PURPOSE OF REVIEW: To provide an update on the literature regarding diagnosis and management of immune checkpoint inhibitor myocarditis. RECENT FINDINGS: The diagnosis of immune checkpoint inhibitor myocarditis has evolv...PURPOSE OF REVIEW: To provide an update on the literature regarding diagnosis and management of immune checkpoint inhibitor myocarditis. RECENT FINDINGS: The diagnosis of immune checkpoint inhibitor myocarditis has evolved to include more reliance on performing endomyocardial biopsy to clarify the diagnosis in selected cases. Additionally, there is recognition of a spectrum of disease both clinically and on endomyocardial biopsy suggesting that there is a range of severity from mild to fulminant. The treatment of immune checkpoint inhibitor myocarditis is shifting towards increased use of additional immunosuppressive medications as steroid sparing agents. There are increased studies including two randomized controlled trials evaluating abatacept in the treatment of immune checkpoint inhibitor myocarditis. This review summarizes the latest literature regarding diagnosis and management of immune checkpoint inhibitor myocarditis and provides our experience and approach to this rare but potentially fatal condition.
Sears SF, Jordan EW, Hashmath Z
… +4 more, Sargeant MM, Catanzaro J, Nekkanti R, Shantha G
Curr Cardiol Rep
· 2025 Mar · PMID 40163218
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PURPOSE OF THE REVIEW: Permanent pacemakers (PPMs) are common cardiac implantable devices indicated for patients with bradycardia or tachycardia. Currently, PPMs include both transvenous pacemakers (TV-PM) and leadless p...PURPOSE OF THE REVIEW: Permanent pacemakers (PPMs) are common cardiac implantable devices indicated for patients with bradycardia or tachycardia. Currently, PPMs include both transvenous pacemakers (TV-PM) and leadless pacemakers (L-PM). This paper reviews the existing data on L-PM technology including: a) medical aspects and indications, b) patient experience and quality of life (QOL) outcome studies, and c) recommendations for optimizing patient QOL through enhanced knowledge and shared decision-making. RECENT FINDINGS: This review includes the seven papers that report on patient-reported outcomes (PRO) in leadless pacemakers and indicate that QOL is as good, if not better, than TV-PM. Existing evidence from descriptive statistics suggests that patients with L-PM report high levels of patient acceptance and satisfaction with esthetic appearance (96%), recovery (91%), and level of physical activity (74%). Leadless pacemakers provide an attractive alternative for the indicated potential patient. The evidence demonstrates the benefits of L-PM such as a minimal implant and lack of leads. Recommendations for future research indicate that electrophysiology-specific metrics are essential and control for the common co-morbidities in the PM population are needed.
Curr Cardiol Rep
· 2025 Mar · PMID 40146392
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PURPOSE OF REVIEW: Gap junctions, comprising connexin proteins, enable the direct intercellular electrical coupling of cardiomyocytes, and disruption of this process is arrhythmogenic. In addition, gap junctions effect m...PURPOSE OF REVIEW: Gap junctions, comprising connexin proteins, enable the direct intercellular electrical coupling of cardiomyocytes, and disruption of this process is arrhythmogenic. In addition, gap junctions effect metabolic coupling and of relevance to this review, propagate host antiviral immune responses. Accordingly, connexins have emerged as viral targets during infection. This review summarizes current knowledge regarding contributions of inflammation vs virally encoded factors in driving alterations to cardiac gap junction function. RECENT FINDINGS: In addition to host immune-mediated effects on cardiac electrophysiology and gap junctions in myocarditis, there is now increasing appreciation for virally encoded factors targeting connexin function in acute/active infection. We now know diverse viral species have independently evolved to directly target connexin function during infection. Understanding both the direct and indirect effects of viral infection on cardiac gap junctions is critical to inform treatment strategies and development of novel therapeutics for acute infection as a distinct disease process from chronic myocarditis.
Ayyad M, Albandak M, Gala D
… +4 more, Alqeeq B, Baniowda M, Pally J, Allencherril J
Curr Cardiol Rep
· 2025 Mar · PMID 40146299
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BACKGROUND: The current classification of acute myocardial infarction (AMI) into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) has limitations in identifyi...BACKGROUND: The current classification of acute myocardial infarction (AMI) into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) has limitations in identifying patients with acute coronary occlusion (ACO) who do not exhibit classic ST-elevation. Emerging evidence suggests that a reclassification to "Occlusive Myocardial Infarction" (OMI) may enhance diagnostic accuracy and therapeutic interventions. METHODS: A comprehensive review of the literature was conducted, focusing on the pathophysiology, electrocardiographic (EKG) patterns, and management of ACO. The utility of the OMI paradigm was evaluated against the traditional STEMI/NSTEMI framework, with a particular emphasis on atypical EKG findings and their role in guiding early intervention. RESULTS: Traditional STEMI criteria fail to identify ACO in approximately 30% of NSTEMI patients, leading to delayed reperfusion and increased mortality. The OMI framework demonstrates improved sensitivity (78.1% vs. 43.6% for STEMI criteria) for detecting ACO by incorporating subtle EKG changes, including hyperacute T-waves, de Winter T-waves, and posterior infarction patterns. OMI-guided management facilitates timely diagnosis and intervention, potentially reducing adverse outcomes. Emerging artificial intelligence (AI) tools further enhance EKG interpretation and clinical decision-making. CONCLUSIONS: Transitioning to the OMI paradigm addresses critical gaps in the STEMI/NSTEMI framework by emphasizing the identification of ACO irrespective of ST-segment elevation. This approach could significantly improve patient outcomes by reducing delays in reperfusion therapy. Future randomized trials are needed to validate the OMI paradigm and optimize its implementation in clinical practice.
Mulvey JF, Meyer EL, Svenningsen MS
… +1 more, Lundby A
Curr Cardiol Rep
· 2025 Mar · PMID 40116972
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PURPOSE OF REVIEW: Despite significant efforts to understand pathophysiological processes underlying cardiac diseases, the molecular causes for the most part remain unresolved. Rapid advancements in -omics technologies,...PURPOSE OF REVIEW: Despite significant efforts to understand pathophysiological processes underlying cardiac diseases, the molecular causes for the most part remain unresolved. Rapid advancements in -omics technologies, and their application in cardiac research, offer new insight into cardiac remodeling in disease states. This review aims to provide an accessible overview of recent advances in omics approaches for studying cardiac remodeling, catering to readers without extensive prior expertise. RECENT FINDINGS: We provide a methodologically focused overview of current methods for performing transcriptomics and proteomics, including their extensions for single-cell and spatial measurements. We discuss approaches to integrate data across modalities, resolutions and time. Key recent applications within the cardiac field are highlighted. Each -omics modality can provide insight, yet each existing experimental method has technical or conceptual limitations. Integrating data across multiple modalities can leverage strengths and mitigate weaknesses, ultimately enhancing our understanding of cardiac pathophysiology.
Curr Cardiol Rep
· 2025 Mar · PMID 40111702
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PURPOSE OF REVIEW: The rising global prevalence of cardiovascular disease is driving the need for innovative biotherapeutics. Recently, exosomes-extracellular vesicles involved in paracrine signaling have shown promise i...PURPOSE OF REVIEW: The rising global prevalence of cardiovascular disease is driving the need for innovative biotherapeutics. Recently, exosomes-extracellular vesicles involved in paracrine signaling have shown promise in aiding heart repair associated with cardiovascular conditions. Their therapeutic potential encompasses several beneficial mechanisms, including anti-fibrosis, anti-inflammation, pro-angiogenesis, anti-oxidation, and anti-apoptosis, all contributing to improved cardiac function. This review provides a comprehensive overview of exosomes and highlights the latest research on their effectiveness in addressing current challenges in regenerative cardiac medicine. RECENT FINDINGS: Current approaches revolve around elucidating and enhancing how different cell types, cargo, and delivery methods impact healing in a pathological cardiovascular environment. The emerging field of therapeutic exosome research is promising for cardiac regeneration due to the beneficial effects of exosomal cargo. The expansion of mechanistic knowledge and the optimization of techniques are required before standard clinical application.
Levene J, Chang A, Reddy A
… +3 more, Hauspurg A, Davis EM, Countouris M
Curr Cardiol Rep
· 2025 Mar · PMID 40111654
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PURPOSE OF REVIEW: This review aims to discuss racial and ethnic differences in the prevalence of hypertensive disorders of pregnancy (HDP), disparities in peripartum and postpartum outcomes, and strategies to improve he...PURPOSE OF REVIEW: This review aims to discuss racial and ethnic differences in the prevalence of hypertensive disorders of pregnancy (HDP), disparities in peripartum and postpartum outcomes, and strategies to improve health equity. RECENT FINDINGS: Racial disparities in HDP are significant contributors to maternal morbidity and mortality. The prevalence of preeclampsia has increased over the last 20 years, with the highest prevalence among non-Hispanic Black, non-Hispanic American Indian and Alaska Native individuals. Black birthing individuals are at increased risk for cardiovascular-related morbidity and mortality, particularly from complications of HDP. Factors such as social determinants of health and systemic racism have a significant impact on disparities in maternal and fetal outcomes related to HDP. System changes and provider implicit bias training can help address systemic racism. Interventions aimed at improving access to care, such as telehealth and home blood pressure monitoring, as well as incorporating health system navigators that provide peripartum and postpartum support can improve outcomes and promote health equity.
Jin L, Hwang B, Rezapourdamanab S
… +4 more, Sridhar V, Nandwani R, Amoli MS, Serpooshan V
Curr Cardiol Rep
· 2025 Mar · PMID 40111543
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PURPOSE OF REVIEW: This review aims to explore recent advancements in bioengineering approaches used in developing and testing in vitro cardiac disease models. It seeks to find out how these tools can address the limitat...PURPOSE OF REVIEW: This review aims to explore recent advancements in bioengineering approaches used in developing and testing in vitro cardiac disease models. It seeks to find out how these tools can address the limitations of traditional in vitro models and be applied to improve our understanding of cardiac disease mechanisms, facilitate preclinical drug screening, and equip the development of personalized therapeutics. RECENT FINDINGS: Human induced pluripotent stem cells have enabled the generation of diverse cardiac cell types and patient-specific models. Techniques like 3D tissue engineering, heart-on-a-chip platforms, biomechanical conditioning, and CRISPR-based gene editing have enabled faithful recreation of complex cardiac microenvironments and disease conditions. These models have advanced the study of both genetic and acquired cardiac disorders. Bioengineered in vitro models are transforming the basic science and clinical research in cardiovascular disease by improving the biomimicry and complexity of tissue analogues, increasing throughput and reproducibility of screening platforms, as well as offering patient and disease specificity. Despite challenges in scalability and functional maturity, integrating multiple bioengineering techniques with advanced analytical tools in in vitro modeling platforms holds promise for future precision and personalized medicine and therapeutic innovations.
PURPOSE OF REVIEW: Constrictive pericarditis (CP) is a potentially curable condition characterized by the thickening, scarring, and calcification of the pericardium. A comprehensive approach, including clinical evaluatio...PURPOSE OF REVIEW: Constrictive pericarditis (CP) is a potentially curable condition characterized by the thickening, scarring, and calcification of the pericardium. A comprehensive approach, including clinical evaluations and imaging techniques such as echocardiography, computed tomography, and magnetic resonance imaging, is essential for timely diagnosis and intervention to prevent chronic complications and enhance patient outcomes. However, the rarity of CP and the specialized expertise required present challenges in diagnosis. RECENT FINDINGS: Emerging artificial intelligence applications show promise in enhancing clinical decision-making and improving outcomes. Studies utilizing cognitive machine learning and deep learning algorithms (ResNet50) achieved an AUC above 0.95 in distinguishing CP from restrictive cardiomyopathy. However, generalization and interpretability issues remain, and the development of AI applications for CP is still nascent due to challenges in obtaining large, high-quality echocardiographic datasets. Future research should evaluate the effectiveness of these models in diverse clinical scenarios, employing comprehensive echocardiography, point-of-care ultrasound, and other modalities to improve CP detection, individualized risk assessment, and treatment planning, ultimately enhancing patient prognosis.
Heine M, Agrawal A, Wensink E
… +2 more, Wang TKM, Klein A
Curr Cardiol Rep
· 2025 Mar · PMID 40063308
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PURPOSE OF REVIEW: Pericarditis can be a chronic and complex disease requiring years of treatment. These patients require close monitoring of labs, medications and their side effects, as well as virtual and inpatient fol...PURPOSE OF REVIEW: Pericarditis can be a chronic and complex disease requiring years of treatment. These patients require close monitoring of labs, medications and their side effects, as well as virtual and inpatient follow up. Due to the complexity of this disease, many of these patients are treated for months and sometimes years. Our review highlights the role Advanced practice providers (APP) play in managing the complexity of these patients by providing efficient and quality care. RECENT FINDINGS: Multi-modality cardiac imaging is the cornerstone to the evaluation and treatment of pericardial diseases. The addition of Interleukin (IL-1) blockers or biologics (Rilonacept, Anakinra) in the last few years provides targeted therapy for these patients. Using imaging guided therapy (IGT) these complex patients require close, continuous follow up and monitoring as well as frequent medication titration. The outcomes for these pericardial patients are improved with these centers due to the specialized medical and surgical care. Advanced Practice Providers play a vital role in a pericardial center with ordering the appropriate imaging and labs, handling medication titration, and providing patient education and continuity of care for these patients. They have been shown to decrease mortality, increase quality of care, and increase medication adherence.
Curr Cardiol Rep
· 2025 Mar · PMID 40053166
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PURPOSE OF REVIEW: This review evaluates the role of vascular inflammation in patients who develop myocardial infarction with non-obstructive coronary arteries (MINOCA). It also introduces pericoronary adipose tissue (PC...PURPOSE OF REVIEW: This review evaluates the role of vascular inflammation in patients who develop myocardial infarction with non-obstructive coronary arteries (MINOCA). It also introduces pericoronary adipose tissue (PCAT) and epicardial adipose tissue (EAT) as possible biomarkers for risk prediction in patients with non-obstructive coronary artery disease (CAD). RECENT FINDINGS: PCAT and EAT contribute to the development and progression of coronary artery inflammation and plaque vulnerability. Coronary computed tomography angiography (CCTA) can detect localized areas of inflammation through changes in the attenuation values of PCAT and EAT. Attenuation values can be further integrated with traditional risk factors using artificial intelligence to generate risk scores that significantly enhance prognostic accuracy in patients with and without obstructive coronary artery disease. Assessing PCAT and EAT inflammation via CCTA and AI-driven risk algorithms enable precise risk prediction of MINOCA and major adverse coronary events (MACE) in patients with non-obstructive CAD.
Khan A, Sorour AA, E Anton G
… +2 more, Lyden SP, Kirksey L
Curr Cardiol Rep
· 2025 Mar · PMID 40047963
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PURPOSE OF REVIEW: Venous insufficiency (VI) is a is a common and debilitating disease that can present with a wide range of manifestations ranging from telangiectasias to venous ulceration. The chapter explores various...PURPOSE OF REVIEW: Venous insufficiency (VI) is a is a common and debilitating disease that can present with a wide range of manifestations ranging from telangiectasias to venous ulceration. The chapter explores various endovascular and open-surgical modalities used for VI, their technique, patient selection, outcomes, complications, and comparison with other modalities. RECENT FINDINGS: The use of non-thermal and non-tumescent ablation techniques are found to have a better quality of life scores; however, the primary closure rates are inferior to thermal ablation techniques. A wide range of treatment modalities are available, ranging from conservative management, endovascular techniques and open-surgical options. Each intervention has its unique benefits, limitations, and potential complications. The management approach for VI is not one-fits-all, and must be meticulously tailored to each patient, carefully considering their disease severity, anatomy, quality of life, and expectations, for an effective treatment.
PURPOSE OF REVIEW: Recent evidence suggests that transthyretin cardiac amyloidosis (ATTR-CM) is significantly more common than once believed, yet it remains frequently under- and mis-diagnosed. With effective treatments...PURPOSE OF REVIEW: Recent evidence suggests that transthyretin cardiac amyloidosis (ATTR-CM) is significantly more common than once believed, yet it remains frequently under- and mis-diagnosed. With effective treatments now available, early and accurate diagnosis has become critical for better patient outcomes. Understanding the interplay between genetics, race, and social determinants of health (SDOH) in influencing both ATTR-CM diagnosis and management is essential for bridging the current gaps. RECENT FINDINGS: Our analysis reveals multiple barriers affecting ATTR-CM care. Specifically, we discuss how clinician awareness, regional differences in clinical practice, and limited access to health care and specialty centers contribute to diagnostic delays. Additionally, we identify several management obstacles, such as inadequate diversity in clinical trials, high cost of available treatments, and limited ancillary resources. We examine these challenges in detail and provide practical solutions to address them. While disparities in heart failure outcomes have been well-documented, those specific to ATTR-CM remain underrepresented in the literature. This review establishes a structured approach to understanding how biological, structural and SDOH-related disparities impact ATTR-CM diagnosis and management while offering concrete strategies to overcome these challenges. We emphasize the need for enhanced SDOH identification and advocate for coordinated, multidisciplinary efforts to improve ATTR-CM patient outcomes.
PURPOSE OF REVIEW: This review examines the current evidence and management strategies for stable coronary artery disease (CAD) and acute coronary syndrome (ACS) in patients with cancer. We outline the unique challenges,...PURPOSE OF REVIEW: This review examines the current evidence and management strategies for stable coronary artery disease (CAD) and acute coronary syndrome (ACS) in patients with cancer. We outline the unique challenges, optimal treatment approaches, and outcomes in this growing population. RECENT FINDINGS: First-line medications for CAD management are consistently underutilized in cancer patients despite serving as standard of care. As a corollary, medical optimization in CAD management in general is less likely to occur in patients with cancer. Early invasive strategies in ACS show improved survival, yet cancer patients receive percutaneous coronary intervention less frequently than non-cancer patients. Optimization of medical management should be prioritized in stable CAD; revascularization with PCI is first line for most patients presenting with ACS. Modification of risk factors contributing to both CAD and cancer is of utmost importance. Cancer survivors should receive vigilant, long-term monitoring for the development of signs of CAD.
Pender A, Lewis-Owona J, Ekiyoyo A
… +1 more, Stoddard M
Curr Cardiol Rep
· 2025 Feb · PMID 40019673
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PURPOSE OF REVIEW: The purpose of this review is to highlight the utility of echocardiography in the diagnosis and management of cardiomyopathies. RECENT FINDINGS: Echocardiographic parameters function synergistically to...PURPOSE OF REVIEW: The purpose of this review is to highlight the utility of echocardiography in the diagnosis and management of cardiomyopathies. RECENT FINDINGS: Echocardiographic parameters function synergistically to guide decision-making ranging from early detection of disease and screening to risk stratification of complex disease. The collective wealth of information available from 2D/3D assessment, Doppler, diastology and strain makes echocardiography an invaluable decision aid.
PURPOSE OF REVIEW: Significant practice variability exists with respect to the role and frequency of echocardiography after heart transplantation. We sought to illustrate key studies relating to the utility and diagnosti...PURPOSE OF REVIEW: Significant practice variability exists with respect to the role and frequency of echocardiography after heart transplantation. We sought to illustrate key studies relating to the utility and diagnostic accuracy of echocardiography for the post-heart transplant patient. RECENT FINDINGS: Several echocardiographic parameters correlate with acute heart transplant rejection, but there is enough heterogeneity between study results or in diagnostic accuracy, such that it precludes parameter use in isolation to rule out rejection. Newer techniques such as strain echocardiography may have better sensitivity. Similarly, resting and stress echocardiography can be combined with modern techniques such as myocardial contrast echocardiography to diagnose and prognosticate cardiac allograft vasculopathy, but studies have again demonstrated variable accuracy. Echocardiography remains an accessible tool in the evaluation and management of patients after heart transplantation. This modality can guide clinical judgment with real-time data and several fairly sensitive parameters for the detection of rejection, cardiac allograft vasculopathy, and other abnormalities. Often, auxiliary diagnostic modalities need to be combined to optimize diagnostic accuracy.
PURPOSE OF REVIEW: Despite growing recommendations for CMR utilization in heart disease evaluation, access remains limited by geography and socioeconomic status. In this review we discuss the role of CMR in addressing he...PURPOSE OF REVIEW: Despite growing recommendations for CMR utilization in heart disease evaluation, access remains limited by geography and socioeconomic status. In this review we discuss the role of CMR in addressing health disparities, review barriers to CMR access, and finally propose solutions to increasing CMR testing globally and in the U.S. RECENT FINDINGS: CMR testing is higher prevalence in academic and urban centers in the Northeast and Midwest and remains sparser in Southern and rural areas which face a high burden of cardiovascular mortality. Globally, CMR is also limited in low- and middle-income countries. Barriers to CMR access include bias in physician referrals based on race, patient income, insurance status, language barriers, health literacy, and disparities in the multimodal cardiovascular imaging workforce. A multimodal approach involving policy makers, hospital systems, cardiologists, and health care personnel is essential to improving national and global barriers to accessing CMR.
Curr Cardiol Rep
· 2025 Feb · PMID 40009333
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PURPOSE OF REVIEW: This review summarizes the role of the novel F-labeled positron emission tomography (PET) sympathetic radiotracers for risk stratification in patients with ischemic heart disease. PET tracers have demo...PURPOSE OF REVIEW: This review summarizes the role of the novel F-labeled positron emission tomography (PET) sympathetic radiotracers for risk stratification in patients with ischemic heart disease. PET tracers have demonstrated prognostic value by characterizing myocardial sympathetic nerve density and by extension the extent of myocardial sympathetic denervation. The unique features of these PET radiotracers are discussed in relation to clinical application. RECENT FINDINGS: Absolute quantification of sympathetic denervation has been possible with F-labeled PET tracers which outperform low ejection fraction (<35%) in predicting sudden cardiac death (SCD) and allow for more optimal risk stratification in patients with heart failure. This underscores their utility in selecting patients for preventable strategies with implantable cardioverter defibrillators (ICD). Appropriate candidate selection for ICD placement is a major priority as at present 80% of patients that die from SCD do not receive an ICD (potentially preventable mortality) while only 1 in 8 patients with an ICD receive a life-saving shock. Furthermore, 1 in 3 patients with ICDs receive inappropriate shocks. Thus, there is a pressing need to more appropriately select and exclude patients who will and will not benefit from ICD placement, respectively, as both suffer poor outcomes. Despite the clear prognostic benefit offered by prior PET sympathetic radiotracers in imaging myocardial sympathetic denervation, their short half-lives necessitated costly onsite cyclotron synthesis obviating their pragmatic clinical use. F-labeled radiotracers have a longer half-life allowing centralized synthesis and transport to their point of use. As such, F-labeled sympathetic radiotracers define an innovation and may offer a more affordable and clinically practical approach for evaluation of risk in patients with cardiovascular disease. F-labeled sympathetic radiotracers are currently available for evaluation and risk stratification of patients with ischemic heart disease and heart failure. These radiotracers may offer a more practical approach for selection of ICD placement and consequent prevention of SCD; a major, yet unmet need, in heart failure patients and those that suffer SCD at large. However, further development and clinical testing of these F-labeled sympathetic radiotracers is required.
PURPOSE OF REVIEW: This review provides an overview of surgical techniques for mitral valve repair, emphasizing advancements in artificial cordal repair, annuloplasty, and resectional approaches. It aims to equip non-car...PURPOSE OF REVIEW: This review provides an overview of surgical techniques for mitral valve repair, emphasizing advancements in artificial cordal repair, annuloplasty, and resectional approaches. It aims to equip non-cardiac surgeons with insights into the principles and strategies that underpin successful valve repair, encouraging broader application in clinical practice. RECENT FINDINGS: Innovations in mitral valve repair, including the adoption of artificial neochordae and advancements in annuloplasty devices, have continued to improve repair durability. Intraoperative tools, such as transesophageal echocardiography, remain essential for optimizing outcomes. Nonetheless, significant variability persists in repair rates across regions and surgeons, highlighting opportunities for improvement. Mitral valve repair remains the gold standard for managing degenerative mitral regurgitation, with proven benefits in survival and long-term outcomes. As techniques become more reproducible and accessible, expanding repair expertise and improving national repair rates could significantly improve patient outcomes.
Lwin N, Suursalmi P, Yong S
… +5 more, Kabir S, Jones MI, Savis A, Qureshi SA, Rosenthal E
Curr Cardiol Rep
· 2025 Feb · PMID 39969687
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PURPOSE OF REVIEW: To provide an overview of fluoroscopy-free transcatheter atrial septal defect (ASD) closure and introduce a simplified approach that avoids pulmonary vein instrumentation. RECENT FINDINGS: Since the fi...PURPOSE OF REVIEW: To provide an overview of fluoroscopy-free transcatheter atrial septal defect (ASD) closure and introduce a simplified approach that avoids pulmonary vein instrumentation. RECENT FINDINGS: Since the first reported fluoroscopy-free ASD closure 24 years ago, only a few small series have described this technique. We present a simplified and less cumbersome approach to encourage wider adoption of the fluoroscopy-free method to suitable ASD anatomy. RESULTS: Fluoroscopy free ASD closure was performed in 9 patients using the conventional technique (Group 1) and 23 patients using our simplified approach of direct placement of the device into the defect (Group 2). Median age and weight were 28 years, 53 kg in Group 1 (range: 5-52 years, 22-88 kg) and 36 years, 66 kg in Group 2 (range: 4-76 years, 16-115 kg). Devices were successfully implanted in all patients, with a median device size of 21 mm (Group 1: 9-36 mm, Group 2: 10-33 mm). Procedural time was 47 min for Group 1 and 35 min for Group 2 (p = 0.09). Length of hospital stay was similar in both groups. There were no acute or long-term complications and no need for reintervention. Transcatheter ASD closure without the use of fluoroscopy using the simplified approach is safe and effective, offers a shorter procedure duration and minimises instrumentation within the left atrium and pulmonary veins. Patient selection is key and with greater experience, this procedure may be applicable to a wider selection of ASD anatomy.