0.82)] and LVESDecho [AUC 0.79 (0.70–0.89)]. LVEFCT was a significantly better predictor of post-operative LV systolic dysfunction than LVEFecho (p = 0.02) and LVESViCT was a significantly better predictor than LVESDecho (p = 0.03). Ejection fraction measured by CT demonstrated significantly greater reproducibility than echocardiography.DiscussionCT-based volumetric measurements may be superior to established 2D echocardiographic parameters for predicting LV systolic dysfunction following mitral valve repair. Validation with prospective study is warranted

Past, present and future of chamois science

The chamois Rupicapra spp. is the most abundant mountain ungulate of Europe and the Near East, where it occurs as two spe- cies, the northern chamois R. rupicapra and the southern chamois R. pyrenaica. Here, we provide a state-of-the-art overview of research trends and the most challenging issues in chamois research and conservation, focusing on taxonomy and systematics, genetics, life history, ecology and behavior, physiology and disease, management and conservation. Research on Rupicapra has a longstanding history and has contributed substantially to the biological and ecological knowledge of mountain ungulates. Although the number of publications on this genus has markedly increased over the past two decades, major differences persist with respect to knowledge of species and subspecies, with research mostly focusing on the Alpine chamois R. r. rupicapra and, to a lesser extent, the Pyrenean chamois R. p. pyrenaica. In addition, a scarcity of replicate studies of populations of different subspecies and/or geographic areas limits the advancement of chamois science. Since environmental heterogeneity impacts behavioral, physiological and life history traits, understanding the underlying processes would be of great value from both an evolutionary and conservation/management standpoint, especially in the light of ongoing climatic change. Substantial contri- butions to this challenge may derive from a quantitative assessment of reproductive success, investigation of fine-scale foraging patterns, and a mechanistic understanding of disease outbreak and resilience. For improving conservation status, resolving taxonomic disputes, identifying subspecies hybridization, assessing the impact of hunting and establishing reliable methods of abundance estimation are of primary concern. Despite being one of the most well-known mountain ungulates, substantial field efforts to collect paleontological, behavioral, ecological, morphological, physiological and genetic data on different popu- lations and subspecies are still needed to ensure a successful future for chamois research and conservation

Left ventricular apical diseases

There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features