New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased rates of adverse events (including mortality and stroke). Its incidence after coronary artery bypass grafting (CABG) is considered to be approximately 30%, and it is believed to be a transient condition. However, studies investigating POAF after CABG fail to provide appropriate data on incidence and arrhythmia patterns due to the use of intermittent rhythm detection strategies. These methods have a low sensitivity as compared with continuous monitoring. Subsequently, studies using these techniques most likely do not identify all patients with arrhythmia and do not adequately demonstrate the long-term incidence of arrhythmia, which in turn may affect its association with adverse events. The Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns (CABG-AF) study (German Clinical Trials Register Number: DRKS00018887) tests the hypothesis that the incidence of AF in the first 12 months after CABG is significantly underestimated. CABG-AF is an investigator-initiated multicenter, prospective, observational study in which 196 patients with no history of arrhythmia who underwent first-time CABG receive an insertable cardiac monitor for continuous postoperative rhythm monitoring. The primary end point of the study is any episode of AF within the first 12 months after surgery. Secondary end points include AF burden, AF density, and the ratio of silent to symptomatic AF episodes. End points will be investigated by automatic and patient-initiated data transfers from the implanted device, by telephone interview of patients, and by follow-up forms sent to patients by mail. The patients will be followed for a planned follow-up of 3 years. In conclusion, the CABG-AF study will provide information on the true incidence of AF after CABG and on the temporal patterns of the arrhythmia.

Cardiac tumors are a rare entity with typically unspecific symptoms. We present the case of a 43-year old female patient with epigastric pain and palpitations with a long history of diagnostics prior to discovery of an epicardial mass. The epicardial tumor with arterial vascularization from the left anterior descending artery was resected in a beating heart procedure and was found to be a lipomatous soft tissue tumor. A lack of mouse double minute 2 (MDM2) gene amplification in fluorescent in situ hybridization (FISH) confirmed the diagnosis of a benign cardiac lipoma. Resection led to a long-term resolution of symptoms.

ImportanceNew-onset postoperative atrial fibrillation (POAF) occurs in approximately 30% of patients undergoing coronary artery bypass grafting (CABG). It is unknown whether early recurrence is associated with worse outcomes.ObjectiveTo test the hypothesis that early AF recurrence in patients with POAF after CABG is associated with worse outcomes.Design, Setting, and ParticipantsThis Swedish nationwide cohort study used prospectively collected data from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other mandatory national registries. The study included patients who underwent isolated first-time CABG between January 1, 2007, and December 31, 2020, and developed POAF. Data analysis was performed between March 6 and September 16, 2023.ExposureEarly AF recurrence defined as an episode of AF leading to hospital care within 3 months after discharge.Main Outcomes and MeasuresThe primary outcome was all-cause mortality. Secondary outcomes included ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 2 years after discharge. The groups were compared with multivariable Cox regression models, with early AF recurrence as a time-dependent covariate. The hypothesis tested was formulated after data collection.ResultsOf the 35 329 patients identified, 10 609 (30.0%) developed POAF after CABG and were included in this study. Their median age was 71 (IQR, 66-76) years. The median follow-up was 7.1 (IQR, 2.9-9.0) years, and most patients (81.6%) were men. Early AF recurrence occurred in 6.7% of patients. Event rates (95% CIs) per 100 patient-years with vs without early AF recurrence were 2.21 (1.49-3.24) vs 2.03 (1.83-2.25) for all-cause mortality, 3.94 (2.92-5.28) vs 2.79 (2.56-3.05) for heart failure hospitalization, and 3.97 (2.95-5.30) vs 2.74 (2.51-2.99) for major bleeding. No association between early AF recurrence and all-cause mortality was observed (adjusted hazard ratio [AHR], 1.17 [95% CI, 0.80-1.74]; P = .41). In exploratory analyses, there was an association with heart failure hospitalization (AHR, 1.80 [95% CI, 1.32-2.45]; P = .001) and major bleeding (AHR, 1.92 [1.42-2.61]; P < .001).Conclusions and RelevanceIn this cohort study of early AF recurrence after POAF in patients who underwent CABG, no association was found between early AF recurrence and all-cause mortality. Exploratory analyses showed associations between AF recurrence and heart failure hospitalization, oral anticoagulation, and major bleeding.

Background: The use of rapid deployment (RD) surgical aortic valve replacement (SAVR) in bicuspid aortic valve morphology (BAV) faces several challenges due to annular asymmetry and massive calcification of the leaflets. Especially BAV with Sievers type 0 morphology, which has only two opposed raphes, and a mostly elliptical annulus must be reconstructed with caution. Nevertheless, RD SAVR might be a feasible approach for all types of BAV by following specific implantation strategies. The study aimed for retrospective feasibility analysis and comparison of RD SAVR in different bicuspid morphologies.

When using rapid deployment surgical aortic valve replacement (RD SAVR) in treating bicuspid aortic valve morphology (BAV), several challenges are faced due to annular asymmetry. The Sievers classification has been traditionally used for the description of BAV morphology. In this study, we aimed to conduct a retrospective feasibility analysis of RD SAVR in relation to the Sievers classification. From January 2014 to March 2022, 31 patients with BAV morphology (15 patients with Sievers type 0 BAV and 16 with Sievers type 1 BAV) underwent RD SAVR. Specific surgical techniques were applied depending on the BAV morphology. Comparable clinical outcomes were observed. No paravalvular leaks and no valvular re-interventions occurred in either group. CPB and cross-clamping times, as well as the prosthesis sizes used, were also not significantly different. Postoperative mean gradients were comparable in both groups. No significant distinction was found between the groups in terms of postoperative pacemaker indication, postoperative stroke, or death. Annular symmetry can be adequately restored through precise prosthesis sizing and placement according to an individual’s valve morphology regardless of the Sievers classification of BAV by choosing a different landmark for the initial suture. RD SAVR seems to be a safe approach for any bicuspid morphology, with good hemodynamic results and time-saving potential in experienced hands.

Despite major advancements in the diagnosis and medical treatment of endocarditis this entity retains a high mortality in the current age [1]. OBJECTIVES The aim of this study was to evaluate the surgical outcome of patients suffering from native aortic valve (NVE) or prosthetic aortic valve endocarditis (PVE) treated with the EDWARDS INTUITY Elite rapid-deployment valve prosthesis. METHODS Between February 2019 and June 2020, 25 patients suffering from NVE (n = 9; 36%) and PVE (n = 16; 64%) of the aortic valve received an INTUITY valve at our institution. Preoperative, operative and follow-up data were collected. RESULTS In our cohort, the mean EuroSCORE II was 13.4%. Eleven patients (44%) received concomitant aortic root patch plasty. Four patients (16%) received coronary artery bypass graft surgery, 3 patients (12%) received mitral valve repair and 2 patients (8%) underwent replacement of the ascending aorta. The cardiopulmonary bypass and aortic cross-clamp times were 124 +/- 56 and 75 +/- 39 min, respectively. The mean intensive care unit stay was 5 days. The mean size of the implanted prostheses was 25 +/- 2 mm and the mean prosthesis transvalvular gradient 3 months after surgery was 9 +/- 4 mmHg. During follow-up, no case of recurrent endocarditis occurred, 1 patient died of multisystem organ failure which had already been present preoperatively. CONCLUSIONS Surgery for NVE and PVE of the aortic valve may be safely performed using the EDWARDS INTUITY Elite valve system. This procedure could be well implemented in cases with extensive infection, fragile root tissue and root abscesses requiring root reconstruction. In our institution, the rapid-deployment aortic valve replacement strategy has become an important tool in the armamentarium of the surgical endocarditis treatment.

Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.

INTRODUCTION:Cardiac surgery may influence occurrence and persistence of atrial fibrillation (AF). In patients with a history of cardiac surgery and postoperative pacemaker or implantable cardioverter defibrillator implantation we attempted to quantify AF characteristics and investigate factors that influence AF recurrence.METHODS:In 426 patients (319 male; age: 73 SD: 9 years) with a history of cardiac surgery (364 CABG; 69 mitral valve; 57 aortic valve and 59 combination procedures) the heart rhythm history (mean: 351 days SD: 54 days) was reconstructed and investigated for AF recurrence patterns.RESULTS:AF developed and subsequently recurred in 75% of patients (n = 320). The mean AF burden in these patients was 0.21 (21% of the total observed time spent in AF) and 4085 episodes of AF were observed and analyzed. AF episodes spontaneously terminated within 24 h (n = 2509), 48 h (n = 700), 72 h (n = 279), and 1 week (n = 31). The probability of spontaneous conversion to sinus rhythm (SR) decreased with time spent in AF and plateaued after approximately 7 days. Patient age, LVEF and presence of coronary artery disease significantly influenced the probability of spontaneous conversion to SR. Type of cardiac surgery also significantly influenced AF episode characteristics.CONCLUSION:AF episodes are common in patients with a history of cardiac surgery. Spontaneous conversion to SR diminishes with increasing time spent in AF and is influenced by AF characteristics and several patient-related factors. Continuous monitoring can provide detailed information about AF recurrence that may immensely improve our understanding and influence the clinical management of AF.

INTRODUCTION:Mitral valve surgery has developed into a strong subspecialty of cardiac surgery with operative techniques and outcomes constantly improving. The development of bradyarrhythmias after mitral valve surgery is not completely understood.METHODS:We investigated a cohort of 797 patients requiring mitral valve surgery with and without concomitant procedures. Incidences and predictors of pacemaker requirement as well as survival were analyzed.RESULTS:In the complete follow-up period (median follow-up time: 6.09 years [95% confidence interval [CI]: 5.94-6.22 years, maximum 8.77 years) 80 patients (10% of the complete cohort) required pacemaker implantation for bradyarrhythmia. The cumulative rate of pacemaker implantation was 6.4% at 50 days (48 patients) with most (54.2%) requiring pacing for atrioventricular block. Mitral valve replacement (odds ratio [OR]: 1.905; 95% CI: 1.206-3.536; p = .041) and tricuspid ring annuloplasty (OR: 2.348; 95% CI: 1.165-4.730, p = .017) were identified as operative risk factors of pacemaker requirement after mitral valve surgery. Insulin-dependent diabetes mellitus was also identified as a predictor of pacemaker requirement (OR: 4.665; 95% CI: 1.975-11.02; p = .001). There was no difference in survival in the paced and unpaced groups.CONCLUSIONS:After mitral valve surgery, a relevant subgroup of patients requires pacemaker implantation-most for atrioventricular block. We identified mitral valve replacement and tricuspid ring annuloplasty as significant operative risk factors and insulin-dependent diabetes mellitus as a demographic risk factor. While anatomic relationships help explain the operative risk factors the role of diabetes mellitus is not completely understood.

Giant Left Atrial Myxoma and Left Ventricular Inflow ObstructionA 58-year-old patient developed dyspnea after undergoing a total hip replacement.Computed tomography revealed an intracardiac mass (arrow in Figure a).Transesophageal echocardiography was performed as part of further diagnostics.This showed an inhomogeneous structure originating in the left atrium and extending to the left ventricle.The 9 × 5 × 5-cm structure with its 1 × 1-cm " endocardial button" (endocardial attachment site-arrow in in Figure b) was successfully excised using an atrial transseptal approach under cardiopulmonary bypass.Histopathology con firmed the diagnosis of myxoma.The postoperative course was unremarkable and no recurrence was seen at 1-year postoperative follow-up.Myxoma is the most common primary cardiac tumor; it is benign, generally located in the left atrium, and usually smaller than in this case.Compared to cardiac thrombi, myxomas tend to be larger, are polypoid in shape, and are mobile structures due to the "stalk" that is usually present.The recurrence rate following myxoma excision is under 5%.

A 58-year-old patient developed dyspnea after undergoing a total hip replacement. Computed tomography revealed an intracardiac mass (arrow in Figure a). Transesophageal echocardiography was performed as part of further diagnostics. This showed an inhomogeneous structure originating in the left atrium and extending to the left ventricle. The 9 × 5 × 5-cm structure with its 1 × 1-cm “ endocardial button” (endocardial attachment site—arrow in in Figure b) was successfully excised using an atrial transseptal approach under cardiopulmonary bypass. Histopathology con firmed the diagnosis of myxoma. The postoperative course was unremarkable and no recurrence was seen at 1-year postoperative follow-up. Myxoma is the most common primary cardiac tumor; it is benign, generally located in the left atrium, and usually smaller than in this case. Compared to cardiac thrombi, myxomas tend to be larger, are polypoid in shape, and are mobile structures due to the “stalk” that is usually present. The recurrence rate following myxoma excision is under 5%.

A 76-year-old patient with an extensive cardiac medical history was referred to our department for primary prevention implantable cardioverter-defibrillator (ICD) implantation. The patient had undergone coronary artery bypass grafting 7 years previously. One year ago the patient's mitral and tricuspid valve regurgitation had been addressed with one clip to the mitral and two clips to the tricuspid valve (MitraClip, Abbott Laboratories, IL). Now presenting with ischemic cardiomyopathy, a severely reduced left ventricular ejection fraction, and a narrow QRS, receiving guideline directed medical therapy ICD implantation for primary prevention was indicated.1, 2 What is the ideal device for the treatment of this patient? What further diagnostics are required before ICD implantation? In patients with tricuspid valve clips implantation of leads through the tricuspid valve can limit the success of the interventional tricuspid repair and can even dislodge clips if performed before fibrous encapsulation has fused the clip with the leaflet tissue. Some data suggest that early fibrous encapsulation may begin prior to 30 days. Histological evaluation of clips removed after over 300 days has shown organized fibrous capsules bridging the leaflets and clip arms3 such that at this point mechanical stability is possible. Nevertheless placement of a trans-tricuspid shock coil may increase tricuspid regurgitation and may furthermore represent a technical challenge in such a case. We subsequently elected to prepare the patient for subcutaneous ICD (S-ICD) implantation (EMBLEM S-ICD-System, Boston Scientific, MA). To evaluate the patient for S-ICD implantation, a detailed patient history and electrocardiography-guided S-ICD-screening are critical. According to European and American Heart Association guidelines, an S-ICD is indicated as an alternative to a transvenous lead ICD in patients where bradycardia support, cardiac resynchronization, and antitachycardia pacing are not required.1, 2 Our patient had no history of bradycardia, ventricular tachyarrhythmias, or bundle branch block. There was no evidence for venous thrombosis, and the patient had slightly reduced kidney function but was not receiving dialysis therapy. Patient screening can be performed using the Model 4744 patient screening tool (Boston Scientific) or with the automated screening tool available with the Model 3120 Programmer (Boston Scientific). The purpose of screening is to detect patients where S-ICD detection and discrimination algorithms are not reliable. After successful screening, an S-ICD was implanted. Intraoperative defibrillation testing, which is currently still mandatory in S-ICD implantation, successfully terminated ventricular fibrillation (VF). Five months after S-ICD implantation, the patient presented to our clinic with a generator pocket infection (Staphylococcus aureus) with cutaneous perforation (Figure 1). In the initial safety and efficacy trial, 4 of 314 (1.27%) developed a device infection requiring device explantation within the 180-day timeframe investigated.4 Boersma et al reported a similarly low rate of infections (1.6% at a mean follow-up of 651 days).5 After explantation of the S-ICD, in light of the patient's age, we first confirmed that the patient wanted reimplantation. We were then once again confronted with the question: what is the appropriate device for this patient? Reimplantation of an S-ICD system after adequate time for resolution of infection. Implantation of an ICD with a trans-tricuspid shock coil under echocardiographic guidance to achieve a low level of regurgitation after lead placement (accepting a risk of clip dislodgment). Implantation of a conventional ICD with an off-label lead combination: a left ventricular pace-sense electrode (transvenous or epicardial), a superior vena cava (SVC) coil, and a subcutaneous array electrode. Implantation of a totally epicardial ICD with an epicardial pace-sense and a retro-cardiac shock electrode. Which mode of therapy would you choose? In Figure 2, you will see the device implanted after interdisciplinary discussion of the case. Can you identify the choice we made? As the reader can surmise from the radiographs presented in the figure we chose option 3. We implanted a conventional ICD (Medtronic Primo VR, Medtronic, MN) with an IS-1/DF-1 setup. A bipolar Attain Stability lead (Medtronic) was placed in a posterolateral vein to allow for ventricular sensing and pacing functionality. This lead would subsequently also allow for antitachycardia pacing. An alternative approach would have been to implant an epicardial pace-sense lead through a lateral mini-thoracotomy but the route of the lead would have brought it very close to the S-ICD pocket infection site and was considered a higher risk option. An SVC coil (Medtronic) was placed in the right atrium, and a 7.5 French unipolar subcutaneous array electrode (Medtronic) was placed in the extrathoracic subcutaneous tissue of the the left lateral chest wall (HVB). The patient had been informed prior to the procedure that this lead/device setup would be an off-label construct. Defibrillation threshold testing was performed, however the device failed to adequately terminate VF even after repositioning of the subcutaneous array electrode. Nonetheless, the device and electrodes were left in place, and repeat defibrillation testing was planned. In defibrillation threshold testing, 2 days postoperatively VF could successfully be terminated with both 35 and 26 J. While there are no data suggesting increased infection rates after reimplanting an S-ICD following explantation of an infected S-ICD, we did not feel comfortable with option 1. As mentioned above, the tricuspid clips should have been safely encapsulated at this point (now over 1½ years after tricuspid clipping). Furthermore, lead placement across the tricuspid valve can be assisted with transesophageal echocardiography to find a lead position resulting in the lowest possible grade of regurgitation. It is however our institutional policy that in patients with tricuspid clips whenever possible a solution should be found where no lead crosses the tricuspid valve (thus we did not choose option 2). We decided against choice 4 due to the fact that the patient had previously received bypass surgery and epicardial lead, and retro-cardiac shock electrode placement in the re-operative setting is associated with a great risk for the patient. Subsequently option 3 was in our view the most appropriate choice. Many factors must be taken into account in choosing a device for antitachycardia therapy. Whether the device is for primary or secondary prevention, the presence of monomorphic ventricular tachycardia, the presence of bradycardia, vascular access options, and kidney function all play a role in choosing the right device. As the era of interventional tricuspid valve therapy has accelerated, the presence of tricuspid valve clips has become another variable which we must consider in the choice of the appropriate ICD. New tricuspid regurgitation therapeutics are being developed at a fast pace such that it is key that the pacemaker surgeon adapt to this new field and the new patient population which is developing. The ICDs implanted in our patient demonstrate two of the myriad options for ICD therapy in the tricuspid clip patient. Open access funding enabled and organized by Projekt DEAL. Stephanie Fichtner has received lecture fees from Medtronic and Abbott Laboratories and has received a research grant from Abbott Laboratories.

BACKGROUND/OBJECTIVE:Ischemic heart disease is a major cause of mortality worldwide. Myocardial tissue engineering aims to create transplantable units of myocardium for the treatment of myocardial necrosis caused by ischemic heart disease - bioreactors are used to condition these bioartificial tissues before application.METHODS:Our group developed a multimodal bioreactor consisting of a linear drive motor for pulsatile flow generation (500 ml/min) and an external pacemaker for electrical stimulation (10 mA, 3 V at 60 Hz) using LinMot-Talk Software to synchronize these modes of stimulation. Polyurethane scaffolds were seeded with 0.750 × 106 mesenchymal stem cells from umbilical cord tissue per cm2 and stimulated in our system for 72 h, then evaluated.RESULTS:After conditioning histology showed that the patches consisted of a cell multilayer surviving stimulation without major damage by the multimodal stimulation, scanning electron microscopy showed a confluent cell layer with no cell-cell interspaces visible. No cell viability issues could be identified via Syto9-Propidium Iodide staining.CONCLUSIONS:This bioreactor allows mechanical stimulation via pulsatile flow and electrical stimulation through a pacemaker. Our stem cell-polyurethane constructs displayed survival after conditioning. This system shows feasibility in preliminary tests.

Background: Lack of autologous graft material restricts the ability to treat patients requiring coronary artery bypass surgery (CABG). An off the shelf tissue engineered small diameter vascular graft is the holy grail of cardiovascular surgery. Methods: Allograft saphenous veins were harvested from organ donors, cryopreserved, deendothelialized and then seeded with autologous endothelial cells prior to implantation during coronary artery bypass surgery. All patients treated were followed-up until death and angiographic results were collected. Grafts were explanted during autopsy and immunohistochemistry was performed. Results: Twelve patients received 15 engineered grafts. Mean patient survival was 9.1 +/- 1.8 years. Six month graft patency was 80 (95% CI: 59-100) and 9 month graft patency was 50 (95% CI: 27-93) - graft patency detected up to 32 months after surgery. Immunohistochemistry in grafts explanted showed a presence of CD31 and CD68 positive cells in the luminal region of the vessel walls and layers of Collagen Type I in the abluminal vessel walls. Conclusions: Our small diameter tissue engineered vascular graft shows openness up to 32 months after implantation. Immunohistochemistry suggests that monocyte activation may lead to vessel remodeling with thickening of the vessel wall. Research should concentrate on a manipulation of remodeling processes.

It is unknown how many pacemaker and implantable cardioverter defibrillator (ICD) leads perforate during lead placement. Symptoms of a perforated lead include shortness of breath and chest pain. Signs of perforation can include a high pacing threshold, reduced lead sensing, and a high lead impedance. We present the case of a patient where perforation of the single coil right ventricular lead was not evident in imaging but incidentally detected during operative aortic valve replacement. The lead perforation rate during device implantation is around 1%-ICD leads have a higher perforation rate.

Objectives: Permanent pacemaker (PPM) requirement is a known complication of heart valve surgery. There is currently only little published data on PPM requirement after tricuspid valve surgery. The aim of this study was to identify the incidence and analyze risk factors for pacemaker requirement after tricuspid valve surgery.

With rapid progress in medicine, a thorough understanding of pharmacology remains crucial. Currently, lecturers are implementing competency‐based learning objectives in medical curricula around the world. Advancing teaching modalities need to be integrated into pharmacology courses in a reasonable way. At Ludwig‐Maximilians‐Universität (LMU) Munich Medical Faculty, a systematic evidence‐based approach was used to modernize pharmacology classes. The needs assessment was conducted by final‐year students. It included focus groups and a large‐scale online survey, which was distributed among all medical students at LMU, with 1018 students participating (response rate 20%). Survey results showed that most of the students (92%) aimed to become pharmacology‐adept doctors. Also, a majority (88%) stated that their goal was to understand the material most critical to application of pharmacology concepts as well as prescribing practice. Only 38% of the students reported satisfaction with the current curriculum, and 93% supported modernization. Thus far, pharmacology teaching at LMU Munich had mainly consisted of lectures attended by 200 students. Now, students advocated for a stronger integration of clinical pharmacology teaching into clinical subjects in the last 2 years of medical school. Specifically, they called for classes with smaller groups of students including problem‐based learning as well as video podcasts. These results provided the foundation for change in curriculum at the LMU medical school. In conclusion, a structured approach for curriculum development that considers students’ views is feasible and can reveal their actual goals and demands. The approach has proven successful at LMU Munich and is transferrable to other universities.

BACKGROUND:The pfm Nit-Occlud® patent ductus arteriosus (PDA) device is well established for interventional closure of PDA. However, there are still limited data concerning its efficacy and follow-up in larger patient groups. AIMS:This study aimed to evaluate the safety and efficacy of the Nit-Occlud® PDA device, implanted both through transpulmonary and transaortic approach, in a large cohort. METHODS:From July 2008 to December 2015, 268 consecutive patients were admitted for transcatheter closure of a PDA and were treated with the Nit-Occlud® coil. Clinical, echocardiographic, and angiographic data were evaluated. RESULTS:The median age was 5.2 years (range, 5 months to 62 years), and the median weight was 19.3 kg (range: 5.5-97 kg). Ten (3.7%) patients had weight <10 kg. The most common ductus types treated were Krichenko Type E and A (44.0% and 33.2%, respectively). Twelve (4.5%) patients were treated for residual shunting after surgical PDA closure. The median diameter at the narrowest point was 1.5 mm (range: 0.4-4 mm), the median size of the ampulla was 5 mm (range: 1-15 mm), and the median length was 9 mm (range: 2-25 mm). Device implantation could be successfully achieved in all cases. Closure rates documented immediately after the procedure, at 3-10 days, 1 month, and 6 months after intervention were 62%, 95.1%, 97.8%, and 98.5%, respectively. With the exception of one minor thromboembolic event, there were no procedure-related complications. CONCLUSION:Closure of PDA with various anatomic variations and sizes can be performed effectively and safely using the Nit-Occlud® coil.

The tricuspid valve is situated in close proximity to cardiac conduction tissue and damage to this tissue can affect postoperative rhythm. The aim of this study was to quantify the incidence of pacemaker requirement after tricuspid valve surgery and investigate predictors.

Patients with congenitally corrected transposition of the great arteries typically initially present with atrioventricular block or heart failure as adults. The corrected transposition leads to a double discordance—discordance of the atrioventricular connection and ventriculo-arterial connection