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INTRODUCTION: Successful closure of patent ductus arteriosus (PDA) can be obtained with surgical ligation or with occlusion via minimally invasive per-catheter techniques. This study was performed to assess feasibility and effectiveness of transjugular PDA occlusion in dogs weighing < 3 kg with a device called Nit-Occlud® PDA. ANIMALS: Thirteen client-owned dogs. MATERIALS AND METHODS: This was a retrospective study. Clinical records of dogs that underwent PDA occlusion with a Nit-Occlud® PDA were reviewed. Data collection included patients' signalment, clinical findings, pre- and post-procedure echocardiographic measurements, device size, procedure time and clinical outcome. RESULTS: The median age of these patients was six months (2.5-38.0 months), with a mean body weight of 2.44 ± 0.43 kg. The mean minimal ductal diameter (MDD) was 1.82 ± 0.43 mm, while the mean ampulla diameter (AD) was 5.51 ± 1.89 mm. Duct closure was successful in 12 cases. Minimal or no residual shunt was observed on echocardiography prior to device release. In one dog, the device was not released owing to unsatisfactory occlusion, prompting an alternative occlusion method. Follow-up echocardiographic examinations showed complete ductal closure and reversed cardiac remodelling in all cases where the device was successfully released. DISCUSSION: The Nit-Occlud® is deployed through a delivery system with an outer diameter of 4 F or 5 F, which makes this solution particularly attractive in patients where vascular access is challenging or unfeasible due to the small size of their vessels. CONCLUSIONS: The Nit-Occlud® PDA appears a feasible and effective occlusion system in small patients weighing <3 kg.

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INTRODUCTION: Lipoprotein(a) [Lp(a)] is linked to higher risks of atherosclerotic cardiovascular disease (ASCVD). Current guideline recommendations are quite liberal on measuring Lp(a) (Class IIa, Level C), and may lead to underuse among (interventional) cardiologists. AREAS COVERED: This case-based narrative review outlines four clinical cases of patients with elevated Lp(a) to illustrate its pathophysiological impact on coronary artery disease (CAD). The expert consensus statements from the American Heart Association (AHA) and European Atherosclerosis Society (EAS) served as the basis of this review. More recent publications, from 2023 to 2024, were accessed through the MEDLINE online library. EXPERT OPINION: We highlighted the importance of routine Lp(a) measurement in identifying patients at high risk for atherosclerosis, necessitating potent risk mitigation. Measuring Lp(a) helps clinicians identify which patients are at highest residual risk, who require potent pharmacological treatment and special attention during catheter interventions. As noninvasive and advanced intravascular imaging modalities evolve, future catheterization laboratories will integrate advanced imaging, diagnostics, and treatment, facilitating tailored patient care. Knowing Lp(a) levels is crucial in this context. While Lp(a)-lowering drugs are currently investigated in clinical trials, it is of paramount importance to know Lp(a) levels and strive toward aggressive management of other modifiable risk factors in patients with elevated Lp(a) and established symptomatic CAD being diagnosed or treated in catheterization laboratories.

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Aim: The Amplatzer Piccolo Occluder (APO) is approved for patent ductus arteriosus (PDA) occlusion in infants weighing >700 g but could offer versatility to treat other lesions.Methods: Retrospective review of children in whom APO was utilized for defects other than PDA between January 2022 and June 2023.Results: The APO was used in nine patients; three for ventricular septal defects, four with coronary fistulas, one for a ventricular pseudoaneurysm and one where APO deployed within a fenestration of a previously placed Amplatzer Septal Occluder. All nine patients had successful occlusions without complications.Conclusion: The APO is a versatile device that can be used to treat various small diameter lesions in children besides the PDA for which it is currently approved for.

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INTRODUCTION: Myocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the heart due to hyperstimulated thyroid function. CASE PRESENTATION: The patient was a 36-year-old woman who presented with left-sided chest pain, dyspnea, palpitation, and tremor. The initial evaluation showed evidence of myocardial ischemia (positive high-sensitivity troponin) caused by a hyperactive thyroid gland. The treatment for myocardial infarction, along with anti-thyroid medications, improved the patient's condition and subsided the symptoms. The coronary angiography revealed no pathologic finding, and the hypokinetic left ventricle, observed in the first echocardiogram, was resolved. The patient was discharged with an excellent clinical condition, and after the 4-month taking of a calcium channel blocker and tapering carbimazole, the thyroid function became normal, and her symptoms resolved completely. CONCLUSION: Patients without evident risk factors for ischemic heart disease, such as non-diabetic, nonsmoker, and young individuals who presented with acute coronary syndrome, should be evaluated for a potential background reason for the imbalance between the oxygen demand and supply of the myocardium. The presence of palpitation, weight loss, tremors, insomnia, and anxiousness, along with ischemic signs, should make the physician think about the probability of the hyperthyroid-induced cardiovascular disorder. CLINICAL KEY POINT: The initial presentation of hyperthyroidism might be accompanied by severe cardiac symptoms. When the demographic features are not aligned with usual ischemic heart disease, other probable symptoms and signs should be investigated, and thyroid function should be checked. The control of thyroid hyperactivity would result in the resolution of both cardiac and non-cardiac symptoms.

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Interventional cardiology is on the cusp of a significant transformation as we approach 2050, driven by emerging trends and groundbreaking technological innovations. This mini review explores the pivotal developments shaping the field, focusing on three key areas: Emerging Trends in Interventional Cardiology, Technological Innovations: The Next Frontier, and the Future Era of Intervention Cardiology from 2024 to 2050. Emerging trends, including advancements in imaging and artificial intelligence, are revolutionizing diagnosis and treatment, allowing for more precise and personalized interventions. Technological innovations, such as robotic-assisted procedures and bioresorbable stents, are redefining the landscape, enhancing procedural accuracy, and expanding access to care through remote interventions. Looking ahead to 2050, we anticipate a future where interventional cardiology is increasingly driven by minimally invasive techniques, AI-driven decision-making, and personalized medicine, offering unprecedented improvements in patient outcomes and reshaping the way cardiovascular diseases are managed.

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A middle-aged man presented with inferior wall ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention with tirofiban administered due to extensive thrombus. He developed sudden-onset dyspnoea, bilateral crepitations, haemoptysis, desaturation and hypotension an hour after starting tirofiban infusion. The tirofiban, antiplatelet medications and heparin were stopped immediately. Chest X-ray showed patchy opacities in the left upper, middle and lower zones. High-resolution CT showed confluent areas of consolidation with surrounding ground glass opacities and interlobular septal thickening (crazy pavement appearance) representing diffuse alveolar haemorrhage (DAH). He was managed with inotropes, non-invasive ventilation and intravenous furosemide. He was asymptomatic with complete resolution of lung opacities in chest X-ray done 2 months follow-up. DAH is a rare but potentially life-threatening complication which is often misidentified with other respiratory syndromes. Treatment includes stopping tirofiban and anticoagulant medication, blood transfusion, and institution of mechanical ventilation.

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Renal denervation may be indicated in patients with treatment-resistant essential hypertension to decrease sympathetic nervous activity and optimise blood pressure. We present the case of a woman in her 50s with long-standing essential hypertension, a previous transient ischaemic attack, obesity and a family history of cardiovascular disease, who presented with persistent 24-hour ambulatory hypertension despite ongoing lifestyle modifications and being on five antihypertensive agents with no evidence of an alternative primary aetiology. She had intermittent palpitations and blurring of vision alongside evidence of left ventricular hypertrophy on a CT scan. She underwent renal denervation, following which, not only was she able to cease all antihypertensive therapy but managed to maintain optimised blood pressure with subsequent reversal of left ventricular hypertrophy. Trials have demonstrated modest but inconsistent reductions in blood pressure whereas our case represents a 'super-response' likely due to a higher number of circumferential ablations in comparison to previous studies.

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BACKGROUND: The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing. METHODS: We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures. RESULTS: There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation. CONCLUSION: Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.

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Renal denervation as an option for difficult to treat hypertension has been a concept for several decades, with recent U.S. FDA approval of new, minimally invasive devices. However, while renal denervation has the potential to improve hypertension management, several challenges require consideration prior to widespread adoption. The effect relative to sham control is modest, and generally similar to addition of a single blood pressure lowering medication. It is possible that with additional technique refinement greater effects may be possible. Key factors to consider beyond the direction, strengths, and limitations of the renal denervation technologies themselves, are an understanding of patient groups that derive greatest benefit and phenotypes or biomarkers that predict greater response. This review provides an update on these challenges in addition to the current state and future of renal denervation within the context of hypertension management and treatment.

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In patients with anomalous origin of the left main coronary artery, accurate classification is essential for effective management. Despite surgical refusal, successful stenting and medication can lead to favorable outcomes. Regular monitoring ensures ongoing cardiac health. Abstract: Coronary artery anomalies, including anomalous origin of the left main coronary artery from the right sinus of Valsalva, are rare occurrences with varying clinical significance. Accurate classification of these anomalies is crucial for determining their implications and guiding management. A 50-year-old man presented with chest pain and was diagnosed with an anomalous origin of the left main coronary artery. Despite refusing surgery, successful stenting and medication led to a favorable outcome. Regular monitoring is scheduled. Accurate classification of coronary anomalies, such as the left main coronary artery anomaly described, is vital for effective management. Even when surgical intervention is declined, alternative treatments, such as stenting, can be successful. Regular monitoring ensures ongoing cardiac health.

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Acute viral myocarditis and hyperthyroidism can present with acute coronary syndrome. However, the link between hyperthyroidism and myocarditis has hardly been explored apart from a small collection of published case reports. We report a case where a patient presents with severe chest pain and was found to have concomitant severe coronary vasospasm and acute myocarditis and was diagnosed with Graves' disease.

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Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation of SDM.

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Virtual reality technology provides an environment for advanced 3-dimensional visualization of complex cardiac anatomy from cross-sectional imaging. Visualization and case planning with procedural simulation is very relevant and likely critical for overall procedural success in complex congenital interventions. We report this case series demonstrating the use of virtual reality to conduct remote, collaborative interinstitutional consultations on computed tomography angiography prior to congenital percutaneous interventions.

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Cardiac computed tomography angiography (CCTA) has become the gold standard for noninvasive anatomic assessment of the coronary arteries. With high positive predictive value and even higher negative predictive value, CCTA allows for rapid determination of the presence or absence of coronary plaque and triage of patients' need for further invasive evaluation and treatment. From an interventional cardiologist's perspective, CCTA (more so than stress testing) is helpful in determining the need for invasive therapy. In conjunction with functional assessments, the anatomic evaluation from CCTA mirrors the anatomical assessment of a coronary angiogram more than any other noninvasive assessment. This allows for catheter selection, percutaneous coronary intervention preplanning, as well as additional decision making before the patient has entered the catheterization laboratory. This manuscript explores some of the more recent developments in noninvasive coronary angiography and discusses the use and utility of CCTA from an interventional cardiologist's perspective.

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The field of interventional cardiology (IC) has evolved dramatically over the past 40 years. Training and certification in IC have kept pace, with the development of accredited IC fellowship training programs, training statements, and subspecialty board certification. The application process, however, remained fragmented with lack of a universal process or time frame. In recent years, growing competition among training programs for the strongest candidates resulted in time-limited offers and high-pressure situations that disadvantaged candidates. A grassroots effort was recently undertaken by a Society for Cardiovascular Angiography & Interventions task force, to create equity in the system by establishing a national Match for IC fellowship. This manuscript explores the rationale, process, and implications of this endeavor.

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This review explores the transformative applications of augmented reality (AR) and mixed reality (MR) technologies in interventional cardiology. The integration of these cutting-edge systems offers unprecedented potential to enhance visualization, guidance, and outcomes during complex cardiac interventional procedures. This review examines four key domains: (1) medical AR/MR systems and technological foundations; (2) clinical applications across procedures like TAVI, PCI, and electrophysiology mapping; (3) ongoing technology development and validation efforts; and (4) educational and training applications for fostering essential skills. By providing an in-depth analysis of the benefits, challenges, and future directions, this work elucidates the paradigm shift catalyzed by AR and MR in advancing interventional cardiology practices. Through meticulous exploration of technological, clinical, and educational implications, this review underscores the pivotal role of these innovative technologies in optimizing procedural guidance, improving patient outcomes, and driving innovation in cardiovascular care.

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Pseudocoarctation of the aorta (PCoA) is a rare congenital anomaly characterized by the abnormal kinking of the thoracic aorta. It is often incidentally diagnosed but gained clinical significance due to its propensity to develop aortic aneurysm and rupture. A standard diagnostic and treatment algorithm for PCoA is lacking, and also, the natural history of the disease is not well studied. We present here a case of PCoA with a fusiform aneurysm of the thoracic aorta to emphasize the need to differentiate it from true coarctation and to rule out associated complications.