Transcatheter aortic valve implantation (TAVI) for pure native aortic regurgitation (AR) remains technically challenging, primarily because absent annular calcification limits prosthesis anchoring. We reviewed contemporary evidence on TAVI for native AR, focusing on devices, procedural performance, complications, and outcomes. A comprehensive PubMed search identified 371 articles, of which 28 studies comprising 3282 patients met the inclusion criteria; notably, 64.3% were published from 2023 onward, reflecting the rapidly expanding evidence in this field. Conventional off-label devices were evaluated in 60.7% of studies and dedicated AR devices in 35.7%, while 3.6% directly compared both strategies. Technical/device success ranged from 72% to 100%, generally exceeding 85–90% in contemporary series, while 30-day mortality ranged from 0% to 23%. To illustrate the technical challenges and expand this evidence, we present a 24-year-old man with MYH7-associated hypertrophic obstructive cardiomyopathy and severe post-myectomy AR complicated by biventricular failure, cardiogenic shock, and multiorgan dysfunction. Given prohibitive surgical risk, rescue transfemoral TAVI was performed. Despite embolization of the first balloon-expandable prosthesis, a second valve was successfully implanted using an individualized anchoring strategy. At 1 year, the patient was in NYHA class I with biventricular recovery. TAVI represents an evolving alternative for carefully selected patients with severe native AR and prohibitive surgical risk.

Background: Severe aortic stenosis (AS) remains the most prevalent primary valvular disease in Europe and North America, causing heart failure (HF), with pulmonary hypertension (PH) occurring in up to 75% of symptomatic patients. The coexistence of AS and atrial septal defect (ASD) is rare and may generate dual mechanisms of PH, complicating both diagnosis and management. Case summary and review: We report a 78-year-old patient with symptomatic severe AS and right heart failure, in whom an unrecognized secundum ASD with significant left-to-right shunt was identified as a major contributor to persistent HF and right ventricular (RV) dysfunction. Due to prohibitive surgical risk, a staged interventional strategy was decided: transcatheter aortic valve implantation (TAVI), followed by cardiac catheterization and ultimately by percutaneous ASD closure. Marked clinical benefit with the reduction of the RV dimensions and improved systolic function were observed at one year follow-up. A focused review of the literature was conducted to contextualize the pathophysiological mechanisms, diagnostic challenges, and therapeutic strategies in patients with coexisting AS and ASD. Conclusions: This case emphasizes the importance of comprehensive hemodynamic assessment in AS complicated by PH and HF, particularly in the presence of congenital anomalies such as ASD.

BACKGROUND:Transcatheter aortic valve implantation (TAVI) has become the preferred therapeutic option for patients with severe aortic stenosis (SAS) at high or intermediate surgical risk. Despite its minimally invasive nature, TAVI is frequently associated with post-procedural complications, among which acute kidney injury (AKI) represents a major clinical concern. Early identification of patients at increased risk for AKI remains a critical unmet need. METHODS:This retrospective, observational, single-center study enrolled consecutive patients with severe aortic stenosis who underwent TAVI between December 2022 and December 2023. The primary endpoint was to identify independent predictors of acute kidney injury (AKI) within 48 hours after TAVI. Secondary endpoint was to identify independent predictors of hospitalization for heart failure (HHF) during follow-up. Predictive modeling was conducted using the eXtreme Gradient Boosting (XGBoost) algorithm, with interpretability enhanced via SHapley Additive exPlanations (SHAP). RESULTS:A total of 116 patients were included (mean age 76±6.5 years; 57% male). Comorbidities were common, including heart failure (41%), coronary artery disease (32%), atrial fibrillation (41%), diabetes mellitus (29%), and chronic kidney disease (34%). Median EuroSCORE II was 2.1 (IQR 1.5-3.9). Median ferritin was 99.5 ng/mL (IQR 40-129), mean hemoglobin 12.3±1.7 g/dL and mean eGFR was 69.9±24.9 mL/min/1.73 m2. After TAVI procedure, AKI occurred in 9% of patients within 48 h. According to the SHAP analysis, ferritin and TSAT emerged as the two most influential features in AKI prediction. The machine learning model achieved high sensitivity (96%) and an F1-score of 0.98, suggesting strong clinical utility for early risk stratification. CONCLUSIONS:In patients undergoing TAVI, iron deficiency, as reflected by low ferritin and TSAT levels, emerged as independent predictors of early post-procedural AKI.

Aim To identify risk factors that may be associated with lack of improvement in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI). Methods We analyzed data from 116 patients with severe aortic stenosis (AS) undergoing TAVI in a tertiary center. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and then at 1–3 months (first follow-up with a bounded time frame), 6 months and 12 months after the procedure. The primary outcome was the MLHFQ score, with higher scores indicating worse QoL. Mixed-effects modeling was used to evaluate predictors of longitudinal changes in QoL. Results The mean MLHFQ score improved significantly from 41.1 ± 16.6 at baseline to 23.4 ± 10 at 12 months ( P < 0.001), indicating enhanced QoL post-TAVI. However, several variables were associated with worse QoL trajectories over time. These included peripheral artery disease (PAD), paravalvular leak (PVL) ≥ grade 2, contrast-induced nephropathy, moderate-to-severe tricuspid regurgitation, pulmonary hypertension (PH), elevated creatinine, lower hemoglobin, reduced left ventricular ejection fraction, and increased left atrial diameter. PAD and PVL were consistent predictors of impaired QoL both early and late after TAVI. Conclusion TAVI significantly improves QoL in most patients with severe AS, but certain comorbidities and complications – particularly PAD, PVL, and PH are associated with suboptimal recovery. Identifying these risk factors may help guide individualized follow-up and supportive strategies to optimize patient-centered outcomes.

Abstract Background Sex-specific differences in aortic stenosis(AS) regarding the underlying pathophysiological mechanisms affecting the valve and left ventricular(LV) response to pressure overload are well recognised. Data on differences in left atrial(LA) and right heart remodelling and function between men and women with AS are scarce. Purpose To investigate sex-related differences in LA and right ventricular(RV) remodelling and function echocardiographic parameters in AS patients(pts) and their association with long term all-cause mortality after TAVI. Methods Fifty-seven women and 57 men with severe AS undergoing TAVI, matched to be similar with respect to age(77±6 vs 78±6 yrs,p=0.67) and LV ejection fraction(55±10 vs 54±8%,p=0.22) were enrolled and examined before and 30 days after TAVI. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for deformation analysis. Peak values of global longitudinal LA strain(LAε), LA systolic strain rate(SSr, reservoir function) and early diastolic strain rate(ESr, conduit function) were measured in all. Contractile LA function(late diastolic strain rate, ASr) was assessed in pts in sinus rhythm(89 pts). Results At baseline, the degree of LA dilation in female pts was higher(indexed LA volume(LAVi): 54.1±12.4 vs 47.9±16.7 ml,p=0.028), global longitudinal LA strain(12.6±6.2 vs 13.7±7.1%), SSr(0.6±0.3 vs 0.7±0.3) and ESr(-0.4±0.3 vs -0.5±0.3) were similar in men and women(all p values >0.05), while women had worse contractile LA function(ASr: -0.9±0.5 vs -1.2±0.6,p=0.034). Women also had a less dilated RV(32±5 vs 35±5mm,p=0.012) and better RV global systolic function(fractional area change, FAC: 44±8 vs 40±6%,p=0.012). A significant improvement in LA volumes, global LA strain, SSr and ESr 30 days after TAVI was observed in both men and women, while the contractile LA function improved only in men. The RV parameters that significantly improved after TAVI were the RV-free wall S wave in both men(p<0.001) and women(p=0.003) and the 6-segments RVLS in women(p=0.037)(Figure 1). During follow-up(4.2±0.7yrs), death occurred in 27 pts(23.7%). Although 1-year and 3-year survival rates were higher in women, 5-year survival rate was similar in both groups(Figure 2). In female pts, the predictors for all-cause mortality were baseline RV-free wall S wave(p=0.045) and LAVi(p=0.036), and after-TAVI LAVi(p=0.023), while in male pts the only predictors were global longitudinal LA strain at baseline(p=0.036) and after-TAVI(p=0.016). Conclusions AS is associated with significant differences in LA and RV response between men and women, with women exhibiting a more significant LA dilatation, poorer LA contractile function, less dilated RV and better RV global systolic function. TAVI is associated with a significant recovery of LA dimensions and function in both men and women, suggesting reverse remodelling, although men show a more significant improvement in LA contractile function. Figure 1 Figure 2

Abstract Background Transcatheter aortic valve implantation (TAVI) has become a standard treatment option in severe symptomatic aortic stenosis (AS). Extra-valvular cardiac damage affects prognosis after aortic valve replacement (AVR). Knowledge of cardiac remodeling factors that predict a poor outcome after TAVI is scarce. Purpose The study aim was to assess if echographic cardiac remodeling parameters could predict mid-term outcome after transfemoral TAVI with balloon expandable valves. Methods This study included 157 consecutive patients (76.4±7.3 yrs., 82 men) with severe AS at increased risk for surgical AVR, undergoing TAVI between October 2017 and December 2019. Patients underwent echocardiography before and 30 days after the procedure and clinical follow-up 3 years after inclusion. Pulmonary hypertension (PH) was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Longitudinal LA strain was assessed in apical views. Peak values of global longitudinal LA strain (LAε), systolic strain rate (SSr) and early diastolic strain rate (ESr) were measured in all patients. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm. Primary outcome was all-cause mortality. Results Three-year follow-up was available for all patients. Mean follow-up was 52±9 months (39-73). During follow-up 45 pts (76.8±7.3 yrs., 24 men) died, mid-term mortality was 29%. Between survivors and non-survivors, we found no differences in age and sex (p=0.3 and 0.8), LV ejection fraction, global longitudinal strain and AS severity. The presence of syncope, angina and significant coronary lesions before TAVI was similar between survivors and non-survivors. There was a significant reduction in sPAP after TAVI (33±11 vs 40±14, p<0.001), still PH was present 30 days after the procedure in 51 pts (32%). Patients with persistent PH at 30 days after TAVI had a significantly higher mid-term mortality (41.6% vs 22.4%, p=0.02), worse global LA strain (-9.2±4.8 vs -13.7±7.1%, p<0.001) and worse LA contractile function (ASr: -1.0±0.6 vs -1.3±0.6, p=0.002). Using binary logistic regression, atrial fibrillation (p=0.004), increased indexed LA volume (baseline and 30 days after TAVI, p=0.006 and p=0.021), impaired peak global LA strain after TAVI (p=0.04), baseline sPAP (p=0.03) and persistent PH (p=0.02) were significant univariate correlates of all-cause mortality. In the multivariable regression model, increased LA volume at baseline (OR 1.01, p=0.012) emerged as an independent predictor of death. Conclusions The mid-term follow-up revealed a mortality of 29% in high-risk patients with severe AS. No echocardiographic parameters of LV or RV systolic function or AS severity were associated with an increased risk of death. PH (at baseline and persistent), LA dilation and impaired LA strain after TAVI were associated with mortality. Increased LA volume before the procedure was an independent predictor of mid-term mortality after TAVI.

AbstractPulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty‐five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow‐up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%–90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease‐associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA‐to‐aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end‐diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre‐capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA‐to‐aorta, RV end‐diastolic area and PH etiology) and long‐term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

Transcatheter aortic valve implantation (TAVI) prostheses have better hemodynamics compared to surgical prostheses, with a lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, the effects of PPM have been controversial regarding clinical impact. This study aims to determine the short-term impact of PPM on cardiac function and the effect of PPM on mid-term outcome in patients undergoing transfemoral TAVI with balloon-expandable valves.

Aortic stenosis is one of the leading causes of valvular disease requiring surgery or transcatheter intervention, with a rising prevalence due to the aging population. Current guidelines recommend transcatheter aortic valve implantation (TAVI) as the first-line treatment for patients with symptomatic severe aortic stenosis and high surgical risk. The indications for TAVI have expanded to low-surgical-risk patients due to increased operator experience and improved implanted devices with a dramatic reduction of complications. Considering the limited durability of bioprostheses, TAVI-in-TAVI procedures have been successfully performed as an alternative to surgery.

Background: Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current capability of the Romanian STEMI program to meet guideline-recommended time intervals is largely unknown. Aims: The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays. Materials and Methods: This prospective study included 500 consecutive patients with STEMI at the "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints. Results: A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary ischemic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients. Conclusions: Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre-hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.

IntroductionRight ventricular (RV) dysfunction and pulmonary hypertension (PH) have been previously associated with unfavorable outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), but little is known about the effect of right ventricle (RV) to pulmonary artery (PA) coupling. Our study aimed to evaluate the determinant factors and the prognostic value of RV-PA coupling in patients undergoing TAVI.MethodsOne hundred sixty consecutive patients with severe AS were prospectively enrolled, between September 2018 and May 2020. They underwent a comprehensive echocardiogram before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis of the left ventricle (LV), left atrium (LA), and RV function. Complete data on myocardial deformation was available in 132 patients (76.6 ± 7.5 years, 52.5% men) who formed the final study population. The ratio of RV free wall longitudinal strain (RV-FWLS) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling. Patients were analyzed according to baseline RV-FWLS/PASP cut-off point, determined through time-dependent ROC curve analysis, as follows: normal RV-PA coupling group (RV-FWLS/PASP ≥0.63, n = 65) and impaired RV-PA coupling group (RV-FWLS/PASP < 0.63, n = 67).ResultsA significant improvement of RV-PA coupling was observed early after TAVI (0.75 ± 0.3 vs. 0.64 ± 0.3 before TAVI, p < 0.001), mainly due to PASP decrease (p < 0.001). LA global longitudinal strain (LA-GLS) is an independent predictor of RV-PA coupling impairment before and after TAVI (OR = 0.837, p < 0.001, OR = 0.848, p < 0.001, respectively), while RV diameter is an independent predictor of persistent RV-PA coupling impairment after TAVI (OR = 1.174, p = 0.002). Impaired RV-PA coupling was associated with a worse survival rate (66.3% vs. 94.9%, p-value < 0.001) and emerged as an independent predictor of mortality (HR = 5.97, CI = 1.44–24.8, p = 0.014) and of the composite endpoint of death and rehospitalization (HR = 4.14, CI = 1.37–12.5, p = 0.012).ConclusionOur results confirm that relief of aortic valve obstruction has beneficial effects on the baseline RV-PA coupling, and they occur early after TAVI. Despite significant improvement in LV, LA, and RV function after TAVI, RV-PA coupling remains impaired in some patients, it is mainly related to persistent pulmonary hypertension and is associated with adverse outcomes.

Aims: There is little evidence guiding the choice between a one-stent and a two-stent approach in unprotected distal left main coronary artery disease (UDLMCAD) presenting as acute coronary syndrome (ACS). We aim to compare these two techniques in an unselected ACS group. Methods and results: We conducted a single center retrospective observational study, that included all patients with UDLMCAD and ACS undergoing PCI between 2014 and 2018. Group A underwent PCI with a one-stent technique (n = 41, 58.6%), Group B with a two-stent technique (n = 29, 41.4%). A total of 70 patients were included, with a median age of 63 years, including n = 12 (17.1%) with cardiogenic shock. There were no differences between Group A and B in terms of patient characteristics, including SYNTAX score (median 23). The 30-day mortality was 15.7% overall, and was lower in Group B (3.5% vs. 24.4%, p = 0.02). Mortality rate at 4 years was significantly lower in Group B (21.4% vs. 44%), also when adjusted in a multivariable regression model (HR 0.26, p = 0.01). Conclusions: In our study, patients with UDLMCAD and ACS undergoing PCI using a two-stent technique had lower early and midterm mortality compared to one-stent approach, even after adjusting for patient-related or angiographic factors.

Abstract Background This review is based on the case of a 71-year-old female patient, with cardiovascular risk factors, who was referred for emergency cardiological evaluation after experiencing severe anterior chest pain that had lasted for more than 5 hours at the time of admission. A diagnosis of inferior-posterior ST-segment elevation myocardial infarction was established, and emergency coronary angiography was performed. It revealed severe, diffuse dilation of the entire arterial coronary tree with slow flow and the presence of a large quantity of thrombotic material in the right coronary artery. Thromboaspiration was deemed unfit since the operator believed that there was a high risk of distal embolization with subsequent no-reflow, when passing with the catheter. As such, the patient started receiving anticoagulant therapy, and after one month she was scheduled for a control angiogram. The follow-up coronary angiography identified complete dissolution of the thrombus from the right coronary artery and a moderate stenosis in the distal segment, so no stent implantation was required. Rationale for review After performing a complete and comprehensive differential diagnosis, presence of isolated coronary artery ectasia was established. Coronary artery ectasia is a rare disease, usually found incidentally during coronary angiograms performed for other indications (chronic and acute coronary syndromes) with a vast etiology and complex pathophysiology. Because there are common morphopathologic pathways between coronary artery ectasia and atherosclerotic coronary artery disease, the clinical presentation of the former might have similar characteristics with the latter, but the management and prognosis of these patients is much less studied compared to the patients suffering from different phenotypes of coronary atherosclerosis. This review aims to summarize the etiopathogenesis, clinical presentation, diagnostic modalities, and different management pathways of coronary artery ectasia.

Defining the best percutaneous coronary intervention (PCI) in acute myocardial infarction is sometimes difficult, bearing in mind that time is of the essence in preventing myocardial tissue damage. There are invasive modalities to determine the best strategy. These include intravascular ultrasound (IVUS) and optical coherence tomography (OCT), methods that could underline plaque rupture, thrombus, positive remodeling, greater plaque burden, and tissue prolapse. Virtual histology IVUS is capable of detecting lesions containing large necrotic cores and thin cap fibroatheroma (independent predictors of no-reflow in acute myocardial patients). Using these imagistic modalities can lead the PCI strategy in order to obtain the best possible outcome of the procedure for the patient.

Abstract Mechanical complications post ST elevation myocardial infarction (STEMI) are life-threating events, that require rapid recognition and appropriate management. Clinical diagnosis, considering high index of suspicion and bedside echocardiography should be considered in all STEMI patients Despite the overall decrease of the incidence of cardiac rupture (CR) secondary to STEMI in context of early revascularization and the wide availability of primary PCI, CR has still an unacceptable high mortality. Purpose To provide demographic, clinical, management and prognostic data associated to cardiac rupture from a tertiary centre of cardiology in Romania and to better describe in-hospital trajectory. The primary endpoint was defined as the incidence of CR and secondary endpoints were rate of surgical interventions, in-hospital mortality rate at 24 hours and after 24 hours during index hospitalization. Methods The analysis of the electronic medical records retrospectively identified 7703 patients admitted for STEMI between 01 Jan 2011 and 31 Dec 2020. A database consisting of demographic data, medical history, cv and non-cv comorbidities, in-hospital management were recorded using an UiPath robotic process automation (RPA) technology. Characteristics of the patients +/− CR were compared, and data analysis was performed using SPSS 26 Ed. Results Of a total number of 7703 consecutive STEMI patients, CR has been identified in 185 patients (mean incidence of 2.4%). The annual rates for CR incidence remained stable during the past decade (Figure 1). Patients with CR were older compared with non-CR (71.6±10.2 vs 61.47±12.8 years; p<0.001) and more commonly female (3.92% vs 1.78% males, p=0.04). The CR patients had more comorbidities and CV risk factors – HTN, smoker status, DLP, more AF, CKD, obesity and chronic cognitive deficit (p<0.05), but not DM (p=0.6). Among the CR group patients, anterior MI was the frequent localisation (52%), followed by inferior MI (17%), infero-lateral (23%) and RV involvement MI (6.4%). According to the type of the mechanical complication, patients developed free wall rupture (50% of cases), 39% IVS rupture and 11% papillary muscle was involved; A number of 50 patients (27%), benefited from emergent cardiac surgery and 31.3% of CR patients received mechanical circulatory support. The overall STEMI mortality in the first 24-hours was 1.84% and in most of these patients the main cause of death was related to CR (31%). Overall total in-hospital mortality was 8.08% (6.5% non-CR group vs. 70.8% the CR group – Figure 1). Conclusions The study presents the epidemiological characteristics of CR complicating STEMI in the largest tertiary cardiovascular hospital in Romania. We have identified a stable trend for the incidence of CR incidence among patients with STEMI. In spite of the high rate of cardiac surgery and MCS, in-hospital mortality remains very high, particularly in the first 24 h since admission Funding Acknowledgement Type of funding sources: None.

Abstract Introduction Coronary artery anomalies are rare congenital abnormalities often found incidentally on conventional coronary angio-gram or coronary computed tomography angiography. They may result in various clinical outcomes. The objective of this study was to investigate the prevalence of coronary artery anomalies, the clinical and laboratory characteristics of patients with coronary artery anomalies, and the outcomes at five-year follow-up of these patients in a high-volume coronary interventional center in Romania. Materials and Methods To define the study population we reviewed all coronary angiograms performed between 01.01.2014 and 31.12.2014. A total number of 5832 coronary angiograms were analyzed, and we identified 31 patients with coronary artery anomalies. Results The prevalence of coronary artery anomalies was 0.53%. Eighty-seven point four percent of the patients had origin and distribution anomalies, and twelve point nine percent of the patients had a coronary artery fistula. The most common coronary artery anomalies were the anomalous origin of the right coronary artery and the anomalous origin of the left circumflex artery from the initial segment of the right coronary artery. Sixty-one point three percent of the patients underwent coronary angiogram due to atypical chest pain. Twenty-nine percent of the patients had significant coronary artery disease. No death or significant complication were recorded in the 31 patients during the 5 years follow-up. Conclusions The prevalence of coronary artery anomalies in this study was slightly lower but still like that of previous studies. The majority of patients presented with atypical symptoms, and only a minority had coronary artery disease. In the context of no death or significant complication at 5-year follow-up highlights the benign prognosis of most coronary artery anomalies.

Abstract Background Left main percutaneous coronary intervention (PCI) has been established as an effective and safe treatment option for left main coronary artery disease. There are data suggesting that different stent platforms can impact the outcomes after left main PCI. The aim of current study was to compare the four-year outcomes of patients with left main stenosis treated by PCI with a balloon-expandable stent or a self-apposing stent. Methods and Results A total of 146 patients with left main stenosis treated by PCI were included, of which 84 (57.5%) had balloon-expandable stents (Group A) and 62 (42.5%) had self-apposing stents (Group B). Baseline SYNTAX scores were higher in Group A than in Group B. Proximal optimization technique was used more often in Group A (45.2% in Group B vs 81.4% in Group A, p<0.001). The same observations were made for kissing balloon postdilation (30.6% Group B vs 62.7% in Group A, p<0.001). Procedural success with TIMI 3 flow was achieved in similar proportions in both groups. Mortality rate and MACE rates at 4-year follow-up were higher in Group B compared to Group A but have not reached statistical significance in univariable or multivariable analysis. Implantation of a self-apposing stent has been an independent predictor for target lesion revascularization rate (TLR) in multivariable analysis (HR 0.06, CI − 1.11–11.7, =0.03). Conclusions In our study, TLR rate was significantly higher in patients with left main lesion treated by PCI with self-apposing stents.

Severe aortic stenosis (AS) is the most common valvular heart disease, with an increasing prevalence due to age-related degenerative modifications of the valve. Once AS becomes symptomatic, the survival of patients is significantly reduced with an annual mortality rate of 25%. Depending on surgical risk, anatomical and technical aspects, and the patient’s option, correction can be made either by surgical valve replacement (SAVR) or by transcatheter aortic valve implantation (TAVI). Although aortic valve implantation brings relief of symptoms, there is little data on the quality of life (QoL) of patients undergoing TAVI and the factors that directly influence it. Even if age and comorbidities are known modifiers of survival, there is no specific tool to assess the impact of AS and to determine the appropriate treatment strategy.

Abstract Coarctation of the aorta (CoA) is a relatively frequent congenital defect. Its natural evolution is marked by serious complications including aortic dissection, heart failure, coronary artery disease, infective endocarditis, or cerebral haemorrhages. Correction of CoA before complications arise is associated with a favourable long-term outcome. Timely diagnosis of CoA is therefore of utmost importance in the prognosis of these patients. Non-invasive imaging techniques, ranging from chest radiography to echocardiography, Cardiac Computed Tomography (CCT), and Cardiac Magnetic Resonance (CMR) have evolved to the extent where they can not only suggest but also precisely characterize the lesion and guide further management. We present a series of 3 case reports, highlighting the diagnostic approach and treatment for this pathology.