Tortuous Coronary Artery Fistula Closed Using a Microvascular Plug in Heart Failure.

Tortuous Coronary Artery Fistula Closed Using a Microvascular Plug in Heart Failure.

BACKGROUND: Large coronary artery fistulas may result in ischemia and heart failure. CASE SUMMARY: A 74-year-old woman was found to have an ejection fraction of 20%-25% with apical and anterior akinesis. A large fistula from the left anterior descending artery to the pulmonary artery was identified as the likely etiology. Multiple attempts at closure failed in the setting of extreme tortuosity with nearly 180° bends. Eventually, a 5-mm vascular plug was advanced through a microcatheter and successfully deployed. Follow-up echocardiography demonstrated improvement of the ejection fraction to 40%-45% and complete resolution of the previous wall motion abnormalities. DISCUSSION: This case illustrates a reversible coronary steal-mediated cardiomyopathy. It highlights the clinical utility of microcatheter-compatible vascular plugs for transcatheter closure of anatomically complex coronary fistulas, even in elderly patients. TAKE-HOME MESSAGE: Percutaneous closure of coronary artery fistulas with microcatheter-compatible devices improves cardiac function even in elderly patients.

Epicardial adipose tissue radiomics complement calcium scoring in black adults with type 2 diabetes mellitus.

BACKGROUND: Conventional markers of risk such as coronary artery calcium (CAC) scores are lower and less predictive in Black adults, despite a high prevalence of Type 2 diabetes mellitus (T2DM) and Metabolic Syndrome We evaluated whether incorporation of epicardial adipose tissue (EAT) features capture prognostic signal beyond CAC and social deprivation index, in predicting major adverse cardiovascular events. METHODS: Adults with T2DM undergoing non-contrast CT calcium scoring from the CLARIFY registry (NCT04075162), including 1024 non-Hispanic Black participants and 3072 propensity-matched non-Hispanic White participants were included. EAT was automatically segmented and radiomic features were extracted and selected using survival-based machine learning. Cox proportional hazards models were constructed using CAC, Social Deprivation Index (SDI), and EAT features alone and in combination. The primary endpoint was 3-point major adverse cardiovascular events (MACE-3P), defined as cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Model discrimination, reclassification, and calibration were assessed. RESULTS: During a median follow-up of approximately 5 years, 206 (20%) Black participants and 422 (14%) matched White participants experienced MACE-3P In Black participants, the SDI+CAC+EAT model demonstrated the highest discrimination (C-index 0.62) and significantly improved reclassification compared with CAC alone (NRI) of 0.29 (95% CI 0.15-0.56; p < 0.0007). In contrast, the SDI+CAC+EAT model showed no improvement in discrimination when compared to CAC alone (C-index 0.67 v. 0.67) in the White cohort. CONCLUSION: In adults with T2DM, EAT may serve as a complimentary imaging marker when combined with CAC scores to provide incremental prognostic information or refine risk characterization.

Tennis: Kinnick triumphs in D-I mixed doubles event - Stripes Okinawa

Tennis: Kinnick triumphs in D-I mixed doubles event&nbsp;&nbsp;Stripes Okinawa

Interview: Charis Costopoulos on Innovation in Structural Heart Disease - EMJ

Interview: Charis Costopoulos on Innovation in Structural Heart Disease&nbsp;&nbsp;EMJ

Edwards Lifesciences Corporation $EW Stock: Birch Hill Investment Advisors LLC Trims Position - MarketBeat

Edwards Lifesciences Corporation $EW Stock: Birch Hill Investment Advisors LLC Trims Position&nbsp;&nbsp;MarketBeat

Full-Endoscopic Spine Surgery Enables High Rates of Pathogen Identification after Short-Term Antibiotic Therapy in Pyogenic Spondylitis.

INTRODUCTION: Prompt and accurate identification of pathogens is essential for effective treatment of pyogenic spondylitis. However, conventional non-surgical methods, such as blood culture and percutaneous needle biopsy, have limited sensitivity and reliability. This multicenter study investigated whether specimen collection during full-endoscopic spine surgery (FESS) is more useful than the conventional diagnostic modalities. METHODS: We retrospectively analyzed data for 53 patients diagnosed with pyogenic spondylitis across three participating institutions between January 2021 and April 2025. Pathogen identification rates were compared between FESS, percutaneous needle biopsy, and blood culture. The patients were stratified into three groups based on duration of pre-procedural antibiotic therapy (0 days, 1-13 days, or ≥14 days) to determine the influence of antibiotic exposure on diagnostic yield. Multivariate analysis was performed to adjust for inflammatory markers and clinical factors. RESULTS: The overall pathogen identification rate was 79.2%, with Escherichia coli (20.8%) and Staphylococcus aureus (17.0%) being the most frequent isolates. FESS achieved the highest identification rate (59.2%), followed by needle biopsy (45.2%) and blood culture (38.6%). Although detection rates were similar among the three methods in antibiotic-naïve patients, FESS demonstrated a significantly higher detection rate in the 1-13-day antibiotic group than blood culture (87.5% vs 16.7%, p=0.026), whereas the difference between FESS and needle biopsy (57.1%) was not statistically significant. FESS yielded positive results in 15.6% of patients, identifying pathogens despite negative findings on both blood culture and needle biopsy. CONCLUSIONS: FESS enables direct targeted sampling of infected tissues, resulting in pathogen identification rates that are higher than those with conventional diagnostic methods, particularly in patients with short-term antibiotic exposure. Unlike needle biopsy, FESS allows for the retrieval of adequate samples under direct vision. These findings indicate that FESS is a valuable diagnostic tool that complements its therapeutic role, potentially facilitating earlier optimization of antimicrobial therapy.

Massive Early Post-Tracheostomy Hemorrhage From Inferior Thyroid Artery Branch Injury: An Oxygenation-Preserving Airway Rescue Strategy.

Early life-threatening hemorrhage following tracheostomy is uncommon and may arise from injury to branches of the inferior thyroid artery. Early recognition is critical because ongoing hemorrhage may rapidly flood and obscure the airway, compromise oxygenation, and make definitive airway management extremely challenging. We report a 70-year-old male with recent ischemic stroke who underwent tracheostomy and percutaneous endoscopic gastrostomy placement and developed massive bleeding from the tracheostomy stoma approximately 26 hours after the tracheostomy placement. During emergent airway management, temporary digital compression was applied to control hemorrhage while ventilation was maintained through the existing tracheostomy tube as oral endotracheal intubation was attempted using video laryngoscopy. After definitive endotracheal tube placement was confirmed, surgical exploration revealed hemorrhage from inferior thyroid artery branches requiring ligation and tracheostomy revision. This case highlights the importance of rapid recognition of early surgical-site arterial bleeding, preservation of oxygenation during airway rescue, and coordinated surgical hemorrhage control.

Bacteroides fragilis Empyema Secondary to Ruptured Pyogenic Liver Abscess: A Rare Cause of Septic Shock.

Pyogenic liver abscess is an uncommon but potentially life-threatening intra-abdominal infection associated with significant morbidity and mortality. Although hepatic abscesses most commonly present with systemic infection or intra-abdominal complications, transdiaphragmatic spread into the pleural cavity resulting in empyema is rare. Bacteroides fragilis, an anaerobic gram-negative bacillus that forms part of the normal gastrointestinal flora, is a well-recognized pathogen in polymicrobial intra-abdominal infections but is infrequently reported as a primary pathogen in empyema originating from hepatic sources. We present the case of a 59-year-old man with uncontrolled hypertension, type 2 diabetes mellitus, and alcohol use disorder who presented with acute right-sided chest pain radiating to the back accompanied by dyspnea, fever, nausea, and malaise. On presentation, he was febrile, hypotensive, and tachypneic. Computed tomography (CT) imaging obtained to evaluate possible aortic pathology revealed a mild ascending thoracic aortic aneurysm measuring 4.1 cm without evidence of dissection, as well as a large fluid collection measuring 9.05 × 4.37 cm posterior to the right hepatic lobe concerning for a ruptured hepatic abscess and a moderate right-sided pleural effusion. Abdominal ultrasound confirmed a 9.6 cm hepatic abscess. The patient underwent interventional radiology-guided percutaneous drainage of the hepatic abscess and thoracentesis. Pleural fluid cultures grew Bacteroides fragilis and Staphylococcus warneri, while culture of the hepatic abscess also yielded Bacteroides fragilis, supporting transdiaphragmatic spread of infection from the ruptured hepatic abscess. Despite initial management with broad-spectrum intravenous antibiotics, persistent loculated pleural infection required video-assisted thoracoscopic surgery (VATS) with decortication. The patient subsequently improved clinically and was discharged on oral antibiotics to complete therapy. This case highlights the importance of early recognition of intra-abdominal sources in patients presenting with empyema and underscores the critical role of prompt diagnostic imaging, targeted antimicrobial therapy, and multidisciplinary source control, including percutaneous drainage and surgical intervention, in achieving favorable clinical outcomes and preventing disease progression.

Anatomy-Driven Transcatheter Edge-to-Edge Repair of the Systemic Atrioventricular Valve in Complex Transposition Anatomy.

Systemic atrioventricular valve (SAVV) regurgitation contributes importantly to systemic right ventricular deterioration in adults with congenitally corrected transposition of the great arteries (ccTGA) and dextro-transposition of the great arteries (d-TGA) after atrial-switch repair. Transcatheter edge-to-edge repair (TEER) has emerged as an option for selected patients at high or prohibitive surgical risk, and prior congenital series have established the feasibility of transseptal, transbaffle, and alternative access strategies. However, procedural execution remains highly anatomy-dependent because systemic venous pathways, atrial baffles, ventricular topology, cardiac orientation, and access-to-valve geometry can substantially alter guide-catheter support and device coaxiality. We report a single-center Interventional Rounds experience of four consecutive high-risk adults undergoing SAVV-TEER across four distinct transposition anatomies: ccTGA with dextrocardia, d-TGA after Mustard atrial-switch repair, Mustard anatomy with severe iliofemoral tortuosity, and ccTGA with interrupted inferior vena cava and azygos continuation. Transfemoral access was used in two patients, and right internal jugular access in two. Three procedures were performed with PASCAL ACE and one with MitraClip. Device implantation was successful in all four patients, with SAVV regurgitation reduced from severe (3+) to mild (1+). Final mean SAVV gradients were 1.5, 2.1, 1.9, and 1.8 mmHg, respectively, and no major acute procedural complications occurred. The principal technical message is that access selection should be guided not only by anatomic patency but by the anticipated mechanical trajectory of the delivery system. Right internal jugular access may be selected prospectively as the preferred primary route when inferior venous anatomy is absent or expected to provide unfavorable curvature, support, or device alignment. Dextrocardia and atrial-switch baffle anatomy may additionally require specific steering and traversal adaptations. These observations represent focused procedural refinements within the evolving congenital TEER experience rather than evidence of comparative efficacy or safety.

Perioperative Outcomes of Vacuum-Assisted Versus Standard Mini-Percutaneous Nephrolithotomy: A Propensity Score Overlap Weighting Analysis.

Background Vacuum-assisted mini-percutaneous nephrolithotomy (mini-PCNL) improves stone fragment evacuation and surgical efficiency. However, comparative evidence remains limited and susceptible to selection bias. We compared perioperative outcomes of standard and vacuum-assisted mini-PCNL using propensity score overlap weighting. Methods This retrospective study included 80 patients undergoing mini-PCNL between January 2022 and December 2025. Forty patients underwent standard mini-PCNL and 40 underwent vacuum-assisted mini-PCNL. Propensity score overlap weighting was performed using demographic and stone-related characteristics, including age, sex, ASA score, comorbidity status, stone size, stone multiplicity, and Guy's Stone Score. Stone-free status was assessed on postoperative non-contrast computed tomography (NCCT) with 3-mm slice thickness and classified as Grade A (no residual fragments), Grade B (residual fragments ≤2 mm), and Grade C (residual fragments 2.1-4 mm). Perioperative outcomes were compared using weighted regression models. Results After overlap weighting, excellent covariate balance was achieved across baseline variables. Vacuum-assisted mini-PCNL was associated with shorter operative time (53.8 ± 10.9 vs. 74.1 ± 3.8 min, p<0.001), shorter laser fragmentation time (p<0.001), shorter stone extraction time (p<0.001), lower postoperative hemoglobin decrease (p=0.041), reduced estimated blood loss (p=0.043), and shorter hospital stay (p=0.023). Needle puncture and fluoroscopy times were comparable between groups (p=0.540 and p=0.844, respectively). Grade A stone-free status was achieved in 32/40 (80.0%) patients in the vacuum-assisted group and 27/40 (67.5%) in the standard group, whereas Grade B status was observed in 3/40 (7.5%) and 2/40 (5.0%), respectively, and Grade C status in one patient (2.5%) in each group. Although Grade A stone-free status and postoperative complication rates favored the vacuum-assisted group, these differences were not statistically significant. Regression analysis confirmed an independent reduction in operative time (β = -20.28, 95% CI -24.60 to -15.96; p<0.001) and postoperative hemoglobin decrease (β = 2.39, 95% CI 0.10-4.67; p=0.041). Conclusions After propensity score overlap weighting, vacuum-assisted mini-PCNL demonstrated superior operative efficiency and reduced perioperative morbidity compared with standard mini-PCNL. NCCT-based stone-free assessment demonstrated a higher Grade A stone-free rate in the vacuum-assisted group, although this difference was not statistically significant. Larger prospective multicenter studies are warranted to validate these findings.

FDA Flags Edwards TMVR Delivery System After Fatality - Medical Product Outsourcing

FDA Flags Edwards TMVR Delivery System After Fatality&nbsp;&nbsp;Medical Product Outsourcing

Tissue Mitral Valve Replacements Market Forecast to 2035, Driven by Aging Population and Transcatheter Innovation - IndexBox

Tissue Mitral Valve Replacements Market Forecast to 2035, Driven by Aging Population and Transcatheter Innovation&nbsp;&nbsp;IndexBox

Four Lots of Edwards Mitral Valve Delivery Systems Pulled After Balloon Bursts Linked to One Patient Death - Medical Daily

Four Lots of Edwards Mitral Valve Delivery Systems Pulled After Balloon Bursts Linked to One Patient Death&nbsp;&nbsp;Medical Daily

Multidimensional Echocardiographic Parameters Predict Left Ventricular Functional Recovery After Coronary Artery Bypass Grafting.

AIM: This study aimed to investigate the predictive value of preoperative and early postoperative echocardiographic parameters for left ventricular function recovery after coronary artery bypass grafting (CABG), and to evaluate the relationship between functional recovery and 1-year clinical prognosis. METHODS: This retrospective cohort included 214 patients undergoing first-time elective CABG at The First Affiliated Hospital of Yangtze University between January 2022 and October 2024. Transthoracic echocardiography was performed preoperatively, 3-7 days postoperatively, and at 6 months to evaluate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), left atrial volume index (LAVI), and ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e'). Based on 6‑month LVEF change, patients were divided into recovery (ΔLVEF ≥5%) and non‑recovery (ΔLVEF <5%) groups. Multivariate logistic regression was used to identify independent predictors, and the corresponding models were established and validated. Major adverse cardiovascular events (MACE) were recorded at 1‑year follow‑up. RESULTS: Of the 214 patients enrolled in the study, functional recovery of the left ventricle was observed in 128 individuals, corresponding to 59.8% of the cohort. Multivariate analysis identified several preoperative and procedural variables as independent predictors of functional recovery, including left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score, and the number of graft vessels. Age, preoperative LVEF, and e' velocity were independently associated with lower odds of functional recovery. Global longitudinal strain (GLS) and diabetes history showed no independent predictive value. The clinical-echocardiographic combined model demonstrated excellent discrimination and showed higher discriminative performance than the basic clinical model and conventional echocardiographic model. Subgroup analysis revealed that GLS showed no independent predictive value across all LVEF subgroups (p > 0.05), whereas LAVI and LAD were significant predictors in patients with LVEF ≥40% (including the 40%-49% subgroup), but showed no predictive relevance in those with LVEF <40%. Early postoperative ΔLVEF predicted 6-month functional recovery with an area under the curve (AUC) of 0.846. After one year of follow‑up, the recovery group exhibited a markedly lower rate of MACE than the non‑recovery group, with left ventricular functional recovery serving as an independent protective factor against MACE. CONCLUSIONS: Preoperative structural parameters, including LAVI, LVEDD, LVESD, and LAD, are independent imaging biomarkers for predicting left ventricular functional recovery after CABG. GLS and E/e' ratio show no independent predictive value in this study. The integrated model combining clinical factors with multi-dimensional echocardiographic parameters demonstrates excellent discriminative ability. Early postoperative LVEF improvement strongly predicts 6-month functional recovery, while postoperative recovery of left ventricular function is associated with a significantly lower 1-year MACE risk.

Medicare Analysis: Surgical vs Transcatheter Tricuspid Repair

T-TEER for Iatrogenic Tricuspid Regurgitation

Tricuspid TEER Biomechanical Forces

NCT03904147: TRILUMINATE

right heart strain changes after transcatheter tricuspid valve replacement

FDA flags Edwards heart-valve delivery system issue after death, injury - Reuters

FDA flags Edwards heart-valve delivery system issue after death, injury&nbsp;&nbsp;Reuters

JenaValve received FDA approval

Trilogy system approval

FDA approval for its Trilogy system

JenaValve FDA approval: Trilogy system for severe aortic regurgitation