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The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.

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Percutaneous left atrial appendage closure (LAAC) is a valid alternative to oral anticoagulation to prevent ischemic stroke in patients with atrial fibrillation.The devices approved in Europe and United States for percutaneous LAAC contain metal and temporary antithrombotic therapy is strongly recommended following implantation to prevent thrombus formation on the atrial device surface. There is still uncertainty regarding to the optimal antithrombotic drug regimen after device implantation for several reasons. Thus, this review aims at summarizing the available evidence and the remaining challenges related to the management of antithrombotic therapy in the context of LAAC procedure.

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OBJECTIVE: This study aims to assess the efficacy and safety of tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) procedures using the MitraClip or TriClip device in high-risk patients with severe secondary tricuspid regurgitation (TR) and provide Turkish-specific data on procedural outcomes and clinical follow-up. METHODS: This study enrolled 42 high-risk patients with severe secondary TR who underwent transcatheter edge-to-edge repair using either the MitraClip or TriClip device. Patient selection criteria included severe TR, high surgical risk (EuroScore ≥ 8 and Tricuspid Regurgitation Impact Severity Score (TRI-SCORE) ≥ 6), symptomatic despite medical therapy, and anatomical suitability for TriClip. Patients underwent rigorous evaluation by a specialized cardiac team before the procedure, including 2D/3D transesophageal echocardiography to assess eligibility. RESULTS: The study achieved a 100% procedural success rate, defined as successful implantation and at least one-degree reduction in TR severity. Post-procedure assessments revealed that 88.1% of patients had mild to moderate TR, indicating significant improvement, while only 11.9% retained severe TR. During the median follow-up of 11.5 months, rehospitalization occurred in 23.8% of patients, and mortality was observed in 7.1% of patients, demonstrating a favorable safety profile. Comparative analysis between TriClip and MitraClip devices showed similar efficacy and safety outcomes, with no significant differences in procedural durations or complication rates. CONCLUSION: The study demonstrates the effectiveness and safety of TV TEER using TriClip or MitraClip devices in managing severe secondary TR in high-risk patients. Procedure success, improved TR severity, and favorable clinical outcomes were observed, supporting the role of transcatheter techniques in TR management.

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Background: Deposition of adipose tissue may have a promoting role in the development of diabetic complications. This study is aimed at investigating the relationship between adipose tissue thickness and risk of contrast-induced nephropathy (CIN) in patients with Type 2 diabetes mellitus (T2DM). Methods: A total of 603 T2DM patients undergoing percutaneous coronary angiography or angioplasty with suspicious or confirmed stable coronary artery disease were enrolled in this study. The thicknesses of perirenal fat (PRF), subcutaneous fat (SCF), intraperitoneal fat (IPF), and epicardial fat (ECF) were measured by color Doppler ultrasound, respectively. The association of various adipose tissues with CIN was analyzed. Results: Seventy-seven patients (12.8%) developed CIN in this cohort. Patients who developed CIN had significantly thicker PRF (13.7 ± 4.0 mm vs. 8.9 ± 3.6 mm, p < 0.001), slightly thicker IPF (p = 0.046), and similar thicknesses of SCF (p = 0.782) and ECF (p = 0.749) compared to those who did not develop CIN. Correlation analysis showed that only PRF was positively associated with postoperation maximal serum creatinine (sCr) (r = 0.18, p = 0.012), maximal absolute change in sCr (r = 0.33, p < 0.001), and maximal percentage of change in sCr (r = 0.36, p < 0.001). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of PRF (0.809) for CIN was significantly higher than those of SCF (0.490), IPF (0.594), and ECF (0.512). Multivariate logistic regression analysis further confirmed that thickness of PRF, rather than other adipose tissues, was independently associated with the development of CIN after adjusted for confounding factors (odds ratio (OR) = 1.53, 95% CI: 1.38-1.71, p < 0.001). Conclusions: PRF is independently associated with the development of CIN in T2DM patients undergoing coronary catheterization.

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Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI. Prototypes combining 2 or even 3 imaging probes with complementary attributes have been developed, and several multimodality systems have already been used in patients, with near-infrared spectroscopy intravascular ultrasound-based studies showing promising results for the identification of high-risk plaques. Moreover, postmortem histology studies have documented that hybrid imaging catheters can enable more accurate characterization of plaque morphology than standalone imaging. This review describes the evolution in the field of hybrid intracoronary imaging; presents the available multimodality catheters; and discusses their potential role in PCI guidance, vulnerable plaque detection, and the assessment of endovascular devices and emerging pharmacotherapies targeting atherosclerosis.

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BACKGROUND: In the literature, obesity has been correlated with coronary artery diseases (CADs) and high health costs. This study aimed to investigate the relationships between obesity parameters and the health costs among patients with CADs undergoing cardiac catheterization. METHOD: A secondary data analysis was done for an original study. The original study was conducted among 220 hospitalized patients undergoing cardiac catheterization from two main hospitals located in the Middle and Northern regions of Jordan. Bivariate Pearson's correlation and forward linear regression analysis were calculated in this study. RESULTS: The average health cost for the participants was 1,344 JOD (1,895.63 USD). A significant positive moderate correlation (r = 0.4) was found between hip circumference (HC) and health cost. There were significant positive weak correlations between low-density lipoprotein (LDL), triglycerides, high-sensitivity C-reactive protein (HS-CRP), hemoglobin A1c (HbA1c), and depression, and the health cost (correlation coefficient 0.17, 0.3, 0.29, 0.22 and 0.17, respectively. HC, waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and body adiposity index (BAI) were significantly associated with health costs among male participants. In contrast, among females, none of the obesity parameters was significantly associated with health costs. The forward regression analysis illustrated that an increase of HC by 3.9 cm (ß (0.292) * SD (13.4)) will increase the health cost by 1 JOD (0.71 USD). The same analysis revealed that HS-CRP increased by 0.4 mg/dl (ß (0.258)*SD (1.43)), or triglycerides increased by 8.3 mg/dl (ß (0.241)* SD (34.3)), or depression score increased by 0.32 score (ß (0.137)* SD (2.3)), or total cholesterol increased by 4 mg/dl (ß (0.163)* SD (24.7)), the health cost will increase by one JOD (0.71 USD). CONCLUSION: Healthcare providers, including nurses, should significantly consider these factors to reduce the health costs for those at-risk patients by providing the appropriate healthcare on time.

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INTRODUÇÃO Cardiomiopatia (CMP) induzida por estresse, como a cardiomiopatia de Takotsubo, pode ter características clínicas semelhantes à isquemia miocárdica, como elevação de troponinas, alterações no Eletrocardiograma (ECG), mas sem obstrução coronariana ou lesões isquêmicas. Semelhante, a CMP induzida por Feocromocitoma possui sintomas também semelhantes a CMP hipertrófica, hipertensão e edema pulmonar devido a fatores cardiogênicos ou não cardiogênicos. Ambas supracitadas podem ter associação com excesso de catecolaminas, mas raramente estão associadas. RELATO DO CASO Paciente masculino, 46 anos, diabético, com história de estresse por situações familiares importantes, recentemente. Chega no serviço de emergência, com queixas de dispnéia, náuseas e êmese, iniciados há 1 dia, associado a retenção urinária e parestesia em mãos e paraparesia de membros inferiores. Refere também tratamento com Amoxicilina + Clavulanato há um mês por Colecistite Aguda. Na chegada, paciente se encontrava taquicárdico, taquipneico e saturando 98% em uso de óculos nasal a 2l/min, além de acidose metabólica. Realizou-se uma tomografia computadorizada de abdome, que evidenciou uma massa em Adrenal, sugestivo de Feocromocitoma, bem como metanefrinas urinárias e catecolaminas positivas. Ainda na emergência, evoluiu com insuficiência respiratória aguda por edema agudo de pulmão, necessitando de manejo com Nitroglicerina e 03 ampolas de Furosemida e uso de máscara não reinalante a 10l/min. Foi encaminhado para Unidade de Terapia Intensiva, onde foi realizado um ECG com alterações primárias da repolarização, seguido de alterações nos valores de Troponina e alterações no Ecocardiograma (ECO) de acinesia apical, hipocinesia de todos os segmentos médios e contratilidade preservada em segmentos basais. Cateterismo cardíaco com achados semelhantes ao ECO e presença de balonamento na ventriculografia, além de ausência de lesões obstrutivas em coronárias. CONCLUSÃO A excepcionalidade desse caso diz respeito ao quadro de síndrome coronariana aguda com dois motivos plausíveis e evidenciados na condução do caso, sendo eles: CMP de Takotsubo e a induzida por Feocromocitoma. Fica evidente, pela evolução do quadro, a gravidade do mesmo e a importância de considerar diagnósticos diferenciais, inclusive os menos comuns.

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BACKGROUND: Despite a rigorous screening process, including cardiac catheterization, a subset of patients with a single right ventricle (SRV) demonstrates suboptimal short-term outcomes after the Fontan operation. The goal of this study was to perform a comprehensive assessment of diastolic function in pre-Fontan patients with an SRV using invasive reference-standard measures and determine their associations with post-Fontan outcomes. METHODS AND RESULTS: Children aged 2 to 6 years with SRV physiology undergoing pre-Fontan heart catheterization were recruited prospectively. Patients were divided into those who had an optimal or suboptimal outcome. A suboptimal outcome was defined as length of stay ≥14 days or heart transplant/cardiac death in first year after Fontan. Patients underwent pressure-volume loop analysis using reference-standard methods. The measure of ventricular stiffness, ß, was obtained via preload reduction. Cardiac magnetic resonance imaging for extracellular volume and serum draws for matrix metalloproteinase activity were performed. Of 19 patients with an SRV, 9 (47%) had a suboptimal outcome. Mean age was 4.2±0.7 years. Patients with suboptimal outcomes had lower ventricular stiffness (0.021 [0.009-0.049] versus 0.090 [0.031-0.118] mL-1; P=0.02), lower extracellular volume (25% [28%-32%] versus 31% [28%-33%]; P=0.02), and lower matrix metalloproteinase-2 (90 [79-104] versus 108 [79-128] ng/mL; P=0.01) compared with patients with optimal outcomes. The only invasive measure that had an association with suboptimal outcome was ß (P=0.038). CONCLUSIONS: Patients with an SRV with suboptimal outcome after the Fontan operation had lower ventricular stiffness and evidence of maladaptive extracellular matrix metabolism compared with patients with optimal outcome. This appears to be a novel phenotype that may have important clinical implications and requires further study.

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RATIONALE: Alcoholic cardiomyopathy (ACM) is associated with various cardiac complications, but the development of isolated right atrial (RA) thrombus without deep vein thrombosis is rare and presents diagnostic challenges. PATIENT CONCERNS: A 53-year-old Hispanic male presented with shortness of breath, chills, cough, bilateral lower extremity edema, and distended abdomen. DIAGNOSES: The patient was diagnosed with ACM, liver cirrhosis, and a large RA thrombus. Initial transthoracic echocardiography showed severe left ventricular systolic dysfunction but failed to detect the RA mass. Subsequent computed tomography scan and transesophageal echocardiography revealed a large oval mass in the RA, measuring 40 mm × 22 mm × 18 mm. INTERVENTIONS: The patient received guideline-directed medical therapy for heart failure and anticoagulation with enoxaparin. He underwent cardiac catheterization for mechanical thrombectomy, which was minimally successful. OUTCOMES: The patient's condition was managed with the prescribed interventions. Regular follow-up was planned to assess thrombolysis. LESSONS: RA thrombosis is an uncommon complication of ACM. A multimodal imaging approach, with a low threshold for transesophageal echocardiography, is crucial in evaluating patients with ACM who present with cardiac complications. This approach enables accurate diagnosis and management of rare conditions like isolated RA thrombosis.

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