Mitral regurgitation (MR) is a common valvular disease associated with poor prognosis. Percutaneous mitral valve repair (PMVR) combined with guideline-directed medical therapy has shown prognostic benefits, yet a substantial proportion of patients experience major adverse cardiovascular events (MACE), including death and heart failure hospitalization, within the first year. Identifying short-term nonresponders remains a clinical priority. This study evaluated the prognostic value of advanced right ventricular (RV) function parameters in predicting MACE following PMVR using the MitraClip system. A total of 60 consecutive patients with symptomatic severe MR undergoing PMVR were analyzed. Echocardiographic assessments were performed at baseline, postprocedure before discharge, and at 6-month follow-up. Parameters included tricuspid annular plane systolic excursion (TAPSE) normalized to pulmonary artery systolic pressure (TAPSE/PASP), right ventricular end-diastolic area (TAPSE/RVAD), and end-systolic area (TAPSE/RVAS), along with RV myocardial work indices. During the first year, 35% of patients experienced MACE. At baseline, those who developed MACE had significantly higher creatinine, troponin T, NT-proBNP levels, larger right heart dimensions, and lower TAPSE (all p <0.05), while other clinical, imaging, and procedural characteristics were similar. In multivariate analysis, TAPSE/PASP, TAPSE/RVAS, and TAPSE/RVAD were independent predictors of MACE (all p <0.05), with AUC values ranging from 0.80 to 0.85, indicating strong predictive capacity. Throughout follow-up, these indices remained significantly lower in patients with MACE, while RV myocardial work parameters had lower predictive accuracy (AUC<0.60). In conclusion, a comprehensive RV assessment, particularly TAPSE-based indices, can help identify patients at higher risk of adverse outcomes after PMVR, whereas RV myocardial work indices appear less reliable.

Cardiac conduction disease often necessitates permanent pacemaker implantation. While right ventricular pacing (RVP) effectively treats bradycardia, it may lead to adverse cardiac remodeling and heart failure. Left bundle branch area pacing (LBBAP) has emerged as an alternative, potentially preserving myocardial function. Non-invasive myocardial work (MW) assessment provides valuable insights into left ventricular systolic function, energetics, and efficiency. This study systematically reviewed and analyzed MW parameters, comparing LBBAP to RVP and His bundle pacing (HBP). A meta-analysis of 241 patients across five studies examined four MW parameters-Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE)-at baseline, post-implantation, and last follow-up (median: 180 days, IQR: 7-360 days). At baseline, MW parameters were similar between LBBAP and RVP. Post-implantation, LBBAP preserved MW more effectively, showing significantly higher GWI than RVP (2250.0 ± 400.0 vs. 1600.0 ± 300.0 mmHg%, p = 0.027), a difference that remained significant at follow-up (p = 0.035). GWE was also significantly higher at follow-up (p = 0.011), while GCW and GWW showed no significant differences. MW parameters did not differ significantly between LBBAP and HBP (all p-values >0.05). These findings suggest that LBBAP provides superior MW preservation compared to RVP, with significant benefits in GWI and GWE, while demonstrating comparable performance to HBP.

Journal Article Corrected proof A rare cause of syndromic mitral valve prolapse Get access Arthur Iturriagagoitia, Arthur Iturriagagoitia Cardiology Department, OLV Hospital Aalst, Moorselbaan 164, Aalst 9300, Belgium Corresponding author. E-mail: arthur_iturri@hotmail.com https://orcid.org/0000-0003-2371-8165 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ward Heggermont, Ward Heggermont Cardiology Department, OLV Hospital Aalst, Moorselbaan 164, Aalst 9300, Belgium Search for other works by this author on: Oxford Academic PubMed Google Scholar Guy Van Camp Guy Van Camp Cardiology Department, OLV Hospital Aalst, Moorselbaan 164, Aalst 9300, Belgium https://orcid.org/0000-0002-5621-4898 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jeae027, https://doi.org/10.1093/ehjci/jeae027 Published: 23 January 2024 Article history Published: 23 January 2024 Corrected and typeset: 01 February 2024

BACKGROUND Unilateral absence of a pulmonary artery (UAPA) is a rare congenital cardiovascular malformation. More than half of UAPA cases have other cardiac lesions such as tetralogy of Fallot or septal defects. Clinical manifestations are diverse and range from heart failure after birth to an incidental finding on chest imaging during adulthood. Whereas early surgical revascularization is recommended in infancy, this is usually not feasible in the adult population. Management in these patients is aimed at treating the complications of UAPA. CASE REPORT A 67-year-old woman was evaluated for subacute right heart failure. An echocardiogram revealed pulmonary stenosis, tricuspid regurgitation, and depressed right ventricular function. Chest computed tomography (CT) showed absence of the right pulmonary artery. Additionally, there was a lung tumor in the right upper lobe. Right-heart catheterization confirmed a critically obstructed pulmonary orifice shown by hemodynamic collapse when crossing the pulmonary valve with the catheter. The patient underwent pulmonary valve balloon dilatation with right ventricular outflow tract stenting followed by percutaneous implantation of a balloon-expandable stent-valve. The clinical course was complicated by a complete heart block. Oncologic management consisted of stereotactic radiotherapy. CONCLUSIONS The combination of UAPA, pulmonary stenosis, and lung cancer is rare. Pulmonary stenosis worsens prognosis in adult patients with UAPA, but also constitutes a therapeutic target. The decision to treat the pulmonary stenosis should be based on the severity of stenosis, the degree of pulmonary hypertension, and individual anatomy. We chose percutaneous pulmonary valve implantation because our patient had a critical pulmonary stenosis with normal pulmonary pressures.

BACKGROUND Catheter ablation is an increasingly used treatment modality for arrhythmias. Periprocedural complications have a low incidence but can be life-threatening. Therefore, knowledge of possible risks during the intervention and early recognition improve patient outcomes. Transseptal puncture from the right atrium is needed for left atrial access. This procedure is a critical step that can be complicated by penetrating cardiac injury. CASE REPORT A 76-year-old patient with previous mitral valve port-access surgery underwent catheter ablation for atrial tachycardia. He developed hypotension following a challenging transseptal puncture, but transesophageal echocardiography did not demonstrate any pericardial fluid. After completing the procedure and arriving at the coronary care unit, the patient was found to be in hemorrhagic shock. CT angiography demonstrated a massive right hemothorax without active bleeding. More than 2.5 liters of blood was evacuated by chest drainage. Despite this serious complication, the patient made a full recovery without need for surgical exploration. CONCLUSIONS Hypotension during or shortly after catheter ablation should alert the physician to possible anaphylaxis, hemorrhage, or air embolism. Most patients develop bleeding near the access site or within the pericardial cavity with subsequent tamponade. This case illustrates that hemothorax due to pericardial laceration should be included in the differential diagnosis. Pleural fluid is visible on echocardiography and fluoroscopy during the procedure. Bedside lung ultrasound saves time in detecting a large hemothorax compared to CT scan. Efforts to optimize the safety of transseptal puncture remain important. Radiofrequency transseptal needles and intracardiac echocardiography are helpful tools in patients with difficult atrial septal anatomy.

We describe a patient with ventricular tachycardia and complete atrioventricular block. Remarkable thinning of the basal interventricular septum preceded left ventricular dysfunction. Endomyocardial biopsy demonstrated giant cell myocarditis. The patient received combined immunosuppressive therapy and a cardioverter-defibrillator. Eligibility screening for heart transplantation was initiated. (Level of Difficulty: Advanced.).