Migraine is a chronic neurovascular disease with a complex, not fully understood pathophysiology with multiple causes. People with migraine suffer from recurrent moderate to severe headache attacks varying from 4 to 72 h. The prevalence of migraine is two to three times higher in women compared with men. Importantly, it is the most disabling disease in women <50 years of age due to a high number of years lived with disability, resulting in a very high global socioeconomic burden. Robust evidence exists on the association between migraine with aura and increased incidence of cardiovascular disease (CVD), in particular ischaemic stroke. People with migraine with aura have an increased risk of atrial fibrillation, myocardial infarction, and cardiovascular death compared with those without migraine. Ongoing studies investigate the relation between migraine and angina with non-obstructive coronary arteries and migraine patients with patent foramen ovale. Medication for the treatment of migraine can be preventative medication, such as beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antiepileptics, antidepressants, some of the long-acting calcitonin gene-related peptide receptor antagonists, or monoclonal antibodies against calcitonin gene-related peptide or its receptor, or acute medication, such as triptans and calcitonin gene-related peptide receptor antagonists. However, these medications might raise concerns when migraine patients also have CVD due to possible (coronary) side effects. Specifically, knowledge gaps remain for the contraindication to newer treatments for migraine. All cardiologists will encounter patients with CVD and migraine. This state-of-the-art review will outline the basic pathophysiology of migraine and the associations between migraine and CVD, discuss current therapies, and propose future directions for research.

Introduction: Increasing survival of adult congenital heart disease (ACHD) patients comes at the price of a range of late complications—arrhythmias, heart failure, and valvular dysfunction. Transcatheter valve interventions have become a legitimate alternative to conventional surgical treatment in selected acquired heart disease patients. However, literature on technical aspects, hemodynamic effects, and clinical outcomes of percutaneous atrioventricular (AV) valve interventions in ACHD patients is scarce. Method: This is a descriptive cohort from CAHAL (Center of Congenital Heart Disease Amsterdam-Leiden). ACHD patients with severe AV valve regurgitation who underwent a transcatheter intervention in the period 2020–2022 were included. Demographic, clinical, procedural, and follow-up data were collected from patient records. Results: Five ACHD patients with severe or torrential AV valve regurgitation are described. Two patients underwent a transcatheter edge-to-edge repair (TEER), one patient underwent a valve-in-valve procedure, one patient received a Cardioband system, and one patient received both a Cardioband system and TEER. No periprocedural complications occurred. Post-procedural AV valve regurgitation as well as NYHA functional class improved in all patients. The median post-procedural NYHA functional class improved from 3.0 (IQR [2.5–4.0]) to 2.0 (IQR [1.5–2.5]). One patient died 9 months after the procedure due to advanced heart failure with multiorgan dysfunction. Conclusion: Transcatheter valve repair is feasible and safe in selected complex ACHD patients. A dedicated heart team is essential for determining an individualized treatment strategy as well as pre- and periprocedural imaging to address the underlying mechanism(s) of AV regurgitation and guide the transcatheter intervention. Long-term follow-up is essential to evaluate the clinical outcomes of transcatheter AV valve repair in ACHD patients.

(1) Background: Prevalence of patent foramen ovale (PFO) in the general population is estimated at around 24%. We hypothesized that right-to-left shunting (RLS) resulting from PFO might contribute to angina symptoms in patients with coronary artery spasm (CAS), potentially triggered by vasoactive metabolites. Therefore, the aim of this study was to investigate the prevalence of PFO-related RLS in patients with documented CAS. (2) Methods: This single-center prospective cohort study included patients with documented CAS undergoing transthoracic echocardiography (TTE), including a contrast bubble study between 2021 and 2023. The Seattle Angina Questionnaire (SAQ) and Migraine Disability Assessment (MIDAS) were used to survey patients. (3) Results: RLS (PFO group) was observed in 11 of the 48 patients included (23%). In the PFO group, 64% had epicardial spasm and 36% microvascular spasm. Furthermore, RLS was more prevalent in patients with CAS and concomitant migraine (29%). Remarkably, the density plot of the SAQ summary score showed a worse score for patients with RLS (median of 38 [Q1–Q3: 31–49]) than patients without RLS (median of 49 [Q1–Q3: 41–55]) (p = 0.0282). (4) Conclusions: The prevalence of RLS due to PFO in patients with CAS was in line with the PFO prevalence in the general population, and patients with RLS are more symptomatic according to the SAQ summary score. Whether PFO closure could be beneficial to patients with CAS and concomitant migraine requires further investigation.

Background: Residual shunt is a known complication in percutaneous patent foramen ovale (PFO) closure, and moderate to large residual shunt has been associated with an increased risk of recurrent stroke. Device‐related factors, such as device size, have been associated with residual shunt, but comparative data per device type are scarce. Aims: We compared the prevalence of moderate to large residual shunt at 6 months between the Amplatzer and Occlutech devices. Methods: In this retrospective cohort study, patients undergoing successful percutaneous PFO closure with an Amplatzer or Occlutech dedicated closure device within the CAHAL centers Amsterdam UMC and Leiden UMC between 2018 and 2024 were included. The study population was divided into patients treated with an Occlutech and an Amplatzer device. The prevalence of moderate/large residual shunt at 6 months of follow‐up was compared between the two groups. As a sensitivity analysis, a logistic regression was conducted to determine the association between the treatment groups and moderate/large residual shunt. The logistic regression was conducted in a weighted population using inverse probability weighting (IPTW), correcting for age, sex, smoking status, shunt size at baseline, device size, and atrial septal aneurysm. Results: A total of 413 patients were included with an average age of 45.8 ± 11.3 years and 51.6% were male. Of the included patients, 279 were treated with an Amplatzer‐ and 134 with an Occlutech device. In the group treated with an Amplatzer, 22.2% of the patients had a moderate or large residual shunt at 6 months compared to 14.9% in the Occlutech group ( p = 0.11). The sensitivity analysis did not show an association between device type and moderate/large shunt OR 0.71 (95% CI: 0.39–1.28, p = 0.25). Conclusion: In this study, no significant difference was observed in moderate/large residual shunt prevalence at 6 months of follow‐up between the Occlutech and Amplatzer devices.