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Perimembranous ventricular septal defects (VSDs) has proximate relation to the aortic and tricuspid valves as well as the conduction tissues. Transcatheter closure utilizes various off-label device designs.

Perimembranous VSD without aortic margin were classified as group A, with thick aortic margin as group B, with membranous septal aneurysm as group C and defects restricted by tricuspid valve attachments as group D. The proposed ideal design was asymmetric device in group A; duct occluder I (ADOI) and muscular ventricular septal occluder (MVSO) in group B; thin profile duct occluder II (ADOII) in group C and ADOI in group D. Device was 0-2 mm larger than the defect.

Eighty patients with VSD measuring 6.83 ± 2.87mm underwent successful closure. Device was retrieved before release in one group A and one group C patient due to aortic regurgitation. Asymmetric device was used in 16 group A defects. Among group B defects, ADOI was used in 5, ADOII in 5, MVSO in one and asymmetric device in 3. Group C defects were closed with ADOI in 7, ADOII in 10 and asymmetric device in 3. Three patients with multiple exits had 2 ADOII devices. Group D defects were closed using ADOI in 20 and ADOII in 10 patients. There was no late aortic regurgitation or heart block on a follow-up exceeding 7 years.

This echocardiographic classification helps device selection in every single patient. While asymmetric device is uniquely suited for group A defects, different designs are appropriate in the other groups.

This echocardiographic classification helps device selection in every single patient. While asymmetric device is uniquely suited for group A defects, different designs are appropriate in the other groups.The Coronary Artery Disease Reporting and Data System (CAD-RADS) is a standardized reporting method for coronary computed tomography angiography (CCTA). It summarizes the findings of CCTA in 6 categories ranging from CAD-RADS 0 (complete absence of coronary artery disease) to CAD-RADS 5 (total occlusion of at least one vessel). It is applied on per patient basis for the highest grade of the stenotic lesion. The CAD-RADS also provides category-specific treatment recommendations, helping patient management. The main objectives of the CAD-RADS are to improve the consistency in reporting, facilitate the communication between interpreting and referring clinicians, recommend the best course of patient management, and produce consistent data for quality improvement, research and education. However, CAD-RADS has many limitations, resulting into the misclassification of the observed findings, misinterpretation of the final category, and misguidance for the treatment based upon the single score. In this review, the authors discuss the CAD-RADS categories and modifiers, along with the strengths and limitations of this new classification system.

Right ventricular (RV) systolic dysfunction is a strong predictor of mortality in pulmonary hypertension (PH). The goal of this study was to investigate whether right atrium (RA) and RV myocardial strain related to PH using speckle tracking echocardiography provide a superior estimation of RV systolic function than 2-dimensional (2D)-echo.

This cross-sectional study analyzed 22 patients with a diagnosis of PH stratified by right heart catheterization, and they were compared to a control group of 22 age- and sex-matched healthy subjects.

Global longitudinal peak systolic strain measured in the RV free wall from the apical 4 chamber view was -15% vs. -14.5% when measured from the subcostal view (p = 0.99). Mean longitudinal strain during reservoir phase, and longitudinal strain rate during atrial reservoir and passive conduit function was significantly impaired measured in the right atrial free wall in patients with PH.

This study showed impaired LV contractility in patients with PH assessed by speckle w in patients with poor acoustic apical 4-chamber windows. The RA strain and strain rates values may be a valuable additive to assess right-sided heart function.

It has been unclear whether statin therapy directly improves coronary flow reserve (CFR) in hypertensive patients at cardiovascular risk, independent of lifestyle modification and antihypertensive medications.

In this double-blind, randomized controlled trial, we randomly assigned 95 hypertensive patients at cardiovascular risk to receive either rosuvastatin 10 mg or placebo for 12 months, in addition to antihypertensive therapy and lifestyle modification for hypercholesterolemia. Using Doppler echocardiography, coronary flow velocity in the distal left anterior descending artery was measured and CFR was calculated as the ratio of hyperemic to basal averaged peak diastolic flow velocity. The primary end point was change in CFR from baseline to 12 months follow-up.

Low-density lipoprotein-cholesterol was changed from 157 ± 23 to 84 ± 16 mg/dL in the rosuvastatin group (p < 0.001) and from 152 ± 19 to 144 ± 22 mg/dL in the control group (p = 0.041, but there were no significant differences between the treatment groups in the changes in C-reactive protein, high-density lipoprotein cholesterol, and blood pressures. CFR was changed from 3.03 ± 0.44 to 3.25 ± 0.49 in the rosuvastatin group (p < 0.001) and from 3.15 ± 0.54 to 3.17 ± 0.56 in the control group (p = 0.65). The primary end point of change in CFR was significantly different between the rosuvastatin group and the control group (0.216 ± 0.279 vs. 0.015 ± 0.217; p < 0.001).

Compared with lifestyle modification alone, addition of rosuvastatin significantly improved CFR in hypertensive patients at cardiovascular risk.

Compared with lifestyle modification alone, addition of rosuvastatin significantly improved CFR in hypertensive patients at cardiovascular risk.Double-outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. The morphology of DORV is characterized by a ventricular septal defect (location and relationship with the semilunar valve); bilateral coni and aortomitral continuity; the presence or absence of outflow tract obstruction; tricuspid-pulmonary annular distance; and associated cardiac anomalies. The surgical approach varies with the type of DORV and is based on multiple variables. Computed tomography (CT) is a robust diagnostic tool for the preoperative and postoperative assessment of DORV. Unlike echocardiography and magnetic resonance imaging (MRI), CT imaging is not limited by small acoustic window, need for anaesthesia and can be used in patients with metallic implants. Durvalumab molecular weight Current generations CT scanners with high spatial and temporal resolution, wide detectors, high-pitch scanning mode, dose-reduction algorithms, and advanced three-dimensional post-processing tools provide a low-risk, high-quality alternative to diagnostic cardiac catheterization or MRI, and have been increasingly utilized in nearly every type of congenital heart defect, including DORV.