Texas Heart Institute Journal最新文献

Lyme carditis represents a rare cardiac complication of Borrelia burgdorferi infection, often causing conduction disturbances but rarely causing malignant arrhythmias. Inflammatory acute coronary syndrome, driven by immune-mediated plaque erosion rather than rupture, represents a nontraditional ischemic mechanism. This case highlights their overlap. The case of a previously healthy man with Lyme disease who experienced cardiac arrest because of ventricular tachycardia is reported. Imaging showed myocardial inflammation together with coronary plaque erosion instead of plaque rupture. The patient underwent advanced diagnostic testing and received multidisciplinary medical care, which led to complete cardiac recovery and implantable cardioverter-defibrillator placement.

Background: Continuous-flow left ventricular assist devices (LVADs) are increasingly used as destination therapy. Although postimplantation stroke rates have been described in the context of bridge-to-transplant or mixed cohorts, stroke development is not well evaluated in patients who receive continuous-flow LVAD with a destination therapy indication. This report characterizes the stroke profile of a modern institutional cohort of patients undergoing destination therapy and evaluates their risk factors for stroke onset.

Methods: Patients implanted with continuous-flow LVAD as destination therapy at the reporting institution between January 2010 and June 2020 were retrospectively reviewed and analyzed. Stroke was defined as any neurologic deficit caused by an abrupt disruption in cerebral blood flow that did not resolve within 24 hours and that was confirmed by imaging. Terminal outcomes of stroke development and death were assessed using a competing-risks model. Fine-Gray regression was used to evaluate potential predictors of stroke development.

Results: Patients who received continuous-flow LVAD (N = 311) were classified by device type: Heart-Mate II (Abbott; n = 97); HeartMate 3 (Abbott; n = 72); and HeartWare Ventricular Assist Device (Medtronic; n = 42). Thirty-five percent of patients (110/311) developed postoperative atrial fibrillation (AF). Estimated stroke incidence was 15% at 1 year, 24% at 3 years, and 27% at 5 years. According to multivariable Fine-Gray regression, receiving a HeartMate 3 device (subdistribution hazard ratio [HR], 0.41 [95% CI, 0.19-0.90]; P = .03) and amiodarone at discharge (HR, 0.55 [95% CI, 0.33-0.94]; P = .03) were associated with lower stroke risk. Postoperative AF (HR, 1.68 [95% CI, 1.03-2.73]; P = .04) was associated with increased stroke risk.

Conclusion: The HeartMate 3 was associated with decreased stroke rates, but risk remained high for patients who developed postoperative AF. Further investigation into protective strategies and use of amiodarone to treat AF after continuous-flow LVAD implantation is needed.

Background: Mitral valvuloplasty is considered the best treatment for pediatric mitral valve regurgitation. The objective of this analysis was to identify risk factors for postoperative mitral valve regurgitation progression and evaluate valvuloplasty effectiveness.

Methods: This retrospective, single-center study investigated the clinical efficacy of mitral valvuloplasty and identified factors that affect prognosis. Pediatric patients with moderate or severe mitral valve regurgitation who had undergone mitral valvuloplasty between September 2016 and August 2023 were included. Kaplan-Meier survival analysis was used to assess freedom from both mitral valve deterioration and cardiovascular death. Univariate and multivariate Cox regression analyses were performed to identify potential risk factors.

Results: The study comprised 137 pediatric patients (mean age, 37.5 months [range, 2.4-167.6 months]) who had moderate (64/137 [46.7%]) or severe (73.137 [53.3%]) mitral valve regurgitation. At midterm follow-up (median, 55.3 months), mitral valve regurgitation had statistically significantly decreased compared with preoperative levels (P < .001, Wilcoxon signed-rank test); freedom from cardiovascular death was 97.5%, and freedom from worsening mitral valve regurgitation was 89.4%. Cox regression analysis identified body weight (P = .02), left ventricular end-diastolic diameter (P = .005), and left ventricular ejection fraction (P = .01) at 1 month and cardiopulmonary bypass time (P = .007) as independent risk factors for deterioration. Patients weighing 10 kg or more (P = .04) or with a ventricular septal defect 8 mm or larger (P = .04) had worse outcomes.

Conclusion: Mitral valvuloplasty resulted in low mortality and positive long-term results in pediatric patients with mitral valve regurgitation. Early aggressive therapy is recommended to avoid late postoperative mitral valve deterioration.

This case study explores the journey of an 80-year-old male patient with a history of hypertension, diabetes, coronary artery disease after coronary artery bypass grafting, atrial fibrillation, and heart failure. Nine months before he presented to the emergency department, he had undergone mitral valve clipping for severe mitral valve regurgitation. Despite initial improvement, the patient experienced return of symptoms, including dyspnea at rest and lower limb edema. The results of this case-discovery of the need for mitral valve replacement-provides insights into the management of complications from mitral valve clipping and emphasizes that management requires a nuanced, meticulous approach.

Key pathobiological components of ischemic heart disease have been identified as follows: (1) In 1970 to 1973, myocardial infarct size was found to be the primary determinant of prognosis after acute myocardial infarction (AMI); (2) in 1973 to 1989, vulnerable coronary artery plaques were found to predispose individuals to coronary plaque disruption and thrombosis, causing major AMI; (3) in 1972, timely coronary reperfusion was demonstrated to limit the size of evolving AMI but with risk of reperfusion injury; and (4) in 1986, myocardial conditioning was found to be a clinically significant modulator capable of delaying AMI progression. Promising cardioprotective strategies combining timely reperfusion with conditioning in experimental animal and proof-of-concept human studies have not been shown to optimize cardioprotection, and this area of research has stalled. Nevertheless, opportunities for further progress against ischemic heart disease have come from new perspectives and approaches, including (1) recognition that functionally significant ischemic heart disease can result from microvascular dysfunction or epicardial coronary atherosclerosis; (2) rapid diagnosis of AMI subtypes through application of the Universal Definition of Myocardial Infarction based on high-sensitivity cardiac troponin measurements; (3) the Canadian Cardiovascular Society classification of AMI based on stages of tissue injury severity, as detected by advanced imaging; (4) implementation of the occlusion vs nonocclusion MI paradigm to prompt aggressive management of all ST-segment elevation MI and the one-third of non-ST-segment elevation MI with total occlusion; and (5) implementation of the Early Heart Attack Care program, which emphasizes prodromal symptom recognition to prevent AMI progression.

A 63-year-old man with a history of hypertension, prediabetes, and sleep apnea presented with pedal edema, weight loss, and flushing. Laboratory work revealed elevated B-type natriuretic peptide and normocytic anemia. Echocardiography showed right ventricular enlargement, severe tricuspid valve regurgitation, and thickened tricuspid valve leaflets, raising suspicion for carcinoid heart disease. Further testing confirmed a neuroendocrine tumor with liver metastasis. Despite somatostatin therapy, the patient's symptoms were refractory to diuretics. Surgical intervention with tricuspid and pulmonary valve replacement was undertaken. Postoperatively, the patient demonstrated substantial improvement in functional tolerance and quality of life. This case highlights the importance of surgical intervention in advanced carcinoid heart disease.

This report highlights a case of early structural valve deterioration with a cusp tear in a second-generation Abbott Trifecta Glide Technology bioprosthetic heart valve. A 70-year-old man had undergone aortic valve replacement with a Trifecta Glide Technology valve 30 months earlier for severe bicuspid aortic valve stenosis. He suddenly developed acute heart failure with dyspnea resulting from severe aortic valve regurgitation, with a cusp tear in the Trifecta Glide Technology valve, as demonstrated by transthoracic echocardiography. The patient was successfully treated with urgent repeat aortic valve replacement.

The Micra device is a leadless pacemaker implanted in the right ventricle via a femoral vein transcatheter approach. There are several indications for and advantages to using a leadless pacemaker, and the device's role in the field of cardiology will probably continue to increase. This article presents the case of a rare complication probably due to inadvertent placement of the device in the left ventricle across an undiagnosed patent foramen ovale.