Puppala R, Gorantla P, Benfor B
… +1 more, Peden E
Methodist Debakey Cardiovasc J
· 2025 · PMID 40486132
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This case describes the use of the Surfacer® Inside-Out Access Catheter System (SIO) from Merit Medical in an occluded inferior vena cava. The procedure typically utilizes right femoral vein access with contraindications...This case describes the use of the Surfacer® Inside-Out Access Catheter System (SIO) from Merit Medical in an occluded inferior vena cava. The procedure typically utilizes right femoral vein access with contraindications of acute iliocaval thrombosis due to possible embolization. After history and imaging studies, the occlusion was determined to be chronic in this case, and a decision was made to employ the SIO procedure using an indwelling catheter. This case demonstrates the use of the SIO procedure in certain settings in patients with central venous occlusions who have exhausted all other options.
Sahai A, Sharma V, Mishra P
… +3 more, Siddanoor A, Bhatia A, Pande DG
Methodist Debakey Cardiovasc J
· 2025 · PMID 40453635
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Methylenetetrahydrofolate reductase gene () mutations can lead to hyperhomocysteinemia, a known risk factor for venous thromboembolism. In some studies, the A1298C and C677T polymorphisms of the gene have been linked to...Methylenetetrahydrofolate reductase gene () mutations can lead to hyperhomocysteinemia, a known risk factor for venous thromboembolism. In some studies, the A1298C and C677T polymorphisms of the gene have been linked to thrombosis, though their clinical significance remains debated. This case presents a detailed analysis of two premenopausal females who presented with pulmonary embolism and were subsequently diagnosed with the A1298C mutation, indicating a potential relation between the A1298C mutation of the gene and the subsequent triggering events of thrombotic manifestations associated with raised levels of homocysteine. The varying clinical presentations and biochemical profiles underscore the complex relationship between genotype and phenotype in -associated thrombophilias.
Assiri S, Alshammakh MS, Alzahrani SM
… +2 more, Alfawara MS, Al-Shaibi K
Methodist Debakey Cardiovasc J
· 2025 · PMID 40385323
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This case addresses the challenges of treating patients with both severe aortic stenosis and subaortic stenosis. In this combined condition, transcatheter aortic valve implantation (TAVI) remains an off-label application...This case addresses the challenges of treating patients with both severe aortic stenosis and subaortic stenosis. In this combined condition, transcatheter aortic valve implantation (TAVI) remains an off-label application, particularly in the presence of a subaortic membrane. Our multimodal imaging approach that incorporates echocardiography, cardiac computed tomography, and fluoroscopic guidance demonstrates the successful application of TAVI in a high-risk clinical scenario. The results underscore the potential of TAVI as a viable alternative to traditional surgical aortic valve replacement for patients with dual-level obstruction who are not candidates for open surgery.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384743
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Heart transplantation is a marvel of modern medicine for patients with end-stage heart failure. Decades of research and surgical innovation have overcome challenges in immunology, organ preservation, and patient care. Fr...Heart transplantation is a marvel of modern medicine for patients with end-stage heart failure. Decades of research and surgical innovation have overcome challenges in immunology, organ preservation, and patient care. From the earliest heart transplants on canines and primates, the field evolved through immunosuppressive therapies, development of the bioptome for endomyocardial biopsy and, recently, the use of cell free DNA and molecular microscopy for assessing rejection. Newer developments in organ preservation systems and transport systems bring remarkable increases in the availability of donors.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384742
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While advances in immunosuppression management have led to excellent 1-year survival after heart transplantation, long-term outcomes remain suboptimal. Contemporary therapies are associated with adverse sequalae, dominat...While advances in immunosuppression management have led to excellent 1-year survival after heart transplantation, long-term outcomes remain suboptimal. Contemporary therapies are associated with adverse sequalae, dominated by chronic kidney disease, and concomitantly by the inadequate control of humoral alloimmunity that is tightly linked to cardiac allograft vasculopathy. The dichotomy between the need for less toxicity and better control of humoral alloimmunity has driven a search for more effective regimens and for strategies to reverse humoral responses. This review provides an overview of immunosuppression in heart transplantation, beginning with critical historical context and followed by basic immunological principles underlying contemporary immunosuppression, the evolution of therapies over the past decade, and considerations for strategies to mitigate humoral alloimmunity. Perspective on the state-of-the field in the current era and considerations for future directions are also provided.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384741
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The evaluation for heart transplantation is a comprehensive endeavor requiring multidisciplinary collaboration. The goal of a heart transplant evaluation is to determine if (1) the patient's cardiac status is limited eno...The evaluation for heart transplantation is a comprehensive endeavor requiring multidisciplinary collaboration. The goal of a heart transplant evaluation is to determine if (1) the patient's cardiac status is limited enough, despite optimal medical therapy, to benefit from heart transplantation; (2) the patient does not have comorbidities that would preclude heart transplantation; and (3) the patient demonstrates compliance and possesses adequate social support. The most common indications for heart transplant are highly symptomatic heart failure with reduced ejection fraction, uncontrolled ventricular arrhythmias, or intractable angina. Extracardiac contraindications require specific considerations regarding whether they will (1) confer mortality risk that will negate the expected improvement in survival after transplantation; (2) affect post-transplant quality of life and hamper rehabilitation efforts; and (3) progress with immunosuppression. With careful and appropriate selection, heart transplant recipients are best positioned to experience the improved quality of life and survival expected after transplantation.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384740
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The field of heart transplantation has experienced remarkable progress over the past decades, transforming from an experimental procedure into a life-saving intervention with continually improving outcomes. As Houston Me...The field of heart transplantation has experienced remarkable progress over the past decades, transforming from an experimental procedure into a life-saving intervention with continually improving outcomes. As Houston Methodist Hospital celebrates its 40-year milestone in heart transplantation, it is both timely and essential to reflect upon the scientific advancements, ongoing challenges, and emerging opportunities in this dynamic field. Persistent shortages of donor organs, complexities associated with immunosuppressive therapies, and the imperative to optimize long-term patient outcomes continue to drive innovative research and clinical advancements. This issue features a collection of articles exploring key aspects of heart transplantation-from its historical foundations to the latest advances that are shaping its future.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384739
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The first heart transplantation in the United States was performed in 1968. The first national heart allocation system was developed two decades later in 1988 as a two-tiered system. Our current heart allocation system,...The first heart transplantation in the United States was performed in 1968. The first national heart allocation system was developed two decades later in 1988 as a two-tiered system. Our current heart allocation system, adopted in 2018 as a six-tiered system, is evolving to become a continuous distribution model. Herein, we review the history of the Organ Procurement and Transplantation Network, the evolution of the cardiac allocation system, modern day challenges of the current heart allocation system policy, and the future of transplantation given ongoing implementation of the modernization initiative.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384738
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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.
Duarte VE, Urey MA, Adler ED
… +5 more, Merkelz B, Hobeika MJ, Suarez EE, Quarti AG, Yousefzai R
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384737
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The prevalence of adult congenital heart disease (ACHD) is increasing, with heart failure being the leading cause of death. For many ACHD patients, heart transplantation is the only treatment option for advanced heart fa...The prevalence of adult congenital heart disease (ACHD) is increasing, with heart failure being the leading cause of death. For many ACHD patients, heart transplantation is the only treatment option for advanced heart failure, though significant extracardiac involvement may require multi-organ transplantation. Despite the rising number of ACHD transplants, multi-organ transplants in this population remain challenging, and a substantial gap remains between those in need and those who receive a transplant. While short-term outcomes may be worse for ACHD patients, long-term outcomes are comparable and even superior to other cardiomyopathies. Extracardiac organ dysfunction is common in ACHD patients, often precluding heart-alone transplantation. Fontan-associated liver disease, pulmonary vascular and restrictive lung disease, and renal dysfunction frequently necessitate multi-organ transplantation. ACHD patients have a unique immunological and sensitization profile, increasing their risk for infection, rejection, and malignancies, requiring specialized pretransplant desensitization and post-transplant immunosuppression strategies. ACHD transplantation presents unique surgical challenges, including chest reentry, vascular access issues, bleeding risks, extensive anatomical reconstruction, the need for longer vascular segments from donors, and prolonged ischemic times. Decisions regarding heart-alone versus heart-liver, heart-lung, or heart-kidney transplantation demand careful evaluation. These complex surgical plans require extensive multimodal imaging and collaboration with ACHD cardiac imaging specialists and abdominal transplant teams. Comprehensive coordination and psychosocial support are crucial for ACHD patients throughout the transplant process. A dedicated multidisciplinary team and an established and separate pathway for pre-, peri-, and postoperative care in centers with ACHD and multi-organ transplant expertise are essential. There is need for a revised organ allocation system to ensure timely access to transplantation for ACHD patients.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384736
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Given the aging population and despite advances in heart failure therapies, the number of patients with advanced heart failure in need of heart transplantation continues to increase, and the longstanding mismatch between...Given the aging population and despite advances in heart failure therapies, the number of patients with advanced heart failure in need of heart transplantation continues to increase, and the longstanding mismatch between organ demand and organ supply persists. In an effort to address this mismatch and expand the donor pool, a number of strategies are being pursued. This article reviews several of those strategies, including transplantation from hepatitis C virus-infected donors, transplantation from donors after circulatory death, the role of organ preservation technologies in facilitating transplantation of hearts that might otherwise be discarded, and the impact of public education and national donation policies.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384735
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Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy has long been the gold standard for monitoring rejection, its invasiveness and limitations have driven...Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy has long been the gold standard for monitoring rejection, its invasiveness and limitations have driven innovations in noninvasive techniques. Molecular diagnostics, including gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA), have emerged as promising alternatives with demonstrated utility. GEP excels in identifying immune activation with high negative predictive value, while dd-cfDNA provides insights into allograft injury, with sensitivity up to 81% and specificity of 85%. Complementary cardiac imaging such as echocardiography and cardiac magnetic resonance enhance graft assessment by providing structural and functional data. Together, these investigations offer a multimodal approach to rejection surveillance, reducing the frequency of endomyocardial biopsy and improving overall care for transplant recipients.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384734
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Cardiac transplantation is one of the most dramatic, esoteric, and sacred procedures available to cardiologists and cardiac surgeons as treatment for a limited number of patients with advanced, end-stage heart failure at...Cardiac transplantation is one of the most dramatic, esoteric, and sacred procedures available to cardiologists and cardiac surgeons as treatment for a limited number of patients with advanced, end-stage heart failure at imminent risk of death. Since the first "successful" allographic heart transplant in Cape Town, South Africa-in which the patient survived only 18 days-the procedure has become sine qua non for dramatic cardiovascular surgical adventures. The sacred aspect of cardiac transplantation relates to its intimate link to circulatory death, brain death, organ donation-and the miraculous gift that follows the decision to donate. It has indeed been called the "Gift of Life," where remarkable donor organ reanimation is seen in recovered hearts removed from a deceased donor. While this issue of the focuses mainly on the current state of cardiac transplantation, Houston Methodist Hospital recently celebrated the 40th anniversary of its reenergized and remodeled cardiac transplant program. The program was led initially by Michael E. DeBakey, MD, with surgeons George P. Noon, H. David Short, and Hartwell H. Whisennand, and received substantial support from the Methodist Hospital cardiology section for what was to become the Multi-organ Transplant Team. This second epoch of the heart transplant program began on February 21, 1984, following commercial availability of the immunosuppressive agent cyclosporin, and it has operated continuously since then. The following highlights several aspects of cardiac transplantation that have led to its success as a lifesaving last resort for the most severe cases, which ultimately helps explain why the procedure is, in fact, sacred.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384733
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This overview of the history of human cardiac transplant shares detailed illustrations to demonstrate how surgical procedures have improved since the first human transplant was performed in 1967 in Cape Town, South Afric...This overview of the history of human cardiac transplant shares detailed illustrations to demonstrate how surgical procedures have improved since the first human transplant was performed in 1967 in Cape Town, South Africa.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384732
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Cardiac allograft vasculopathy (CAV) is a type of coronary artery disease unique to heart transplant recipients that can result from chronic rejection of the transplanted heart. CAV is a major cause of morbidity and mort...Cardiac allograft vasculopathy (CAV) is a type of coronary artery disease unique to heart transplant recipients that can result from chronic rejection of the transplanted heart. CAV is a major cause of morbidity and mortality after the first year of transplantation. Both immune and nonimmune mechanisms contribute to the initiation and progression of CAV and result in intimal thickening, fibrosis with luminal stenosis, chronic myocardial ischemia and eventual graft failure. Recent advances in imaging modalities-including invasive intracoronary imaging and noninvasive imaging with cardiac positron emission tomography-have improved the early detection of CAV and may allow for optimization of CAV-targeted therapies to reduce CAV progression and ultimately preserve graft function.
Garry DJ, Garry MG, Nakauchi H
… +5 more, Masaki H, Sachs DH, Weiner JI, Reichart D, Wolf E
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384731
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The only curative therapy for end-stage heart failure is orthotopic allogeneic heart transplantation. This therapy has extended the survival of patients worldwide but is limited due to the scarcity of donor organs. Poten...The only curative therapy for end-stage heart failure is orthotopic allogeneic heart transplantation. This therapy has extended the survival of patients worldwide but is limited due to the scarcity of donor organs. Potential alternative donor sources of organs for transplantation include genetically-modified (GM) large animal donors (ie, xenografts) and human organs developed in large animal hosts. These strategies utilize gene editing and somatic cell nuclear transfer technologies to engineer partially or completely humanized organs. Preclinical xenotransplantation studies of GM pig hearts into baboons have already provided an important clinical foundation, as two patients have received cardiac xenografts from GM pigs and have survived for up to 2 months. Additional issues need to be addressed in order for patients to survive more than 1 year, which would make these strategies clinically applicable. Thus, in combination with immunosuppression agents, xenogeneic and exogenic organ sources hold tremendous promise for an unlimited and transformative supply of organs for transplantation.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384730
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We present a case of a 75-year-old female with a history of idiopathic small fiber neuropathy, essential hypertension, and heterozygous familial hypercholesterolemia who was evaluated for exertional dyspnea and fatigue....We present a case of a 75-year-old female with a history of idiopathic small fiber neuropathy, essential hypertension, and heterozygous familial hypercholesterolemia who was evaluated for exertional dyspnea and fatigue. Coronary computed tomography angiography demonstrated a 16-mm wide-neck windsock aneurysm of the interventricular septum along with a patent foramen ovale and left-to-right shunting. This case underscores the role of advanced cardiac imaging in detecting rare structural abnormalities.
Methodist Debakey Cardiovasc J
· 2025 · PMID 40384729
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Oliver Wendell Holmes Sr. (1809-1894) was a poet, essayist, educator, and physician who played an important role in the formation of the American medical establishment. After studying medicine in Paris, Holmes penned wha...Oliver Wendell Holmes Sr. (1809-1894) was a poet, essayist, educator, and physician who played an important role in the formation of the American medical establishment. After studying medicine in Paris, Holmes penned what may be his most memorable satirical poem, "The Stethoscope Song," which was first published around 1848. He was a master of stethoscopy and used this ballad to reflect upon the initial resistance to its widespread adoption as well as to give a cautionary tale that auscultation should not replace a thorough medical examination. Holmes was a prominent clinician with important contributions to both medical literature and pedagogy, but he also became a notable author who set a precedent upon which future generations of physician-writers could build.
Quiñones MA, Avenatti E, Javed Z
… +6 more, Lador A, Saavedra R, Patham B, Calderon A, Vijayaraghavan K, Sareen N
Methodist Debakey Cardiovasc J
· 2025 · PMID 40322623
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This 76-minute webcast features a conversation about "Obesity and the Heart"-the focus of Issue 21.2. Led by the issue's editor, the discussion engages the authors on emerging themes and lessons learned while researching...This 76-minute webcast features a conversation about "Obesity and the Heart"-the focus of Issue 21.2. Led by the issue's editor, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/4867850.