Archives of Cardiovascular Diseases最新文献

{"title":"First-Trimester Screening for Severe Congenital Heart Defects in High-Risk Fetuses: The French PréCaFoet Study","authors":"Matthias Lachaud","doi":"10.1016/j.acvd.2025.06.059","DOIUrl":"10.1016/j.acvd.2025.06.059","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital heart defects (CHDs) are among the most common congenital anomalies, with significant postnatal mortality. Prenatal detection is crucial for preparing parents and healthcare providers for prognosis and management. In France, since 2022, the CNEOF guidelines recommend first-trimester cardiac ultrasound screening for all pregnancies, including low-risk cases. However, limited studies have evaluated the diagnostic accuracy of this approach in non-tertiary care settings.</div></div><div><h3>Method</h3><div>The PRéCaFoet study was a prospective multicenter cohort study conducted from November 2020 to May 2024 across 12 French centers. It aimed to assess the diagnostic performance of first-trimester screening for severe CHDs in high-risk pregnancies. Inclusion criteria included increased nuchal translucency (&gt;<!--> <!-->3.5<!--> <!-->mm), first-degree family history of CHD, or suspicion of cardiac or extracardiac anomalies during routine first-trimester ultrasound. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) compared to gold-standard second-trimester ultrasound or fetal autopsy.</div></div><div><h3>Results</h3><div>Among 401 eligible pregnancies analyzed, 375 had conclusive first-trimester reference ultrasounds (Echo Ref T1). Severe CHDs were detected in 33 fetuses at T1 and confirmed in 30 at T2. Sensitivity and specificity for severe CHD detection at T1 were 83.3% and 93%, respectively, with a PPV of 58.1% and an NPV of 98%. Sequential screening (Echo Ref T1 followed by fetal echocardiography in abdnormal or inconclusive cases) reduced non-contributive cases from 5.7% to 2.8%. Prognostic evaluation revealed significant uncertainties: among 40 severe CHD cases, cardiac type (univentricular <em>vs.</em> biventricular) remained undetermined in 37.5%, and curability could not be assessed in 37.5% of cases. Detection rates varied by defect type: univentricular defects (87.5%), transposition of the great arteries (100%), atrioventricular canal defects (75%), tetralogy of Fallot (50%), ventricular septal defects (25%), and total anomalous pulmonary venous return (0%).</div></div><div><h3>Conclusion</h3><div>First-trimester screening for severe CHDs demonstrated high sensitivity and specificity in a high-risk population within a non-tertiary care network. However, prognostic assessment at T1 proved challenging, with inconclusive classifications in over one-third of cases, underscoring limitations in early counseling for complex defects.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Page S279"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter closure of large perimembranous ventricular septal defects from infancy to adulthood with Amplatzer vascular plug II","authors":"Alain Fraisse ,&nbsp;Alban-Elouen Baruteau ,&nbsp;Clement Karsenty ,&nbsp;Hélène Bouvaist ,&nbsp;Sébastien Armero ,&nbsp;Jose Diogo Ferreira-Martins ,&nbsp;Radwa Bedair ,&nbsp;Aleksander Kempny ,&nbsp;Carles Bautista-Rodriguez","doi":"10.1016/j.acvd.2025.06.042","DOIUrl":"10.1016/j.acvd.2025.06.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Perimembranous ventricular septal defects (pmVSD) are the most frequent type of VSD. Around 50% will become significant. The surgical approach under cardiopulmonary bypass is the usual treatment for large pmVSD but less invasive ranscatheter closure of pmVSD with rigid asymmetric devices was initially a promising alternative. Unfortunately, despite high success rates, those devices were associated with high incidence of complete heart block, arrhythmias, tricuspid and/or aortic valve dysfunction, and haemolysis. They were abandoned. More recently, limited experience with softer devices has been successful in selected cases. However, closure of large defect in patients with cardiac failure and/or pulmonary hypertension is often not feasible. The aim of this study is to report our experience with large pm VSD defects from childhood to adulthood using the Amplatzer vascular plug II (AVPII) (Abbott, USA), paying particular attention to the impact on conduction tissue.</div></div><div><h3>Method</h3><div>This retrospective multicenter study included children and adults with hemodynamically significant large (&gt;<!--> <!-->8<!--> <!-->mm diameter) pmVSD undergoing transcatheter device closure with AVPII between May 2016 and June 2024. A subgroup of patients was paired with control patients undergoing surgical closure for dyssynchrony assessment by echocardiography.</div></div><div><h3>Results</h3><div>86 patients were included (75% children and 21<!--> <!-->&lt;<!--> <!-->10 Kg). Success rate was 95% (90% in children<!--> <!-->&lt;<!--> <!-->10Kg). Complications were embolisation (n<!--> <!-->=<!--> <!-->2), new mild aortic and tricuspid regurgitation (n<!--> <!-->=<!--> <!-->2 and 3, respectively). No atrioventricular block occured. Median follow-up was 5.6 years (1 month–7.9 years) in children and 4.7 years (4 months–7.5 years) in adults. 2 children and 2 adults had residual shunt 1-month after the procedure. The left cavities dilation normalised in all cases. No significant rhythm/conduction abnormalities occured. Synchrony assessment was performed in 51 device closure patients and in 51 matched surgical patients. Surgical patients had longer QRS duration and a higher rate of right bundle branch blocks (<em>p</em> <!-->=<!--> <!-->0.002). The surgical group showed higher prestretch and postsystolic shortening amplitudes and longer time-to-peak postsystolic shortening.</div></div><div><h3>Conclusion</h3><div>Transcatheter closure of pmVSD using the AVP II through a retrograde approach is safe and effective in children and adults with large pmVSD. This is associated with less electromechanical impairment compared to the surgical approach.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Page S269"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Congenital Non-Ebstein Tricuspid Dysplasia","authors":"Sofiane Mimoun ,&nbsp;Pierre Mauran ,&nbsp;Jelena Radojevic ,&nbsp;Belli Emre","doi":"10.1016/j.acvd.2025.06.054","DOIUrl":"10.1016/j.acvd.2025.06.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-Ebstein tricuspid dysplasia (NTD) is a rare congenital malformation of the tricuspid valve, characterized by the absence of delamination defects and normal leaflet insertion without apical displacement. The valvular lesions present as thickening and restriction, leading to significant tricuspid regurgitation (TR). The anatomical and morphological variability of this condition makes surgical management complex, and there are no established surgical guidelines.</div></div><div><h3>Method</h3><div>We conducted a retrospective, single-center study from November 2010 to March 2023, assessing the surgical management of NTD in pediatric and adult patients with short-term follow-up. Patients with single-ventricle heart disease, Ebstein anomaly, or any congenital heart defect involving the tricuspid valve were excluded. The surgical techniques employed (valve reconstruction, annuloplasty) and their post-operative outcomes were analyzed (TR, right ventricular (RV) function, post-operative complications, and short- to medium-term survival).</div></div><div><h3>Results</h3><div>Sixteen patients (six children and ten adults) were included in this analysis, most of whom were symptomatic at the time of surgery. The mean age at surgery was 28 years. Tricuspid valve reconstruction combined with annuloplasty was performed in 80% of adults but only in two children. Patients who underwent valve reconstruction with annuloplasty were more likely to have TR grades I and II at discharge (<em>p</em> <!-->=<!--> <!-->0.026). At discharge, 70% of patients who underwent valve reconstruction and annuloplasty had only mild TR. At one-year follow-up, TR grade progression was not significantly different between surgical techniques. However, in the annuloplasty group, TR tended to progress to grade III in 37.5% of cases. In contrast, 80% of post-operative grade II TR cases remained stable in the reconstruction-only group. No deaths were reported, and the rate of major complications was low (5%, mainly transient arrhythmias).</div></div><div><h3>Conclusion</h3><div>Our study evaluates the surgical management of biventricular physiology NTD in 16 adult and pediatric patients at a specialized center. This congenital heart defect is often misdiagnosed as Ebstein anomaly and lacks standardized diagnostic criteria. Our findings suggest that NTD surgery provides encouraging short-term outcomes, with excellent survival rates and limited complications, including in pediatric patients. Early surgical intervention, before RV dilation or dysfunction develops, is crucial to preserving right ventricular function and achieving optimal TR outcomes. Valve reconstruction combined with annuloplasty seems to effectively reduce TR in the immediate post-operative period.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Pages S276-S277"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the cardiac response during deceleration? An experimental study using a fetal sheep model","authors":"Naïma Abshir Ali ,&nbsp;Sanchez Maeva ,&nbsp;Baptiste Teillet ,&nbsp;Geoffroy Chevalier ,&nbsp;Sharma Duty ,&nbsp;Kevin Leduc ,&nbsp;Charles Garabedian ,&nbsp;Ali Houeijeh","doi":"10.1016/j.acvd.2025.06.026","DOIUrl":"10.1016/j.acvd.2025.06.026","url":null,"abstract":"<div><h3>Introduction</h3><div>The study aim was to describe fetal cardiovascular physiology during cord compressions that mimicked uterine contractions.</div></div><div><h3>Method</h3><div>For this experimental study in a near-term fetal sheep model, an impedance measurement probe was surgically inserted into the fetal left ventricle to enable pressure and volume measurements. An axillary arterial catheter was used for gasometric sampling. The protocol involved mimicking contractions using umbilical cord occlusion (UCO) with six complete 1-min UCO every 10<!--> <!-->min. During these occlusions, cardiac parameters, including dynamic (<em>i.e.</em> pressure–volume curve), hemodynamic, and gasometric parameters were recorded.</div></div><div><h3>Results</h3><div>Five fetuses were included. At 10s after the start of UCO, heart rate fell by 26.1%, left-ventricular end-diastolic volume by 14,6%, end-systolic volume by 4,8%, and left-ventricular output by 69.7%. Simultaneously, end-diastolic pressure rose by 8,8% and end-systolic pressure by 15.1%. There was an increase in pCO2 (+8%) and a parallel decrease in partial pressure of oxygen (pO2, −20%) during the first 10s, while arterial pH remained stable. Pressure–volume curve analysis revealed a decrease in volume and flow, with preservation of systolic function and decline of diastolic function, followed by an increase in volume and a decrease in contractility.</div></div><div><h3>Conclusion</h3><div>This study shows cardiac adaptation to UCO, with an initial increased systemic pressure with transient decrease of the left ventricle volumes and systemic cardiac output. Otherwise, cardiac systolic function was preserved during the first part of the UCO, followed by a slow decrease during the second part. Nevertheless, diastolic cardiac dysfunction was observed at the early UCO stage. This cardiac adaptation highlights the multiple physiological mechanisms involved in fetal deceleration during labor.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Pages S260-S261"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memoriam–Roberto Lang","authors":"","doi":"10.1016/j.acvd.2025.07.001","DOIUrl":"10.1016/j.acvd.2025.07.001","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Pages 423-424"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Diagnosis and Treatment of Transposition of the Great Arteries: A Single-Center Experience in Tunisia","authors":"Rania Gargouri ,&nbsp;Molka Louati ,&nbsp;Mariem Jabeur ,&nbsp;Afef Ben Thabet ,&nbsp;Salma Charfeddine ,&nbsp;Leila Abid","doi":"10.1016/j.acvd.2025.06.030","DOIUrl":"10.1016/j.acvd.2025.06.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical management of congenital heart disease, particularly transposition of the great arteries (TGA), remains challenging in resource-limited settings. With predominant postnatal diagnosis and delayed correction, outcomes differ from high-income countries.</div><div>The aim of our study was to define the epidemiological and clinical characteristics ofTGA in a Tunisian population, describe its management in our setting, identify factors associated with morbidity and mortality, and evaluate short- and medium-term (one-year) follow-up outcomes in our patients.</div></div><div><h3>Method</h3><div>This was a retrospective, descriptive, and analytical study conducted over a 9-year period (2014–2022), including 51 patients with TGA hospitalized in the pediatrics, neonatology, and cardiology departments of Hedi Chaker University Hospital in Sfax. Epidemiological, clinical, and cardiac ultrasound data were collected for all patients, along with initial and subsequent surgical management, early and late preoperative mortality and its predictive factors, and patient outcomes.</div></div><div><h3>Results</h3><div>In hospital frequency of TGA was 1.82 per 1000 admissions, with a male-to-female ratio of 2.92. Prenatal diagnosis was made in 5.9% of cases, with a mean age at detection of 2 days. Simple TGA accounted for 82.4% (42 patients), while complex TGA represented 17.6% (9 patients). During initial management in our country, balloon atrial septostomy (BAS) was performed in 80.4% of cases. Early preoperative mortality was 19.6%, significantly associated with low birth weight and insufficient shunting. Surgical repair was performed in 80.4% of cases at a mean age of 27 days. Only one patient was operated in Tunisia, with a perioperative mortality rate of 4.9% and no late mortality at one year. The arterial switch operation was the preferred technique, performed in 95.1% of operated patients, with a low reintervention rate of 2.6%. Short- and medium-term follow-up outcomes were comparable to those in developed countries.</div></div><div><h3>Conclusion</h3><div>Despite the lack of appropriate diagnostic and therapeutic resources for early and adequate TGA management in our country, our patients achieved satisfactory outcomes with a high survival rate following often delayed treatment abroad. Improving initial neonatal management, particularly through more frequent prenatal diagnosis, would significantly reduce preoperative mortality and enhance survival rates.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Page S263"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of malnutrition and its impact on postoperative outcomes in children operated on for a cardiac malformation","authors":"Rémi Barbaud,&nbsp;Elodie Garnier,&nbsp;Nathalie Soulé,&nbsp;Jean Issa,&nbsp;Paul Neville,&nbsp;Jean Marc El Arid,&nbsp;Bruno Lefort","doi":"10.1016/j.acvd.2025.06.023","DOIUrl":"10.1016/j.acvd.2025.06.023","url":null,"abstract":"<div><h3>Introduction</h3><div>It has been shown that malnutrition is associated with an increase in mortality and postoperative complications. Based on the new HAS (Haute Autorité de Santé) recommendations for diagnosing malnutrition, the objectives of our study were: 1) to measure the extent of malnutrition in children undergoing congenital heart disease surgery at the University Hospital of Tours, 2) to identify factors potentially associated with malnutrition, and 3) to evaluate the impact of malnutrition on the occurrence of postoperative complications.</div></div><div><h3>Method</h3><div>The perioperative medical data of 300 consecutive children who underwent cardiac surgery between 2021 and 2024 at the University Hospital of Tours were retrospectively collected. Malnutrition was defined according to the HAS by a body mass index (BMI) below the IOTF 18.5 curve (International Obesity Task Force curves), and severe malnutrition by a BMI–IOTF<!--> <!-->≤<!--> <!-->17.</div></div><div><h3>Results</h3><div>56% of the children in the cohort were malnourished the day before surgery, and 37% had severe malnutrition. Children with a ventricular septal defect (VSD), mitral regurgitation, or a truncus arteriosus were the most malnourished. Moreover, malnutrition was significantly associated with heart failure, treatment with Furosemide and/or ACE inhibitors, and a younger age. Children of African origin, supported by humanitarian organizations, were also more malnourished.</div><div>Malnourished children on the day before surgery experienced more wound dehiscence, longer aortic clamping, lower hemoglobin levels, and a higher number of platelet transfusions. However, mortality, length of hospital stay, or infections did not differ between malnourished and non-malnourished children.</div></div><div><h3>Conclusion</h3><div>More than 50% of children who underwent cardiac surgery at our center were malnourished. The main factor for malnutrition was the presence of heart failure. Optimal preoperative nutritional support seems necessary to prevent postoperative complications, which are more frequent in these children.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Page S259"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can prostaglandin E1 dosage adjustment calibrate the ductus arteriosus?","authors":"Aude Givone ,&nbsp;Mohamed Riadh Boukhris ,&nbsp;Jean Benoit Baudelet ,&nbsp;Olivia Domanski ,&nbsp;Laurent Storme ,&nbsp;Sixtine Gilliot ,&nbsp;Kevin Le Duc","doi":"10.1016/j.acvd.2025.06.039","DOIUrl":"10.1016/j.acvd.2025.06.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostaglandin E1 (PGE1) infusion is commonly used to maintain ductus arteriosus (DA) patency in neonates with duct-dependent congenital heart disease or severe pulmonary hypertension. Identifying reliable parameters for calibrating DA patency in response to dosage adjustments is essential. This study investigates whether there is a dose-dependent relationship between PGE1 infusion and the inner diameter of the DA.</div></div><div><h3>Method</h3><div>A retrospective study was conducted in a level III neonatal intensive care unit from January to December 2022. Newborns who received PGE1 infusion and underwent transthoracic echocardiography before and after any dose adjustment were consecutively included. We assessed DA's inner diameter, mean and end-diastolic velocities in the left pulmonary artery (LPA), and maximal left-to-right transductal velocity.</div></div><div><h3>Results</h3><div>A total of 19 newborns were included: 12 with duct-dependent congenital heart diseases and 7 with severe pulmonary hypertension. Before dosage adjustment, the median DA inner diameter, mean LPA velocity, end-diastolic LPA velocity, and maximal transductal shunt velocity were 3.0 (2.3–3.6) mm, 0.49 (0.4–0.57) m.s⁻¹, 0.24 (0.19–0.30) m.s⁻¹, and 1.2 (1.0–1.55) m.s⁻¹, respectively. The median reduction in PGE1 dose was −0.0035 (−0.001 to −0.008) μg/kg/min. After dose modification, the median DA inner diameter, mean LPA velocity, end-diastolic LPA velocity, and maximal transductal shunt velocity were 3.0 (2.0–3.9) mm, 0.51 (0.38–0.67) m.s⁻¹, 0.26 (0.20–0.38) m.s⁻¹, and 1.09 (0.8–1.5) m.s⁻¹, respectively. No statistically significant changes were observed across these parameters.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that changes in echocardiographic hemodynamic parameters of the DA do not correlate with modifications in PGE1 dosage in routine clinical practice. Therefore, no pharmacodynamic model could be predicted based on PGE1 dosage adjustments.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Page S268"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Management of Atypical Scimitar Syndrome with Dual Venous Drainage","authors":"Nour Gangate ,&nbsp;Clement Batteux ,&nbsp;Guillaume Reverdito ,&nbsp;Grégoire Albenque ,&nbsp;Gilles Bosser ,&nbsp;Phalla Ou ,&nbsp;Jean-Marc Lupoglazof ,&nbsp;Lucie Mantes ,&nbsp;Valentin Baland ,&nbsp;Joy Zoghbi ,&nbsp;Régine Roussin ,&nbsp;Lisa Guirgis ,&nbsp;Ghita Afilal ,&nbsp;Alice Capel ,&nbsp;Estíbaliz Valdeolmillos ,&nbsp;Emre Belli ,&nbsp;Sebastien Hascoet","doi":"10.1016/j.acvd.2025.06.045","DOIUrl":"10.1016/j.acvd.2025.06.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Scimitar syndrome is a rare congenital anomaly characterized by partial anomalous pulmonary venous return from the right lung to the inferior vena cava (IVC). An atypical rare variant involves dual drainage—into both the IVC and a left atrial connection—potentially allowing for a catheter-based intervention.</div></div><div><h3>Method</h3><div>We report three patients diagnosed with atypical scimitar anatomy over a 12-month period at our institution. All underwent multimodal imaging and transcatheter intervention.</div></div><div><h3>Results</h3><div>Patients were aged 5, 26, and 34 years. Scimitar syndrome was diagnosed incidentally during follow-up for asthma or recurrent respiratory infections. Patients were in NYHA-WHO functional class 2. All presented with dual venous drainage on cardiac CT, confirmed by catheterization. Cardiac MRI showed significant left-to-right shunting and right ventricular dilation. Pulmonary artery pressures were normal in 2 patients (mean pulmonary artery pressure at 17 and 19<!--> <!-->mmHg) and slightly elevated in one patient (22<!--> <!-->mmHg). No patient had associated intra-cardiac left to right shunt.</div><div>Balloon occlusion testing at the IVC opening of the scimitar vein demonstrated adequate left atrial drainage without pressure elevation. Two patients had stenosis at the IVC connection. All three underwent transcatheter closure of the scimitar vein's IVC connection using amplatzer duct occluder (<span><span>Figure 1</span></span>). Systemic-to-pulmonary collaterals, present in 2 patients, were embolized. All procedures were successful and complication-free. Symptomatic patients reported clinical improvement during follow-up.</div></div><div><h3>Conclusion</h3><div>In this rare anatomical configuration, transcatheter closure of the anomalous IVC drainage is feasible, safe, and effective. This strategy may prevent long-term complications of chronic left-to-right shunting and represents a minimally invasive alternative to surgery in selected cases.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Pages S270-S271"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of transcatheter closure of ostium secundum atrial septal defects with multiple versus single device in 2,253 children and adults","authors":"Grégoire Albenque ,&nbsp;Mohamed Jaber ,&nbsp;Estíbaliz Valdeolmillos ,&nbsp;Marine Cachanado ,&nbsp;Jerome Petit ,&nbsp;clement Batteux ,&nbsp;Sebastien Hascoet","doi":"10.1016/j.acvd.2025.06.043","DOIUrl":"10.1016/j.acvd.2025.06.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Transcatheter closure of ostium secundum atrial septal defect (osASD) is the first-line treatment in most children and adults. However, the use of multiple devices during the same procedure is uncommon, and data on the feasibility and safety of this approach remain limited. This study aims to assess the outcomes of osASD closure using multiple devices.</div></div><div><h3>Method</h3><div>This prospective, single-center cohort study included patients who underwent transcatheter osASD closure with an Amplatzer Septal Occluder (ASO) between May 1998 and December 2021 at Marie Lannelongue Hospital. Periprocedural data and major adverse events (MAEs) were retrospectively analyzed. A comparison was then made between patients who received a single device versus multiple devices.</div></div><div><h3>Results</h3><div>Among 2,253 patients, 216 (9.6%) had complex osASD, including 6.4% with double osASD and 3.7% with multi-fenestrated osASD. Multiple devices were implanted in 19 patients (0.8%), including four pediatric cases. One 53-year-old patient was implanted with three devices (ASO sizes 20, 12, and 10<!--> <!-->mm). Patients with multiple devices were more likely to have an interatrial septal aneurysm (OR 3.54 [1.38−9.06], <em>p</em> <!-->=<!--> <!-->0.008). Procedural success was 100%, with no major adverse events in these patients. No significant differences in minor complications, atrial tachycardia, residual shunt, or pericardial effusion were observed between groups. Long-term follow-up of 6.2 years showed no deaths, cardiac reinterventions, significant residual shunts, thromboembolic events, atrial arrhythmias, or conduction disturbances in the multiple-device group.</div></div><div><h3>Conclusion</h3><div>Transcatheter closure of complex osASD using multiple devices is a feasible and safe approach, with excellent procedural and long-term outcomes when required.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 8","pages":"Pages S269-S270"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}