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Paravalvular leaks (PVL) are seen in 5-17% of patients after surgical mitral and aortic valve replacement. This is usually well-tolerated in the majority of patients; however, up to 5% will require re-intervention due to either hemodynamically significant regurgitation or hemolysis requiring repeated blood transfusion. Transcatheter closure of PVLs is becoming the treatment of choice in many patients owing to the high risk of redo surgery, high rates of recurrence with the surgical approach, and substantial improvements in device technology and growing expertise in structural heart disease interventions. Careful selection of the appropriate candidates by the Heart Team with in-depth analysis of clinical and multimodality imaging data is critical to ensuring good short- and long-term outcomes. The defect is usually oval/ crescentic and often serpiginous in nature, which poses significant challenges in the optimal size and number of devices to implant - especially with large size defects. Generally, defects involving more than 25-30% of the sewing ring are generally deemed unsuitable for percutaneous closure. While the Amplatzer family of vascular plugs (e.g. AVP3 and AVP2) is commonly used for percutaneous closure of PVLs, there are currently no approved dedicated devices for this indication, except the paravalvular leak device (Occlutech) which is not universally available. Small and relatively circular defects can usually be closed using a single plug, conventionally utilizing a size that is 25-30% larger than the mean diameter of the defect. Larger and crescentic defects on the other hand frequently require more than one plug and can be quite challenging in terms of choosing the appropriate size(s). We report two cases with very large defects with irregular shape in which 3D printed modeling was extremely useful for bench testing to optimize the number and sizes of devices to be implanted. [ABSTRACT FROM AUTHOR]

Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) has emerged as a powerful intravascular imaging modality in recent years. The introduction of frequency-domain OCT has simplified the procedure and enabled its safe utilisation in different clinical settings including acute coronary syndromes, where it can determine the mechanism of plaque disruption, thrombus burden, and guide percutaneous coronary intervention. In patients presenting with stent failure (stent thrombosis and instent restenosis), OCT can also be very useful in determining the underlying mechanism and guiding therapy thereafter. This article aims to review the role of OCT in acute coronary syndromes as well as its potential clinical applications. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) is currently indicated for patients with severe symptomatic aortic stenosis who are unfit for surgery or when the surgical risk is high. Thanks to the increasing experience of surgeons, better patient selection, and substantial improvements in device technology, the procedure is now being performed with excellent outcomes and a progressively lower rate of complications. As a result, the cut-off threshold to implant a transcatheter valve is gradually moving toward lower risk patients. However, this is not supported by strong evidence from rigorous large clinical trials. The PARTNER 2A and SAPIEN 3 trials were conducted to address this gap in our knowledge. [ABSTRACT FROM AUTHOR]

The advancement that took place in assessing fractional flow reserve (FFR) using various competing modalities led to numerous research trials to evaluate the clinical impact of each. Among those trials is the recently published PLATFORM study. The data was designed to compare two clinical scenarios; a combination of computed fluid dynamics with computed tomographic angiography (CTA-guided strategy) in non-obstructive coronary artery disease (CAD) on one arm, compared to the standard practice representing the other clinical arm. The study's results were evaluated for further evidence and clinical insights. [ABSTRACT FROM AUTHOR]

The article discusses the lessons learned from various randomized trials regarding the comparison between culprit lesion-only and complete revascularization in patients with ST-elevation myocardial infarction (STEMI).

One of the most intriguing aspects of cell biology is the state of pluripotency, where the cell is capable of self-renewal for as many times as deemed "necessary", then at a specified time can differentiate into any type of cell. This fundamental process is required during organogenesis in foetal life and importantly during tissue repair in health and disease. Pluripotency is very tightly regulated, as any dysregulation can result in congenital defects, inability to repair damage, or cancer. Fuelled by the relatively recent interest in stem cell biology and tissue regeneration, the molecules implicated in regulating pluripotency have been the subject of extensive research. One of the important molecules involved in pluripotency, is NaNog, the subject of this article. [ABSTRACT FROM AUTHOR]

Contrary to its central role in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) in stable ischemic heart disease (SIHD) remains largely restricted to patients in whom medical treatment fails to control symptoms, or those with a large area of myocardium at risk and/or high risk findings on non-invasive testing. These recommendations are based on a number of studies - the largest of which is COURAGE - that failed to show any reduction in mortality or myocardial infarction (MI) with PCI compared to optimal medical therapy (OMT) in this group of patients. A possible limitation in these studies was relying on visual assessment of angiographic stenoses (which is now well-known to be imprecise) to determine lesions responsible for myocardial ischemia. Non-invasive stress testing - including imaging - may also be inaccurate in patients with multivessel coronary artery disease. These limitations have inadvertently led to the inclusion of patients with non-ischemic lesions in these studies, which may have diluted any potential benefit with PCI. Given the superiority of fractional flow reserve (FFR) in identifying ischemic lesions compared to angiography, Fractional flow reserve versus Angiography for Multivessel Evaluation 2 (FAME 2) investigators hypothesized that when guided by FFR, PCI plus medical therapy would be superior to medical therapy alone in patients with SIHD. [ABSTRACT FROM AUTHOR]

The article provides information on research on the reversal of ageing cardiac and skeletal muscle. Topics addressed include the prevalence of heart failure with preserved ejection fraction (HFpEF), influence of ageing skeletal muscle on heart function, and mechanisms responsible for the decline in skeletal muscle. It also mentioned the molecular pathogenesis of HFpEF.

The article explores whether the PARADIGM-HF clinical trial has achieved a new paradigm in the treatment of heart failure. The trial compares the impact between LCZ696, a combination of an angiotensin-receptor blocker and neprilysin inhibitor sacubitril, and the angiotensin converting enzyme inhibitor enalapril in patients with left ventricular systolic dysfunction and heart failure. It emphasizes that the trial results provide an optimism that progress is made towards heart failure treatment.

The use of radiation in medicine is now pervasive and routine. From their crude beginnings 100 years ago, diagnostic radiology, nuclear medicine and radiation therapy have all evolved into advanced techniques, and are regarded as essential tools across all branches and specialties of medicine. The inherent properties of ionizing radiation provide many benefits, but can also cause potential harm. Its use within medical practice thus involves an informed judgment regarding the risk/benefit ratio. This judgment requires not only medical knowledge, but also an understanding of radiation itself. This work provides a global perspective on radiation risks, exposure and mitigation strategies. [ABSTRACT FROM AUTHOR]

Data from the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial6 and 5-year results from the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI)7 are evaluated for further evidence on the effectiveness and safety of a pharmacoinvasive approach for patients presenting with acute ST-segment elevation myocardial infarction (STEMI). [ABSTRACT FROM AUTHOR]

The St Vincent's Screening TO Prevent Heart Failure (STOP-HF) study is a recently published trial that assessed the use of brain natriuretic peptide (BNP) as a screening tool for HF in an at-risk population in reducing newly-diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction. The study provides an excellent model to the global community on how to integrate primary care simple screening with secondary and tertiary level targeted diagnostic and therapeutic system. This integration includes screening of high-risk groups, use of a sensitive screening tool, early diagnostic modalities, early therapeutic interventions, and proper assessment of the hard clinical outcomes. However, more studies are needed across multiple sites around the world with different levels of health care services and variable biomarkers to identify higher-risk groups. [ABSTRACT FROM AUTHOR]

The use of bivalirudin during primary percutaneous coronary intervention (PPCI) is perceived to be associated with less bleeding compared to unfractionated heparin (UFH). However, evidence supporting this observation is confounded by the frequent co-administration of glycoprotein IIb/IIIa inhibitors in the UFH arm in the majority of previous large trials. The "How Effective Are Antithrombotic Therapies in Primary PCI (HEAT-PPCI)" trial was conducted to test the efficacy and safety of UFH vesrus bivalirudin in patients undergoing PPCI when GP IIb/IIIa inhibitors are used selectively. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 26-year-old male patient who was admitted with acute onset of haemoptysis, orthopnoea and dyspnoea. Echocardiography revealed peculiar morphology of the aortic root, moderate mitral regurgitation and severe aortic regurgitation. Computed tomography confirmed an un-ruptured right sinus diagnosis of Valsalva aneurysm and the patient underwent aortic root surgery.

Heart failure with preserved ejection fraction (HFpEF) continues to be a challenging form of heart failure - one in which no therapy has yet been proven to improve outcome. Aldosterone antagonists have previously been shown to improve survival in a wide spectrum of patients with heart failure with reduced ejection fraction (HFrEF), and more recently, small trials suggested that they might have role in HFpEF patients. The effect of spironolactone on clinical outcomes in HFpEF was tested in the TOPCAT study. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the efficacy of biventricular (BiV) over right ventricular pacing in heart failure patients with atrioventricular (AV) block. Details on the randomization of 691 patients with left ventricular (LV) ejection fraction (LVEF) of less than 50% is discussed. The superiority of the long-term clinical and functional outcomes of BiV pacing in patients with AV block and indications for cardiac pacemaker implantation and mild LV dysfunction is explained.

The author reflects on the discovery of PCSK9inhibitors as a result of further research after the discovery of the role of low-density lipoprotein (LDL) receptors in lipid clearance in a translational research. A history of the development of the strategies to inhibit the protein or RNA is offered. The author articulates that the discovery serves as an example of creativity as defined by late biologist Peter Medawar with a methodology that follows inventor Steve Job's approach.

Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies. [ABSTRACT FROM AUTHOR]

Venous aneurysms are relatively rare anomalies which can affect different parts of the vascular system. Diagnosis and management of this condition could pose important problems. We here report a giant false aneurysm of the subclavian vein with emphasis on the thought process that determined the management strategy. [ABSTRACT FROM AUTHOR]

The article discusses a study on the results of the Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia trial (TASTE), a randomized clinical trial for patients with ST-segment elevation myocardial infarction.

The article focuses on the Randomized Ischemic Mitral Evaluation (RIME) trial to study repairing of the disorder of the heart moderate Ischemic Mitral Regurgitation (IMR) at the time of surgical revascularization. The trial conducted on patients receiving coronary artery bypass grafting (CABG) with mitral valve repair showed significant improvement than patients receiving the CABG only. It suggests further studies to identify the moderate IMR patients.

We examine the one-year mortality rates from the STREAM trial, recently published in Circulation. [ABSTRACT FROM AUTHOR]