Journal of Cardiovascular Development and Disease

11 pages, 379 KB

Open AccessSystematic Review

ChatGPT Applications in Heart Failure: Patient Education, Readability Enhancement, and Clinical Utility

by Robert S. Doyle, Jack Hartnett, Hugo C. Temperley, Cian P. Murray, Ross Walsh, Jamie Walsh, John McCormick, Catherine McGorrian, Katie Murphy and Kenneth McDonald

J. Cardiovasc. Dev. Dis. 2025, 12(11), 422; https://doi.org/10.3390/jcdd12110422 (registering DOI) - 24 Oct 2025

Abstract

Background: Heart failure (HF) affects over 64 million people globally, imposing substantial morbidity, mortality, and economic burdens. Despite advances in guideline-directed therapies, adherence remains suboptimal due to low health literacy and complex regimens. ChatGPT, an advanced large language model by OpenAI, offers conversational [...] Read more.

Background: Heart failure (HF) affects over 64 million people globally, imposing substantial morbidity, mortality, and economic burdens. Despite advances in guideline-directed therapies, adherence remains suboptimal due to low health literacy and complex regimens. ChatGPT, an advanced large language model by OpenAI, offers conversational capabilities that could enhance HF education, management, and research. This systematic review synthesizes evidence on ChatGPT’s applications in HF, evaluating its accuracy in patient education and question-answering, enhancing readability, and clinical documentation/symptom extraction. Methods: Following PRISMA guidelines, we searched PubMed, Embase, and Cochrane up to July 2025 using the terms “ChatGPT” and “heart failure”. Inclusion: Studies on ChatGPT (3.5 or 4) in HF contexts, such as in education, readability and symptom extraction. Exclusion: Non-HF or non-ChatGPT AI. Data extraction covered design, objectives, methods, and outcomes. Thematic synthesis was applied. Results: From 59 records, 7 observational studies were included. Themes included patient education/question-answering (n = 5), readability enhancement (n = 2), and clinical documentation/symptom extraction (n = 1). Accuracy ranged 78–98%, with high reproducibility; readability improved to 6th–7th grade levels; and symptom extraction achieved up to 95% F1 score, outperforming traditional machine learning baselines. Conclusions: ChatGPT shows promise in HF care but requires further randomized validation for outcomes and bias mitigation. Full article

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14 pages, 491 KB

Open AccessArticle

Metabolic Syndrome and Outcome Predictions: Friends or Foes?

by Alessandro Menotti and Paolo Emilio Puddu

J. Cardiovasc. Dev. Dis. 2025, 12(11), 421; https://doi.org/10.3390/jcdd12110421 - 23 Oct 2025

Abstract

Objectives: An analysis based on epidemiological material to show whether the term Metabolic Syndrome (MS) should be adopted when aiming at predicting coronary heart disease (CHD) and major cardiovascular disease (CVD) fatal events. Material and Methods: MS was defined according to the International [...] Read more.

Objectives: An analysis based on epidemiological material to show whether the term Metabolic Syndrome (MS) should be adopted when aiming at predicting coronary heart disease (CHD) and major cardiovascular disease (CVD) fatal events. Material and Methods: MS was defined according to the International Diabetes Federation (IDF) and risk factors were identified in the Italian Risk Factors and Life Expectancy (RIFLE) population study covering over 25,000 adult men from a pool of 19 Italian population samples. The original MS definition and the plain original units of measured risk factors were challenged in Cox proportional hazard models predicting 196 CHD and 412 major CVD fatal events in a seven-year follow-up. Parallel models were run including also total serum cholesterol as a covariate, an unfortunately excluded covariate in the MS definition. The performance of the various models was tested by the log-likelihood statistics treated with the Akaike Information Criterium (AIC). Results: Models using the plain measurements of the risk factors involved were systematically and significantly outperforming any other categorized score based on the IDF-MS classification. An intermediate role was played by a model where the predictive variable was a factor score (derived from a Factor Analysis) where the MS risk factors were linearly combined. The same models also including serum cholesterol provided a significantly better prediction when compared with those without serum cholesterol, based on AIC. Conclusions: The use of a subset of classical CVD risk factors classified according to the IDF-MS criteria adds nothing better than the exclusive use of the risk factors treated by traditional procedures. The addition of serum cholesterol definitely helps in the prediction of the CHD component of major CVD events. Its omission is erroneous. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

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15 pages, 659 KB

Open AccessArticle

Prediction of Postoperative Mortality After Fontan Procedure: A Clinical Prediction Model Study Using Deep Learning Artificial Intelligence Techniques

by Jacek Kolcz, Anna Budzynska, Justyna Stefaniak, Renata Szydlak and Andrzej A. Kononowicz

J. Cardiovasc. Dev. Dis. 2025, 12(11), 420; https://doi.org/10.3390/jcdd12110420 - 23 Oct 2025

Abstract

Background: The Fontan procedure is a palliative surgery for patients with single-ventricle congenital heart disease (CHD), but it is associated with postoperative and long-term mortality and morbidity. Accurate, individualized risk stratification remains a challenge with traditional models. This study aimed to develop and [...] Read more.

Background: The Fontan procedure is a palliative surgery for patients with single-ventricle congenital heart disease (CHD), but it is associated with postoperative and long-term mortality and morbidity. Accurate, individualized risk stratification remains a challenge with traditional models. This study aimed to develop and validate a deep learning (DL) model to predict postoperative mortality after the Fontan procedure and to identify key predictive factors. Methods: We retrospectively analysed data from 230 patients who underwent the Fontan procedure between 2010 and 2024. A Deep Neural Network (DNN) model was developed using comprehensive preoperative, intraoperative, and postoperative clinical, biochemical, and hemodynamic variables. The dataset was split using five-fold cross-validation, with 80% for training and 20% for testing in each fold. The Synthetic Minority Over-sampling Technique (SMOTE) was used to fix class imbalance. Model performance was evaluated using five-fold stratified cross-validation. We assessed accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC-ROC). SHapley Additive exPlanations (SHAP) analysis was employed to enhance model interpretability and identify the importance of features. A user-friendly clinical application interface was developed using Streamlit. This study was reported in accordance with the TRIPOD + AI reporting guidelines. Results: The DNN model demonstrated superior performance in predicting postoperative mortality, achieving an overall accuracy of 91.5% (95% CI: 87.2–94.8%), precision of 83.3% (95% CI: 76.5–89.1%), recall (sensitivity) of 90.9% (95% CI: 85.2–95.1%), specificity of 92.5% (95% CI: 88.3–95.7%), F1-score of 87.0% (95% CI: 82.1–91.3%), and an AUC-ROC of 0.94 (95% CI: 0.88–0.99). SHAP analysis identified key predictors of mortality, such as pulmonary artery pressure, ventricular end-diastolic pressure, preoperative BNP levels, and severity of AV valve regurgitation. The Streamlit application offered a user-friendly interface for personalized risk evaluation. Conclusions: A deep learning model that incorporates detailed clinical data can precisely forecast postoperative mortality in patients undergoing Fontan surgeries. This AI-based method, combined with interpretability techniques, provides a valuable tool for personalized risk assessment. It has the potential to improve preoperative counseling, optimize perioperative care, and enhance patient outcomes. However, additional external validation is needed to verify its broader applicability and clinical usefulness. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Imaging Diagnosis, Treatment, and Future Challenges)

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14 pages, 2028 KB

Open AccessReview

Therapeutic Challenges in Total Situs Inversus Associated with Sick Sinus Syndrome, Ventricular Arrhythmias, and Heart Failure with Preserved Ejection Fraction: Narrative Review and Case Report

by Cristina Tudoran, Mariana Tudoran, Dragos Cozma, Cristina Văcărescu, Ahmed Abu-Awwad, Simona-Alina Abu-Awwad, Dragos Cătălin Jianu and Florica Voitță-Mekereș

J. Cardiovasc. Dev. Dis. 2025, 12(11), 419; https://doi.org/10.3390/jcdd12110419 - 22 Oct 2025

Abstract

Background: Total situs inversus (TSI) is a rare genetic anomaly, and approximately half of the affected individuals also have other associated cardiovascular anomalies. Thus, the concomitance of conduction and rhythm disturbances is seldom described in the medical literature. Methods: We searched the medical [...] Read more.

Background: Total situs inversus (TSI) is a rare genetic anomaly, and approximately half of the affected individuals also have other associated cardiovascular anomalies. Thus, the concomitance of conduction and rhythm disturbances is seldom described in the medical literature. Methods: We searched the medical literature for similar cases published as full text, in English, on Clarivate, PubMed, and Google Scholar between 2016 and 2025. Results: We found 9 reports on TSI patients also having sick sinus syndrome (SSS) associated with rhythm disturbances, mainly atrial fibrillation, raising diagnostic and procedural challenges due to the anatomical anomalies requiring a peculiar approach. We describe the case of a 43-year-old woman diagnosed with TSI associated with ventricular arrhythmias in 2015 who experienced SSS requiring the implantation of a pacemaker during 10 years of follow-up but continued to have frequent episodes of nonsustained ventricular tachycardia (NSVT), raising multiple diagnoses and therapeutic challenges. After developing heart failure with preserved ejection fraction, she received guideline-adjusted treatment and, surprisingly, her clinical status improved, and NSVT diminished in frequency and then disappeared. Conclusions: Highlighting TSI′s clinical implications, often associated with other cardiovascular abnormalities, is important for an accurate diagnosis and adapted therapeutic management, considering the procedural challenges and potential complications. Full article

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14 pages, 1036 KB

Open AccessReview

Ocean Acidification, Iodine Bioavailability, and Cardiovascular Health: A Review of Possible Emerging Risks

by Charalampos Milionis, Costas Thomopoulos, Emilia Papakonstantinou and Ioannis Ilias

J. Cardiovasc. Dev. Dis. 2025, 12(11), 418; https://doi.org/10.3390/jcdd12110418 - 22 Oct 2025

Abstract

Anthropogenic climate change drives ocean acidification, which alters marine iodine cycling and increases bioaccumulation in marine ecosystems. This environmental shift may alter marine iodine cycling and, under certain conditions, lead to increased dietary and atmospheric iodine exposure, particularly in coastal populations, with potential [...] Read more.

Anthropogenic climate change drives ocean acidification, which alters marine iodine cycling and increases bioaccumulation in marine ecosystems. This environmental shift may alter marine iodine cycling and, under certain conditions, lead to increased dietary and atmospheric iodine exposure, particularly in coastal populations, with potential risks for thyroid dysfunction and downstream cardiovascular complications. Experimental data suggest that acidification may enhance iodine uptake in marine organisms such as kelp and seafood, with possible implications for consumption by humans. Because chronic iodine excess has already been associated with thyroid disease and its related cardiovascular disorders, these connections are worthy of further examination. In this narrative review we provide a synthesis of the possible mechanistic pathways by which ocean acidification, iodine bioavailability, thyroid function, and cardiovascular health may be connected. We also highlight the need for ongoing investigation, environmental monitoring, and interdisciplinary collaboration to further explain and address these tentative associations. Full article

(This article belongs to the Special Issue Cardiovascular Disease and Nutrition)

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16 pages, 1589 KB

Open AccessArticle

Diagnostic Predictive Scores of Amyloid Cardiomyopathy in Patients with Heart Failure with Preserved Ejection Fraction and Left Ventricular Hypertrophy

by Denise Cristiana Faro, Fabrizia Romeo, Valentina Losi, Dario Simonetti, Davide Capodanno and Ines Paola Monte

J. Cardiovasc. Dev. Dis. 2025, 12(11), 417; https://doi.org/10.3390/jcdd12110417 - 22 Oct 2025

Abstract

Background: Wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) is a frequent but underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) and left ventricular hypertrophy (LVH). Early identification is essential given the availability of disease-modifying therapies. The T-Amylo and Davies scores are non-invasive tools [...] Read more.

Background: Wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) is a frequent but underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) and left ventricular hypertrophy (LVH). Early identification is essential given the availability of disease-modifying therapies. The T-Amylo and Davies scores are non-invasive tools for estimating ATTR CM probability, but their comparative performance in the same real-world population is not well defined. Objectives: To compare the diagnostic accuracy of T-Amylo and Davies scores in consecutive patients referred for suspected cardiac amyloidosis. Methods: We retrospectively analyzed 81 patients (mean age 76.8 ± 8.3 years, 74% male) who underwent a standardized work-up: ECG, echocardiography with strain, NT-proBNP and troponin, bone scintigraphy, and immunofixation. ATTR CM was diagnosed according to established non-biopsy criteria. Both scores were calculated retrospectively, and sensitivity, specificity, predictive values, accuracy, and agreement were assessed. Results: ATTR CM was confirmed in 28 patients (34.5%). T-Amylo showed higher sensitivity (91.2% vs. 73.5%) and NPV (89.7% vs. 79.1%), while Davies had greater specificity (85.0% vs. 65.0%) and PPV (80.5% vs. 70.8%). Overall accuracy was comparable (T-Amylo 77.0% vs. Davies 79.7%). Agreement between scores was moderate (κ = 0.59). Conclusions: T-Amylo is best suited as a screening tool for suspected ATTR CM, while Davies offers confirmatory value in high-probability cases. Combining these tools in a sequential strategy may optimize diagnostic efficiency, reduce unnecessary testing, and expedite initiation of disease-modifying therapy. Full article

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11 pages, 365 KB

Open AccessReview

The Importance of Early Diagnosis and Treatment to Limit the Impact of Dystrophic Cardiomyopathy—We’ve Seen This Film Before, and We Didn’t Like the Ending

by DeWayne Townsend

J. Cardiovasc. Dev. Dis. 2025, 12(11), 416; https://doi.org/10.3390/jcdd12110416 - 22 Oct 2025

Abstract

Duchenne muscular dystrophy (DMD) is a rare neuromuscular disorder that is characterized by skeletal muscle wasting, loss of ambulation, and respiratory failure. In addition to these obvious external signs of disease, heart disease, the leading cause of death in DMD patients, is also [...] Read more.

Duchenne muscular dystrophy (DMD) is a rare neuromuscular disorder that is characterized by skeletal muscle wasting, loss of ambulation, and respiratory failure. In addition to these obvious external signs of disease, heart disease, the leading cause of death in DMD patients, is also progressing. Dystrophic cardiomyopathy is largely clinically silent with cardiac dysfunction masked by concurrent loss of skeletal muscle function. In older DMD patients the prevalence of heart disease is very high, offering the unique potential to predict impending heart disease from a much earlier genetic diagnosis. Randomized clinical trial data and subsequent retrospective studies in DMD demonstrate that early initiation of cardiac directed therapy results in a significant delay in the onset of cardiac dysfunction and prolonged survival. Clinical guidelines reflect this, recommending the initiation of cardiac therapy at an age of 10 years old, even in the absence of documented contractile dysfunction. Despite this data, a recent examination of registry data reveals that most DMD patients are not receiving the treatments recommended by these guidelines. While there is great excitement regarding newly developed therapies for DMD, there are so many signs that deploying the safe and effective therapies we already have can improve clinical outcomes. This review will highlight the basic science behind and clinical importance of using early cardiac directed therapy to extend the duration and quality of life of DMD patients and will offer some suggestions that may aid in achieving this goal. Full article

(This article belongs to the Section Basic and Translational Cardiovascular Research)

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14 pages, 503 KB

Open AccessReview

Iron Deficiency in Heart Failure: Cellular Mechanisms and Therapeutic Implications

by Anastasios Tsarouchas, Vassilios P. Vassilikos, Dimitrios Mouselimis, Christodoulos E. Papadopoulos, Dimitrios Tachmatzidis, Aikaterini Vassilikou and Constantinos Bakogiannis

J. Cardiovasc. Dev. Dis. 2025, 12(11), 415; https://doi.org/10.3390/jcdd12110415 - 22 Oct 2025

Abstract

Iron deficiency (ID) is a prevalent comorbidity in heart failure (HF), affecting 37–75% of patients and contributing significantly to symptom burden and adverse outcomes independent of anemia status. Current diagnostic criteria for ID in HF include absolute deficiency (ferritin <100 μg/L) and functional [...] Read more.

Iron deficiency (ID) is a prevalent comorbidity in heart failure (HF), affecting 37–75% of patients and contributing significantly to symptom burden and adverse outcomes independent of anemia status. Current diagnostic criteria for ID in HF include absolute deficiency (ferritin <100 μg/L) and functional deficiency (ferritin 100–299 μg/L with transferrin saturation <20%). Major clinical trials including AFFIRM-AHF, IRONMAN, HEART-FID, and FAIR-HF2 have demonstrated that intravenous iron therapy, particularly ferric carboxymaltose, reduces HF hospitalizations and improves quality of life and exercise capacity. The 2023 European Society of Cardiology guidelines recommend intravenous ferric carboxymaltose for symptomatic iron-deficient patients with heart failure with reduced ejection fraction. Despite these advances, significant knowledge gaps remain regarding optimal diagnostic approaches, the relationship between ID and ferroptosis in cardiac tissue, and the efficacy of newer iron formulations. This review synthesizes current understanding of ID in HF and highlights emerging therapeutic strategies. Full article

(This article belongs to the Special Issue Heart Failure: Clinical Diagnostics and Treatment, 2nd Edition)

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11 pages, 245 KB

Open AccessArticle

Prescription Trends and the Role of Cardiologists in the Diagnosis and Treatment of Erectile Dysfunction

by Filip Tkaczyk, Michal Chudzik, Aleksandra M. Piotrowska, Tim Stolpe, Julia Zurawska and Zbigniew Siudak

J. Cardiovasc. Dev. Dis. 2025, 12(10), 414; https://doi.org/10.3390/jcdd12100414 - 21 Oct 2025

Abstract

Introduction: Erectile dysfunction (ED) is strongly associated with metabolic and cardiovascular diseases and may serve as a marker of vascular pathology. Phosphodiesterase type 5 (PDE-5) inhibitors are the mainstay of treatment. Considering this link, cardiologists and internists might be expected to play a [...] Read more.

Introduction: Erectile dysfunction (ED) is strongly associated with metabolic and cardiovascular diseases and may serve as a marker of vascular pathology. Phosphodiesterase type 5 (PDE-5) inhibitors are the mainstay of treatment. Considering this link, cardiologists and internists might be expected to play a key role in therapy initiation. Purpose: This study evaluated prescription patterns of PDE-5 inhibitors in Poland, focusing on physician specialization and consultation type. Methods: We performed a retrospective analysis of electronic health records from over 300 outpatient clinics (2014–2024). Men >18 years with newly diagnosed ED were included. Data on the first prescriptions of sildenafil and tadalafil were assessed. Ethical approval was obtained. Results: A total of 11,998 patients were identified (mean age 42 years; mean BMI 26.54 kg/m²). Common comorbidities included hypercholesterolemia (67.0%), hypertension (58.5%), obesity (31.5%), and diabetes (12.4%). PDE-5 inhibitors (predominantly tadalafil (≈67%)) were prescribed in 71.5% of cases. Urologists accounted for 51.0% of prescriptions, sexologists 14.9%, internists 20.4%, and cardiologists only 0.10%. Treated patients were younger and had a lower BMI, fewer comorbidities, and more favorable metabolic profiles (all p < 0.05). Conclusions: Contrary to expectations, cardiologists and internists rarely initiate PDE-5 therapy. Prescribing is dominated by urologists despite high rates of cardiovascular comorbidities. A multidisciplinary approach incorporating metabolic and cardiovascular risk assessment is warranted. Full article

(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond: 2nd Edition)

13 pages, 801 KB

Open AccessArticle

Risk Factors for Reintervention in Children with Subvalvular Aortic Stenosis: A 20-Year Single-Center Study

by Jelena Hubrechts, Alessandra Zanfardino, Catherine Barrea, Thierry Detaille and Alain Poncelet

J. Cardiovasc. Dev. Dis. 2025, 12(10), 413; https://doi.org/10.3390/jcdd12100413 - 21 Oct 2025

Abstract

Subvalvular aortic stenosis (SAS) is a frequent cause of left ventricular outflow tract (LVOT) obstruction in children. Surgical resection is the standard treatment, yet recurrence requiring reintervention remains a significant concern. We aim to identify risk factors associated with surgical reintervention. This retrospective [...] Read more.

Subvalvular aortic stenosis (SAS) is a frequent cause of left ventricular outflow tract (LVOT) obstruction in children. Surgical resection is the standard treatment, yet recurrence requiring reintervention remains a significant concern. We aim to identify risk factors associated with surgical reintervention. This retrospective study included 76 patients under 18 years who underwent surgical resection for SAS between 2000 and 2020. Preoperative, intraoperative, and postoperative data were analyzed. The mean age at initial surgery was 5.8 years. In addition to subaortic membrane resection, myomectomy was performed in 73.7% of patients. Reintervention was required in 13.1% of cases, with reintervention-free survival at 5 and 10 years of 93.4% and 89.5%, respectively. Significant predictors of reintervention included younger age and shorter stature at surgery. Myomectomy reduced postoperative gradients but was not protective against recurrence and was associated with a higher rate of conductive disorders requiring pacemakers. While surgical resection of SAS is associated with excellent survival, recurrence remains a concern, especially in younger patients and those with tunnel-like lesions. Individualized surgical planning is essential to balance recurrence risk with potential complications. Full article

(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)

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11 pages, 4653 KB

Open AccessArticle

A Fluoroscopy-Free Ablation Workflow for Persistent Atrial Fibrillation Using a Pentaspline Pulse Field Ablation Catheter Guided by Left-Sided Intracardiac Echo Imaging and Electroanatomic Mapping: A Case Series

by Adam Mohmand-Borkowski

J. Cardiovasc. Dev. Dis. 2025, 12(10), 412; https://doi.org/10.3390/jcdd12100412 - 17 Oct 2025

Abstract

Background: Pulse field ablation (PFA) is a novel ablation technology with efficacy and safety, potentially making it a preferred ablation technology for persistent atrial fibrillation (AF). There is no optimal procedural workflow established to optimize efficacy, limiting the number of PFA applications and [...] Read more.

Background: Pulse field ablation (PFA) is a novel ablation technology with efficacy and safety, potentially making it a preferred ablation technology for persistent atrial fibrillation (AF). There is no optimal procedural workflow established to optimize efficacy, limiting the number of PFA applications and risks of the procedure. Due to the importance of optimal catheter–tissue contact for effective pulse field ablation, a workflow combining superior left atrial intracardiac echo (ICE) imaging and electroanatomic mapping (EAM) is an attractive strategy for PFA of persistent AF. Methods: A detailed procedural workflow was developed for fluoroscopy-free PFA using a pentaspline ablation catheter supported by left atrial ICE and EAM, and a case series of its execution in 30 consecutive patients with persistent AF is presented. All patients underwent pulmonary vein and posterior wall isolation as the index procedure, followed by additional ablation targeting non-pulmonary vein triggers and other inducible atrial arrhythmias. Results: Left atrial ICE imaging and EAM guided procedure resulted in successful isolation of the pulmonary veins and posterior wall in all patients, with additional ablation of spontaneous arrhythmias or non-pulmonary triggers if induced. There were no major complications of the procedure. Average procedure times and short-term efficacy were comparable with reported PFA outcomes using traditional imaging techniques. Conclusions: Fluoroscopy-free PFA guided by left-sided ICE for persistent AF can be performed with superior catheter–tissue contact imaging in a safe manner with a comparable procedural time and short-term efficacy as reported with the use of other imaging modalities. Full article

(This article belongs to the Special Issue Risk Assessment and Treatment of Atrial Fibrillation: Focus on Catheter Ablation)

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2 pages, 170 KB

Open AccessReply

Reply to Al Ebrahim, K.E. Comment on “Leivaditis et al. Between Air and Artery: A History of Cardiopulmonary Bypass and the Rise of Modern Cardiac Surgery. J. Cardiovasc. Dev. Dis. 2025, 12, 365”

by Vasileios Leivaditis, Andreas Maniatopoulos, Francesk Mulita, Paraskevi Katsakiori, Nikolaos G. Baikoussis, Sofoklis Mitsos, Elias Liolis, Vasiliki Garantzioti, Konstantinos Tasios, Panagiotis Leventis, Nikolaos Kornaros, Andreas Antzoulas, Dimitrios Litsas, Levan Tchabashvili, Konstantinos Nikolakopoulos and Manfred Dahm

J. Cardiovasc. Dev. Dis. 2025, 12(10), 411; https://doi.org/10.3390/jcdd12100411 - 17 Oct 2025

Abstract

We are grateful to Dr. Al Ebrahim for his thoughtful and constructive commentary on our historical review of cardiopulmonary bypass (CPB) [...] Full article

27 pages, 3387 KB

Open AccessReview

Coronary Bifurcation PCI—Part I: Fundamentals

by Sara Pollanen, Rongras Damrongwatanasuk, Ju Young Bae, Jason Wen, Michael G. Nanna, Abdulla Al-Damluji, Mamas A. Mamas, Elias B. Hanna and Jiun-Ruey Hu

J. Cardiovasc. Dev. Dis. 2025, 12(10), 410; https://doi.org/10.3390/jcdd12100410 - 16 Oct 2025

Abstract

Percutaneous coronary intervention (PCI) of bifurcation lesions remain one of the most technically challenging areas in interventional cardiology. Careful planning and execution are needed to preserve main vessel and side branch patency, with evolving evidence guiding the choice between provisional and two-stent strategies, [...] Read more.

Percutaneous coronary intervention (PCI) of bifurcation lesions remain one of the most technically challenging areas in interventional cardiology. Careful planning and execution are needed to preserve main vessel and side branch patency, with evolving evidence guiding the choice between provisional and two-stent strategies, and between individual techniques. This narrative review, which represents the first installment of a two-part series, synthesizes current knowledge on bifurcation PCI, detailing the anatomical classifications, lesion assessment tools, procedural planning, and execution of techniques including T and Protrusion (TAP), double-kissing (DK) crush, mini-crush, culotte, V-stent, and emerging modifications. We contextualize the choice of strategy within lesion complexity, procedural goals, and patient-specific considerations. This review is intended as a visual, practical, technique-focused reference for interventionalists and interventional trainees involved in the management of bifurcation lesions. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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2 pages, 159 KB

Open AccessComment

Comment on Leivaditis et al. Between Air and Artery: A History of Cardiopulmonary Bypass and the Rise of Modern Cardiac Surgery. J. Cardiovasc. Dev. Dis. 2025, 12, 365

by Khaled Ebrahim Al Ebrahim

J. Cardiovasc. Dev. Dis. 2025, 12(10), 409; https://doi.org/10.3390/jcdd12100409 - 16 Oct 2025

Cited by 1

Abstract

We read with great interest the historical review by Leivaditis et al [...] Full article

(This article belongs to the Section Cardiac Surgery)

14 pages, 1508 KB

Open AccessCase Report

Aortic Regurgitation in a Patient with Rheumatoid Arthritis/Systemic Lupus Erythematosus Overlap Syndrome (Rhupus): Case Report and Review of Literature

by Mislav Radić, Hana Đogaš, Tina Bečić, Petra Šimac, Ivana Jukić, Josipa Radić and Damir Fabijanić

J. Cardiovasc. Dev. Dis. 2025, 12(10), 408; https://doi.org/10.3390/jcdd12100408 - 16 Oct 2025

Abstract

Background/Objectives: Cardiovascular diseases (CVDs), including valvular heart disease (VHD), remain the leading cause of morbidity and mortality in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Case Presentation: We report a rare case of a woman in her fifth decade of [...] Read more.

Background/Objectives: Cardiovascular diseases (CVDs), including valvular heart disease (VHD), remain the leading cause of morbidity and mortality in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Case Presentation: We report a rare case of a woman in her fifth decade of life diagnosed with overlap syndrome (RA and SLE), in whom transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed a degenerative altered bicuspid aortic valve with moderate aortic regurgitation (AR) and preserved left ventricular systolic function. The patient presented with a recent history of continuous, moderate chest discomfort and progressive exertional dyspnea, along with a mild elevation in highly cardioselective enzymes. AR was confirmed as the cause of her symptoms, rather than acute coronary syndrome or heart failure. Conclusions: This case highlights the potential contribution of chronic systemic inflammation in RA/SLE to the pathogenesis of AR, an extra-articular manifestation associated with adverse clinical outcomes. These findings support the routine use of echocadiography in rheumatologic patients as a key strategy for early detection and prevention of life-threatening CV complications. Full article

(This article belongs to the Special Issue Cardiovascular Imaging in Heart Failure and in Valvular Heart Disease)

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11 pages, 4386 KB

Open AccessReview

Surgical Explantation of Transcatheter Aortic Valve Requires Patient-Tailored Management, but Challenges Remain

by Vasiliki Androutsopoulou, Andrew Xanthopoulos, Kalliopi Keramida, Arian Arjomandi Rad, Georgia Nazou, Prokopis-Andreas Zotos, John Skoularigis, Thanos Athanasiou and Dimitrios C. Iliopoulos

J. Cardiovasc. Dev. Dis. 2025, 12(10), 407; https://doi.org/10.3390/jcdd12100407 - 15 Oct 2025

Abstract

Transcatheter aortic valve replacement has become a widely accepted alternative to surgical aortic valve replacement even in younger, lower-risk patients with longer life expectancy. The increasing use of transcatheter aortic valve replacement is leading to a rise in the need for surgical explantation [...] Read more.

Transcatheter aortic valve replacement has become a widely accepted alternative to surgical aortic valve replacement even in younger, lower-risk patients with longer life expectancy. The increasing use of transcatheter aortic valve replacement is leading to a rise in the need for surgical explantation of failing transcatheter valves, a complex procedure associated with increased periprocedural risks and technical challenges. The absence of established guidelines for the treatment of this life-threatening condition highlights an important clinical challenge. Published experience with surgical explantation of transcatheter aortic valve remains limited. Standardized explanation protocols, patient-tailored management, careful patient selection, detailed preoperative imaging, and early surgical referral are essential for improving safety and efficacy. Optimal outcomes require collaboration among cardiac surgeons, cardiologists, infectious disease specialists, and radiologists. Full article

(This article belongs to the Special Issue Contemporary Controversies and Evolving Paradigms in Cardiovascular Surgery)

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17 pages, 364 KB

Open AccessReview

Addressing Complications in Cardiac Implantable Electronic Devices: A Guideline to Prevention of CIED Infection

by Benito Baldauf, Roberto Cemin, Mauro Biffi, Antonio Rapacciuolo, Giulio Zucchelli, Maria Grazia Bongiorni, Ernesto Casorelli, Gianfranco Mitacchione, Felix Hohendanner, Emanuele Durante-Mangoni, Veronica Dusi, Paul William Xavier Foley, Angelo Pan, Giuseppe Arena, Archana Rao, Sebastian Spencker, Alexander Steger, Carlo Tascini, Valerio Zacà, Federico Migliore, Ojan Assadian, Marzia Giaccardi, Hendrik Bonnemeier and Kerstin Bode Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2025, 12(10), 406; https://doi.org/10.3390/jcdd12100406 - 13 Oct 2025

Abstract

Background: Cardiac implantable electronic devices (CIEDs) are vital for managing arrhythmias but carry a notable risk of infection, which increases patient morbidity, mortality, and healthcare burden. This review examines current evidence on risk factors and preventive strategies for CIEDI. Methods: A structured search [...] Read more.

Background: Cardiac implantable electronic devices (CIEDs) are vital for managing arrhythmias but carry a notable risk of infection, which increases patient morbidity, mortality, and healthcare burden. This review examines current evidence on risk factors and preventive strategies for CIEDI. Methods: A structured search was performed in PubMed, Embase, and the Cochrane Library using terms such as “CIED,” “infection,” “pacemaker,” “ICD,” “infection prevention,” “biofilm,” “antibiotic prophylaxis,” and “antibiotic-eluting envelope.” Study selection followed PRISMA guidelines. Results: For well-established topics, recommendations are based on high-quality evidence from the literature. In areas with limited CIED-specific data, evidence from related surgical fields was considered, and expert consensus was used to guide recommendations. Conclusions: This review offers practical guidance for clinicians on CIED infection prevention, addressing gaps not previously covered in existing guidelines. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

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13 pages, 644 KB

Open AccessArticle

Pilot Study Assessing the Hemodynamic Impact and Post-Exercise Hypotension Induced by High- Versus Low-Intensity Isometric Handgrip in Patients with Ischemic Heart Disease

by Giuseppe Caminiti, Matteo Vitarelli, Maurizio Volterrani, Giuseppe Marazzi, Vincenzo Manzi, Valentino D’Antoni, Simona Fecondo, Sara Vadalà, Barbara Sposato, Domenico Mario Giamundo, Alberto Grossi, Valentina Morsella, Ferdinando Iellamo and Marco Alfonso Perrone

J. Cardiovasc. Dev. Dis. 2025, 12(10), 405; https://doi.org/10.3390/jcdd12100405 - 12 Oct 2025

Abstract

Background: Isometric handgrip (IHG) exercise reduces blood pressure (BP) in both normotensive and hypertensive individuals. However, there are few studies specifically addressing its effects in hypertensive patients with ischemic heart disease (IHD). This research aimed to compare acute hemodynamic responses and post-exercise [...] Read more.

Background: Isometric handgrip (IHG) exercise reduces blood pressure (BP) in both normotensive and hypertensive individuals. However, there are few studies specifically addressing its effects in hypertensive patients with ischemic heart disease (IHD). This research aimed to compare acute hemodynamic responses and post-exercise hypotension to single bouts of IHG handgrip performed at two different intensities in patients with IHD. Methods: Fifty-four sedentary patients were enrolled and randomly assigned to one of three groups: (1) high-intensity isometric handgrip performed at 70% of maximal voluntary contraction (MVC) (IHG-70%); (2) low-intensity isometric handgrip performed at 30% of MVC (IHG-30%); (3) control group (no exercise). Heart rate and BP were measured, and transthoracic echocardiography was performed at baseline, during exercise (lasting 3 min), and after 15 min post-exercise. BP was also measured at 30, 45, and 60 min of recovery. Results: No significant changes in systolic BP occurred during the exercise phase between the three study groups. Systolic BP decreased significantly in IHG-70% compared to the control at 30 (−7.7 ± 1.9; p = 0.035) and 45 min (−8.1 ± 2.3; p = 0.021) post-exercise, while there were no significant differences between IHG-70% and IHG-30% at different time-points. There were no significant changes in diastolic BP between the two active groups and between IHG-70 and IHG-30 versus control at different time-points (repeated-measures ANOVA p = 0.257). Global work efficiency was unchanged in IHG-70% (−4%) and IHG-30% (+1%) compared to control (ANOVA p = 0.154). Conclusions: High-intensity and low-intensity isometric handgrip exercises did not cause hemodynamic impairment in IHD. High-intensity exercise was more effective than low-intensity in reducing post-exercise systolic BP. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)

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9 pages, 2750 KB

Open AccessBrief Report

Minimally Invasive Repair of Sinus Venosus Atrial Septal Defects and Anomalous Pulmonary Venous Connections via Vertical Right Axillary Thoracotomy

by Sameh M. Said, Ali H. Mashadi, Yasin Essa, Kristin Greathouse, Nicholas Brown, Mahmoud I. Salem and Joseph Giamelli

J. Cardiovasc. Dev. Dis. 2025, 12(10), 404; https://doi.org/10.3390/jcdd12100404 - 11 Oct 2025

Abstract

(1) Background: There has been an increase in the utilization of the minimally invasive vertical right axillary thoracotomy approach for repairing congenital heart defects in children recently. We aim, in the current study, to evaluate the outcomes of this approach in repairing anomalous [...] Read more.

(1) Background: There has been an increase in the utilization of the minimally invasive vertical right axillary thoracotomy approach for repairing congenital heart defects in children recently. We aim, in the current study, to evaluate the outcomes of this approach in repairing anomalous pulmonary venous connections with or without an associated sinus venosus defect. (2) Methods: A total of 23 consecutive patients underwent surgical repair of anomalous pulmonary venous connections between April 2018 and February 2024. Perioperative and clinical follow-up data were obtained. (3) Results: The median age and weight were 36 months (1–277 months) and 14.4 kg (3.6–79.4 kg), respectively. More than half were females (13; 56.5%). There was no conversion to sternotomy. Partial anomalous pulmonary venous connections were the most frequent primary diagnoses (14; 60.9%), followed by scimitar syndrome (3; 13%), while two patients (8.7%) had total anomalous pulmonary venous connections. Repair techniques included single patch in 10 patients (43.5%), Warden in 6 (26.1%), and two-patch technique in 4 (17.4%). The median cardiopulmonary bypass and aortic cross-clamp times were 91 and 62 min, respectively. All patients were extubated in the operating room. The median length of hospital stay was 2 days. There were no mortalities or reoperations for pulmonary/systemic venous pathway obstruction. (4) Conclusions: Vertical right axillary thoracotomy is a valuable approach for repairing anomalous pulmonary venous connections with or without sinus venosus defects. All repair techniques, including Warden and scimitar, can be performed safely through this approach. The cosmetic superiority and short hospital stay make this approach worth considering. Full article

(This article belongs to the Section Cardiac Surgery)

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Journal of Cardiovascular Development and Disease

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