Background:With the increasing use of coronary computed tomography angiography (CCTA), isolated coronary artery fistulas (ICAFs) are increasingly identified during routine or non-targeted imaging, but the large-scale epidemiological and anatomical data remain limited. This study aims to explore the prevalence, anatomical features, and clinical manifestations of ICAFs in adults who underwent CCTA. Methods:A retrospective analysis was performed on 378,556 consecutive adult patients who underwent CCTA at Fuwai Hospital between 2010 and 2022. Two experienced radiologists independently reviewed CCTA images to confirm the presence of ICAFs and assess their anatomical features, including origin, drainage site, and size. Demographic, clinical, and procedural data were analyzed to evaluate associations with symptoms and treatment strategies. Results:A total of 252 adult patients with ICAFs were identified, yielding a prevalence of 0.07%. The mean age was 48.29±15.03 years, and 47.20% were male. The majority originated from the anterior descending artery (30.56%) and drained into the pulmonary artery (62.3%). The mean diameter of the fistula was 7.30±5.19 mm with 32.54% categorized as with large ICAFs. Symptomatic ICAFs patients were younger than asymptomatic patients (43.81±14.18 vs. 52.05±14.73 years, P=0.016). The average diameter of the draining site was larger in symptomatic ICAFs group (7.95 vs. 5.85 mm, P=0.033). Among the whole cohort, 70 patients underwent transcatheter closure and 28 patients underwent surgical closure, with no significant differences in baseline characteristics. The clinical efficacy was similar between both groups, however, transcatheter closure was infeasible in 15.71% of the attempted cases. Most untreated ICAFs patients maintained their physical activity levels and barely underwent follow-up assessments. Conclusions:The prevalence of ICAFs was 0.07% among adult population who underwent CCTA. Large-sized ICAFs was the anatomical features significantly associated with clinical symptoms.

Quadricuspid pulmonary valve (QPV) is a rare congenital anomaly with limited reports. This study characterizes QPV morphology and function by multimodal imaging, evaluates predictors of moderate-to-severe pulmonary regurgitation (PR), and assesses mid-term prognosis. Retrospective search of the imaging database at a tertiary medical center identified patients diagnosed with QPV between October 2004 and September 2024. Multimodal imaging was utilized to assess the characteristics of QPV and associated abnormalities. Among 1,367,280 cardiac CT and MR exams, 16 patients were diagnosed with QPV (38

OBJECTIVES:To evaluate the efficacy and safety of antithrombotic treatment for migraine prevention in participants with patent foramen ovale (PFO). DESIGN:Investigator initiated, multicentre, prospective, randomised, active controlled, open label clinical trial with blinded outcome assessment and hierarchical hypothesis testing. SETTING:Secondary and tertiary care hospitals across 39 centres in China. PARTICIPANTS:1000 adults aged 18-64 years with a diagnosis of migraine for more than one year, experiencing at least four migraine days per month, and with PFO confirmed by echocardiography. All participants completed a 12 week screening period before randomisation during which eligibility was confirmed and baseline headache data were prospectively recorded. Participants with previous stroke, transient ischaemic attack, intracranial haemorrhage, non-PFO right-to-left shunt, or contraindications to study drugs were excluded. Of the randomised participants, 984 (75.1% female) were included in the full analysis set. INTERVENTIONS:After the screening phase, participants were randomised in a 1:1:1:1 ratio to receive aspirin (300 mg once daily), clopidogrel (75 mg once daily), rivaroxaban (20 mg once daily), or metoprolol (25 mg twice daily) for 12 weeks. No additional preventive migraine treatments were permitted during the intervention period. MAIN OUTCOME MEASURES:The primary outcome was the proportion of participants achieving a ≥50% reduction in monthly migraine days or attacks from baseline to weeks 9-12. Safety outcomes included bleeding and other adverse events. RESULTS:For the primary endpoint, aspirin, clopidogrel, and rivaroxaban were all non-inferior to metoprolol. Responder rates were 61.7% (148/240) with aspirin, 66.8% (157/235) with clopidogrel, 78.4% (185/236) with rivaroxaban, and 61.8% (144/233) with metoprolol. Rivaroxaban further showed a statistically higher responder rate than metoprolol, with an absolute difference of 16.2% (98.33% confidence interval 6.0 to 26.4; P<0.001). Among secondary endpoints, rivaroxaban was associated with greater reductions in migraine days and attacks, higher rates of complete migraine cessation, and greater improvements in migraine specific quality-of-life scores than metoprolol. No major bleeding events occurred. CONCLUSIONS:The antithrombotic agents evaluated in this trial (aspirin, clopidogrel, and rivaroxaban) were all non-inferior to metoprolol for responder rate in participants with PFO and migraine. Rivaroxaban also showed superior responder rates over metoprolol without an increase in major bleeding events. TRIAL REGISTRATION:ClinicalTrials.gov NCT05546320.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment for symptomatic severe aortic stenosis (AS). However, China’s unique patient population presents distinct challenges, including a higher prevalence of bicuspid aortic valves (BAVs) and severe valve calcification. This study used real-world clinical data from Chinese patients to assess the safety and efficacy of the SAPIEN 3 balloon-expandable transcatheter heart valve (THV) in TAVR, particularly in patients with BAVs. Methods: This retrospective, multicenter study enrolled consecutive severe AS patients treated with SAPIEN 3 THVs via a transfemoral approach from June 2020 to March 2024. The primary endpoint was 30-day mortality, while secondary endpoints included procedural mortality, procedural success, conversion to surgery, coronary artery occlusion, THV-in-THV deployment, permanent pacemaker implantation, and paravalvular leaks (PVLs). Results: Among the 1642 enrolled patients, 56.0% had BAVs, and 44.0% had tricuspid aortic valves (TAVs). The 30-day mortality rate was 0.90%. Propensity score matching revealed no statistically significant differences between patients with BAVs and TAVs in terms of 30-day mortality (odds ratio (OR): 1.51, 95% confidence interval (CI): 0.42 to 5.36; p = 0.531), immediate procedural mortality, procedural success, coronary artery occlusion, THV-in-THV deployment, permanent pacemaker implantation, or moderate to severe PVLs. However, a significant difference was found in the conversion rate to open surgery (OR: 5.07, 95% CI: 1.11 to 23.2; p = 0.036). Conclusions: This study demonstrates the safety and feasibility of SAPIEN 3 balloon-expandable THVs in TAVR for Chinese patients with severe AS, including those with BAV stenosis. These findings challenge historical relative contraindications for TAVR in BAV patients and highlight the potential of TAVR in diverse patient populations. Larger prospective studies with extended follow-ups are needed to refine patient selection and evaluate longer-term outcomes.

BACKGROUND:The clinical implications of hypoattenuating leaflet thickening (HALT) and its potential link to thrombosis detected via computed tomography (CT) scans in post transcatheter pulmonary valve replacement (TPVR) patients are unknown. In this study we aimed to explore the prevalence, heart function, valvular hemodynamics, and early outcomes of HALT after TPVR. METHODS:We studied 64 of 76 consecutive multicentre patients who underwent TPVR, with the implantation of a Venus-P device (Venus MedTech Inc, Hangzhou, China). CT characteristics within a year, echocardiographic data, and early-term clinical end points were analyzed in patients with and without HALT. RESULTS:CT scans revealed HALT in 28 patients (56%) and reduced leaflet motion in 11 patients (20.8%) within 1 year (median interval, 184 [interquartile range, 104-214] days). HALT patients exhibited a lower percentage of normal tricuspid annular plane systolic excursion at the CT scan time (58.3% vs 73.7%; P = 0.020), although valvular hemodynamics and clinical end points were similar. Older age at intervention (odds ratio, 1.05; 95% confidence interval, 1.01-1.09) and larger body mass index (odds ratio, 1.17; 95% confidence interval, 1.01-1.36) were associated with HALT, whereas the use of anticoagulation was not identified as a protective factor. The HALT severity was positively correlated with the degree of leaflet motion (r = 0.67 and 0.69, respectively). CONCLUSIONS:HALT was highly prevalent, although it was subclinical. Early follow-up showed uneventful valvular hemodynamics and clinical outcomes. However, the HALT group exhibited suboptimal right ventricular function during CT scans, with older age and higher body mass index linked to this issue.

Transcatheter pulmonary valve replacement (TPVR) is effective for treating significant pulmonary regurgitation (PR), but mid-term data in patients with pyramidal right ventricular outflow tract (RVOT) anatomy are limited. This multi-center retrospective study included patients who underwent TPVR between May 2014 and September 2023. Baseline and echocardiographic data were compared between patients with pyramidal and non-pyramidal RVOT. The primary endpoint was peri-procedural device success, defined as technical success, optimal valve function on discharge echocardiography (RVOT gradient < 30 mmHg, less than moderate PR, no significant paravalvular leak), and absence of in-hospital mortality or re-intervention. The secondary endpoint was 1-year freedom from all-cause mortality, cardiac hospitalization, endocarditis, significant stent fracture, valve dysfunction, and device-related re-intervention. Sixty-eight patients were enrolled. Device success was achieved in 86.7

INTRODUCTION AND OBJECTIVES:This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas. METHODS:All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups. RESULTS:This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P<.001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P=.011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas. CONCLUSIONS:MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.

AbstractThere is limited data on the prognostic implications of residual mild coarctation (RMC) in patients with repaired native coarctation of the aorta (CoA). To explore the association of RMC with mid‐term comorbidities in post‐interventional patients, and the predictive value of the residual pressure gradient. The authors retrospectively analyzed 79 native CoA patients who received successful intervention at our hospital between October 2010 and June 2023. The outcomes of the study were late arterial hypertension (either raised blood pressure or commencement of hypotensive medications) only in normotensive patients at early follow‐up and the composite mid‐term comorbidities including new‐onset aortic injury, re‐stenosis, and re‐intervention. At a median follow‐up of 60 months, late hypertension and mid‐term comorbidities occurred in 16 (28.1%) and nine (11.4%) patients, respectively. Multivariate Cox proportional hazard regression analysis identified invasive peak systolic CoA pressure gradient (PSPG) as the best independent predictor of both outcomes. The maximally selected rank statistics indicated 10 mm Hg as the best PSPG cut‐off value for predicting late hypertension. Compared to patients with PSPG < 11 mm Hg, the cumulative event rates of both outcomes were higher in those with PSPG ≥ 11 mm Hg (log‐rank test, p < .001 for both endpoints). PSPG ≥ 11 mm Hg was proved to be the independent predictor of late hypertension with a significantly increased risk. In patients with non‐surgical CoA repair, the post‐interventional RMC and PSPG ≥11 mm Hg are important predictors of clinical comorbidities at mid‐term follow‐up.

BACKGROUND:Coronary Artery Fistulas (CAFs) Patients with aneurysm may face severe complications, necessitating prompt treatment. However, data on the outcomes of transcatheter closure in CAFs patients with aneurysm are notably scarce. METHODS:This retrospective study included all consecutive CAFs patients who underwent transcatheter closure at Fuwai Hospital from January 2010 to December 2023. Patients were divided into two groups based on the presence of aneurysm, and baseline characteristics, anatomical features, and transcatheter closure outcomes were further compared. RESULTS:The study ultimately included 104 patients, consisting of 56 in the aneurysm group and 48 in the non-aneurysm group. Patients in the aneurysm group were younger [39.79 (16.35) versus 50.69 (13.31) years, p < 0.001] and more frequently present with heart murmurs (21.43% vs. 6.25%, p = 0.03). Multivariate logistic regression indicated that a larger fistula diameter and the presence of CCFs are independent risk factors for the presence of aneurysm in CAF patients. The procedural success rate (75% vs. 75%, P = 1), fistula recanalization rate (11.11% vs. 16.67%, p = 0.42), and reintervention rate (3.7% vs. 6.25%, p = 0.89) were similar between the aneurysm and non-aneurysm groups. CONCLUSION:A larger fistula diameters and the presence of coronary-cameral fistulas are independent risk factors for the occurrence of aneurysms in patients with CAFs. The outcomes of transcatheter closure are comparable for CAFs patients with and without aneurysm, though post-closure thrombosis within the fistula appears to be more common in patients with aneurysm.

Introduction and objectives: This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas.Methods: All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups.Results: This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P < .001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P = .011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas.Conclusions: MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.

BACKGROUND:Quadricuspid aortic valve (QAV) is a rare congenital heart disease with a limited body of literature. This retrospective cohort study investigates QAV morphology, function, and clinical outcomes. METHODS:Echocardiography was used to assess valvular function. Morphological characteristics such as phenotypes, raphe, regurgitant orifice area (ROA), and aortic dilation (diameter >40 ​mm) were assessed by cardiac CT. Patients were followed up for the combined event of all-cause death and aortic valve replacement (AVR). RESULTS:Ninety QAV patients (screened from 322385 CT scans) were included (mean age 55.2 ​± ​13.6 years, 61.1 ​% male). Isolated significant aortic regurgitation (AR) was present in 75.6 ​% of patients. The cohort was dominated by type I (four equal leaflets, 37.8 ​%) and type II (3 larger and 1 smaller leaflets, 42.2 ​%) QAV. Fused raphe was present in 26.7 ​% of patients. ROACT was correlated with AR severity and aortic dilation (41.1 ​%, n ​= ​37). Among patients without AVR at baseline (n ​= ​60), one died and 17 underwent AVR during a median follow-up of 35.0 months (IQR:17.3-62.8). ROACT was associated with an increasing risk of combined event (as a categorical variable with a cut-off of 21.4 ​mm2, HR ​= ​4.25, 95%CI 1.49-12.17, p ​= ​0.007; as a continuous variable (per mm2 increment), HR ​= ​1.04, 95%CI 1.01-1.07, p ​= ​0.003). Additionally, ROACT had incremental prognostic value when added to the AR severity model (area under the receiver-operating characteristic curve increased from 86.8 to 88.4, p ​= ​0.004). CONCLUSION:QAV is characterized by variable anatomy, progressive AR, concomitant cusp fusion and aortic enlargement. ROACT may be a potential ancillary prognostic marker in patients with QAV.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data ofvarious off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs. 62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59-32.64; p=0.01). In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions: Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background: Congenital left circumflex coronary artery fistula (LCX-CAF) is a relatively rare type of coronary artery fistula (CAF); little is known about the outcomes of transcatheter closure (TCC) of LCX-CAF. Methods and Results: All consecutive patients admitted to Fuwai Hospital and scheduled for TCC of LCX-CAF between January 2012 and December 2022 were reviewed retrospectively. Of the 25 consecutive patients (mean [+/- SD] age 34 +/- 20 years; 48% male) admitted and scheduled for TCC of congenital LCX-CAF, the procedure was feasible in 22 (77.3%). The mean (+/- SD) diameter of the fistulas was 6.99 +/- 2.04 mm; 21 (84%) patients had a large fistula (i.e., diameter >2-fold greater than non-feeding coronary artery). Occluders were deployed via a transarterial approach and arteriovenous loop in 6 (27.3%) and 16 (72.7%) patients, respectively. No procedural complications were recorded. Although the procedural success rates are similar for single LCX-CAF and left anterior descending CAF (81.25% vs. 92.86%; P=0.602), the mean time from initial angiography to first occluder deployment is significantly longer for LCX-CAF (83.06 +/- 36.07 vs. 36.00 +/- 9.49 min; P<0.001). The mean (+/- SD) follow-up time was 62.2 +/- 45.5 months. The incidence of myocardial infarction and recanalization of the fistula was 4.5% (1/22) and 9.1% (2/22), respectively. Conclusions: TCC of LCX-CAF is a feasible and effective alternative to surgical repair, with comparable outcomes in selected patients. Optimal medical therapy to prevent post-closure myocardial infarction requires further investigation.

Background: The Venus-P valve was the first self-expanding valve used world-wide for transcatheter pulmonary valve replacement (TPVR) in patients with severe pulmonary regurgitation (PR). We intended to report the extended follow-up results from the prospective trial (No. NCT02590679). Methods: A total of 38 patients with severe PR (mean age 24.2 +/- 13.2) were included. Follow-up data were obtained after implanted at 1, 6, and 12 months and yearly after. The frame geometry was assessed on post-implant computer tomography (CT) scan-ning by calculating the non-circularity [circularity ratio (minimum diameter/maximum diameter) < 0.9] and under-expansion [expansion ratio (derived external valve area/nominal external valve area) < 0.9). Adverse events (all-cause mortality, reintervention, valve dysfunction, stent fracture and endocarditis) were recorded. Results: All valves were implanted successfully with normal function at discharge. Geometric CT analysis showed under -expanded valve was detected in 22 patients (63%) and non-circular valve was seen in 16 patients (46%). During a median follow-up of 4.8 years (range 0.3-8.1), there were 1 death and 1 surgical explant, both resulting from endocarditis. Five-year freedom from valve dysfunction and stent fracture were 84.8% (95%CI 74.8-94.7) and 83.5% (95%CI 73.8-93.2). Endocarditis occurred in 3 patients at a median time of 7 months. Stent fracture was more common in patients with non-circularity stents. Conclusion: TPVR using Venus-P valve is associated with favorable outcomes at 5 years. Non-circular shapes in the valve level may have a higher risk of stent fracture.

由于生物瓣膜不需要长期抗凝的特点,外科应用生物瓣膜治疗主动脉瓣功能障碍的患者比例不断增加.然而,由于瓣膜衰败等因素影响,生物瓣膜寿命较短,二次外科手术的风险高,尤其是在老年患者中.瓣中瓣经导管主动脉瓣置换术(ViV-TAVR)是外科生物瓣膜衰败后、患者二次外科手术可行的替代方案.目前世界上大多数Vi V-TAV R手术多是TAV R失败的一种补救措施,而无支架外科生物瓣膜X线标记物,对介入治疗可能更具挑战性.本文报道1例无支架生物瓣膜衰败后于X线引导下行经导管主动脉瓣置换术.因此术前全面CT检查对整体手术过程具有重要参考价值,该病例对临床上的类似情况提供新的思路.

目的:分析生物瓣主动脉根部置换术(Bio-Bentall手术)后远期行经导管主动脉瓣"瓣中瓣"置换术(ViV-TAVR)的冠状动脉阻塞风险,并讨论冠状动脉阻塞风险与主动脉根部解剖结构、冠状动脉开口与人工血管的吻合方式、人工血管直径等因素之间的关系,为改良Bio-Bentall手术方法提供依据.方法:回顾性分析 2017 年 1 月至 2021 年 6 月期间中国医学科学院阜外医院血管外科中心由 3 位术者完成Bio-Bentall手术的患者的临床资料,筛选出其中能获取清晰、可用CT资料的患者 39 例.通过 3mensio软件分析患者Bio-Bentall术前及术后的CT资料,评估术后远期行ViV-TAVR的冠状动脉阻塞风险及相关影响因素.结果:术后平均随访(4.7±8.8)个月,门控增强心脏CT提示,39 例患者术后右冠状动脉开口高度较术前明显降低[18.9(14.8,24.4)mm vs.22.0(18.4,27.4)mm,P=0.028],其中 22 例(56.4％)为冠状动脉阻塞高风险患者.术后生物瓣与人工血管的同轴性夹角对术后远期右冠状动脉阻塞风险有显著影响(HR=0.55,95％CI:0.37～0.83,P=0.013),冠状动脉开口与人工血管的吻合方式对术后远期冠状动脉阻塞风险无明显影响(HR=1.10,95％CI:0.83～1.40,P=0.648).结论:在现有手术策略下,Bio-Bentall手术患者术后远期行ViV-TAVR的冠状动脉阻塞风险极高.目前的Bio-Bentall手术方法亟需改进,以降低术后远期因生物瓣衰败行ViV-TAVR的冠状动脉阻塞风险,最大限度地提高未来行ViV-TAVR的可行性.

目的 分析使用球囊扩张瓣膜(Sapien3,S3)行经皮主动脉瓣置换术后亚临床血栓(subclinical leaflet thrombosis,SLT)现象的影响因素.方法 回顾性分析2020年9月—2022年6月在中国医学科学院阜外医院使用S3行经皮主动脉瓣置换术62例重度主动脉瓣狭窄患者的临床资料.选取既往有血管粥样硬化病史或术后随访主动脉瓣流速/压差明显升高或下降不明显患者进行CT检查.结果 最终纳入26例患者,平均年龄(70.31±8.90)岁,男性占比更大(n=15,57.69％).其中5例检出SLT,相对于非SLT组,SLT组年龄偏大[(68.52±8.80)岁vs.(77.80±4.66)岁,P=0.007].年龄因素(≥75岁)、升主动脉内径与SLT发生有相关性(P均＜0.05).结论 高龄患者SLT发生率更高,推测SLT发生与球囊扩张瓣膜短、瓣架低血流动力学等特点有关.

Background: Coronary arteries drain into the left ventricle, known as coronary-left ventricular fistula (CLVF), an extremely rare anomalous coronary artery disease. Little is known about the outcomes following transcatheter closure (TC) or surgical closure (SC) of CLVF.Method: This was a single-center retrospective study including 42 consecutive patients who underwent either the TC or SC procedure from January 2011 to December 2021. The baseline and anatomic characteristics of the fistulas, procedural outcomes, and late outcomes were summarized and analyzed.Results: The mean age was 31.6 +/- 16.2 years, with 28 male patients (66.7%). Fifteen patients underwent SC group and the remaining received TC group. There were no differences in age, comorbidities, clinical presentations, and anatomic characteristics between the 2 groups. The procedural success rate was similar (93.3% vs. 85.2%, P = 0.639) without operative and in-hospital mortality in both groups. Notably, patients who underwent TC had a significantly shorter postoperative in-hospital length of stay (2.11 +/- 1.49 vs. 7.73 +/- 2.37 days, P<0.001). The median follow-up time was 4.6 years (2.5-5.7 years, TC group) and 3.98 years (0.42-7.15 years, SC group), respectively. No difference was observed in the incidence of recanalization of the fistula (7.4% vs. 6.7%, P = 1) and myocardial infarction (0% vs. 0%). Cerebral infarction due to discontinuation of anticoagulants happened to two patients in the TC group. Importantly, thrombotic occlusion of the fistulous tract with patent parent coronary artery was found in 7 patients of the TC group.Conclusion: Both transcatheter and SC are safe and effective for patients with CLVF. Thrombotic occlusion is a noteworthy late complication, and its presence indicates the use of anticoagulants lifelong.(c) 2023 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.

1 临床资料 患者女性,29岁.因"法乐四联症矫治术后17年,活动后胸闷、气短1年"于2020年12月4日入住我院.患者曾于1993年在我院行法乐四联症外科矫治术.经胸超声心动图示:肺动脉重度狭窄[峰值压差77.4 mmHg(1 mmHg=0.133 kPa)],三尖瓣中量反流,右心室重度扩大.

经导管主动脉瓣置换术(TAVR)和经导管二尖瓣置换(TMVR)能用于治疗主动脉瓣位和二尖瓣位的外科瓣生物瓣衰败,然而一站式经股同期行TAVR和TMVR治疗双生物瓣衰败鲜有报道.本报告将展示一例主动脉瓣位与二尖瓣位双外科生物瓣衰败患者的详细CT评估,围术期经食道超声心动图测量和完整经导管双瓣膜置换操作.