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J Med Case Rep. 2025 Jun 18;19(1):282. doi: 10.1186/s13256-025-05341-9.

ABSTRACT

BACKGROUND: Calcified nodules within coronary stents are increasingly recognized as contributors to in-stent restenosis and stent thrombosis, which pose significant cardiovascular risks. Advanced imaging techniques, such as optical coherence tomography, have been crucial in detecting calcified nodules, which are more prevalent in patients undergoing hemodialysis and those with pre-existing calcified lesions.

CASE PRESENTATION: A 67-year-old British man with a history of diabetes, hypertension, and heart failure presented with chest pain, dyspnea, and diaphoresis, leading to a diagnosis of non-ST-elevation myocardial infarction based on elevated troponin and B-type natriuretic peptide levels. Imaging revealed significant coronary artery disease, including a patent left anterior descending stent with focal stenosis due to a calcified nodule, chronic total occlusion of the left circumflex artery, and right coronary artery occlusion. The patient was treated with intravenous lithotripsy and balloon angioplasty, along with medical therapy, including dual antiplatelet therapy, statins, beta-blockers, angiotensin-converting enzyme inhibitors, and diuretics. The discussion highlights the challenges of managing calcified coronary lesions, comparing rotational atherectomy, intravenous lithotripsy, and conventional stenting techniques. While rotational atherectomy is effective for superficial plaque modification, intravenous lithotripsy offers deeper calcium modification with fewer complications, though both modalities require careful patient selection for optimal outcomes.

CONCLUSION: Calcified nodules within coronary stents are a significant cause of in-stent restenosis and thrombosis, leading to adverse cardiovascular events. Advanced imaging techniques such as intravascular ultrasound and optical coherence tomography are crucial for early detection and accurate diagnosis. Effective management of calcified nodule-related lesions remains challenging, with rotational atherectomy and intravenous lithotripsy emerging as viable adjunctive therapies for optimal stent expansion. This case highlights the successful use of rotational atherectomy in treating a patient with severe in-stent calcification presenting with non-ST-elevation myocardial infarction. A tailored approach combining advanced imaging, lesion preparation, and optimal stent deployment is essential for improving outcomes in patients with complex calcified coronary disease.

PMID:40533839 | PMC:PMC12178041 | DOI:10.1186/s13256-025-05341-9

J Nucl Med. 2025 Jun 18:jnumed.125.269457. doi: 10.2967/jnumed.125.269457. Online ahead of print.

ABSTRACT

Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest (MBFrest) and stress (MBFstress). Methods: Consecutive patients undergoing 82Rb PET imaging with regadenoson stress testing at a tertiary care center between August 2019 and August 2024 were included in this study. The 2 coprimary outcomes were a composite of death or heart failure (HF) hospitalization and a composite of myocardial infarction (MI) or late revascularization. Multivariable Andersen-Gill Cox models with robust variance estimators were used to incorporate recurrent events. Outcomes were modeled as a smooth function of MBFstress and MBFrest, with restricted cubic splines to allow nonlinearity. Results: The analysis included 8,131 consecutive patients (median age of 68 y; 46.1% were women; median follow-up of 520 d (interquartile range, 186-921 d), among whom 471 deaths, 828 HF hospitalizations, 164 MIs, and 429 late revascularizations occurred. After adjusting for the relevant covariates, an MFR of 2 achieved through a lower MBFrest was associated with a significantly lower incidence of death and HF hospitalization, whereas an MFR of 2 achieved through a greater MBFstress was associated with a significantly lower incidence of MI and late revascularization. Assessments of the partial χ2 statistic, which measures the importance of predictors, similarly confirmed that MBFrest was more important for predicting death or HF hospitalization whereas MBFstress was more important for predicting MI or late revascularization. Conclusion: Measurements of absolute myocardial blood flow offer complementary prognostic value to MFR. A diminished MBFstress may signal a greater risk of future ischemic outcomes, whereas an elevated MBFrest may signal a greater risk of future death or HF hospitalization.

PMID:40533355 | DOI:10.2967/jnumed.125.269457

Harefuah. 2025 Jun;164(6):388-389.

ABSTRACT

A 61-year-old man with a complex cardiovascular history and chronic kidney disease was hospitalized with an anterior STEMI and found on catheterization to have severe occlusions in multiple coronary arteries. He underwent PCI followed by urgent coronary artery bypass surgery. On the day after the surgery, he developed acute abdominal pain, and a CTA revealed thrombosis of the superior mesenteric artery (SMA) with ischemia of the small intestine - a condition that was treated surgically with bowel resection and thrombectomy.

PMID:40530637

J Cardiovasc Med (Hagerstown). 2025 Jun 6. doi: 10.2459/JCM.0000000000001744. Online ahead of print.

ABSTRACT

AIMS: Inflammation is a main pathophysiological driver in atherosclerotic cardiovascular diseases (ASCVD). Low-dose long-term colchicine for secondary prevention in patients with established ASCVD has been studied in multiple randomized trials in the last decade.This meta-analysis aimed to evaluate the efficacy and safety of long-term low-dose colchicine for secondary prevention in patients with established ASCVD.

METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate studies reporting long-term outcomes in patients with ASCVD. We systematically searched PubMed, EMBASE and Scopus databases for relevant studies up to 1 December 2024. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), a composite of cardiovascular death (CVD), myocardial infarction (MI) and stroke. Random-effects models were used to calculate pooled risk ratios (RRs).

RESULTS: Ten randomized clinical trials enrolling 22 532 patients were identified. Addition of colchicine to standard medical treatment in patients with established ASCVD reduced the risk for MACE by 27% [RR 0.73, 95% confidence interval (CI) 0.57-0.95], with a number needed to treat of 52. Colchicine was found to significantly reduce the risk of MI (RR 0.83, 95% CI 0.72-0.96) and coronary revascularization (RR 0.79, 95% CI 0.65-0.94). There were no significant differences between the two groups concerning cardiovascular and noncardiovascular mortality, risk of serious gastrointestinal events, infections requiring hospitalization and cancer.

CONCLUSIONS: These findings support the use of long-term low-dose colchicine for secondary prevention of MACE in clinical practice.

PMID:40530569 | DOI:10.2459/JCM.0000000000001744

Zhonghua Xin Xue Guan Bing Za Zhi. 2025 Jun 24;53(6):679-682. doi: 10.3760/cma.j.cn112148-20240605-00312.

ABSTRACT

冠状动脉旁路移植术（CABG）是冠状动脉多支病变患者的主要治疗手段之一，乳内动脉桥血管对于CABG术后患者的远期生存率至关重要。该文报道1例CABG术后罹患主动脉弓部动脉瘤患者，且主动脉瘤开口位于左锁骨下动脉开口处，造成的血肿亦累及左锁骨下动脉，应用一体式分支型支架联合体外开窗及内分支技术，在处理主动脉弓部动脉瘤的同时保证了颈动脉及乳内动脉的供血。术后患者恢复良好，未见明显并发症。.

PMID:40528607 | DOI:10.3760/cma.j.cn112148-20240605-00312

Cardiol Rev. 2025 Jun 18. doi: 10.1097/CRD.0000000000000972. Online ahead of print.

ABSTRACT

Myocardial infarction and heart failure remain among the leading global causes of morbidity and mortality, mainly due to the irreversible loss of cardiomyocytes and the human heart's inherently limited regenerative capacity. Cardiac regeneration has emerged as a transformative frontier in cardiovascular medicine in response to this clinical and biological impasse. This review examines current approaches to rebuilding damaged heart tissue and improving cardiac function. Early investigations into cell-based therapies, particularly mesenchymal stem cells, and bone marrow-derived mononuclear cells, showed modest improvements in heart function. These benefits appeared to arise primarily through paracrine signaling, rather than direct tissue regeneration. More recently, researchers have focused on extracellular vesicles and exosomes, acellular messengers that deliver molecular signals to encourage new blood vessel growth, reduce inflammation, and promote cell survival. Breakthroughs in direct cardiac reprogramming now make it possible to convert fibroblasts into cardiomyocyte-like cells, while induced pluripotent stem cell-derived cardiomyocytes open new doors for personalized disease modeling and potential myocardial reconstruction. Advances in gene editing, most notably clustered regularly interspaced short palindromic repeats/Cas9, are elevating the precision and efficiency of regenerative interventions. Finally, synthetic biology and tissue engineering innovations are accelerating the development of physiological cardiac tissue patches and driving the aspiration of a fully implantable bioartificial heart. These multidisciplinary innovations are redefining the boundaries of cardiac care and bringing the prospect of myocardial regeneration increasingly within reach.

PMID:40530862 | DOI:10.1097/CRD.0000000000000972

Chin Med. 2025 Jun 18;20(1):90. doi: 10.1186/s13020-025-01141-x.

ABSTRACT

INTRODUCTION: Ischemic heart diseases are the leading cause of death worldwide due to the inability of regeneration of adult cardiomyocytes (CMs). Natural products from medical herbs are an important source of innovative drugs for many diseases including cardiovascular diseases.

OBJECTIVES: In this study, we set out to screen novel small-molecule therapies from natural products to protect heart against ischemic injury.

METHODS: High-throughput screening was performed using a natural product library to identify the potential small molecules which can promote survival of CMs under ischemic and ischemic/reperfusion conditions. In addition, myocardial infarction (MI) and ischemia/reperfusion (I/R) mice models were used to evaluate the in vivo effects of the screened candidate. We also applied various analysis including cell viability, qPCR, Western blot, immunofluorescent staining, echocardiography, Masson's staining, TTC staining, and network pharmacology.

RESULTS: High-throughput screening showed that the small molecule compound Darutigenol (Dar), derived from the Chinese traditional herb Herba Siegesbeckiae, could significantly promote CM survival and proliferation under ischemic conditions. Moreover, I/R-induced CM apoptosis and ROS generation could be significantly reduced by Dar treatment. In addition, in vivo administration of Dar was able to attenuate MI- and I/R-induced cardiac injury in adult mice by decreasing fibrosis and apoptosis, thereby improving cardiac function. Network pharmacology analysis and molecule docking assay showed that Dar has the highest binding affinity with AKT1 protein. Western blotting assay further revealed that AKT1 activation was significantly enhanced by Dar administration in the infarcted hearts.

CONCLUSIONS: Our data revealed that the small molecule compound Dar, screened from the natural product library in this study, is capable of protecting heart against MI and I/R injury by activating AKT1 pathway. These findings enrich the natural product candidates for cardiovascular disease treatment and provide new insights into potential therapeutic agents for MI and I/R injury.

PMID:40533778 | PMC:PMC12175470 | DOI:10.1186/s13020-025-01141-x

Atherosclerosis. 2025 Jun 13:120405. doi: 10.1016/j.atherosclerosis.2025.120405. Online ahead of print.

ABSTRACT

Influenza infection is a well-established trigger of acute cardiovascular events, particularly myocardial infarction, mediated by systemic inflammation, endothelial dysfunction, and thrombosis. In this review, we examine the evidence supporting influenza vaccination as a preventive strategy in cardiovascular disease. Observational studies and randomized trials consistently show reduced cardiovascular event rates among vaccinated individuals, with the most pronounced benefit seen after myocardial infarction. Emerging data suggest that the effects of vaccination extend beyond infection prevention, involving immunomodulatory effects, including regulatory T cell activity, features of trained innate immunity, and mechanisms promoting resolution of inflammation. Unlike conventional anti-inflammatory therapies, vaccination appears to rebalance immune responses without compromising host defence. We also consider an evolutionary perspective, proposing that historical influenza exposure may have contributed to the genetic architecture of atherosclerosis. Taken together, current evidence positions influenza vaccination as a safe, low-cost, and biologically plausible intervention in the prevention of cardiovascular events. However, important questions remain. Whether revaccination during hospitalization provides added benefit in previously immunized individuals, and the potential of high-dose or next-generation vaccine platforms such as mRNA, warrant further study. Dedicated outcome trials conducted outside the influenza season are especially needed to clarify nonspecific cardiovascular benefits. Cardiologists and other stakeholders share a responsibility to implement existing guidelines with the same commitment given to statins and platelet inhibitors.

PMID:40533320 | DOI:10.1016/j.atherosclerosis.2025.120405

Int Immunopharmacol. 2025 Jun 17;161:115065. doi: 10.1016/j.intimp.2025.115065. Online ahead of print.

ABSTRACT

Sepsis-induced myocardial dysfunction (SIMD), a life-threatening complication of systemic infection, lacks effective therapies. This study investigated whether Gastrodin (GAS) alleviates SIMD by modulating ubiquitination and histone lactylation pathways. Using an in vivo lipopolysaccharide (LPS)-induced murine model and in vitro TNF-α-stimulated human cardiomyocytes (AC16), we evaluated the effects of GAS on myocardial injury, inflammation, and apoptosis. GAS treatment significantly reduced myocardial damage, serum cardiac injury markers (cTnT, CK-MB), and pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) in mice. Transcriptomic analysis also enriched for inflammatory and apoptotic pathways. In vitro, GAS protected AC16 cells from TNF-α-induced apoptosis and suppressed glycolysis-derived lactate accumulation. Mechanistically, GAS enhanced CDT2-KAT2A binding, promoting ubiquitin-mediated KAT2A degradation, which reduced histone H3 lysine 14 lactylation (H3K14la) and restored energy metabolism. Multi-omics integration confirmed the role of GAS in glycolytic inhibition and lactylation modulation. These findings demonstrated that GAS ameliorates SIMD by targeting the CDT2-KAT2A axis to regulate ubiquitination-lactylation, providing novel therapeutic insights for septic cardiomyopathy.

PMID:40532326 | DOI:10.1016/j.intimp.2025.115065

J Cardiovasc Med (Hagerstown). 2025 May 22. doi: 10.2459/JCM.0000000000001737. Online ahead of print.

ABSTRACT

BACKGROUND: De-escalation of dual antiplatelet therapy (DAPT) by early discontinuation of one antiplatelet agent has been proposed as an alternative to 12-month DAPT to balance ischemic and bleeding risks in patients with acute coronary syndrome (ACS). However, the efficacy and safety of abbreviated DAPT regimens in ST-elevation myocardial infarction (STEMI) - a subset of ACS with distinct clinical and risk profiles - remain uncertain.

METHODS: Randomized trials and sub-analyses of randomized trials comparing DAPT de-escalation by early discontinuation versus 12-month DAPT in patients with STEMI treated with primary angioplasty were included. Co-primary endpoints were major bleeding and major adverse cardiovascular events (MACE). Secondary endpoints included net adverse clinical events (NACE), individual ischemic outcomes, and clinically relevant bleeding. Trial sequential analysis (TSA) and sensitivity analyses were prespecified (CRD42024608709).

RESULTS: Eight randomized trials encompassing 10,216 patients were included. Short DAPT regimens significantly reduced major bleeding [hazard ratio, 0.50; 95% confidence interval (CI), 0.30-0.85; P = 0.011] compared with standard DAPT. No significant differences were observed in MACE (hazard ratio, 1.21; 95% CI, 0.91-1.64; P = 0.193) or NACE (hazard ratio, 0.94; 95% CI, 0.80-1.10; P = 0.427). The results of TSA reinforced these findings. Other secondary outcomes showed no significant differences, but interpretation was limited by the small number of studies reporting these events.

CONCLUSION: Abbreviated DAPT significantly reduces major bleeding risk in patients with STEMI compared with standard 12-month DAPT, without apparently compromising ischemic protection. However, further research is needed to clarify net clinical outcomes in this high-risk ACS subset.

PROTOCOL REGISTRATION IDENTIFIER: CRD42024608709.

PMID:40530547 | DOI:10.2459/JCM.0000000000001737

Zhonghua Xin Xue Guan Bing Za Zhi. 2025 Jun 24;53(6):653-660. doi: 10.3760/cma.j.cn112148-20240608-00324.

ABSTRACT

Objective: To explore the impact of changes of myocardial infarct size on left ventricular adverse remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods: This was a prospective cohort study. The STEMI patients who underwent primary PCI in the First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing Anzhen Hospital, Hainan Hospital of the Chinese People's Liberation Army General Hospital and Guangxi Yulin First People Hospital from January 1, 2017 to January 1, 2022 were enrolled. Cardiac magnetic resonance (CMR) was performed to dynamically assess the myocardial infarct size and calculate the rate of infarct size change between the acute phase (5 to 7 days post-primary PCI) and 6-month follow-up. The endpoint was left ventricular adverse remodeling which was defined as an increase of more than 20% in left ventricular end-diastolic volume (LVEDV) assessed by CMR at 6 months after primary PCI compared with LVEDV at 1 week after primary PCI. Based on serial CMR assessments, the patients were divided into left ventricular adverse remodeling group and non-remodeling group. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of infarct size change for left ventricular adverse remodeling, and according to the optimal cutoff value, improved infarct size was defined as a decrease of >20% in the infarct size measured by CMR at 6 months after primary PCI compared with infarct size at 1 week after primary PCI. Multivariate logistic regression analysis was performed to identify the protective factors and risk factors for left ventricular adverse remodeling. Results: A total of 267 patients were enrolled, aged (58±11) years, with 234 males (87.6%). And 73 cases in the left ventricular remodeling group and 194 cases in the non-remodeling group. Infarct size assessed by CMR at 6 months after primary PCI decreased significantly compared with infarct size at 1 week after primary PCI in the left ventricular remodeling group ((23±13)% vs. (27±12)%, P=0.004), the same as in the non-remodeling group ((18±10)% vs. (23±10)%, P<0.001). The area under the ROC curve for the rate of infarct size change in predicting left ventricular remodeling was 0.735 (95%CI 0.670-0.799, P<0.001), a 20% reduction was the optimal cut-off value. Compared to the patients with non-improved infarct size, the incidence of left ventricular adverse remodeling was significantly lower in the patients with improved infarct size (18% (24/133) vs. 37% (49/134), P=0.001). Multivariate logistic regression analysis showed that improvement in IS was a protective factor for left ventricular adverse remodeling (OR=0.376, 95%CI 0.236-0.721, P=0.002). Conclusion: Patients with STEMI who experience obvious reduction in infarct size after primary PCI have a significantly reduced risk of left ventricular adverse remodeling.

PMID:40528603 | DOI:10.3760/cma.j.cn112148-20240608-00324

Expert Rev Cardiovasc Ther. 2025 Jun 17. doi: 10.1080/14779072.2025.2520827. Online ahead of print.

ABSTRACT

INTRODUCTION: Bleeding risk stratification tools are essential for optimizing ischemic protection while minimizing bleeding complications, particularly in patients undergoing percutaneous coronary intervention (PCI) or dual antiplatelet therapy (DAPT).

AREAS COVERED: A structured search of PubMed, Scopus, and Web of Science was conducted for studies published from January 2005 to December 2024. This review evaluates traditional and novel bleeding risk models in MI management. Established tools like CRUSADE, ACUITY-HORIZONS, ACTION, and PRECISE-DAPT aid in predicting in-hospital and early post-discharge bleeding but have limitations in long-term risk assessment and adapting to modern PCI techniques. Emerging models - SWEDEHEART, ARC-HBR, BLEED-MI, CREDO-KYOTO, and BleeMACS - offer enhanced risk stratification by incorporating broader clinical variables and long-term bleeding predictors, improving their applicability to contemporary MI management.

EXPERT OPINION: Despite advancements, current models exhibit moderate predictive accuracy (c-statistics 0.70-0.80) and rely on static baseline factors, limiting real-time applicability. They also fail to integrate ischemic risk assessment, creating challenges in balancing thrombotic and bleeding risks. Future research should focus on AI-driven dynamic risk models, broader validation across diverse populations, and integrating bleeding and ischemic risk stratification into a unified framework. Embedding these tools into electronic health records (EHRs) will enhance clinical decision-making and improve patient outcomes.

PMID:40528388 | DOI:10.1080/14779072.2025.2520827

J Am Coll Cardiol. 2025 Jun 24;85(24):2386-2398. doi: 10.1016/j.jacc.2025.04.028.

ABSTRACT

BACKGROUND: Survival for hypoplastic left heart syndrome (HLHS) and variants has improved over the past 4 decades; however, survival remains low compared with other forms of congenital heart disease. There is a paucity of data concerning long-term outcomes.

OBJECTIVES: This study aims to: 1) examine long-term survival and the impact of patient factors on survival for newborns with HLHS; and 2) examine functional and health outcomes, including quality-of-life (QOL) in adulthood.

METHODS: The study cohort included patients with HLHS and variants undergoing the Norwood or hybrid procedure between January 1984 and December 2023. Data on patient characteristics and management were abstracted from medical records. Vital status was ascertained by direct subject and family contact, review of the medical record, and publicly available data. Functional outcomes and QOL in adults (≥18 years of age) were assessed by patient reports. The primary outcome was death or cardiac transplantation at last follow-up.

RESULTS: In the study period, 2,012 neonates underwent staged reconstructive surgery for HLHS (Norwood, n = 1,921 and hybrid, n = 91). Transplant-free survival was 31.0% at 35 years. Transplant-free survival improved over time but is not different across recent eras. Most responders reported good to excellent general health.

CONCLUSIONS: In this cohort of newborns undergoing staged reconstructive surgery for HLHS, fewer than one-third are alive without a transplant at 35 years of age. Survival has not improved in recent years. However, there is a group of survivors who report good to excellent outcomes and QOL, consistent with a "high-performing" Fontan phenotype.

PMID:40533128 | DOI:10.1016/j.jacc.2025.04.028

Ecotoxicol Environ Saf. 2025 Jun 17;302:118474. doi: 10.1016/j.ecoenv.2025.118474. Online ahead of print.

ABSTRACT

Air pollution poses a significant global health threat, largely due to its role in triggering chronic inflammation through molecular pathways. Among these, The NF-κB signaling cascade, comprising nuclear factor kappa-light-chain-enhancer elements in B lymphocytes, serves as a pivotal regulator in orchestrating innate defense mechanisms against anthropogenic contaminants through transcriptional activation processes.This review explores how air pollutants such as particulate matter (PM2.5), heavy metals, NF-κB signaling is activated by exposure to diesel exhaust, triggering the expression of inflammatory mediators including cytokines and chemokines with pro-inflammatory properties.The activation of this pathway involves upstream stimuli including Toll-like receptors (TLRs) and reactive oxygen species (ROS), Modified sentence：These processes serve to amplify pro-inflammatory signaling pathways. Prolonged activation of the NF-κB pathway is implicated in the pathogenesis of pulmonary disorders.cardiovascular conditions, and immune dysfunction. Understanding these mechanisms is crucial for identifying therapeutic targets and designing effective interventions. Strategies including the use of NF-κB inhibitors and public health regulations to reduce exposure are discussed as avenues for mitigating pollutant-induced inflammation and associated diseases.

PMID:40532606 | DOI:10.1016/j.ecoenv.2025.118474

Chem Biodivers. 2025 Jun 18:e03431. doi: 10.1002/cbdv.202403431. Online ahead of print.

ABSTRACT

Self-healing zwitterionic hydrogels (ZIHs) have sparked widespread attention because of their intriguing properties and potential applications. One of the key features of ZIHs is their inherent antifouling properties, making them appealing for various biomedical applications. A notable characteristic of ZIHs is their self-healing capability, enabling them to mend damage and restore their mechanical properties, hence prolonging their lifespans and enhancing their functionality. Self-healing ZIHs exhibit excellent properties as wound-dressing materials by creating a moist environment that promotes the healing process. In addition to their antifouling, self-healing, wound-healing, and wound-dressing applications, zwitterionic self-healing hydrogels have shown promise in cardiac tissue engineering and cell encapsulation. In cell encapsulation, ZIHs provide promising platforms for the encapsulation and delivery of numerous cell types, including stem cells and therapeutic cells, as well as enable controlled release and protection during transplantation. The self-healing feature of ZIHs provides long-term stability and durability of these materials. This review focuses on state-of-the-art advancements in the synthesis strategies, self-healing mechanisms, and applications of ZIHs, offering an integrated perspective not previously addressed in the literature.

PMID:40531749 | DOI:10.1002/cbdv.202403431

ASAIO J. 2025 Jun 18. doi: 10.1097/MAT.0000000000002488. Online ahead of print.

NO ABSTRACT

PMID:40530717 | DOI:10.1097/MAT.0000000000002488

J Thorac Dis. 2025 May 30;17(5):3297-3306. doi: 10.21037/jtd-2025-259. Epub 2025 May 28.

ABSTRACT

BACKGROUND: Organ shortage remains a considerable challenge in the field of lung transplantation. There is an urgent need now for a new standard that can include more donor lungs and expand the donor pool to benefit more patients. To increase lung utilization rates and facilitate the standardization of the lung donor evaluation process, Heiden et al. formulated a novel lung donor (LUNDON) acceptability score. Our study applied data from a Chinese hospital to this model to demonstrate the practicability of the new model and reveal its potential to expand the donor lung pool and improve the efficiency and success rate of lung transplantation.

METHODS: This study was conducted in one of the largest lung transplant centers in China. Our study retrospectively analyzed a cohort of patients who underwent lung transplantation in Wuxi People's Hospital, Jiangsu Province, China, between January 1, 2018 and December 31, 2022, and applied the same exclusion criteria as those described in Heiden et al.'s study. The LUNDON score is an integer score established based on the model. Higher scores correspond to an increased likelihood of lung acceptance.

RESULTS: A total of 553 donor lungs were used for transplantation. According to the LUNDON score, the donors' integer-based score ranged from 9 to 30 points, and the predicted probability of donor lung acceptance was about 6.0% to 95.3%. Utilization of low-LUNDON-score donors increased progressively over the study period. The LUNDON score demonstrated concordance with the lung acceptance rate as designated by the International Society for Heart and Lung Transplantation (ISHLT) standard score. There was a statistically significant difference in the survival rate between donors and recipients with high or low LUNDON scores (P=0.03). The survival rate at 1 year after transplantation was 66.1% for the high-score group and 55.7% for the low-score group. The LUNDON score, as a newly developed practical model, can promote a further understanding of donor lung assessment and has the potential to effectively expand the donor pool.

CONCLUSIONS: This study confirmed the practicability of the newly developed lung donor (LUNDON) scoring model. The LUNDON score was found to be a valuable tool and may revolutionize and optimize the allocation of scarce organ resources. It is possible that the novel model can be applied to various populations, expand the pool of potential available lungs, and enhance the efficiency and success of lung transplantation.

PMID:40529731 | PMC:PMC12170127 | DOI:10.21037/jtd-2025-259

J Med Case Rep. 2025 Jun 18;19(1):280. doi: 10.1186/s13256-025-05241-y.

ABSTRACT

BACKGROUND: Right-sided infective endocarditis is a rare clinical entity, with isolated pulmonary valve infective endocarditis being extremely uncommon. Infective endocarditis carries a high mortality rate and significant complications, making early identification and prompt management crucial in improving outcomes. This case highlights an unusual presentation of right-sided infective endocarditis isolated to the pulmonic valve in a pediatric patient with no apparent preexisting heart disease.

CASE PRESENTATION: A 7-year-old girl of Yoruba ethnicity presented with septicemic illness, congestive heart failure, and no evidence of congenital cardiac lesion, underlying valvular disease, or identifiable predisposing factors. She had underweight malnutrition, cachexia, and severe respiratory distress. Echocardiography, which was delayed due to resource limitations, ultimately revealed isolated myxomatous vegetation on the pulmonary valve, dilated right cardiac chambers, and pulmonary hypertension. Blood cultures grew Pseudomonas aeruginosa. The patient was managed with antimicrobial agents, an anticardiac failure regimen, antiplatelets, and supportive therapy. Management was complicated by financial constraints, which delayed optimal intervention.

CONCLUSION: Although isolated pulmonary valve infective endocarditis is rare in the pediatric population, particularly in the absence of identifiable heart disease, a high index of suspicion is essential. Early diagnosis via echocardiography and prompt, adequate treatment are crucial for favorable outcomes. Awareness of potential diagnostic delays and financial barriers can aid in optimizing timely intervention and improving prognosis.

PMID:40533870 | PMC:PMC12178004 | DOI:10.1186/s13256-025-05241-y

Pediatr Cardiol. 2025 Jun 18. doi: 10.1007/s00246-025-03920-7. Online ahead of print.

ABSTRACT

Extubation on the operating table is increasingly utilized to minimize ventilator-associated complications and promote early recovery in pediatric cardiac surgery. However, its safety across diverse congenital heart disease (CHD) populations remains insufficiently defined. To evaluate the feasibility, safety, and clinical outcomes of on-table extubation across a broad spectrum of corrective and palliative congenital heart surgeries in children. This retrospective multicenter study included 986 pediatric patients (aged 7 days to 16 years) who underwent on-table extubation after CHD surgery between 2019 and 2025. Patients were grouped as corrective (n = 632) or palliative (n = 354) cases. Primary outcomes were reintubation and mortality. Secondary outcomes included ICU and hospital stay durations, and incidence of ventilator-associated pneumonia (VAP). Overall reintubation and mortality rates were 5.78 and 1.22%, respectively. Corrective procedures demonstrated significantly lower reintubation (4.11%) and mortality (0.63%) compared to palliative surgeries (8.76 and 2.26%, respectively; p < 0.01 and p < 0.05). Highest complication rates were observed in HLHS (reintubation and mortality 40%) and aortopulmonary shunt (53.13 and 21.88%). In contrast, Glenn and Fontan procedures showed low reintubation (1.69, 2.91%) and minimal mortality. No cases of VAP were reported. Mean ICU and hospital stays were 3.69 and 9.7 days. Of the 57 reintubation events, 23 (40.4%) occurred within 6 h of extubation, suggesting extubation failure, while 34 (59.6%) occurred between 6 and 24 h, potentially due to secondary complications. Early reintubations (0-6 h) were more common in aortopulmonary shunt (17 cases) and coarctation/IAA repair (3 cases), whereas later reintubations (6-24 h) predominated in ToF (5 cases), truncus arteriosus (4 cases), and TGA (3 cases). A moderate correlation was found between reintubation and mortality (Spearman's r = 0.45, p < 0.01). On-table extubation is a safe and feasible strategy in pediatric cardiac surgery, particularly in corrective procedures and select single-ventricle palliation. However, caution is warranted in high-risk physiologies such as HLHS and shunt-dependent circulation. Careful perioperative evaluation remains essential for optimal outcomes.

PMID:40533645 | DOI:10.1007/s00246-025-03920-7

J Am Coll Cardiol. 2025 Jun 24;85(24):2386-2398. doi: 10.1016/j.jacc.2025.04.028.

ABSTRACT

BACKGROUND: Survival for hypoplastic left heart syndrome (HLHS) and variants has improved over the past 4 decades; however, survival remains low compared with other forms of congenital heart disease. There is a paucity of data concerning long-term outcomes.

OBJECTIVES: This study aims to: 1) examine long-term survival and the impact of patient factors on survival for newborns with HLHS; and 2) examine functional and health outcomes, including quality-of-life (QOL) in adulthood.

METHODS: The study cohort included patients with HLHS and variants undergoing the Norwood or hybrid procedure between January 1984 and December 2023. Data on patient characteristics and management were abstracted from medical records. Vital status was ascertained by direct subject and family contact, review of the medical record, and publicly available data. Functional outcomes and QOL in adults (≥18 years of age) were assessed by patient reports. The primary outcome was death or cardiac transplantation at last follow-up.

RESULTS: In the study period, 2,012 neonates underwent staged reconstructive surgery for HLHS (Norwood, n = 1,921 and hybrid, n = 91). Transplant-free survival was 31.0% at 35 years. Transplant-free survival improved over time but is not different across recent eras. Most responders reported good to excellent general health.

CONCLUSIONS: In this cohort of newborns undergoing staged reconstructive surgery for HLHS, fewer than one-third are alive without a transplant at 35 years of age. Survival has not improved in recent years. However, there is a group of survivors who report good to excellent outcomes and QOL, consistent with a "high-performing" Fontan phenotype.

PMID:40533128 | DOI:10.1016/j.jacc.2025.04.028