Cardiovascular disease (CVD) remains the leading cause of global disease burden. The Global Burden of Disease (GBD) Study 2023 systematically assessed the CVD burden and the impact of its risk factors across 204 countries and territories worldwide between 1990 and 2023, integrating diverse data sources including mortality, incidence, and risk factor exposure. CVDs mainly included atherosclerotic CVD (ischemic heart disease, ischemic stroke, peripheral artery disease, and cerebrovascular disease), structural heart disease (cardiomyopathy, and calcific and degenerative valvular disease), atrial myopathy with atrial fibrillation or flutter (atrial fibrillation/atrial flutter), and infection-related heart disease (rheumatic heart disease, endocarditis, and myocarditis in some cases). In 2023, the number of people affected by CVD worldwide reached 626 million, resulting in 437 million disability-adjusted life years (DALYs) and 19.2 million deaths. Notably, 79.6% of these DALYs were attributable to modifiable risk factors, including metabolic, behavioral, and environmental/occupational factors. From 1990 to 2023, the number of CVD patients in China increased from 4.377 5 million to 11.1402 million, with a standardized incidence rate of 512.09 per 100 000 individuals. In 2023, there were 4.522 million CVD deaths, with a standardized mortality rate of 209.05 /100 000 individuals. The spectrum of cardiovascular diseases in China is consistent with that globally, with ischemic heart disease (IHD) and stroke being the most common. According to the China Cardiovascular Disease Surveillance System, the age-standardized incidence rates of ischemic heart disease and stroke in 2023 were 513.28/100 000 and 137.16/100 000 individuals, respectively. China faces a particularly heavy CVD burden, driven by population aging, urbanization, uneven urban-rural development, and various risk factors. Given the severe CVD epidemic situation, there is an urgent need to strengthen CVD prevention and control strategies. Implementing targeted interventions for modifiable risk factors is crucial for effectively addressing the escalating public health challenges and reducing the disease burden.
Right ventricular outflow tract (RVOT) dysfunction is a common long-term complication after surgical repair in patients with RVOT obstructive congenital heart disease. It is mainly caused by pulmonary regurgitation and/or residual obstruction, which may lead to right ventricular dilation, impaired cardiac function, and an increased risk of morta-lity. Given the substantial trauma and high risk associated with repeat surgical intervention, transcatheter pulmonary valve replacement (TPVR), as a minimally invasive approach, has emerged as a first-line therapeutic option. This review systematically summarizes the recent advances and technical optimization strategies of TPVR from four key aspects: device systems, imaging assessment, procedural strategies, and long-term management, aiming to provide references for clinical practice and future research directions in TPVR. Regarding valve systems, balloon-expandable valves are supported by robust long-term data and are primarily suitable for patients with valved conduits. In contrast, self-expanding valves demonstrate superior anatomical adaptability and sealing performance, making them more appropriate for native or patch-augmented RVOTs with larger diameters and irregular morphologies. In terms of imaging evaluation, preprocedural contrast-enhanced computed tomography (CT) remains the core method, while multiple new technologies have emerged for intraoperative guidance and postoperative assessment. In procedural strategies, prestenting combined with balloon-expandable valve implantation has expanded the applicability of interventional treatment for native RVOT dysfunction, and techniques such as the use of an artificial tricuspid annuloplasty ring to reduce RVOT diameter, transthoracic access, and parallel anchoring provide new options for patients with complex anatomy. With the management paradigm shifting from perioperative care to a lifelong perspective, the prevention, monitoring, and treatment of arrhythmias, infective endocarditis, and valve degeneration have become major clinical concerns.
Structural heart disease (SHD) refers to any disease involving the structure of the heart and adjacent great vessels, excluding electrical cardiac disorders and coronary artery disease. It is characterized by the potential for treatment through correction or alteration of the structure of the heart and great vessels. Major types of SHD include ventricular cardiomyopathies, valvular heart diseases, and congenital heart diseases. Globally, the incidence of SHD is showing an increasing trend, and is gradually becoming a major global public health concern. In recent years, with the development of artificial intelligence (AI), AI has been widely applied in imaging examinations (including echocardiography, X-ray, cardiac CT, and MRI), electrocardiographic examinations, patient management, and risk assessment. AI models can identify features of SHD on echocardiographic, X-ray, cardiac CT, and MRI images, thereby playing an important role in large-scale SHD screening. Meanwhile, AI can be used to construct patient-specific cardiac anatomical models for accurate preoperative assessment, surgical planning, and prediction of postoperative mortality risk. Clinicians can also use AI to predict individual responses to medications, identify drug interactions, predict adverse reactions, and optimize treatment strategies. Although the application of AI in SHD diagnosis and treatment still faces challenges, including poor accessibility of high-cost technologies, complexity in multimodal data integration, and difficulties in adapting to new diagnostic standards, advances in AI technology for clinical practice, multimodal imaging technologies, and preventive strategy formulation are expected to enable precise prevention and treatment of SHD and reduce the disease burden.
Ebstein's anomaly (EA) is a rare cardiac disease, and there are few reports of cases in newborns with ventricular preexcitation and right bundle branch block. This article reports a case of a child diagnosed with EA and ventricular preexcitation via a left-sided accessory pathway on the day of birth, who was found to have incomplete right bundle branch block on a follow-up electrocardiogram three months later. After the child's condition stabilized, corrective surgery for a congenital double aortic arch was performed, while surgery for EA was deferred. During regular follow-up over two years after surgery, the child remained clinically stable, although ventricular preexcitation and incomplete right bundle branch block persisted. The China National Knowledge Infrastructure (CNKI), Chinese Medical Journal Network, Wanfang Database, PubMed, and Embase databases were searched for literature published between 1990 and 2025. A total of seven articles reporting eight cases of EA combined with preexcitation and right bundle branch block were retrieved. Among them, three patients with EA and preexcitation developed right bundle branch block after electrophysiological stimulation, all of whom had right-sided accessory pathways. Five patients with EA had both preexcitation and right bundle branch block, including four with right-sided accessory pathways and one with a left-sided accessory pathway. These findings suggest that when EA is accompanied by preexcitation and right bundle branch block, a right-sided accessory pathway is more common. Of the eight patients, two recovered satisfactorily after tricuspid valvuloplasty and radiofrequency ablation. Three underwent radiofrequency ablation alone, two of whom developed right bundle branch block after the procedure. The outcomes of the remaining three patients were unknown. Therefore, when a newborn's electrocardiogram indicates ventricular preexcitation or right bundle branch block, attention should be paid to the possibility of tricuspid valve disease to avoid missed diagnosis.
Objective This study aims to analyze the clinical features and renal pathologic findings of kidney di-sease in patients with malignancy, clarify the etiological composition of kidney disease in tumor patients, explore the association between renal pathological features and tumors, and evaluate patient prognosis, thereby providing a basis for the clinical understanding and management of malignancy-related kidney disease. Methods Renal biopsy cases performed in the Department of Nephrology at Zhongshan Hospital, Fudan University from January 2010 to June 2025 were collected, and patients who met inclusion criteria and were diagnosed with malignancy (including hematologic or solid malignancy) before undergoing renal biopsy were consecutively enrolled. The association between kidney disease and the malignancy itself or anticancer therapy was determined based on tumor activity status, anticancer therapy exposure, the background of kidney disease onset, and renal pathologic findings. In addition, follow-up was conducted to compare the renal outcomes among patients with different etiological categories of kidney disease. Results A total of 13 386 renal biopsy cases were collected, among which 395 patients with a confirmed malignancy and relatively complete clinical and follow-up data were included. Proteinuria was present in 329 patients (329/395, 83.29%), and 253 (253/395, 64.05%) had acute kidney injury. Etiologic analysis showed that kidney disease was considered related to the malignancy itself in 63 patients (63/395, 15.95%), related to anticancer therapy in 204 patients (204/395, 51.65%), and not definitely associated with either the malignancy or anticancer therapy in 128 patients (128/395, 32.41%). Among the 267 patients with malignancy- or anticancer therapy-related kidney disease, 152 (152/267, 56.93%) had a single pathologic pattern, whereas 115 (115/267, 43.07%) had two or more pathologic patterns, or showed reactivation of pre-existing kidney disease, or newly superimposed injury. In the 36 patients with hematologic malignancy-related kidney disease, monoclonal immunoglobulin-associated kidney disease was the most common lesion (20/36, 55.56%), followed by renal infiltration by tumor cells (9/36, 25.00%). In the 27 patients with solid tumor-related kidney disease, tumor-associated glomerular disease predominated (22/27, 81.48%), with membranous nephropathy as the most common subtype (10/22, 45.45%). Among the 204 patients with anticancer therapy-related kidney disease, immune checkpoint inhibitor-related cases accounted for the highest proportion (86/204, 42.16%), mainly presenting as acute interstitial nephritis (78/86, 90.70%). This was followed by antiangiogenic therapy-related kidney disease (58/204, 28.43%), among which thrombotic microangiopathy predominated (42/58, 72.41%). As of January 31 2026, the median follow-up duration for all patients was 8.93 (interquartile range, 4.90-22.13) months. Analysis of renal outcomes showed that patients with anticancer therapy-related kidney disease had the highest overall remission rate (158/204, 77.45%). The overall remission rate was also higher in patients with malignancy-related kidney disease than in those without a definite association with the malignancy or its therapy, although the difference was not statistically significant (65.08% vs 52.34%, P=0.095). Conclusions Kidney disease in patients with malignancy is highly heterogeneous and may result from direct tumor infiltration, tumor-related mechanisms, or anticancer therapy. In particular, the consti tution ratio of cases of kidney disease associated with immunotherapy and targeted therapies is high (267/395). A substantial proportion of cases, however, show no definite association with either the malignancy itself or its therapy.
