Safety and Efficacy of GLP-1 Agonists in a Cohort of Patients with Fontan Circulation.

There are a growing number of adult patients palliated to a Fontan circulation. As these patients age, many develop symptomatic heart failure (d'Udekem et al in Circulation 130:S32-S38, 2014) that is exacerbated by acquired comorbidities such as obesity and hypertension. Increased body mass index (BMI) and adiposity have been associated with worse hemodynamics and clinical outcomes in these patients (Yogeswaran et al in J Am Hear Assoc: Cardiovasc Cerebrovasc Dis 12:e026732, 2023).

Mortality and morbidity after combined heart and liver transplantation in the failing Fontan: An updated dual center retrospective study.

Introduction: As the adult Fontan population with Fontan associated liver disease continues to increase, more patients are being referred for transplantation, including combined heart and liver transplantation.

Methods: We report updated mortality and morbidity outcomes after combined heart and liver transplant in a retrospective cohort series of 40 patients (age 14 to 49 years) with Fontan circulation across two centers from 2006-2022.

Results: The 30-day, 1-year, 5-year and 10-year survival rate was 90%, 80%, 73% and 73% respectively.

Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices.

Purpose Of Review: This paper reviews the latest literature on the growing field of heart failure in the adult congenital heart disease population.

Recent Findings: After highlighting the increasing prevalence and a few of the unique potential causes, including the concept of early senescence, this review begins with novel medical management strategies such as the angiotensin II receptor blocker and neprilysin inhibitors and sodium glucose cotransporter-2 inhibitors. Then, it addresses the latest applications of percutaneous techniques like implantable hemodynamic monitoring, transcatheter pulmonary and aortic valve replacement, and mitral clips.

Loss of Right Atrial Pacing Lead Capture Due to Myocardial Infarction Obscuring Diagnosis on Electrocardiogram.

Right coronary artery occlusion can lead to failure to capture from the right atrial pacing lead. In this case, acute infarction resulted in failure of the right atrial lead to capture and thus increased right ventricular pacing. The new ventricular pacing masked the diagnosis of acute myocardial infarction.

Diuretic use in the adult Fontan.

Objectives: To explore diuretic use in Fontan patients and its association with clinical features and adverse outcomes.

Background: In Fontan circulatory failure, ventricular dysfunction, chronically elevated systemic venous pressures, lymphatic abnormalities, and preload deprivation lead to volume expansion, prompting initiation of diuretics, yet use of diuretics has not been widely studied in the adult Fontan patient.

Methods: Single center retrospective review of Fontan patients ≥18 years between 2005 and 2018.

Tracking the Temporal Footprint Effect of Thermonociception and Denervation on the Brain's Pain Matrix: fMRI and BOLD Study in Rats.

Objective: Pain constitutes an essential alarm for preserving the organism's integrity. Damage to the nervous system produces a pathological condition known as neuropathic pain.

Purpose: Blood oxygenation level-dependent (BOLD) and functional magnetic resonance imaging (fMRI) have been widely used to map neuroanatomy and the active regions of interest (ROI) of nociceptive processing.

Diagnosis and management of cardiac allograft vasculopathy.

One of the main causes of death beyond the first year after heart transplantation is cardiac allograft vasculopathy (CAV). This review summarises the current understanding of its complex pathophysiology, detection and treatment, including the available data on non-invasive imaging modalities used for screening and diagnosis. A better understanding of this entity is crucial to improving the long-term outcomes of the growing population of patients with a heart transplant.

Immune benefit of combined heart and liver transplantation.

Purpose Of Review: Understanding the mechanisms involved in immune protection provided by a hepatic allograft is imperative as further therapies for highly sensitized patients could be developed and thus expanding the donor pool and improving outcomes.

Recent Findings: The clinical data from immune protection comes mainly from combined liver and kidney transplants with excellent results in overall survival and also that of the allograft. This phenomenon has also been observed in dual liver transplants with heart, lung, skin and intestines, albeit with less data.

Acute myocarditis following high-dose interleukin-2 treatment.

We describe the case of a 49-year-old woman with metastatic renal carcinoma receiving treatment with high-dose interleukin-2 (IL-2) who developed acutely progressive dyspnea on exertion and an elevated troponin level. Cardiac magnetic resonance imaging (CMR) was used to establish the diagnosis of IL-2-associated cardiotoxicity, differentiating myocarditis from acute coronary syndrome (ACS) and preventing an unnecessary invasive coronary angiogram. < ACS and myocarditis can present with similar symptoms and elevation in troponin levels.

Alginate microencapsulation of human mesenchymal stem cells as a strategy to enhance paracrine-mediated vascular recovery after hindlimb ischaemia.

Stem cell-based therapies hold great promise as a clinically viable approach for vascular regeneration. Preclinical studies have been very encouraging and early clinical trials have suggested favourable outcomes. However, significant challenges remain in terms of optimizing cell retention and maintenance of the paracrine effects of implanted cells.