2024 Statement from Asia expert operators on transcatheter pulmonary valve replacement.

Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the pulmonary valve by delivering an artificial pulmonary prosthesis through a catheter into the diseased pulmonary valve under the guidance of X-ray and/or echocardiogram while the heart is still beating not arrested. In recent years, TPVR has achieved remarkable progress in device development, evidence-based medicine proof and clinical experience. To update the knowledge of TPVR in a timely fashion, and according to the latest research and further facilitate the standardized and healthy development of TPVR in Asia, we have updated this consensus statement. After systematical review of the relevant literature with an in-depth analysis of eight main issues, we finally established eight core viewpoints, including indication recommendation, device selection, perioperative evaluation, procedure precautions, and prevention and treatment of complications.

Pattern of aortic dilatation in different bicuspid aortic valve phenotypes and its association with aortic valvular dysfunction and elasticity.

OBJECTIVES: We aim to study the pattern of aortic dilatation in different BAV phenotypes and to find any correlations between aortic dilatation, aortic elasticity and AS and/or AR in our local population. METHODS: All BAV patients and controls were retrospectively studied. Aortic distensibility and stiffness index of the ascending aorta were calculated. RESULTS: A total of 191 patients with BAV and 180 controls were enrolled. Aortic dilatation involving a single site was more common with dilatation involving only the ascending aorta (R-N phenotype) and aortic root (N-L phenotype). AR was most common in patients with N-L and R-L phenotypes and AS in R-N phenotype. Aortic elasticity had no correlation with the different BAV phenotypes. CONCLUSIONS: There are different patterns of aortic dilatation in different BAV phenotypes, which may further contribute to the development of aortic stenosis or regurgitation. Aortic elasticity is independent of the BAV phenotypes and is impaired in BAV patients regardless of AS or AR severity.

Ventricular septal rupture following acute myocardial infarction.

OBJECTIVE: Ventricular septal rupture (VSR) is a complication of acute myocardial infarction (AMI) that is associated with significant mortality. We aim to review the clinical outcome in the current era. METHODS AND RESULTS: Patients admitted to a single tertiary centre from 1997 to 2008 with VSR post-AMI were identified from the local cardiac registry. We performed a retrospective review on 25 patients. Mean age (15 women) was 71 years. Most patients had cardiovascular risk factors (84%); the commonest was hypertension (72%). Anterior AMI (80%) and apical VSR (84%) formed the majority of the cases. Eleven patients (44%) received prior coronary reperfusion therapy either via thrombolysis or PCI. Median time to rupture was 1 day from diagnosis of infarction. More than half (60%) of the patients were in Killip class 3 or 4 at diagnosis of rupture. Mean left ventricular ejection fraction (LVEF) was 33 +/- 10%. Most patients (80%) required IABP for haemodynamic support. All patients who underwent surgery had ventricular septal repair; amongst them 47% had concomitant CABG. Those managed conservatively were older (P = 0.01). Overall mortality rate was 44%. Most died within the first four days (82%). Surgical and non-surgical survival rates were 68% and 17%, respectively (P= 0.039). Patient demographics, prior coronary reperfusion techniques, Killip class status and LVEF were not significant predictors of mortality. However, non-anterior wall AMI and non-apical VSR were significantly associated with poorer survival (P = 0.009, P = 0.026 respectively). CONCLUSIONS: While the occurrence ofVSR post-AMI appears to be low compared to earlier studies, it continues to be associated with significant mortality. Non-anterior wall AMI and non-apical VSR were associated with poorer survival and surgical repair conferred survival advantage over conservative management.

Computational Platform Based on Deep Learning for Segmenting Ventricular Endocardium in Long-axis Cardiac MR Imaging.

This paper presents an automated computational platform based on deep learning (DL) approach for left ventricular (LV) and right ventricular (RV) endocardium segmentation in long-axis cine cardiovascular magnetic resonance (CMR). The proposed method uses modified deep U-Net convolutional networks. We trained our model using 4800 images from 40 human subjects (20 healthy volunteers, 20 patients with various cardiac diseases) and validated the technique in 6000 images from 50 subjects (10 healthy volunteers, 40 patients). An average Dice metric of 0.929 ± 0.036 along with an average Jaccard index of 0.869 ± 0.059 were achieved for all the studied subjects. In addition, a high level of correlation and agreement with the ground truth contours for LV ejection fraction (R=0.975), LV fractional area change (R=0.959 to 0.971), and RV fractional area change (R=0.927) were observed. The proposed DL-based segmentation process took less than 3 seconds per subject (or < 30 milliseconds per image over 120 images for each subject). Therefore, our proposed framework offers a promising means to achieve fully automated and rapid segmentation for both LV and RV endocardium in long-axis cine CMR images using an appropriately trained deep convolutional neural network.

Emergency admissions in Asians with adult congenital heart disease.

BACKGROUND AND AIM: In the area of acute emergency care, the needs of adult congenital heart disease patients (ACHD) are unique and burden on hospital resources are likely substantial. We aim to understand the reasons for emergency admissions and associations of increased hospital length of stay (LOS). METHODS: We evaluated 600 ACHD patients in our adult congenital database. Patients who required emergency admissions between January 2007 and December 2007 were studied from hospital records. RESULTS: Sixty-eight ACHD patients (11%) required emergency admissions, culminating in a total of 108 admissions. Mean age was 37.6 years (SD 18.0), with a female preponderance (56%). Most were either schooling or working (62%) and were single (62%). Atrial septal defect (24%), ventricular septal defect (19%) and tetralogy of fallot (13%) formed the majority of diagnoses, mirroring proportions in our cohort. A third of the admissions were for cardiac reasons including arrhythmia, heart failure, endocarditis, and thromboembolism; the remaining two-thirds were for non-cardiac reasons. Median hospital LOS was 5.0 days. Those who were older (p=0.02) and neither employed nor schooling (p=0.021) had longer LOS. Thromboembolism accounted for longer LOS (p=0.047). One-third of the admissions that required interdisciplinary referrals had increased LOS (p<0.001), with utilization of non-cardiac investigations (p=0.002). Increased LOS was not associated with adverse clinical outcome (p=0.68). CONCLUSIONS: ACHD patients require emergency admissions for both cardiac and non-cardiac reasons. Older age groups, unemployment and thromboembolic complications were associated with increased LOS. Non-cardiac conditions required interdisciplinary resources and were associated with increased LOS. Understanding their diverse acute needs may potentially improve care and outcome for these patients.

Large pulmonary artery aneurysm associated with Marfan syndrome.

Pulmonary artery aneurysms are rare, and published data on the subject are limited. The first case of Marfan syndrome associated with a large pulmonary artery aneurysm complicated by pulmonary artery thrombi and pulmonary hypertension is described. Serial echocardiograms showed progressive dilation of the aneurysm, which reached a massive size of 90 mm. Cardiac catheterization, pulmonary angiography and computed tomography angiography were used in the preoperative evaluation. The patient died suddenly while awaiting a decision for surgical intervention, thereby underscoring the need for aggressive management.

An adult with truncus arteriosus and unilateral pulmonary hypertension.

We report a young man who has persistent truncus arteriosus (TA), severe truncal regurgitation and unilateral pulmonary hypertension. Our patient had palliative main pulmonary artery (PA) banding done during infancy that was not followed by definitive corrective surgery. Unilateral irreversible left sided pulmonary hypertension developed due to migration of the PA band to the right PA. The patient presented to us with infective endocarditis of the truncal valve. This had resolved with medical treatment. Discussion was made on general management of TA and specific difficult management issues of palliated TA in adult, as found in our patient.