Percutaneous Closure of an Iatrogenic Intracardiac Shunt in Treating Torrential Tricuspid Regurgitation.

A patient presented with severe right heart failure due to a large LV-to-RA shunt with left-to-right shunting and torrential tricuspid regurgitation 6-weeks following surgical sub-aortic stenosis resection. Retrograde delivery of an Occlutech ventricular septal defect device produced instantaneous resolution of shunt, reduction in tricuspid regurgitation, and impressive diuresis of 28 kg.

Long-term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomized controlled trial.

Background: Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known.

Objective: The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF.

Methods: Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life.

Antimicrobial resistance as a super wicked problem: how do we engage the public to be part of the solution.

Antimicrobial resistance (AMR) is now regarded as one of the greatest global challenges of the 21 century. The complexity, urgent timeframe, and lack of clear solution to AMR have contributed to its classification as a 'super wicked problem'. Yet knowledge surveys of the general public have found that they still harbour numerous misconceptions linked to both the sources and impact of AMR.

Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation.

Background: Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation).

Methods: All patients underwent echocardiography preablation, 3 and 12 months post-ablation.

Assessment of left ventricular tissue mitochondrial bioenergetics in patients with stable coronary artery disease.

Recurrent myocardial ischemia can lead to left ventricular (LV) dysfunction in patients with coronary artery disease (CAD). In this observational cohort study, we assessed for chronic metabolomic and transcriptomic adaptations within LV myocardium of patients undergoing coronary artery bypass grafting. During surgery, paired transmural LV biopsies were acquired on the beating heart from regions with and without evidence of inducible ischemia on preoperative stress perfusion cardiovascular magnetic resonance.

The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience.

Background: The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom.

Hepatocellular carcinoma in an adult with Alagille syndrome: case report and literature review.

Alagille syndrome (AS) is an autosomal dominant multisystem disorder which can lead to hepatopathy and the development of focal hepatic lesions. The majority of the hepatic lesions are benign, including regenerative nodules, focal hyperplasia, and adenoma. Hepatocellular carcinoma (HCC) is extremely rare in AS, with very few cases reported in the literature.

Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial.

Aims: Long-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF.

Multi-centre prospective internal and external evaluation of the Brompton Harefield Infection Score (BHIS).

Background: Previously, we reported that the Brompton Harefield Infection Score (BHIS) accurately predicts surgical site infection (SSI) after coronary artery bypass grafting (CABG). The BHIS was developed using two-centre data and stratifies SSI risk into three groups based on female gender, diabetes or HbA1c > 7.5%, body mass index ≥ 35, left ventricular ejection fraction < 45% and emergency surgery.

Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF): study protocol for a randomised controlled trial.

Background: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation.

Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis.

Background: Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI.

Methods: A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone-iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK).

Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study.

Background: Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort.

Objective: To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF.

Identification of myocardial diffuse fibrosis by 11 heartbeat MOLLI T mapping: averaging to improve precision and correlation with collagen volume fraction.

Objectives: Our objectives involved identifying whether repeated averaging in basal and mid left ventricular myocardial levels improves precision and correlation with collagen volume fraction for 11 heartbeat MOLLI T mapping versus assessment at a single ventricular level.

Materials And Methods: For assessment of T mapping precision, a cohort of 15 healthy volunteers underwent two CMR scans on separate days using an 11 heartbeat MOLLI with a 5(3)3 beat scheme to measure native T and a 4(1)3(1)2 beat post-contrast scheme to measure post-contrast T , allowing calculation of partition coefficient and ECV. To assess correlation of T mapping with collagen volume fraction, a separate cohort of ten aortic stenosis patients scheduled to undergo surgery underwent one CMR scan with this 11 heartbeat MOLLI scheme, followed by intraoperative tru-cut myocardial biopsy.

Right Coronary Artery and Left Anterior Descending Artery Occlusion after Aortic Valve Replacement.

Coronary artery stenosis is a potentially life-threatening complication after heart valve surgery. The details are presented of a patient with unobstructed coronary arteries, who underwent routine aortic valve replacement and developed dissection of the right coronary artery (RCA) on the third postoperative day, and occlusion of the left anterior descending (LAD) artery one month after surgery. This complication required prompt clinical recognition and diagnosis by repeat coronary angiography, and a rapid intervention with coronary artery bypass grafting or with angioplasty and stenting.

Left atrial intramural hematoma after percutaneous coronary intervention.

We describe a rare complication of a complex chronic total occlusion recanalization procedure. Perforation of a distal right coronary artery collateral results in a left atrial intramural hematoma with consequent circulatory collapse. Access to prompt transoesophageal echocardiography and urgent surgical intervention were lifesaving and the case highlights possible implications on the planning of complex chronic total occlusion recanalization procedures.

Management of a left atrial intramural hematoma after percutaneous intervention.

Left atrial intramural hematoma is a rare complication of percutaneous intervention. We report the case of a 69-year-old man with recurrent angina after CABG 19 years ago who was admitted for percutaneous intervention. After an attempt to recanalize the native circumflex artery and the vein graft, he had a cardiac arrest and was resuscitated successfully.

Fungal endocarditis of the eustachian valve in carcinoid heart disease: a case report.

The case is presented of a fungal-origin endocarditis affecting the eustachian valve. During surgery for pulmonary and tricuspid valve replacement, a 54-year-old male with carcinoid disease was found to have a 3-cm vegetation attached to the eustachian valve. Histopathological assessment of the vegetation revealed the presence of Candida species.

Successful double bioprosthetic valve replacement in a 64-year-old man with carcinoid syndrome and bipolar disorder: case report.

The case is described of a 64-year-old man with bipolar disorder and severe carcinoid heart disease who required a double valve replacement. Multidisciplinary team involvement and extensive preoperative investigations resulted in a successful regimen which prevented reactivation of carcinoid syndrome and avoided the serious side effects of lantreotide and lithium therapy. In addition, two bioprosthetic valves were used, thereby avoiding the potential complications of anticoagulation in a patient with known hepatic metastases.

Comparison of flow characteristics and vascular reactivity of radial artery and long saphenous vein grafts [NCT00139399].

Background: The morphological and functional differences between arteries and veins may have implications on coronary artery bypass graft (CABG) survival. Although subjective differences have been observed between radial artery (RA) and long saphenous venous (LSV) grafts, these have not been quantified. This study assessed and compared the flow characteristics and in-vivo graft flow responses of RA and LSV aorto-coronary grafts.

Regional ventricular dynamics during acute coronary occlusion: a comparison of invasive with non-invasive echocardiographic markers to detect and quantify myocardial ischaemia-observations made during off-pump coronary surgery.

Objectives: To investigate the performance of non-invasive markers used in stress echocardiography to detect the presence and depth of myocardial ischaemia. We therefore sought to compare these non-invasive markers during acute coronary occlusion in humans.

Methods: 27 patients with stable angina and normal LV cavity size were studied during off-pump coronary artery bypass grafting to the left anterior descending coronary artery using transoesophageal echocardiography and simultaneous high fidelity LV pressure.