Patent Foramen Ovale and Hypoxemia.

Although the most common clinical manifestations of a patent foramen ovale (PFO) are cryptogenic stroke and migraine with aura, PFO is also associated with platypnea-orthodeoxia syndrome, obstructive sleep apnea, and chronic obstructive pulmonary disease with hypoxemia out of proportion to the extent of pulmonary disease. This article will discuss these conditions and summarize the related literature.

A case report of recurrent primary posterior mediastinal perivascular epithelioid cell tumour compressing the right inferior pulmonary vein, atria, and inferior vena cava.

Background: Perivascular epithelioid cell tumours (PEComas) are rare soft tissue neoplasms that commonly occur in the uterus, skin, and liver and less commonly in the retroperitoneum, colon, and mediastinum.

Case Summary: A 36-year-old male patient with a history of mediastinal PEComa status post resection, essential hypertension, and atrial fibrillation status post appendage ligation currently not on anticoagulation presented with a 1-week history of fevers, chills, productive cough, chest pain, dyspnoea on exertion, loss of appetite, and general weakness. Vital signs, physical exam, laboratory data, electrocardiogram, and chest radiograph were grossly unremarkable.

A case report of successful transaneurysmal repair of a giant isolated membranous ventricular septal aneurysm.

Background: Isolated membranous ventricular septal aneurysms are infrequent in clinical practice. Furthermore, current guidelines do not dictate how to diagnose or manage such lesions.

Case Summary: A 54-year-old male patient with a history of essential hypertension and tobacco use presented with chest pain associated with dyspnoea and nausea.

Generating OCT B-Scan DME images using optimized Generative Adversarial Networks (GANs).

Diabetic Macular Edema (DME) represents a significant visual impairment among individuals with diabetes, leading to a dramatic reduction in visual acuity and potentially resulting in irreversible vision loss. Optical Coherence Tomography (OCT), a technique that produces high-resolution retinal images, plays a vital role in the clinical assessment of this condition. Physicians typically rely on OCT B-Scan images to evaluate DME severity.

Fuzzy Logic-Based System for Identifying the Severity of Diabetic Macular Edema from OCT B-Scan Images Using DRIL, HRF, and Cystoids.

Diabetic Macular Edema (DME) is a severe ocular complication commonly found in patients with diabetes. The condition can precipitate a significant drop in VA and, in extreme cases, may result in irreversible vision loss. Optical Coherence Tomography (OCT), a technique that yields high-resolution retinal images, is often employed by clinicians to assess the extent of DME in patients.

Cardiac patterns for differentiation of neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage versus acute ischemic stroke.

Aims: Neurogenic stunned myocardium (NSM) has heterogeneous presentations for acute ischemic stroke (AIS) and aneurysmal subarachnoid hemorrhage (SAH). We sought to better define NSM and differences between AIS and SAH by evaluating individual left ventricular (LV) functional patterns by speckle tracking echocardiography (STE).

Methods: We evaluated consecutive patients with SAH and AIS.

Mortality and Complications of COVID-19 Among Adult Congenital Heart Disease Patients: A Retrospective Cohort Study Using the National Inpatient Sample Database.

This study examines in-hospital mortality and complicated COVID-19 infection among adult congenital heart disease (ACHD) patients admitted with COVID-19, using the National Inpatient Sample (NIS). A total of 4219 COVID-19 patients with ACHD were included. We demonstrated that COVID-19 patients with ACHD were more likely to experience in-hospital mortality (OR 1.

Noninvasive Assessment With Transthoracic Echocardiography in End-Stage Heart Failure.

Heart failure is a common cardiac condition that carries a substantial risk of morbidity and mortality despite advances in management. Echocardiography plays a central role in its diagnosis, elucidation of mechanisms, and detailed hemodynamic analysis. In this E-Challenge, the authors review a few transthoracic echocardiographic findings that yield insights into the hemodynamics.

Management of Recurrent Myocarditis Due to Desmoplakin Cardiomyopathy: Diagnostic and Therapeutic Challenges.

We present the case of a 25-year-old woman with desmoplakin cardiomyopathy-related myocarditis. Her high-sensitivity troponin and symptoms improved with pulse steroid therapy and mycophenolate mofetil. The literature lacks data to effectively guide the management of recurrent myocarditis in desmoplakin cardiomyopathy.

Novel ensemble of optimized CNN and dynamic selection techniques for accurate Covid-19 screening using chest CT images.

The world is significantly affected by infectious coronavirus disease (covid-19). Timely prognosis and treatment are important to control the spread of this infection. Unreliable screening systems and limited number of clinical facilities are the major hurdles in controlling the spread of covid-19.

Pericardiocentesis induced right ventricular changes in patients with and without pulmonary hypertension.

Background: Pericardial effusion drainage in patients with significant pulmonary hypertension (PH) has been questioned because of hemodynamic collapse concern, mainly because of right ventricular (RV) function challenging assessment. We aimed to assess RV function changes related to pericardiocentesis in patients with and without PH.

Methods: Consecutive patients with symptomatic moderate-to-large pericardial effusion who had either echocardiographic or clinical signs of cardiac tamponade and who underwent pericardiocentesis from 2013 to 2018 were included.

Three-Dimensional Echocardiographic Left Atrial Appendage Volumetric Analysis.

Background: Left atrial appendage (LAA) echocardiographic assessment is difficult because of the complex shape and relatively small size of the LAA. Three-dimensional (3D) echocardiographic imaging can overcome the limitations of two-dimensional imaging. Pulsed-wave Doppler is the only currently standard LAA functional parameter.

Pooled Analysis of PFO Occluder Device Trials in Patients With PFO and Migraine.

Background: Although observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine, randomized clinical trials have not met their primary efficacy endpoints.

Objectives: The authors report the results of a pooled analysis of individual participant data from the 2 randomized trials using the Amplatzer PFO Occluder to assess the efficacy and safety of percutaneous device closure as a therapy for episodic migraine with or without aura.

Methods: The authors analyzed individual patient-level data from 2 randomized migraine trials (the PRIMA [Percutaneous Closure of Patent Foramen Ovale in Migraine With Aura] and PREMIUM [Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the Amplatzer PFO Occluder Compared to Medical Management] studies).

Comparison of Contractility Patterns on Left Ventriculogram Versus Longitudinal Strain by Echocardiography in Patients With Takotsubo Cardiomyopathy.

Background: Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular (LV) dysfunction, electrocardiographic changes that can mimic acute myocardial infarction (MI), and release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Conventionally, gross visual assessment of LV angiogram has been used to classify TTC. We aim to compare quantitative assessment of different regions of LV on angiogram and segmental strain on transthoracic echo to determine a better way to classify TTC rather than conventional qualitative visual assessment.

Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Disease.

Purpose Of Review: The purpose of this review article is to summarize the preclinical and clinical evidence supporting the notion of clonal hematopoiesis of indeterminate potential (CHIP), highlight current knowledge gap, and provide future directions.

Recent Findings: Epidemiological studies show that advanced age is a major risk factor for the development of cardiovascular disease (CVD) and cancer, the two leading causes of morbidity and mortality worldwide. While the negative effect of aging on CVD is a reflection of cumulative exposure to various established traditional CVD risk factors, genetic sequencing of whole blood-derived DNA recently revealed that clonal mutations in myeloid stem cells are associated with higher risks of cardiovascular events and hematopoietic malignancies.

Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke.

Importance: Recent epidemiologic and therapeutic advances have transformed understanding of the role of and therapeutic approach to patent foramen ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible for approximately 5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults.

Observations: Randomized clinical trials have demonstrated that, to prevent recurrent ischemic stroke in patients with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure is superior to antiplatelet medical therapy alone; these trials have provided some evidence that, among medical therapy options, anticoagulants may be more effective than antiplatelet agents.

A comparison of methods to determine patent foramen ovale size.

Background: Patent foramen ovale (PFO) is implicated in the pathogenesis of clinical conditions such as cryptogenic stroke and migraine with aura. This study evaluated the challenges of sizing a PFO with different contemporary imaging modalities and assessed the relationship between PFO size and severity of the right-to-left shunt (RLS).

Methods: Patients who were referred to interventional cardiology with the diagnosis of a PFO and had undergone intra-procedural balloon sizing (n = 147), transesophageal echocardiogram (TEE) imaging (n = 67), or intracardiac echocardiogram (ICE) imaging (n = 73) at the time of workup were included in this study.