Simultaneous Transcatheter Closure of a Ventricular Septal Defect and Pulmonary Valvuloplasty: A Case Report.

BACKGROUND Congenital heart diseases (CHDs) are the most common form of birth defects, affecting the structure and function of neonatal hearts. Pulmonary valve stenosis (PVS) and ventricular septal defects (VSD) are 2 of the more prevalent forms, both of which can lead to significant morbidity if left untreated. The emergence of transcatheter techniques has revolutionized the therapeutic landscape, presenting minimally invasive yet effective alternatives to open-heart surgery and significantly reducing associated patient morbidity and recovery time. CASE REPORT The presented case details the management of a 19-year-old man with complex CHDs, highlighting the nuanced decision-making process that led to a transcatheter approach. The patient's clinical presentation, marked by symptoms reflective of significant cardiac compromise, demanded a tailored approach that utilized the latest advancements in non-surgical intervention. The successful closure of the VSD with an Amplatzer device and the resolution of PVS via balloon valvuloplasty were achieved without complications, showcasing the potential of these techniques in managing similar cases. The post-intervention period was marked by a noteworthy recovery, confirming the procedural efficacy and enhancing the patient's quality of life. CONCLUSIONS The favorable outcome of this case highlights the pivotal role of transcatheter interventions in treating complex CHDs and suggests a shift towards less invasive approaches in cardiac care. This case contributes valuable insights to the existing body of evidence, reinforcing the potential of transcatheter techniques to become the preferred treatment modality. With promising immediate and short-term results, these techniques highlight the need for continued research into their long-term efficacy and application across diverse patient demographics.

Acute Myocardial Infarction Associated With Amphetamine Use and Smoking in a Young Healthy Individual.

One of the primary causes of death among methamphetamine users is cardiovascular disease, which is a result of the narrowing and spasm of blood vessels caused by the drug. This leads to increased blood pressure and heart rate, which can damage the heart muscle at the molecular level. The most common forms of chronic cardiovascular disease associated with methamphetamine use are coronary artery disease and cardiomyopathy. Here, we report a case of myocardial infarction (MI) due to amphetamine use and smoking in a young healthy male who developed ST-elevation myocardial infarction, ventricular fibrillation (VF), and cardiac arrest. A 28-year-old male presented to the emergency department with chest pain and shortness of breath during exercise. Immediately upon presentation, electrocardiography was done which initially showed sinus tachycardia that progressed to right bundle branch block and ST elevation with a shark fin morphology, followed by VF and cardiac arrest. He was resuscitated and underwent percutaneous coronary intervention with stenting of the left anterior descending artery. Cardiotoxic manifestations such as acute MI, heart failure, or arrhythmia related to misuse of amphetamines have been rarely documented. This case report describes the clinical course and management of a young male patient who suffered a life-threatening cardiac event triggered by smoking and amphetamine abuse.

The prevalence of non-syndromic orofacial clefts and associated congenital heart diseases of a tertiary hospital in Riyadh, Saudi Arabia.

BACKGROUND: Orofacial clefts are considered one of the most common birth defects and are frequently associated with other malformations. Congenital heart disease is one of the most prevalent congenital malformation. OBJECTIVE: To investigate the prevalence of congenital heart diseases associated with non-syndromic orofacial clefts in the Saudi population. METHODS: Electronic files of non-syndromic orofacial cleft patients who visited the Oral and Maxillofacial Surgery Department in King Abdulaziz Medical City of Riyadh, Saudi Arabia from January 2015 to December 2018 were retrospectively reviewed. Data were recorded in an excel sheet and analyzed using SPSS via frequency tests. RESULTS: In the cleft children identified, the prevalence of non-syndromic orofacial clefts was (77%). Orofacial clefts showed a male predominance (62%). The most common orofacial phenotype was unilateral cleft lip and palate (34%). The prevalence of associated congenital malformations with orofacial clefts was (41%). The most prevalent congenital malformation was congenital heart disease (35%), mainly found in unilateral cleft lip and palate patients (33%). The prevalence of associated congenital heart disease with orofacial clefts was (19%). The most frequent type of congenital heart disease was atrial septal defect (37%). CONCLUSION: This study highlights the recognition of the associated congenital heart disease with non-syndromic orofacial cleft patients. Global screening protocols designed for newborns with non-syndromic orofacial cleft are needed to eliminate late diagnosis of critical congenital heart diseases which might present operative risks of anesthesia and/or surgical procedures.

Myocardial Flow Reserve and Coronary Calcification in Prognosis of Patients With Suspected Coronary Artery Disease.

OBJECTIVES: The aim of this analysis is to examine the incremental prognostic value of coronary artery calcium (CAC) score and myocardial flow reserve (MFR) in patients with suspected coronary artery disease (CAD) undergoing positron emission tomography (PET) myocardial perfusion imaging (MPI). BACKGROUND: Advances in cardiac PET and computed tomography imaging enabled the simultaneous acquisition of anatomic and physiological data for patients suspected of CAD. METHODS: Consecutive patients who underwent PET MPI and CAC score calculation at King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, between May 2011 and May 2018 were included in the study. MPI and CAC images were obtained in the same setting. The primary endpoint of the study was a composite of cardiac death and nonfatal myocardial infarction. Cox proportional hazard regression was used to assess the incremental prognostic value of CAC and MFR by sequentially adding the variables to a model that included clinical and PET variables. RESULTS: A total of 4,008 patients (mean age 59.7 ± 11.6 years, 55% women) were included in the analysis. Risk factors were prevalent (77.6% hypertension, 58.1% diabetes). In total, 35.9% of the cohort had CAC of 0, 16.5% had CAC ≥400, and 43.9% had MFR <2. Over a median follow up of 1.9 years, 130 (3.2%) patients had cardiac death/nonfatal myocardial infarction. CAC and MFR score added incremental prognostic value over clinical and perfusion variables (base model: c-index 0.8137; Akaike information criterion [AIC]: 1,865.877; p = 0.0011; CAC model: c-index = 0.8330; AIC: 1,850.810; p = 0.045 vs. base model; MFR model: c-index = 0.8279; AIC: 1,859.235; p = 0.024). Combining CAC and MFR did not enhance risk prediction (c-index = 0.8435; AIC: 1,846.334; p = 0.074 vs. MFR model; p = 0.21 vs. CAC model.) CONCLUSIONS: In this large cohort of patients referred for PET MPI, both CAC and MFR independently added incremental prognostic value over clinical and MPI variables. Although combining both may have synergetic prognostic effect, this relation was not shown in multivariable model of this analysis.

Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

OBJECTIVES: Coronary artery bypass grafting (CABG) is among the most frequently performed cardiac surgical procedures. However, it is associated with high readmission rates for a plethora of causes, which can substantially increase healthcare costs. This study aimed to assess the rates and associated risk factors of 30-day readmissions for CABG patients. METHODS: We conducted this retrospective cohort study at King Abdulaziz Medical City. The study targeted adult patients who underwent CABG between January 1, 2016, and January 31, 2019. Data were extracted from the BEST Care system. Frequencies and percentages were generated for categorical variables. Mean and standard deviation were calculated for quantitative variables. Bivariable and multivariable logistic regressions were used to detect readmission risk factors. RESULTS: Among 534 adult patients, the overall 30-day readmission rate was 16.1% (n = 86). The multivariable logistic regression analysis showed that diabetes mellitus (P = .002), amiodarone use (P = .04), statin use (P = .04), amlodipine use (P = .006), asthma (P < .001), and hyperlipidemia (P = .04) were significantly correlated with 30-day readmission. CONCLUSIONS: Our study showed an estimated 16.1% 30-day readmission rate after CABG. Diabetes mellitus, asthma, hyperlipidemia, and use of medications such as amiodarone, statins, and amlodipine were associated with readmission. Further studies are needed to develop tailored and practical strategies to reduce CABG readmissions and mitigate patient and health care facility burdens.

Surgical Management and Outcomes of Homozygous Familial Hypercholesterolemia in Two Cousins: A Rare Case Report.

Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition characterized by high levels of low-density lipoprotein (LDL) cholesterol in the blood, which increases a person's risk of developing early atherosclerotic cardiovascular disease (ASCVD). In this report, we present two cases of related patients with aortic stenosis and mitral regurgitation as complications of HoFH. We also discuss the surgical interventions they underwent and their outcomes. The two related patients with HoFH were admitted to our hospital with signs and symptoms of heart failure. Physical examination revealed an ejection systolic murmur over the aortic valve. Echocardiography revealed valvular disease, and coronary angiography revealed coronary artery disease (CAD). They had undergone the Bentall procedure, mitral valve replacement, and coronary artery bypass graft (CABG) surgery. We elaborate on the progressive course of HoFH, the possible complications associated with this condition, treatment options, and prognosis for the disease. HoFH is very rare and associated with many cardiovascular complications that can be fatal. The medical treatment of HoFH is rarely sufficient to manage the disease, and surgical interventions are eventually required. The outcomes of surgical treatment are generally good and acceptable.