Background: Pectus excavatum (PE) can cause cardiopulmonary compression with a wide range of symptoms and psychosocial effects. Few validated surveys assess the extensive symptomatology of the adult pectus population. A comprehensive symptom survey was developed and validated with outcomes presented. Methods: An observational and validation study of a novel symptom survey [Phoenix Comprehensive Assessment of Pectus Excavatum Symptoms (PCAPES)] was performed that included patients evaluated for PE from October 2020–September 2021 at Mayo Clinic Arizona. Survey validation was performed in three phases. Results: After survey validation, 432 patients completed the PCAPES survey: median age was 30 years [interquartile range (IQR), 23.0, 39.9 years], 57.8% males, median Haller index: 4.2 (IQR, 3.6, 5.4). Common neurological complaints included headaches (74%) and positional dizziness (67%). Regarding cardiovascular symptoms, 6/7 exercise related questions had at least 70% of patients reporting limitations or inability to perform. Pulmonary-wise, >80% noted restricted breathing both with normal activity and during exercise. For gastrointestinal symptoms, nearly half reported some degree of dysphagia with 52% noting post-prandial dyspnea. Psychosocially, patients reported either avoiding activities where their chest could be visible (68%) or feeling bothered by the overall appearance of their chest (80%). Commonly reported complaints were feelings of depression and anxiety (65% each). Females and older patients (≥30) were more severely affected with cardiac symptoms (P<0.05 for all comparisons). Despite being more symptomatic, females were more likely to feel dismissed by their physicians. Conclusions: Pectus causes a variety of symptoms, and a comprehensive survey should be performed for assessment and indication of further testing.

Lipoprotein (a) is a complex lipid molecule that has sparked immense interest in recent years, after studies demonstrated its significant association with several cardiovascular conditions. Lp(a) promotes cardiovascular disease through its combined proatherogenic, pro-inflammatory, and prothrombotic effects. While the measurement of Lp(a) has become widely available, effective methods to reduce its concentration are currently limited. However, emerging data from ongoing clinical trials involving antisense oligonucleotides have indicated promising outcomes in effectively reducing Lp(a) concentrations. This may serve as a potential therapeutic target in the management and prevention of myocardial infarction, calcific aortic stenosis, and cerebrovascular accidents. In contrast, the role of Lp(a) in atrial fibrillation, in-stent restenosis, cardiac allograft vasculopathy, and bioprosthetic aortic valve degeneration remains unclear. This review article aims to thoroughly review the existing literature and provide an updated overview of the evidence surrounding the association of Lp(a) and these cardiovascular diseases. We seek to highlight controversies in the existing literature and offer directions for future investigations to better understand Lp(a)’s precise role in these conditions, while providing a summary of its unique molecular characteristics.

Bioprosthetic aortic valve degeneration (BAVD) is a significant clinical concern following both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). The increasing use of bioprosthetic valves in aortic valve replacement in younger patients and the subsequent rise in cases of BAVD are acknowledged in this review which aims to provide a comprehensive overview of the incidence, diagnosis, predictors, and management of BAVD. Based on a thorough review of the existing literature, this article provides an updated overview of the biological mechanisms underlying valve degeneration, including calcification, structural deterioration, and inflammatory processes and addresses the various risk factors contributing to BAVD, such as patient demographics, comorbidities, and procedural variables. The difficulties in early detection and accurate diagnosis of BAVD are discussed with an emphasis on the need for improved imaging techniques. The incidence and progression of BAVD in patients undergoing TAVR versus SAVR are compared, providing insights into the differences and similarities between the two procedures and procedural impacts on valve longevity. The current strategies for managing BAVD, including re-intervention options of redo surgery and valve-in-valve TAVR, along with emerging treatments are discussed. The controversies in the existing literature are highlighted to offer directions for future investigations to enhance the understanding and management of BAVD.

Aortic stenosis is a progressive condition with substantial implications for morbidity and mortality. In recent years, attention has shifted toward risk stratification and the development of individualized management plans to optimize treatment outcomes. The management of asymptomatic patients has become a topic of significant controversy, as emerging studies challenge traditional watchful waiting guidelines and propose the potential benefits of early intervention. While early intervention may reduce overall morbidity and mortality in this patient population, the associated procedural risks remain a critical consideration. This review seeks to analyze the existing literature, offering an updated perspective on patient risk stratification and evidence evaluating both management approaches.

Background: This study aims to assess the trends of emergency department (ED) visits among kidney transplant recipients in a high-volume transplant centre. Methods: This retrospective cohort study targeted patients who underwent renal transplantation at a high-volume transplant centre from 2016 to 2020. The main outcomes of the study were ED visits within 30 days, 31–90 days, 91–180 days, and 181–365 days of transplantation. Results: This study included 348 patients. The median (interquartile range) age of patients was 45.0 years (30.8, 58.2). Over half of the patients were male (57.2%). There was a total of 743 ED visits during the first year after discharge. 19% (n=66) were considered high-frequency users. High-volume ED users tended to be admitted more frequently as compared to those with low frequencies of ED visits (65.2% vs. 31.2%, respectively, P<0.001). Conclusion: As evident by the large number of ED visits, suitable coordination of management through the ED remains a pivotal component of post-transplant care. Strategies addressing prevention of complications of surgical procedures or medical care and infection control are aspects with potential for enhancement.