Journal of the Saudi Heart Association最新文献

Atrial septal defects are common congenital heart anomalies and may coexist with rare systemic venous abnormalities. We describe a one-year-old female with a large secundum atrial septal defect and an unusual retrocardiac innominate vein. Transthoracic echocardiography suggested a persistent left superior vena cava, but the innominate vein was absent from its usual location and the coronary sinus was not dilated. Cardiac CT angiography demonstrated a retrocardiac innominate vein draining into the azygos system and subsequently to the right atrium. Surgical atrial septal defect closure was successful. Recognition of this anomaly is essential for accurate diagnosis and procedural planning.

Background: Double dorsal aorta is a rare congenital embryological vascular anomaly resulting from incomplete regression and fusion of the dorsal aortae during embryogenesis. This anomaly could be associated with various other congenital heart defects (CHDs), including transposition of the great arteries, ventricular septal defect (VSD), persistent truncus arteriosus, tetralogy of Fallot (TOF), and Coarctation of the aorta (COA).

Clinical presentation: This is a 9 year old girl with complex congenital heart disease and a double dorsal aorta who underwent a single ventricle palliation and this anomaly was detected during pre Fontan evaluation. She presented at age of 2 weeks with cyanosis, initial diagnosis was situs inversus, Dextrocarida, DORV with malposed great arteries, subpulmonary and valvular pulmonary stenosis, Patent ductal arteriosus and left superior vena cava. Patient was discussed with cardiothoracic team and Underwent left bidirectional Glenn at 10 months of age (2017) During pre-Fontan catheterization (June 2021) → incidental discovery of double descending (double dorsal) aorta, subsequently confirmed by CTA Fontan Completion: Deferred due to multiple severe comorbidities.

Conclusion: Double dorsal aorta is an extremely rare embryologic vascular anomaly due to failure of fusion of the paired dorsal aortae. Although was asymptomatic, its identification is important in complex congenital heart disease because it may affect surgical planning and catheter based interventions. In this patient, the anomaly was detected incidentally during pre Fontan evaluation emphasizing the value of detailed preoperative imaging.

Objectives: Carbohydrate antigen 125 (CA125) is associated with different cardiovascular conditions. This study aimed to determine CA125 levels in patients with acute coronary syndrome (ACS) and the potential relationship between major adverse cardiac events (MACE) in the short-term following.

Methods: This prospective cohort study was conducted in a coronary care unit between May and November 2022. Plasma CA125 levels were measured only once upon hospital admission. Patients were followed for six months. All-cause mortality, recurrent acute coronary syndrome, requirement for revascularization, decompensated heart failure, cardiogenic pulmonary edema, atrial fibrillation, and stroke were recorded as MACE.

Results: A total of 127 patients were included in this study. The mean left ventricular ejection fraction (LVEF) was 50.5 %. The median plasma CA125 level was 14.6 KU/L. There was a, significant positive relationship between CA125 and high-sensitivity cardiac troponin (hs-cTn) (r = 0.315, p < 0.001) and pro-B-type natriuretic peptide (proBNP) (r = 0.423, p < 0.001), and a weak negative relationship with LVEF (r = -0.186, p = 0.037) value.

Conclusions: Plasma CA125 levels were correlated with the pro-BNP and hs-cTn, established ACS biomarkers. An additional notable finding was the weak correlation with LVEF. Elevated plasma CA125 levels might be used to identify patients with ACS who are at higher risk of MACE at six months.

Objective: Use of vascular closure devices (VCDs) for femoral artery puncture site hemostasis has increased but their safety and efficacy have remained unclear. This study was designed to compare safety and efficacy of Obtura, Angioseal, and Proglide VCD to manual compression (MC) and also between for femoral artery haemostasis.

Methods: This was prospective, randomized controlled study where patients were randomly assigned on 1:1:1:1 basis. Primary endpoints were time to hemostasis (TTH) and ambulation time (AT) while secondary endpoints were deployment success, device related adverse events and technical success rate. ANOVA and Tukey HSD was conducted to draw significant difference between individual strategies. P < 0.05 was considered statistically significant.

Results: Total of 1000 patients (250 in each arm) who underwent transfemoral intervention at LPS Institute of Cardiology, Kanpur, India between January 2025 and March 2025 were evaluated. Sheath size, common femoral artery diameter and device size did not differ significantly across all the groups. Mean TTH was shortest for Angioseal (1.30 min) followed by Obtura (2.58 min), Perclose (3.97 min), and MC (17.61 min). Similarly, mean AT was shortest for Angio-Seal (123.06 min) followed by Perclose ProGlide (162.56 min), Obtura (185.42 min) and MC (743.23 min). Technical success in Angio-Seal, Obtura and Perclose ProGlide were 99.1%, 97.4% and 94.6% respectively. No access site complications (re-bleeding, infection, arteriovenous fistula, and transient access site nerve injury) were noted. There were 2(0.8%), 5(2%), 7(3.2%) and 12 (4.8%) cases of haematoma in Angio-Seal, Obtura, Perclose ProGlide and MC arm respectively. There were 2(0.8%), 2(0.8%), and 4 (1.6%) case of arterial pseudoaneurysm Obtura, Perclose ProGlide and MC arm respectively while none in Angio-Seal arm.

Conclusion: Vascular closure devices showed significantly faster haemostasis and shorter ambulation time compared to manual compression highlighting their clinical efficiency and Angio-Seal was superior safety and efficacy over Obtura and Perclose ProGlide.

We present a rare case of simultaneous anterior and inferior ST-elevation myocardial infarction caused by the acute occlusion of both the right coronary artery and the left anterior descending artery. The culprit LAD lesion involved a true bifurcation, which was successfully treated using the nano-crush stenting technique, achieving complete reperfusion. This case highlights the feasibility of complex bifurcation intervention in a hemodynamically unstable patient with double-vessel STEMI. It underscores the importance of rapid diagnosis, aggressive revascularization, and appropriate stenting strategy in managing multivessel acute myocardial infarction.

Background: Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited.

Methods: We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes.

Results: Of 4080 CIED recipients, 114 (2.8 %) developed device infections (incidence 98.8 per 10,000 person-years). CRT-P (cardiac resynchronization therapy pacemaker) devices had the highest infection rate (7.7 %). Revision procedures carried higher infection rates than initial implants or generator replacements (10.0 % vs 2.1 % vs 2.7 %; P < 0.001). The most common pathogens were Staphylococcus aureus (30.1 %), coagulase-negative staphylococci (10.6 %), and Pseudomonas aeruginosa (8.8 %); 38.9 % of infections were culture-negative. Systemic infections and patients managed without device removal had significantly higher mortality (32.3 % vs 8.2 % for systemic vs pocket; 48.4 % vs 12.0 % for no extraction vs extraction; P < 0.001 for both).

Conclusions: In this large Saudi cohort, CIED infection occurred in 2.8 % of patients, particularly following revision procedures and in CRT-P recipients. Infections were often culture-negative and associated with substantial mortality, especially in systemic cases or when devices were not removed. These findings highlight the importance of strict infection-prevention protocols, early recognition, and prompt complete device extraction to improve patient outcomes.

Sinus of Valsalva aneurysm is a rare cardiac anomaly, affecting approximately 0.09 % of the population. Its rupture represents a life-threatening event that can rapidly lead to heart failure. We report a 32-year-old woman with mixed connective tissue disease presenting with right-sided heart failure. Echocardiography demonstrated a ruptured right coronary cusp sinus of valsalva aneurysm into the right ventricle with moderate aortic regurgitation. Surgical repair was successfully performed, and histopathology supported an autoimmune-mediated etiology. To our knowledge, this is the first reported case of ruptured sinus of valsalva aneurysm occurring in a patient with autoimmune mixed connective tissue disease.

Background: Anthracyclines, notably doxorubicin, are potent cytotoxic agents that substantially improved outcomes across numerous malignancies. However, their use is restricted by their cardiotoxicity, a dose-dependent adverse effect that manifests acutely, during treatment, or years post-therapy. It encompasses a spectrum of phenotypes including asymptomatic ventricular dysfunction, heart failure, arrhythmias, and cardiomyopathy, contributing to considerable morbidity and mortality as cancer survival rates improve.

Objective: This narrative review summarises current insights into anthracycline-induced cardiotoxicity pathophysiology and evaluates pharmacologic strategies for its prevention and management.

Methods: A comprehensive literature search was conducted through August 2025, prioritizing randomised controlled trials, meta-analyses, observational studies, and guideline statements addressing pharmacologic interventions to mitigate anthracycline cardiotoxicity.

Results: Anthracycline cardiotoxicity arises from various mechanisms, including oxidative stress, mitochondrial dysfunction, topoisomerase IIβ-induced DNA damage, calcium dysregulation, and reticulum stress. Neurohormonal modulation with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers has shown modest preservation of left ventricular ejection fraction, especially when initiated early in high-risk patients; spironolactone appears more effective than eplerenone among mineralocorticoid receptor antagonists. Sacubitril/valsartan demonstrates promising superiority in preclinical and early clinical cohorts, though further randomised control trials are ongoing. Metabolic modulators such as metformin and sodium-glucose cotransporter 2 inhibitors exhibit cardio-protectivity via AMPK activation, attenuation of oxidative and inflammatory pathways, but evidence in non-diabetic cancer populations is limited. Statins have shown reduced left ventricular ejection fraction decline and lower cardiotoxicity rates in randomised studies, while dexrazoxane-through iron chelation and topoisomerase IIβ inhibition-remains the only approved agent for anthracycline-induced cardiotoxicity prevention, strongly supported by adult and paediatric data.

Conclusion: Several pharmacologic strategies offer potential benefit in limiting anthracycline-induced cardiotoxicity and preserving cardiac function. Tailored, risk-based approaches that incorporate cardioprotective therapies early in anthracycline treatment-guided by biomarkers and imaging-are most promising. Further large-scale randomised studies are required to establish optimal combinations and confirm long-term benefit.