Background:Ring annuloplasty failure after mitral valve repair frequently occurs after long-term follow up. Valve-in-ring transcatheter mitral valve replacement (TMVR) is an emerging therapeutic option for this high surgical risk condition. While a dual-chamber implantable cardioverter-defibrillator (ICD) is frequently utilized for sudden cardiac death prevention in this population, valve-in-ring TMVR intraprocedural difficulty associated with atrial lead presence is rarely known. Case summary:A 76-year-old male, with history of coronary artery bypass graft surgery and mitral ring annuloplasty experienced recurrence of severe mitral regurgitation. Due to high surgical mortality risk and unsuitable anatomy of mitral valve for transcatheter edge-to-edge repair, this patient underwent mitral valve-in-ring TMVR. Using transvenous-transseptal access, a 26 mm SAPIEN-3 prosthetic valve was delivered to the mitral area. However, as the patient has a history of dual-chamber ICD, a prosthetic valve cannot pass through during delivery, due to atrial lead entanglement. To overcome this difficulty, atrial septum balloon dilatation manoeuvre was done to facilitate valve delivery, which resulted in successful prosthetic valve delivery and deployment at the mitral position with satisfactory results. Discussion:Valve delivery difficulty due to atrial lead entanglement can occur during valve-in-ring TMVR in patients with dual-chamber ICD implantation history. Atrial septum balloon dilatation can be performed to overcome this problem.

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is an interventional technology in which an artificial aortic valve is compressed and assembled outside the body, then delivered through a catheter and implanted at the site of the diseased aortic valve, thereby functionally replacing the native valve. Two versions of the Chinese expert consensus on TAVR were issued in China in 2015 and 2020, respectively. To promptly update the field's understanding of TAVR and to promote its broader, more standardized, and higher-quality application in China, an expert panel has developed this new version of the consensus. This consensus includes substantial updates compared with the previous version, covering topics such as the epidemiology of aortic valve disease, recent advances in TAVR research, indications, procedural standards, post-procedural antithrombotic therapy, prevention and management of complications, management of special cases, and future development trends. This consensus integrates international research evidence and references international guidelines to ensure rigor and evidence-based recommendations, while also incorporating domestic research findings and clinical practice in China, thereby enhancing both its forward-looking perspective and practical applicability.

Background:Standard echocardiography reports use complex terminology, limiting patient comprehension and exacerbating preconsultation anxiety. Large language models (LLMs) can transform technical data into patient-friendly narratives by incorporating longitudinal comparisons with prior examinations. Objective:This study aims to develop an LLM-based patient-friendly echocardiography reporting system and evaluate its professional safety, patient comprehension, and impact on short-term anxiety. Methods:This study consisted of 2 stages. In the retrospective development stage, 60 patients were included. Clinical diagnosis, hospitalization records, and serial echocardiographic data were integrated as model inputs using DeepSeek-V3.2. Generated reports followed a standardized 4-module structure. Report quality was independently evaluated by 2 clinicians and an external LLM (Kimi 2.5, Moonshot AI) across 4 domains: data accuracy, information completeness, appropriateness of interpretation, and reasonableness of recommendations. In the prospective clinical evaluation stage, 100 patients undergoing echocardiography and 85 family members were enrolled. Participants received both conventional and LLM-generated patient-friendly reports. A 5-point Likert scale assessed helpfulness in understanding results, effectiveness in addressing concerns, helpfulness in improving disease-related knowledge, and anxiety relief. Anxiety was measured using the STAI-6 (6-item short-form State-Trait Anxiety Inventory) at 3 time points: after echocardiography, after conventional report release, and after reading the patient-friendly report. Results:All 60 reports in the retrospective stage were successfully generated. Professional evaluation showed high overall quality scores from both clinicians and the external LLM, with no significant difference between evaluators (mean total scores 18.15, SD 1.36 vs 18.28, SD 1.26; P=.55). One hallucination event was identified. In the prospective stage, all 100 patients received patient-friendly reports. Both patients and family members rated the reports highly, with no significant between-group difference in total scores (17.61, SD 1.60 vs 17.62, SD 1.03; P=.95). Subgroup analyses showed greater perceived benefit among older patients and outpatients (both P<.001); these subgroup findings should be considered exploratory given the lack of adjustment for multiple comparisons. Patients with chronic heart failure, reduced left ventricular ejection fraction (≤40%), and left ventricular enlargement (>55 mm) reported higher scores for addressing concerns (all P<.001). Anxiety scores increased significantly after conventional report release and decreased significantly after reading the patient-friendly report (both P<.001). Older patients (>60 y) and outpatients showed significantly higher anxiety change rates than their counterparts (both P<.001). The reduction in anxiety was positively correlated with subjective anxiety relief ratings (r=0.531; P<.001). Conclusions:The LLM-based patient-friendly echocardiography reporting system with longitudinal comparison demonstrated good feasibility and promising preliminary clinical usefulness. While maintaining high professional quality, it was associated with improved patient understanding of echocardiographic findings and was associated with reduced short-term anxiety, particularly among older adults and outpatients. Causality cannot be inferred from this nonrandomized sequential design, and longer-term outcomes remain to be evaluated.

Background Transcatheter aortic valve replacement is a promising alternative treatment for patients with severe aortic stenosis (AS), but uncertainties remain regarding its long-term durability. Objectives This study aimed to evaluate the safety and feasibility of Sikelia transcatheter heart valve with polymeric leaflets in AS. Methods In this first-in-human, prospective, nonrandomized, single-arm, multicenter study, patients with severe symptomatic AS eligible for the novel valve were recruited. Clinical outcomes and hemodynamic performance were reported at discharge and 30-day, 6-month, and 1-year follow-up. Results Twelve patients (73.75 ± 7.28 years, 25% female, mean Society of Thoracic Surgeons score 4.51% [4.07%-4.87%], 66.67% bicuspid valve) were enrolled. Procedural success was achieved in 83.33% (1 fully device retrieval and 1 death due to coronary obstruction). All patients successfully underwent transcatheter aortic valve replacement were in NYHA functional class I/II at the 30-day follow-up, and significant improvement was shown in 6-minute walk distance and Kansas City Cardiomyopathy Questionnaire score (all P < 0.001). At 1 year, the effective orifice area (2.31 ± 0.33 cm2 vs 0.82 ± 0.14 cm2) and mean pressure gradient (6.33 ± 2.54 mm Hg vs 47.50 ± 13.82 mm Hg) improved substantially, so did those in bicuspid patients (all P < 0.001). No moderate/severe paravalvular leakage was recorded, and computed tomography scans revealed no evidence of subclinical leaflet thrombosis during follow-up. After discharge, no patients reported death, stroke, new pacemakers, or valve-related reintervention. Conclusions The preliminary outcomes of the novel transcatheter heart valve demonstrated a favorable hemodynamic performance with an acceptable safety profile at 1 year. Long-term follow-up is warranted to assess its durability in treating patients with AS.

BACKGROUND:Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Prophylactic chimney stenting is a bailout strategy but carries long-term risks. CASE SUMMARY:A 72-year-old woman with severe aortic stenosis and high-risk coronary artery obstruction anatomy (low left coronary ostium height of 9.1 mm, redundant calcified leaflet) underwent TAVR. Angiography after valve deployment showed ambiguous left coronary leaflet displacement with delayed contrast clearance. However, immediate and dynamic fractional flow reserve (FFR) assessments consistently remained above the ischemic threshold (>0.80) despite aggressive balloon postdilations. Consequently, chimney stenting was safely deferred. The patient was asymptomatic at the 3-month follow-up. DISCUSSION:Relying solely on anatomical predictors may lead to overtreatment. Physiological assessment using FFR effectively defines the functional significance of anatomical proximity, safely avoiding unnecessary permanent implants. TAKE-HOME MESSAGE:Dynamic FFR monitoring differentiates anatomical proximity from true functional ischemia during TAVR, safely guiding the avoidance of unnecessary chimney stenting.

ObjectiveTo evaluate the clinical impact of ultrasound-guided venous cannulation positioning during the initiation of venous-arterial extracorporeal membrane oxygenation (VA-ECMO).MethodsThis retrospective study included 48 patients who received bedside VA-ECMO support between June 2019 and August 2024. Patients were divided into an ultrasound-guided group (UG, n = 23) and conventional body surface landmark group (BSL, n = 25). Clinical outcomes, cannula positioning accuracy, complications, infection markers, and prognosis were compared. A subgroup analysis was performed in patients who did not undergo cardiopulmonary resuscitation (non-CPR).ResultsCompared to BSL group, patients in the UG group had significantly higher rates of optimal venous cannula positioning (p < 0.01), lower incidence of unstable flow and pulmonary edema, and shorter aortic valve closure time, infection markers (WBC, PCT) were also significantly lower in the UG group (p < 0.05). In the non-CPR subgroup, the UG group had shorter ECMO duration, hospital stay, and dual antibiotic therapy duration (all p < 0.05), with non-significant trends toward better survival.ConclusionUltrasound-guided venous cannulation improves cannula positioning accuracy, reduces early complications, and may enhance clinical outcomes, particularly in non-CPR patients. Routine use of ultrasound guidance is thus recommended in bedside VA-ECMO procedures.

Background:Trauma-related acute myocardial infarction represents a complex and high-risk condition in the emergency department, necessitating a range of sophisticated treatment strategies. Failure to provide timely and accurate intervention significantly increases the risk of short-term mortality. Case summary:We present the case of a 36-year-old male who was admitted to local hospital following a penetrating chest trauma. Relevant diagnostic evaluations revealed haemopneumothorax and shock. Following initial stabilization measures, the patient was urgently transferred to our institution due to haemopericardium, which was initially suspected to be secondary to traumatic aortic dissection. However, the admission electrocardiogram clearly demonstrated concurrent anterior and high lateral wall myocardial infarction. Coronary angiography revealed occlusion of the left anterior descending (LAD) artery. We attempted interventional therapy on the LAD to restore blood flow. However, intraoperative findings revealed complete rupture of the LAD. The patient was transferred to the cardiac surgery department for emergency coronary artery bypass grafting (CABG). The foreign body was successfully retrieved, and the CABG was completed without complications. The patient gradually recovered under short-term ECMO support and was discharged successfully. Follow-up assessments indicate a favourable recovery. Discussion:The mechanism underlying traumatic myocardial infarction is complex and variable. Given that emergency physicians and cardiologists often lack extensive experience in such cases, they should exercise caution, conduct a thorough assessment, and meticulously plan each step of diagnosis and treatment.

BACKGROUND:Refractory cardiogenic shock (CS), despite successful reperfusion of myocardial infarction, carries a poor prognosis and high mortality. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a treatment for refractory CS is widely adopted, but can cause catastrophic complications owing to unopposed retrograde blood flow. CASE SUMMARY:A 78-year-old man diagnosed with subacute inferior myocardial infarction and multiple comorbidities experienced refractory CS even after successful reperfusion, necessitating VA-ECMO implantation. However, VA-ECMO resulted in left ventricle (LV) distention syndrome, which warranted LV decompression. A combined decompression strategy using a microaxial-flow pump (MAFP) on top of balloon atrial septostomy (BAS) was implemented, effectively improving the patient's clinical condition. DISCUSSION:Combining BAS and MAFP enables direct left atrium monitoring, synergistically improving hemodynamics and oxygenation through simultaneous venting and unloading. TAKE-HOME MESSAGE:MAFP on top of BAS is an effective and safe decompression strategy to alleviate LV distention syndrome that can be applied in catastrophic clinical conditions.

Yue Ren, Zhiyi Chen, Bin Wang Department of Endocrinology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, People&rsquo;s Republic of ChinaCorrespondence: Bin Wang, Email wangb1229@tjutcm.edu.cn

In the marine environment, mooring anchor chains bear complex loads such as axial tension and out of plane bending. These loads cause wear and corrosion damage to the anchor chain, reducing its fatigue strength, and even leading to fatigue fracture. The inspection load applied to the anchor chain before leaving the factory will generate residual stress, which will affect the stress characteristics and fatigue life of the anchor chain during service. This article aims to obtain the residual stress generated by the test load on the anchor chain through numerical simulation, and explore the impact of the test load residual stress on the stress characteristics and wear performance of the anchor chain; Analyze the stress and contact characteristics of anchor chains under different bending angles and wear depths, and obtain the locations where fatigue damage is prone to occur in the later stage of anchor chain wear.

BACKGROUND:Angiopoietin-like protein 3 (ANGPTL-3) modulates lipid metabolism and the risk of coronary artery disease (CAD), especially stable angina (SA), via suppressing lipoprotein lipase (LPL). However, whether there are other mechanisms is not elucidated yet. The current research explored the modulatory roles of ANGPTL-3 on high-density lipoprotein (HDL), which further affects atherosclerotic development. METHODS:A total of 200 individuals were enrolled in the present study. Serum ANGPTL- 3 levels were detected via enzyme-linked immunosorbent assays (ELISA). Cholesterol efflux capacity induced by HDL particles was detected through H3-cholesterol loading THP-1 cell. RESULTS:The serum ANGPTL-3 levels presented no significant discordance between the SA group and the non-SA group, whereas the serum ANGPTL-3 levels in type 2 diabetes mellitus (T2DM) group were significantly elevated compared with those in the non-T2DM group [428.3 (306.2 to 736.8) ng/ml vs. 298.2 (156.8 to 555.6) ng/ml, p <0.05]. Additionally, the serum ANGPTL-3 levels were elevated in patients with low TG levels compared to those in patients with high TG levels [519.9 (377.6 to 809.0) ng/ml vs. 438.7 (329.2 to 681.0) ng/ml, p <0.05]. By comparison, the individuals in the SA group and T2DM group presented decreased cholesterol efflux induced by HDL particles [SA: (12.21±2.11)% vs. (15.51±2.76)%, p <0.05; T2DM: (11.24±2.13)% vs. (14.65± 3.27)%, p <0.05]. In addition, the serum concentrations of ANGPTL-3 were inversely associated with the cholesterol efflux capacity of HDL particles (r=-0.184, p <0.05). Through regression analysis, the serum concentrations of ANGPTL-3 were found to be an independent modulator of the cholesterol efflux capacity of HDL particles (standardized β=-0.172, p <0.05). CONCLUSION:ANGPTL-3 exhibited a negative modulatory function on cholesterol efflux capacity induced by HDL particles.

Extracorporeal membrane oxygenation (ECMO) is identified as a novel therapeutic strategy that offers short-term support to the metabolism of the heart and lungs in humans. Recently, the clinical centers, which provide ECMO has increased rapidly worldwide. The indications for the use of ECMO in daily clinical practice were broadened dynamically. However, even with the widespread adoption of ECMO, it still remains significant morbidity and mortality, and the underlying mechanisms are still not elucidated. Notably, one of the vital complications during ECMO was proposed as the inflammatory progression within the extracorporeal circulation. via the development of inflammatory response, patients with ECMO may further suffer from systemic inflammatory response syndrome (SIRS), posing serious risks to human health. Recently, growing evidence confirmed that through exposure of blood into the ECMO circuit could lead to the stimulation of the immune system which also facilitated the inflammatory response and systemic impaired. In the current review, the pathological development of inflammatory progression in patients with ECMO is well-listed. Furthermore, the relationship between immune-related activation and the development of inflammation is also summarized, which may further help us to decide the therapeutic strategies in daily clinical practice.

Electrolytes have become a research frontier in the electrochromic community owing to their widespread applications in advanced electronic devices especially in electrochromic devices (ECDs). However, traditional ECDs with liquid electrolytes commonly suffer from inflexibility, complicated configurations, and poor electrochromic properties. To achieve solid‐ or flexible‐state ECDs, an alternative method is to employ polymer electrolyte gels, which integrate the virtues of both liquid‐ and solid‐state electrolytes. In this review, first, the device configurations of conventional ECDs are introduced, where the classification of electrolytes for ECDs is comprehensively introduced. Then the current situation and applications of hydrogels for ECDs, where it is expected to reveal the developing trends of hydrogel‐based ECDs are specially reviewed. Finally, the insights on the design methods of hydrogel electrolytes for flexible and efficient ECDs are proposed.

Objective: Patients with untreated severe aortic regurgitation (AR) have a high risk of mortality. Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a treatment option for AR; however, the safety and efficacy of this technique have not been sufficiently established. This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR. Methods: Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers. The primary endpoint was device success at 1 month after TAVR. The secondary endpoint was the composite of major adverse cardiovascular events (MACE) at 6 months, including all-cause death, ischemic stroke, emergency conversion to cardiac surgery, and permanent pacemaker implantation. Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up. Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors. Results: Between September 2019 and February 2022, 79 patients with AR were enrolled in the study. At 1 month, device success was achieved in 60 (75.9%) patients. By 6 months, 29 (36.7%) patients had MACE. Echocardiography revealed improved left ventricular function after TAVR. Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons risk score (odds ratio 0.760, 95% confidence interval (CI): 0.584-0.989; P = 0.041) and annulus perimeter (odds ratio 0.888, 95% CI: 0.796-0.992; P = 0.035) were 2 predictors of device success. Moreover, annulus perimeter (<80.2 mm), but not Society of Thoracic Surgeons risk score, was associated with a significant reduction in MACE at 6 months (hazard ratio 2.223, 95% CI: 1.060-4.659; P = 0.028). Conclusions: TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR, particularly those with a less enlarged annulus.

OBJECTIVE:Our study aimed to compare the decannulation-related outcomes of two different decannulation methods in patients who underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, namely percutaneous decannulation with Perclose ProGlide device and conventional surgical repair.BACKGROUND:Surgical vascular repair is a standard strategy when ECMO is to be terminated and sometimes associated with severe complications. Percutaneous decannulation using Perclose ProGlide has been reported to be feasible and safe in selected patients, but there is a paucity of literature to make systematic comparisons between the two decannulation methods.METHODS:41 patients who were supported with VA-ECMO for refractory cardiogenic shock, cardiac arrest, or escort of complex interventions from December 2018 to December 2021 were enrolled. Of these, 30 underwent percutaneous Perclose ProGlide decannulation and 11 underwent surgical repair. The clinical characteristics and complication rates were analyzed.RESULTS:Patients in the two groups showed a similar incidence of vascular-related complications, such as acute lower limb ischemia, major bleeding, severe hematoma, pseudoaneurysm, and arteriovenous fistula [20% versus 18.2%, p=.896]. The incidence of groin infection and delayed healing was significantly higher in the surgical removal group [3.3% versus 36.4%, p=.014].CONCLUSIONS:Percutaneous decannulation of veno-arterial extracorporeal membrane oxygenation with the Perclose ProGlide device is a feasible and safe technique that simplifies the decannulation process, shortens the hospitalization duration, and lowers the potential risk of groin infection and delayed wound healing.