Methodist Debakey Cardiovasc J
· 2025 · PMID 41078848
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Interventional radiology is increasingly turning to robotic solutions to overcome limitations of manual catheterization, such as operator fatigue, procedural complications, and radiation exposure. Despite rapid advanceme...Interventional radiology is increasingly turning to robotic solutions to overcome limitations of manual catheterization, such as operator fatigue, procedural complications, and radiation exposure. Despite rapid advancements in robotic technologies, existing platforms face barriers to widespread adoption due to complex hardware, nonintuitive controls, and limited modularity, thereby affecting sterility, the absence of true force feedback, heavy reliance on fluoroscopy, high costs, and a lack of truly disruptive innovation. In effect, many systems function more as extensions of the surgeon's hand rather than as disruptive leaps. This review surveys 19 commercial and emerging robotic systems categorized based on the methods and technologies used, with a discussion of benefits and limitations for various specific indications. Integration of imaging, haptics, and economic considerations are also discussed. This comprehensive synthesis aims to offer insights into current capabilities, limitations, and potential future directions for researchers and engineers to advance this domain.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40980727
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This interactive CME case poses the challenge of diagnosing a male patient in his late 60s who presented to the emergency department of a tertiary care hospital with neurological symptoms. He complained of transient blur...This interactive CME case poses the challenge of diagnosing a male patient in his late 60s who presented to the emergency department of a tertiary care hospital with neurological symptoms. He complained of transient blurred vision lasting for 20 minutes and was later identified to be in shock.
Sabri MS, Benedict L, Souder D
… +4 more, Kaugars L, Patel K, Bozorgnia B, Nazir T
Methodist Debakey Cardiovasc J
· 2025 · PMID 40860770
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Wolff-Parkinson-White (WPW) syndrome is a congenital condition characterized by the presence of an accessory pathway (AP) that can lead to tachyarrhythmias such as atrial fibrillation (AF). Patients with WPW are at an in...Wolff-Parkinson-White (WPW) syndrome is a congenital condition characterized by the presence of an accessory pathway (AP) that can lead to tachyarrhythmias such as atrial fibrillation (AF). Patients with WPW are at an increased risk of developing AF, with a prevalence of up to 30%. Despite successful ablation of the AP, AF recurrence remains a challenge, particularly in older patients or those with a history of AF. Concomitant pulmonary vein isolation (PVI) may help reduce the risk of recurrence by targeting atrial remodeling and pulmonary vein involvement in AF. This case describes a 70-year-old male with WPW and AF who underwent a combined PVI and AP ablation procedure. The patient remained free of AF post-procedure, suggesting that this approach may be effective in high-risk patients. Further randomized controlled trials are necessary to evaluate the efficacy of this combined approach in reducing AF recurrence compared to AP ablation alone, especially in older patients.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40860769
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Kommerell's diverticulum (KD) is a rare vascular anomaly characterized by aneurysmal dilation of the descending aorta at the origin of an aberrant subclavian artery, which can occur in either a right- or left-sided aorti...Kommerell's diverticulum (KD) is a rare vascular anomaly characterized by aneurysmal dilation of the descending aorta at the origin of an aberrant subclavian artery, which can occur in either a right- or left-sided aortic arch. Aberrant right subclavian arteries are found in approximately 0.5% to 2% of the population while aberrant left subclavian arteries are less common, occurring in only 0.04% to 0.4%. KD is associated with aberrant subclavian arteries in 60% to 82% of cases. It is often identified incidentally during imaging studies performed for unrelated reasons, which contributes to the limited understanding of its natural progression. However, KD carries significant risks, including a 53% chance of aneurysm rupture and a 19% incidence of aortic dissection. As a result, surgical management is generally recommended. Although no standardized treatment exists, options include thoracic endovascular aortic repair, hybrid procedures, and open repair. Intervention is typically advised when the orifice diameter exceeds 3 cm and depth exceeds 5 cm due to elevated rupture risk. We present a case of incidentally detected KD originating from a right aortic arch with an aberrant left subclavian artery.
Mohammed AAA, Ali H, Bux SS
… +3 more, Prabhakar P, Hussain A, Dita W
Methodist Debakey Cardiovasc J
· 2025 · PMID 40860768
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Chylopericardium (CP), defined as the accumulation of chyle in the pericardial cavity, is a rare condition, especially in the absence of an identifiable secondary cause. Primary idiopathic chylopericardium (PIC) is even...Chylopericardium (CP), defined as the accumulation of chyle in the pericardial cavity, is a rare condition, especially in the absence of an identifiable secondary cause. Primary idiopathic chylopericardium (PIC) is even more uncommon, with limited cases reported in the literature. We report the case of a 43-year-old South Asian woman who presented with palpitations and fatigue. Echocardiography revealed a large pericardial effusion with signs of cardiac tamponade, necessitating emergent pericardiocentesis. The pericardial fluid aspirated was pinkish and turbid, which turned to milky white after centrifugation. Analysis of the pericardial fluid demonstrated a high triglyceride concentration, lymphocytic predominance, and fat globules, consistent with chylous effusion. A thorough diagnostic workup-including infectious, rheumatologic, and oncologic evaluations-was unrevealing, confirming a diagnosis of PIC. Lymphoscintigraphy was misleading in this case, with no thoracic duct abnormalities reported. Following an initial response to conservative management with pericardiocentesis and a medium-chain triglyceride-rich diet, the patient experienced recurrence of symptoms and fluid reaccumulation. Definitive management via thoracic duct ligation and pericardial window surgery was performed, resulting in complete resolution of the effusion. At 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the importance of considering primary CP in the differential diagnosis of pericardial effusion. Absence of classical inflammatory signs and symptoms can be suggestive of chylous effusion. The report also supports surgical intervention as a definitive treatment even if lymphoscintigraphy does not reveal clear thoracic duct pathology.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822376
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Given the large amount of myocardium supplied by the left anterior descending (LAD) artery, it understandably receives additional scrutiny during coronary angiography. However, these same features make the interpretation...Given the large amount of myocardium supplied by the left anterior descending (LAD) artery, it understandably receives additional scrutiny during coronary angiography. However, these same features make the interpretation of pressure wire physiology more nuanced to avoid overtreatment. This review provides case examples to underpin an extensive literature review supporting the argument that a "positive" fractional flow reserve (FFR) in the LAD needs to be approached with caution. A large hyperemic gradient, or low FFR, can arise from either a severe and focal lesion in conjunction with low flow or diffuse disease coupled with intact or normal flow. Separating these two scenarios, and the wide continuum between them, ultimately requires upstream assessment of absolute myocardial perfusion, although a pressure wire pullback can help identify diffuse patterns unsuitable for revascularization.
Williams KW, DiGregorio H, Jagannath D
… +1 more, Feher A
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822375
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Patients with autoimmune rheumatologic diseases (ARDs) exhibit an elevated risk for atherosclerosis, not fully accounted for by traditional risk factors alone. This review aims to explore how advanced multimodality cardi...Patients with autoimmune rheumatologic diseases (ARDs) exhibit an elevated risk for atherosclerosis, not fully accounted for by traditional risk factors alone. This review aims to explore how advanced multimodality cardiovascular imaging techniques can provide critical insights into the shared inflammatory pathways that contribute to endothelial damage and the development of atherosclerotic coronary artery disease. By highlighting the diagnostic potential and future applications of these techniques, we aim to provide a comprehensive overview for clinicians and researchers.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822373
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The development of catheter-based interventions has revolutionized the treatment of coronary artery disease (CAD), from the first heart catheterization in 1929 to the emergence of drug-coated balloons (DCBs) as a treatme...The development of catheter-based interventions has revolutionized the treatment of coronary artery disease (CAD), from the first heart catheterization in 1929 to the emergence of drug-coated balloons (DCBs) as a treatment for in-stent restenosis (ISR). This review explores the evolution and clinical application of DCBs in CAD, with a particular focus on their role in managing ISR, de novo coronary disease, and complex lesions. DCBs deliver antiproliferative drugs such as paclitaxel or sirolimus to the vessel wall and have emerged as a promising alternative to traditional stent-based therapies, reducing the need for permanent metallic implants and associated thrombotic risks. Early research demonstrated the effectiveness of DCBs in ISR, and recent studies have expanded their application to small vessel disease, bifurcation lesions, and long diffuse lesions. Notably, DCBs have shown non-inferiority to drug-eluting stents in certain cases, including high-risk patients and those with complex coronary anatomy. Despite some challenges, such as the potential for coronary dissection and the need for optimal lesion preparation, DCBs have demonstrated strong potential in reducing restenosis and improving long-term outcomes in a variety of patient populations. While further studies are required to refine their use in off-label indications, DCBs may represent a versatile, effective, and safer approach in the management of CAD.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822372
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Early primary prevention of coronary artery disease (CAD) is limited by lack of biomarkers to detect CAD risk among young asymptomatic individuals. Although early prevention is more effective than secondary interventions...Early primary prevention of coronary artery disease (CAD) is limited by lack of biomarkers to detect CAD risk among young asymptomatic individuals. Although early prevention is more effective than secondary interventions, conventional risk factors such as hypertension usually do not appear until the fifth or sixth decade of life. Conversely, genetic risk, which accounts for 50% of all CAD risk, is randomly distributed at conception and does not change with age; therefore, it can be determined any time after birth using a genetic polygenic risk score (PRS). Genetic risk is markedly modified by lifestyle changes and, specifically, lowering levels of low-density lipoproteins (LDL). CAD risk depends on the concentration and duration of exposure to plasma LDL, which is estimated by the product of age times LDL (mg-years). The minimum threshold for a myocardial infarction (MI) in someone with a plasma LDL of 125 at age 40 is 5,000 mg-years. The goal of primary prevention is to delay reaching the minimal clinical threshold as long as possible. This review makes the case for a long-acting, lipid-lowering drug, administered annually starting at age 30, that could delay the threshold for MI until age 100.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822370
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Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a critical clinical challenge associated with high morbidity and mortality. Temporary mechanical circulatory support (tMCS) devices can stabil...Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a critical clinical challenge associated with high morbidity and mortality. Temporary mechanical circulatory support (tMCS) devices can stabilize hemodynamics, improve cardiac output, and enhance survival, thereby continuing to be more favorable with operators. This review summarizes the pathophysiology of AMI-CS and examines the evidence informing recommendations for tMCS device implementation-specifically the intra-aortic balloon pump, Impella (Abiomed/J&J MedTech), TandemHeart™ (LivaNova, Inc.), and venoarterial extracorporeal membrane oxygenation-with a particular focus on clinical trial data and recent guideline recommendations to assist operators in implementing decision-making.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822369
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Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelon...Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches-including an official White House portrait of President Ronald Reagan-to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations. If you would like to see your art published in the , submit your creation online at journal.houstonmethodist.org as a "Humanities" entry.
Murthy NM, Yoo TT, Sanchez A
… +5 more, Chhitu M, Abramov D, Gatling J, Mamas MA, Parwani P
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822368
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Despite medical advances and increased perioperative testing, mortality and cardiovascular complications of noncardiac surgery (NCS) have hardly declined since the early 2000s. Studies demonstrate a disproportionate over...Despite medical advances and increased perioperative testing, mortality and cardiovascular complications of noncardiac surgery (NCS) have hardly declined since the early 2000s. Studies demonstrate a disproportionate overutilization of preoperative diagnostic testing with a concurrent underutilization of interventions that have been shown to meaningfully modify mortality. Consequently, there has been a paradigm shift in the approach to perioperative testing. Current thinking advocates for a more judicious and individualized approach-that is, reserving noninvasive testing for select cases at highest risk of periprocedural cardiovascular events, where it may more effectively alter management. Thus, this review provides an update of the latest evidence-based recommendations on preoperative diagnostic assessment of patients with cardiovascular risk factors undergoing NCS, proposes a framework that can be referenced when approaching such a patient in clinical practice, and highlights areas that need more data to guide decision-making in clinical practice.
Yousefzai S, Amin Z, Faizan H
… +7 more, Ali M, Soni S, Friedman M, Kazmi A, Metlock FE, Sharma G, Javed Z
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822367
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Perimenopause, or menopause transition (MT), is a critical life stage that encompasses significant physiological, emotional, and psychosocial changes that impact women's cardiovascular health and quality of life. The dec...Perimenopause, or menopause transition (MT), is a critical life stage that encompasses significant physiological, emotional, and psychosocial changes that impact women's cardiovascular health and quality of life. The decline in estrogen during MT induces adverse metabolic changes that increase the risk of dyslipidemia, obesity, insulin resistance, atherogenesis, and poor downstream outcomes such as diabetes, hypertension, stroke, and other adverse changes. Concurrently, stress plays an important role in shaping overall cardiovascular well-being during MT and long-term heart health post-menopause. In addition, nontraditional risk factors-particularly social determinants of health (SDoH) such as economic well-being, access to health care, built environment, social support, and others-are key upstream determinants of cardiovascular disease in women during perimenopause. Coordinated efforts are needed to screen, identify, and address the primary SDoH for optimal heart health in the clinically vulnerable MT patient population. Patient-centered care pathways that focus on assessing social needs and connecting socially vulnerable patients with available community resources are much needed for holistically addressing patient needs. Community-centered efforts are key to addressing persistent inequities in women's cardiovascular health via navigation and connection to community resources that may help address SDoH barriers.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822366
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Intravascular ultrasound (IVUS) has significantly advanced the field of percutaneous coronary intervention (PCI), offering enhanced visualization and assessment capabilities that surpass traditional angiography. IVUS tec...Intravascular ultrasound (IVUS) has significantly advanced the field of percutaneous coronary intervention (PCI), offering enhanced visualization and assessment capabilities that surpass traditional angiography. IVUS technology generates images from reflected ultrasound waves, providing critical insights into plaque characteristics, vessel size, and lesion morphology. These capabilities facilitate precise stent placement, optimal sizing, and the identification of features associated with stent failure, such as underexpansion and malapposition. Studies have demonstrated that IVUS-guided PCI significantly reduces major adverse cardiovascular events and improves long-term outcomes, particularly in complex lesions. This comprehensive review outlines the technical nuances, evidence, and clinical applications of IVUS.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822365
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This column discusses radiation-induced coronary artery disease (RICAD), a distinct and increasingly recognized cause of CAD among cancer survivors after receiving chest radiation therapy. RICAD typically presents years...This column discusses radiation-induced coronary artery disease (RICAD), a distinct and increasingly recognized cause of CAD among cancer survivors after receiving chest radiation therapy. RICAD typically presents years or even decades after mediastinal radiation therapy, often affecting young patients without traditional cardiovascular risk factors. Unlike typical atherosclerosis, RICAD is driven by chronic inflammation and fibrosis. Clinicians should maintain a high index of suspicion in cancer survivors, and management often favors medical therapy and percutaneous coronary intervention when indicated.
Hoover JA, Catakam K, Wittenberg RE
… +4 more, Bloom JP, Yeh DD, Han QJ, Stefanescu Schmidt AC
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822364
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Coronary artery anomalies are rare congenital abnormalities involving abnormal coronary artery origin and incomplete/abnormal vessel development. These anomalies encompass a broad anatomical spectrum with varied clinical...Coronary artery anomalies are rare congenital abnormalities involving abnormal coronary artery origin and incomplete/abnormal vessel development. These anomalies encompass a broad anatomical spectrum with varied clinical presentations ranging from sudden cardiac arrest in young athletes to incidental findings in asymptomatic adults. While more data on anatomy and clinical presentation has emerged in the last decade, management remains highly individualized, guided by clinical presentation, anatomical characteristics, and patient preferences. This review provides an overview of each anomaly and recent advances in imaging, surgical planning, and risk stratification. We also highlight the challenges in optimizing management strategies, addressing gaps in evidence, and achieving consensus to refine risk stratification tools and support clinical decision-making.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822363
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Despite significant progress in the prevention and treatment of coronary artery disease (CAD), substantial disparities persist across racial subgroups. While traditional cardiovascular risk factors such as hypertension a...Despite significant progress in the prevention and treatment of coronary artery disease (CAD), substantial disparities persist across racial subgroups. While traditional cardiovascular risk factors such as hypertension and diabetes play a role, these differences are further influenced by variations in healthcare access, socioeconomic status, and environmental context. Minority populations remain underrepresented in research and clinical trials, which limits our understanding of these inequities. Focused efforts are needed to identify and act on opportunities that promote equity in cardiovascular care and outcomes.
Burnette-Phelps K, Sohn LS, Bhardwaj A
… +4 more, Sharma V, Kritya M, Sahai A, Shamim S
Methodist Debakey Cardiovasc J
· 2025 · PMID 40822362
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We report the case of a 67-year-old female with heart failure and a reduced ejection fraction (25%). Angiography revealed that all of her major coronary vessels stemmed from a single ostium at the right aortic sinus.We report the case of a 67-year-old female with heart failure and a reduced ejection fraction (25%). Angiography revealed that all of her major coronary vessels stemmed from a single ostium at the right aortic sinus.
Warren B, Patel A, Pasupuleti S
… +1 more, Kotwani R
Methodist Debakey Cardiovasc J
· 2025 · PMID 40547044
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About 25% of patients diagnosed with coronavirus disease 19 (COVID-19) experience cardiovascular complications, contributing to 40% of related deaths. Here we discuss a 69-year-old male with a history of congestive heart...About 25% of patients diagnosed with coronavirus disease 19 (COVID-19) experience cardiovascular complications, contributing to 40% of related deaths. Here we discuss a 69-year-old male with a history of congestive heart failure and preserved ejection fraction at New York Heart Association (NYHA) class II who presented with new dyspnea, cough, and paroxysmal nocturnal dyspnea. He was subsequently diagnosed with COVID-19 pneumonia, and while he initially recovered, he later showed worsening symptoms with progression to NYHA class IV. Follow-up echocardiogram revealed a decline in ejection fraction to 40% and severe aortic insufficiency. He underwent surgical aortic valve replacement, resolving his symptoms. This case highlights COVID-19's potential to cause rapid progression of valvular disease.