Methodist DeBakey cardiovascular journal最新文献

Cardiac allograft vasculopathy (CAV) is a type of coronary artery disease unique to heart transplant recipients that can result from chronic rejection of the transplanted heart. CAV is a major cause of morbidity and mortality after the first year of transplantation. Both immune and nonimmune mechanisms contribute to the initiation and progression of CAV and result in intimal thickening, fibrosis with luminal stenosis, chronic myocardial ischemia and eventual graft failure. Recent advances in imaging modalities-including invasive intracoronary imaging and noninvasive imaging with cardiac positron emission tomography-have improved the early detection of CAV and may allow for optimization of CAV-targeted therapies to reduce CAV progression and ultimately preserve graft function.

The field of heart transplantation has experienced remarkable progress over the past decades, transforming from an experimental procedure into a life-saving intervention with continually improving outcomes. As Houston Methodist Hospital celebrates its 40-year milestone in heart transplantation, it is both timely and essential to reflect upon the scientific advancements, ongoing challenges, and emerging opportunities in this dynamic field. Persistent shortages of donor organs, complexities associated with immunosuppressive therapies, and the imperative to optimize long-term patient outcomes continue to drive innovative research and clinical advancements. This issue features a collection of articles exploring key aspects of heart transplantation-from its historical foundations to the latest advances that are shaping its future.

[This corrects the article DOI: 10.14797/mdcvj.1079.].

This case addresses the challenges of treating patients with both severe aortic stenosis and subaortic stenosis. In this combined condition, transcatheter aortic valve implantation (TAVI) remains an off-label application, particularly in the presence of a subaortic membrane. Our multimodal imaging approach that incorporates echocardiography, cardiac computed tomography, and fluoroscopic guidance demonstrates the successful application of TAVI in a high-risk clinical scenario. The results underscore the potential of TAVI as a viable alternative to traditional surgical aortic valve replacement for patients with dual-level obstruction who are not candidates for open surgery.

Aortic stenosis (AS) leads to a reduced effective orifice of the aortic valve, and severity is based on obstructions in flow and velocity. In some patients, coexisting structural cardiac abnormalities that increase left ventricular volume, such as patent ductus arteriosus (PDA), may complicate evaluation and management. We present the case of a patient with severe AS and unrepaired PDA and discuss the hemodynamic implications and important physiological changes resulting from the interactions between these lesions. It is important for clinicians to consider the impact of PDA closure in the evolution of AS and related symptoms.

This 76-minute webcast features a conversation about "Obesity and the Heart"-the focus of Issue 21.2. Led by the issue's editor, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/4867850.

Immune checkpoint inhibitor (ICI)-induced myocarditis is rare but carries a high morbidity and mortality rate. While cardiac magnetic resonance imaging (CMR) is the first-line imaging modality to support diagnosis, the need for endomyocardial biopsy is needed in negative CMR cases.

A 30-year-old patient with end-stage chronic kidney disease presented in critical condition due to the exhaustion of vascular access options and recurrent episodes of peritonitis precluding peritoneal dialysis. A percutaneous, tunneled hemodialysis catheter was successfully placed via the right internal thoracic vein, providing life-saving vascular access and enabling immediate initiation of renal replacement therapy.

We discuss the case of a 47-year-old female who presented to our institution with progressive exertional shortness of breath. Her history was notable for severe acne medicated with 100 mg oral daily minocycline for 2 years and a presumptive diagnosis of a bicuspid aortic valve. Investigations revealed severe aortic stenosis, prompting a decision for elective aortic valve repair. Intraoperatively, significant calcification of a unicuspid aortic valve, atypically blackened valve, and endocardium of the left ventricle and aorta were visualized.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disorder that can lead to sudden cardiac death (SCD) in young individuals with structurally normal hearts. This case report presents a novel instance of CPVT caused by a Ryanodine receptor channel-2 (RyR2) gene mutation in a young adult. A 24-year-old male presented with recurrent syncope and pre-syncopal episodes. Initial cardiac evaluations, including electrocardiography and echocardiography, were unremarkable. The patient experienced multiple syncopal events, including an episode of aborted SCD. Implantation of a loop recorder and subsequent implantable cardioverter-defibrillator (ICD) revealed recurrent ventricular tachycardia (VT). Comprehensive genetic testing identified a pathogenic mutation in the RyR2 gene, confirming the diagnosis of CPVT. The patient was initiated on beta-blocker therapy (propranolol) for primary prevention of VT episodes and to reduce ICD interventions. The ICD was maintained for secondary prevention. This case underscores the importance of considering genetic arrhythmia syndromes in the differential diagnosis of unexplained syncope in young adults, even when initial cardiac assessments appear normal. It also highlights the critical role of genetic testing in the diagnosis and management of inherited cardiac conditions and emphasizes the need for family screening due to the autosomal dominant inheritance pattern of RyR2 mutations.