Journal of Cardiovascular Development and Disease最新文献

Heart transplantation remains the definitive therapy for end-stage heart failure, but donor coronary artery disease (CAD) is a common reason for allograft refusal, limiting organ availability. We describe a case of orthotopic heart transplantation using a donor heart with isolated coronary artery disease managed with concurrent surgical revascularization. A 66-year-old male with end-stage non-ischemic cardiomyopathy requiring temporary mechanical circulatory support underwent heart transplantation using a donor allograft with a focal lesion in a large first diagonal artery. Following standard implantation, a left internal mammary artery-to-first diagonal artery bypass was performed prior to reperfusion. The patient was successfully weaned from cardiopulmonary bypass with improving left ventricular function and had an uncomplicated postoperative course aside from transient delirium and dysphagia. Echocardiography demonstrated recovery of normal left ventricular function, and the patient remained clinically well with preserved biventricular function at 7-month follow-up. This case demonstrates the feasibility of orthotopic heart transplantation with concurrent coronary artery bypass grafting using an arterial conduit and supports surgical optimization of select donor hearts, with focal coronary disease as a potential strategy to expand the donor pool without compromising short-term outcomes.

Thoracic aortic pathology involving the aortic arch is most commonly treated with open total arch replacement. However, open surgery is still associated with significant risk of mortality and morbidity, particularly in the elderly, patients with high-risk comorbidities, and those with previous cardiac surgery. Multiple endovascular approaches to enable zone 0 arch reconstruction have been developed, including custom-made, physician-modified, and off-the-shelf fenestrated/branched endografts. The initial experiences of this approach have been plagued by high incidence of stroke; although improvements have been made over the past decade, it remains suboptimal. Several factors contribute to this stagnation, including limited descriptive studies with small sample sizes, heterogeneous patient populations, varied techniques, and lack of data granularity and standardization. These limitations reduce the ability to analyze factors that could improve patient selection, device design, and procedural techniques. In addition, consistent follow-ups have not been reported, and the long-term outcome of these interventions are unknown. To address these issues, a randomized controlled trial of open versus endovascular arch repair or multicenter registry with standardized data reporting, follow-up protocol, and sufficient sample size would be needed. High-quality data will help identify patient clinical or anatomical features as well as procedural factors that can improve outcomes.

Coronary artery fistulas (CAFs) are rare congenital coronary anomalies in children and are frequently detected incidentally; however, the optimal management of asymptomatic cases and long-term outcomes remain debated. We retrospectively evaluated patients <18 years who underwent cardiac catheterization and coronary angiography for CAF at a single tertiary center between 2003 and 2022, analyzing demographic, clinical, angiographic, procedural, and follow-up data; fistulas were classified using a modified Sakakibara system, and temporal changes in institutional clinical approach and device selection were also assessed. Forty-two patients (mean age 7.4 ± 5.9 years) were included, most of whom were asymptomatic (80.9%); the left coronary artery was the most frequent origin and 85% drained to right-sided chambers. Transcatheter closure was attempted in 25 patients and was technically successful in 23 (92%); complete occlusion was achieved angiographically in 61% immediately and exceeded 90% during follow-up due to spontaneous resolution of residual shunts. One patient required surgery for persistent moderate residual flow, and no major procedural complications, thrombotic events, or ischemic outcomes were observed. In selected children, transcatheter CAF closure is safe and effective, while conservative follow-up appears appropriate for small, hemodynamically insignificant fistulas, supporting individualized, anatomy-guided management.

Introduction: The global disease burden of aortic valve disease is already substantial and is projected to rise significantly in the coming decades. Aortic valve replacement (AVR) with a biological prosthesis has become highly popular and commonly used. This study aims to assess long-term outcomes after biological AVR with regard to structural and non-structural deterioration.

Methods: In this single-centre retrospective study, 918 patients undergoing surgical AVR with a biological prosthesis at the University Hospital Frankfurt from January 2006 to July 2009 were included. The primary endpoints were freedom from reoperation and from structural and non-structural deterioration, and the secondary was long-term survival. Follow-up was completed in 95.6% with a median of 7.6 years, accounting 6610 patient-years. The mean age was 74.9 years and a median EuroSCORE II (range) was 3.34 (0.77-62.4). Twenty-two percent of surgeries were either emergent or urgent. Many patients had concomitant surgery, while coronary artery bypass grafting in 45.3% of patients was the most common. Three prosthetic valve models were used in our patient population: Carpentier Edwards Perimount (CEP) Model 2900, Model 3000 and Medtronic Mosaic (MM).

Results: Reoperation occurred in 36 patients (3.9%) due to endocarditis (2.0%), aortic root aneurysm (0.1%), isolated or combined aortic stenosis or aortic regurgitation (1.9%). Freedom from reoperation at 5, 10 and 15 years was 97 ± 0.6%, 95.6 ± 0.8% and 90.3 ± 2.3%, respectively. Freedom from major stroke at 5, 10 and 15 years was 97.9 ± 0.0%, 96.4 ± 0.8%, and 96.1 ± 0.08%, and freedom from major bleeding event at 5, 10 and 15 years was 98.5 ± 0.4%, 95.7 ± 0.9% and 92.7 ± 2.2%, respectively. A subgroup analysis of the Carpentier Edwards (CEP) valves and the Medtronic Mosaic (MM) valves showed no significant differences regarding the primary endpoints. The overall survival at 5, 10 and 15 years was 67 ± 1.7%, 39.8 ± 1.8%, and 15.1 ± 2.2% respectively. The Kaplan-Meier survival estimator was 96 ± 2.2 months.

Conclusion: This study showed a good long-term survival of surgical AVR with biological prostheses in relatively high-risk and elderly patient population. All biological prosthetic valves showed good long-term durability with low levels of complications and reoperations. The different models did not show any significant differences. Surgical AVR remains a valuable therapeutic option even though transcatheter aortic valve implantation has been greatly expanded since its introduction.

Atherogenic dyslipidemia is a condition characterized by high lipid levels that promote the development of atherosclerosis. While the clinical manifestations of atherosclerosis typically manifest in adulthood, early vascular damage can be identified in children and adolescents. Dyslipidemia is not uncommon in childhood and adolescence, and its development depends on the interaction between genetic and environmental factors. Forms caused by genetic defects tend to manifest earlier and usually require drug treatment. Forms caused by unhealthy lifestyles and eating habits tend to manifest later and often only require dietary and behavioural treatment. The review describes the most common primary forms, diagnostic criteria and treatment options, both pharmacological and non-pharmacological, emphasizing the differences and specificities of dyslipidemia in children compared to adults. The review's objective is also to provide a clinically focused summary of the current evidence on atherogenic dyslipidemia in children and adolescents.

(1) Background: The left atrioventricular coupling index (LACI) is a novel parameter for evaluating cardiac function. This study focused on its association with major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients. (2) Methods: A retrospective cohort of AMI patients from Peking University First Hospital was enrolled. All underwent transthoracic echocardiography on admission for LACI measurement. The primary endpoint was MACE (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death). (3) Results: Among 843 AMI patients (62.07 ± 12.24 years, 77.94% male), the median LACI was 0.24 (IQR 0.18-0.33). During a median follow-up of 4.31 years, 151 patients (17.91%) developed MACE. The optimal LACI cutoff for risk stratification was 0.257. After multivariable adjustment, each standard deviation increase in LACI was associated with significantly elevated risks of MACE (HR 1.17, 95% CI 1.02-1.34), all-cause death (HR 1.19, 95% CI 1.05-1.35), cardiovascular death (HR 1.33, 95% CI 1.10-1.61), and stroke (HR 1.23, 95% CI 1.05-1.43). (4) Conclusions: LACI is an independent predictor of poor prognosis in AMI patients and may serve as a valuable tool for risk stratification in secondary prevention.

Subclinical coronary atherosclerosis is common but its biological aggressiveness and interplay with extracoronary disease in asymptomatic individuals remain unclear. We evaluated the prevalence of high-risk coronary plaques (HRPs) and their relationship with mild carotid atherosclerosis and coronary calcium in a cardiovascular (CV) high-risk cohort in primary prevention. This retrospective multicenter study enrolled 269 asymptomatic adults with multiple CV risk factors who underwent Coronary Computed Tomography Angiography (CCTA) after prior carotid duplex ultrasound (CDUS). Coronary artery disease (CAD) was graded as absent, non-obstructive (<50% stenosis) or obstructive (≥50%), and HRPs were identified by ≥1 adverse morphological feature (low attenuation, positive remodeling, napkin-ring sign, spotty calcification). Carotid disease was classified as CDUS 0 (no plaque), CDUS 1-49% (mild), or CDUS ≥ 50% (significant). Pre-specified analyses explored prevalence of HRPs across CDUS-calcium-score strata (cut-off 100 Agatston) and independent predictors within the CDUS 1-49% subgroup. CAD was absent in 31%, non-obstructive in 41%, and obstructive in 28%. HRPs were present in 30.9% of all cases, in 26.6% of non-obstructive and in 64.6% of obstructive CAD. HRPs prevalence rose step-wise from 10.0% (CDUS 0 + Ca < 100) to 27.7% (CDUS 1-49% + Ca < 100), 41.2% (CDUS 0 + Ca ≥ 100) and 59.4% (CDUS 1-49% + Ca ≥ 100). In patients with CDUS 1-49%, current smoking independently predicted HRPs (OR 2.1, 95% CI 1.0-4.5; p = 0.049). Nearly one-third of asymptomatic adults with high CV risk already showed HRPs. Mild carotid atherosclerosis synergized with a calcium score ≥ 100 to identify a subgroup in which six of ten individuals exhibited HRPs. Smoking was the only independent clinical correlate identified of plaque vulnerability. Combined carotid ultrasound, calcium scoring and CCTA may substantially refine primary prevention risk stratification beyond traditional factors.

Atherosclerosis is a chronic, progressive disease of the arterial wall and the principal pathological substrate underlying most cardiovascular diseases, including ischemic heart disease, stroke, and peripheral arterial disease. Despite advances in prevention, imaging, and therapy, atherosclerosis remains the leading cause of cardiovascular morbidity and mortality worldwide. From a pathological perspective, the disease represents a dynamic and heterogeneous process characterized by endothelial dysfunction, lipid retention and modification, chronic inflammation, immune activation, smooth muscle cell phenotypic modulation, extracellular matrix remodeling, and thrombogenic surface alterations. This review provides a comprehensive overview of atherosclerosis from a pathologist's perspective, integrating classical morphological concepts with contemporary insights into immunopathology, plaque classification, and mechanisms of plaque instability. We summarize the structure and function of the arterial wall, the stepwise pathogenesis of lesion initiation and progression, and the histopathological classification systems established by the American Heart Association and subsequently refined through Virmani's framework. Particular emphasis is placed on plaque instability, highlighting the qualitative features-such as fibrous cap thinning, necrotic core expansion, macrophage-driven inflammation, plaque erosion, and calcification patterns-that determine clinical outcomes rather than luminal stenosis alone. Furthermore, the review discusses the expanding role of immunohistochemical markers in defining plaque biology, including lineage markers and functional indicators of inflammation, matrix integrity, osteogenic signaling, and local anticoagulant balance. These pathological insights are integrated with contemporary risk assessment tools, imaging modalities, preventive strategies, and therapeutic interventions, including emerging lipid-lowering and RNA-based therapies. In conclusion, pathology remains central to understanding atherosclerosis as a biologically active disease and to refining concepts of plaque instability. Integrating histopathology with molecular profiling, imaging, and clinical data is essential for advancing precision prevention and targeted treatment strategies in atherosclerotic cardiovascular disease.

The objective of this paper was to review the possibility that the QT interval may be a marker of adult human longevity or life expectancy. Following a literature review, data supporting this possibility was assembled and consists of the following. First, in adults, QT interval increases with increasing age. This is analogous to aging-induced hypertension and diabetes mellitus, both of which are associated with shorter longevity. Second, older persons frequently die suddenly regardless of whether or not they have chronic illnesses for which death is expected. Third, longer QTintervals are associated with increased probability of sudden death. Fourth, patients with two conditions associated with accelerated brain aging, namely dementia and Parkinson's disease, show longer QTcs than age-matched controls. Both of these conditions are associated with sudden cardiac death. Fifth, aging processes may affect the molecular determinants of the QT interval, alter heart composition with increased myocardial fibrosis, or alter the amount of sympathetic and parasympathetic tone, any or all of which can alter myocardial repolarization and the duration of the QTc. Sixth, considering the molecular determinants of the QT interval in the aging heart, which has longer transmembrane action potentials, several factors can account for this change, including changes in late inward Na⁺ current (I_NaL), I_Kr, I_ca, I_to, and K_ATP channels. Transgenic mice overexpressing the Kir6.1 subunit of a K_ATP channel show a prolonged QT interval and reduced longevity, with animals appearing to die suddenly. Seventh, chronic kidney disease, which is associated with a reduced lifespan, is associated with reduced expression of the anti-aging factor Klotho and Klotho-deficient mice have a prolonged QTc and a reduced lifespan. Taken together, there is a cogent case for factors that increase action potential duration in the aging heart, as recognized by increased QTc, to act in concert with other factors to produce fatal arrhythmias leading to sudden cardiac death and shortened longevity.

Background: Cardiac metastases from cutaneous melanoma are uncommon and often underdiagnosed due to their variable and frequently asymptomatic presentation. To better describe their clinical features, diagnostic strategies, and outcomes, we performed a systematic review of published case reports and present an illustrative clinical case.

Case presentation: We report the case of a 67-year-old man with a history of stage IIA cutaneous melanoma who presented with progressive fatigue and dyspnea. Disease recurrence was confirmed by skin biopsy. Multimodal imaging, including echocardiography, FDG PET-CT, and cardiac magnetic resonance (CMR), demonstrated extensive myocardial infiltration consistent with cardiac metastases. Despite treatment with immunotherapy, the patient experienced progressive clinical deterioration and died six months after diagnosis.

Discussion: The systematic review encompassed 23 published articles reporting 27 individual cases, with a mean age at diagnosis of 55.9 years and a clear male predominance. Cardiac involvement exhibited marked heterogeneity in both clinical presentation and anatomical distribution, most frequently affecting the left ventricular free wall and the interventricular septum. Echocardiography consistently served as the initial diagnostic modality, while cardiac magnetic resonance and CT/FDG PET-CT were used to refine lesion characterization and assess extracardiac disease. Notably, a complete multimodal imaging strategy was reported in fewer than one-third of cases, reflecting variability in diagnostic approaches. Survival outcomes were highly heterogeneous, with substantial mortality, underscoring the need for earlier detection and more accurate diagnostic strategies for cardiac involvement in melanoma.

Conclusions: Cardiac metastases from melanoma represent advanced disease and remain associated with poor and heterogeneous outcomes. An integrated multimodal imaging approach supports detailed diagnostic characterization and may aid clinical evaluation and management in selected cases.