Perventricular Device Closure of Native Congenital Muscular Ventricular Septal Defects in Small Infants   <math altimg="urn:x-wiley:15221946:media:ccd70020:ccd70020-math-0001" wiley:location="equation/ccd70020-math-0001.png" display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mrow><mo>\unicode{x02009}</mo></mrow></mrow></math>  ≤ 5 kg: Single‐Center Study of the Risk Factors for Failure of the Intervention and Non‐Optimal Outcome

ABSTRACT Background and Aims Perventricular device closure of muscular VSD in small infants is a less invasive option than surgical closure under cardiopulmonary bypass and offers better outcomes than palliative pulmonary artery banding. However, the specific risk factors that could affect procedural success and optimal outcomes have not been comprehensively examined in prior studies. The aim of this study is to analyze the risk factors for procedural failure and nonoptimal outcome in perventricular device closure of muscular VSD. Methods Results of perventricular closure of muscular VSD in infants over 17 years at a tertiary center were retrospectively analyzed. The procedure was considered successful if the occluder could be placed in correct position without significant residual shunt. Optimal outcome was defined as uneventful course after successful device implantation. Results A perventricular approach was required for 27 significant defects in 24 infants aged 3−7, median 5 months, and weighing 3.2−5.3, median 4.3 kg. The procedure was successful in 23 of the 27 defects (85%) and the outcome was optimal in 19 of the 24 infants (79.1%). There was no significant difference between the successful and unsuccessful groups in terms of age, body weight, defect locations, presence of single vs multiple large defects, and device types used. Larger defects (≥ 12 mm) and larger devices (≥ 14 mm) were significantly more common in both the procedural failure and non‐optimal outcome groups. Both the success and optimal outcomes of the procedure were negatively impacted by the proximity of the defect to the moderator band of the RV. Conclusion Procedural success and outcomes in perventricular device closure of muscular VSDs in small infants are negatively impacted by larger defects requiring ≥ 14 mm devices and the proximity of the defect to the moderator band. Both factors may hinder the proper opening of the RV disc and prevent adequate conforming to the smaller RV size in these infants.

Reassessing Long‐Term Valve Durability in Small Annuli: A Critical Look at SEV Versus BEV Outcomes

Evaluating Zero‐Contrast Transcatheter Aortic Valve Implantation (TAVI) for Patients With Renal Impairment: A Pooled Meta‐Analysis of 1505 Patients

ABSTRACT Transcatheter Aortic Valve Implantation (TAVI) is a well‐established treatment for severe aortic stenosis (AS) but poses risks for chronic kidney disease (CKD) patients due to contrast‐induced nephropathy (CIN). Zero‐contrast TAVI offers a promising alternative, though evidence on its safety and effectiveness is limited. We aim to evaluate the safety and effectiveness of zero‐contrast TAVI compared to standard TAVI in patients with AS and CKD. We followed the Cochrane Handbook and PRISMA guidelines, searching databases until September 2024. We conducted the meta‐analysis using the ‘metafor’ package with a random‐effects model, calculating mean differences (MDs) and risk ratios (RRs) along with their corresponding 95% confidence intervals (CIs). We included 1505 patients from six papers. The single‐arm meta‐analysis of zero‐contrast TAVI showed a significant implantation success rate (proportion = 0.97; 95% CI: [0.95, 0.99]; p < 0.01). Double‐arm analysis revealed no significant difference in implantation success between both groups (RR = 1.02; 95% CI: [0.97, 1.08]; p = 0.34). The postoperative mean transvalvular gradient was comparable (MD = 0.19 mmHg; 95% CI: [−0.99, 1.39]; p = 0.75). The initial pooled analysis found no significant difference in in‐hospital AKI (RR = 0.66, 95% CI: 0.20–2.17), though this was confounded by significant heterogeneity (I 2 = 71.26%). Sensitivity analysis resolved this heterogeneity and revealed a significant reduction in AKI with Zero‐contrast TAVI (RR = 0.47, 95% CI: [0.24, 0.92]; p = 0.03). Post‐procedural permanent pacemaker (PPM) implantation risk was higher in the zero‐contrast group, while Stroke rates were comparable. Zero‐contrast TAVI offers comparable success to contrast‐based approaches and potential renal benefits but carries a higher risk of PPM implantation. Trial Registration This meta‐analysis was registered on PROSPERO. No.: CRD42024597951.

Active Side‐Branch Protection Strategy for Culprit Bifurcation Lesion in STEMI Patients: The Multicenter STEMI‐BIF Registry

ABSTRACT Background To date, the best side branch (SB) protection strategy in patients with coronary bifurcation lesions (CBLs)‐related ST‐segment elevation myocardial infarction (STEMI) has not yet been settled. Aims This study sought to evaluate the clinical outcome of the jailed balloon (JBT) and jailed wire techniques (JWT) for the SB protection strategy in STEMI patients with culprit CBLs. Methods This large‐scale multicenter ( n  = 10) observational retrospective study included STEMI patients with culprit CBLs who underwent PCI with provisional stenting. The primary endpoint was major adverse cardiac events (MACE) as the combination of death from cardiac causes, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). Propensity score‐matching analysis was performed. Results A total of 1218 consecutive patients (male: 1020 [83.7%], mean age: 57.68 ± 11.76 years) were included in this study. The study cohort was divided into two groups as JBT ( n  = 196) and JWT ( n  = 1022). The incidences of the SB intervention (21.4% vs. 36.2%, p  < 0.001) and residual stenosis of SB ≥ 70% (23.0% vs. 45.5%, p  < 0.001) were significantly lower in the JBT group compared to the JWT group. Whereas procedure time (47.21 ± 17.70 vs. 40.94 ± 13.18 min, p  < 0.001) and fluoroscopy time (15.92 ± 9.51 vs. 13.39 ± 6.69 min, p  = 0.001) were notably higher in the JBT group than in the JWT group. The risk‐adjusted midterm MACE (HR: 0.688, p  = 0.200) and clinally driven TLR (HR: 0.566, p  = 0.170) did not differ in individuals with culprit CBLs to protect the SB with JBT and the JWT in the propensity‐matched cohort. Conclusion The present study suggests that risk‐adjusted MACE and TLR rates were comparable between both techniques at midterm follow‐up.

Prevalence and Prognostic Impact of Coronary Chronic Total Occlusions in Patients With Cardiogenic Shock

ABSTRACT Background Mortality in patients with cardiogenic shock (CS) remains high despite advanced treatment strategies in CS patients, underlining the need for the identification of predictors of prognosis in CS patients. Therefore, the present study investigates the prognostic impact of coronary chronic total occlusions (CTO) in patients with CS. Methods All consecutive patients being acutely admitted with CS to an intensive care unit (ICU) and undergoing invasive coronary angiography (ICA) from 2019 to 2021 were included, irrespective of the etiology of CS. Patients with at least one CTO were compared to non‐CTO patients with regard to the risk of all‐cause mortality at 30 days. Further risk stratification was performed according to the extent of coronary artery disease (CAD). Results A total of 192 CS patients undergoing ICA during index hospitalization were included. At least one CTO was present in 24% of CS patients. Patients with CTO were older (median 78 vs. 68; p  = 0.001) and presented more frequently with non‐ST‐elevated myocardial infarction (21% vs. 12%; p  = 0.048). The presence of a CTO was associated with higher rates of 30‐days all‐cause mortality (70.2% vs. 47.6%; HR = 1.783, 95% CI 1.176−2.702; p  = 0.009), even after multivariable adjustment (adjusted HR = 1.898; 95% CI 1.116−3.229; p  = 0.018). Patients with CTO were accompanied by an even higher 30‐days all‐cause mortality as compared to patients with multi‐vessel CAD without CTO (adjusted HR = 1.723; 95% CI 1.058−2.805; p  = 0.029). Conclusion Coronary CTO are common in patients with CS and represent an independent predictor of all‐cause mortality at 30 days.

Are Women at Higher Risk for Isolated Surgical Aortic Valve Replacement? Results From 178,000 STS Adult Cardiac Surgery Database Patients

ABSTRACT Background Female sex is a well‐established risk factor for morbidity and mortality in cardiac surgery. Aims This study aimed to assess the characteristics and contemporary outcomes of surgical aortic valve replacement (SAVR) in women compared to men. Methods All patients who underwent isolated SAVR from 2014 through 2022 were identified using the Society of Thoracic Surgery national database. Patient characteristics were compared between women and men. The primary interest of outcomes was operative mortality. Results A total of 178,014 patients undergoing isolated SAVR were identified, including 64,684 36.3%) women and 113,330 (63.7%) men. Women were older (66.1 years vs. 63.6 years in men, SMD = 0.21) and had a smaller body surface area (1.84 vs. 2.09 m 2 in men, SMD = 1.15). A history of infective endocarditis was more common in men (10.5% vs. 5.4% in women, SMD = 0.19), while women were more likely to undergo annular enlargement (8.4% vs. 2.9% in men, SMD = 0.24). Propensity score matching yielded 33,228 pairs in each sex category. After matching, operative mortality was comparable (2.2% in women vs. 1.7% in men, SMD = 0.04). Likewise, postoperative complications were similarly observed. Conclusion Women undergoing isolated SAVR demonstrated similar morbidity and mortality compared to men despite having smaller body surface area and higher frequency of annular enlargement. Given the improved outcomes with contemporary practice in SAVR, sex may no longer be a risk factor for worse outcomes in isolated SAVR.

The Prognostic Value of Troponin in Acute Pulmonary Embolism: A Systematic Review and Meta‐Analysis

ABSTRACT Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Troponin elevation is increasingly used for risk stratification, but its prognostic utility remains variably reported across studies. To evaluate the prognostic value of troponin elevation in patients with acute PE, concerning short‐term mortality and adverse clinical outcomes. A systematic review and meta‐analysis were conducted according to PRISMA 2020 guidelines. PubMed was searched from January 2000 to the present, using terms such as “pulmonary embolism,” “troponin,” and “prognosis.” Eligible studies reported associations between troponin elevation and mortality or adverse events in adult patients with PE. Data were synthesised quantitatively and narratively. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Sixty studies ( n  = 25,282) were included. Meta‐analysis showed that elevated troponin was significantly associated with increased in‐hospital mortality (OR: 5.42; 95% CI: 4.35–6.83), 30‐day mortality (OR: 4.35; 95% CI: 3.30–5.74), right ventricular dysfunction (OR: 3.42; 95% CI: 2.69–4.31), haemodynamic instability (OR: 3.29 95% CI: 2.48–4.39), and intensive care unit admission (OR: 5.81 95% CI: 3.52–9.68). Non‐meta‐analysed mortality data were similar to the meta‐analysed data, showing an association between elevated troponin levels and worse outcomes in PE. These associations were observed across both conventional and high‐sensitivity assays, as well as normotensive or low‐risk patients. Elevated troponin is a strong and consistent predictor of short‐term mortality and clinical deterioration in acute PE. With further research, it has the potential to be more widely integrated into risk stratification frameworks.

Left Ventricular Apical Thrombus in Apical Hypertrophic Cardiomyopathy Without Aneurysm or Arrhythmia: A Case Report

ABSTRACT Apical hypertrophic cardiomyopathy (ApHCM) is a rare variant of hypertrophic cardiomyopathy, typically associated with a benign course. However, complications such as ventricular arrhythmias, apical aneurysms, and thrombus formation may occur. Left ventricular (LV) thrombus is an unusual finding in ApHCM, especially in patients with preserved systolic function and normal sinus rhythm. A 54‐year‐old male with a history of pulmonary embolism and ApHCM was under routine surveillance. He remained asymptomatic with a normal sinus rhythm. Transthoracic echocardiography (TTE) identified an echogenic mass in the LV apex. Cardiac magnetic resonance imaging (CMR) confirmed severe apical hypertrophy, preserved LV systolic function, and a large apical mass measuring 24 × 19 mm. The mass showed no contrast uptake on early or late gadolinium enhancement sequences, consistent with thrombus. Native T1 mapping was mildly elevated, suggesting diffuse interstitial fibrosis, and focal non‐ischaemic replacement fibrosis was noted. There was no evidence of apical aneurysm or mid‐ventricular obstruction. The patient was anticoagulated with warfarin and remains under close follow‐up. This case represents a rare occurrence of a large LV thrombus in ApHCM without associated apical aneurysm or impaired LV function. The findings suggest that regional fibrosis and altered apical flow dynamics may contribute to thrombus formation even in hypercontractile ventricles. Multimodal imaging, particularly CMR, is essential for accurate diagnosis and risk assessment. Clinicians should maintain vigilance for thrombotic complications in ApHCM, even in the absence of classical risk factors, as subtle fibrosis or flow abnormalities may predispose to thrombus formation.

Novel Copy Number Deletion Involving NUS1 Associated With Epilepsy, Tremor, and Intellectual Disability

ABSTRACT Copy number variations (CNVs) contribute to various disorders including intellectual disability, developmental disorders, and cancer. This study identifies a de novo 2.62 Mb deletion at 6q22.1_q22.31, implicating the NUS1 gene in epilepsy, spinal abnormalities, and intellectual disability, thereby expanding its known phenotypic associations.

Takotsubu Cardiomyopathy Patient With Coronary Artery Disease: The Chicken or the Egg

ABSTRACT This case emphasizes the rare occurrence of Takotsubo cardiomyopathy (TTC) in a patient with moderate coronary artery disease (CAD), highlighting the complexity of diagnosis and management. Clinicians should maintain a high index of suspicion for TTC in patients with CAD, especially when echocardiographic findings suggest apical ballooning. Balancing therapies for both conditions is essential.