2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee.

Mitral regurgitation (MR) is a complex valve lesion that can pose significant management challenges. This expert consensus decision pathway emphasizes that recognition of MR should prompt an assessment of its etiology, mechanism, and severity, as well as consideration of the indications for treatment. The document is a focused update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation, with some sections updated and others added in light of the publication of new trial data related to secondary MR, among other developments.

When to close iatrogenic atrial septal defect after percutaneous edge to edge repair of mitral valve regurgitation.

Transseptal puncture is increasingly utilized in electrophysiology and interventional cardiology. With a wide range of therapeutic indications, incidence of iatrogenic atrial septal defect (iASD) is likely to increase. However, the clinical and hemodynamic significance of iatrogenic atrial septal defect is not clear.

Comparison of percutaneous device closure versus surgical closure of peri-membranous ventricular septal defects: A systematic review and meta-analysis.

Background: While percutaneous device closure (PDC) is a first-line therapy for isolated muscular ventricular septal defects (mVSD), surgery is still the preferred approach for peri-membranous ventricular septal defects (pmVSD).

Objective: We sought to compare the outcomes of percutaneous versus open surgical closure of pmVSDs.

Methods: PubMed, Cochrane Library, and Web of Science databases were searched through October 15, 2014 for English language studies comparing outcomes of PDC with surgical closure of pmVSDs.

Left Atrial Volume and Post-Operative Atrial Fibrillation after Aortic Valve Replacement.

Post-operative atrial fibrillation (POAF) after valve surgery is associated with increased morbidity and mortality. Risk factors identified in the past to predict POAF are of moderate accuracy. We performed a retrospective analysis of 139 patients undergoing aortic valve replacement for aortic stenosis.

Peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare, idiopathic, life-threatening disease of late pregnancy and early puerperium, occurring in patients with previously healthy hearts. Risk factors include multiparity, age>30 years, African American race, multiple pregnancies, obesity, hypertension, and toxemia. Signs and symptoms of PPCM resemble systolic heart failure, and it is diagnosed by exclusion.

Ventricular metastasis without atrial or caval involvement: a rare presentation.

Right ventricular metastases from renal cell carcinoma without inferior vena cava (IVC) or right atrium involvement are rare. We discuss a 44-year-old male who presented with a left thigh mass, which was resected and the pathology revealed an epithelial sarcoma or a possible metastasis from another organ. His preradiotherapy cardiac evaluation showed mass in the right and left ventricles, which was confirmed by transesophagial echocardiogram.

Delayed defibrillator lead perforation: an increasing phenomenon.

Delayed intracardiac lead perforation has been defined as migration and perforation after one month of implantation. It is a rare complication; pathophysiology and optimal management are currently unclear. Recognition of these cases becomes important with increasing use of these devices.

Fibrosing mediastinitis presenting as pulmonary stenosis: stenting works.

A rare case of fibrosing mediastinitis from histoplasmosis with extrinsic compression of the right pulmonary artery is reported. A 41-year-old patient presented with worsening symptoms of cough, fever, migratory arthralgia, chest pain, and progressive dyspnea. The pulmonary artery involvement was suspected by transthoracic echo and was confirmed by transesophageal echo, CT scan of chest, and right heart catheterization.

Diagnosis and management of diastolic dysfunction and heart failure.

Diastolic heart failure occurs when signs and symptoms of heart failure are present but left ventricular systolic function is preserved (i.e., ejection fraction greater than 45 percent).

The effect of soy protein isolate on bone metabolism.

Objective: This double-blind, 15-month pilot study was designed to investigate the effect of soy protein isolate with varying concentrations of isoflavones on early postmenopausal bone loss and lipids.

Design: A total of 65 women, with a mean age of 55 years and 7.5 years since menopause, were randomized to one of three groups; soy protein with 96 mg isoflavones/day, soy with 52 mg isoflavones/day, or soy without isoflavones (< 4 mg isoflavones/day).