Background: Studies focused on pregnant women with congenital heart disease (CHD)–associated pulmonary hypertension (PH) are scarce and limited by small sample sizes and single-center design. This study sought to describe the pregnancy outcomes in women with CHD with and without PH. Methods: Outcomes for pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. PH was diagnosed on the basis of echocardiogram or catheterization. The incidence of maternal death, cardiac complications, and obstetric and offspring complications was compared for women with CHD and no PH, mild, and moderate-to-severe PH. Results: A total of 2220 pregnant women with CHD had completed pregnancies. PH associated with CHD was identified in 729 women, including 398 with mild PH (right ventricle to right atrium gradient 30–50 mm Hg) and 331 with moderate-to-severe PH (right ventricle to right atrium gradient >50 mm Hg). Maternal mortality occurred in 1 (0.1%), 0, and 19 (5.7%) women with CHD and no, mild, or moderate-to-severe PH, respectively. Of the 729 patients with PH, 619 (85%) had CHD-associated pulmonary arterial hypertension, and 110 (15%) had other forms of PH. Overall, patients with mild PH had better maternal outcomes than those with moderate-to-severe PH, including the incidence of maternal mortality or heart failure (7.8% versus 39.6%; P <0.001), other cardiac complications (9.0% versus 32.3%; P <0.001), and obstetric complications (5.3% versus 15.7%; P 100 ng/L (odds ratio, 1.9 [95% CI, 1.0–3.4], P =0.04) and New York Heart Association class III to IV (odds ratio, 2.9 [95% CI, 1.6–5.3], P <0.001) were independently associated with adverse maternal cardiac events in pregnancy with PH, whereas follow-up with a multidisciplinary team (odds ratio, 0.4 [95% CI, 0.2–0.6], P <0.001) and strict antenatal supervision (odds ratio, 0.5 [95% CI, 0.3–0.7], P =0.001) were protective. Conclusions: Women with CHD-associated mild PH appear to have better outcomes compared with women with CHD-associated moderate-to-severe PH, and with event rates similar for most outcomes with women with CHD and no PH. Multimodality risk assessment, including PH severity, brain natriuretic peptide level, and New York Heart Association class, may be useful in risk stratification in pregnancy with PH. Follow-up with a multidisciplinary team and strict antenatal supervision during pregnancy may also help to mitigate the risk of adverse maternal cardiac events.

Hypothesis: This study hypothesized that augmented reality (AR) technology has comparable accuracy and safety to conventional CT localization in guiding percutaneous transthoracic lung puncture (PTLP) to localize small pulmonary nodules. Methods: This study was a prospective, non-inferiority randomized clinical trial. Patients were randomly assigned between 23 May 2023, and 26 September 2023. Patients with small peripheral lung nodules (≤2 cm) were recruited. Patients were randomly assigned to either the CT-guided PTLP group or the AR-guided PTLP group, with a 1:1 allocation ratio. The primary outcome was the accuracy of lung nodule localization measured by localization error. The secondary outcomes included procedure duration, radiation exposure dosage and complications. Results: A total of 70 patients underwent either CT- or AR-guided lung nodule localization and subsequent surgeries. Localization error was smaller in the AR-guided group than in the CT-guided group (mean ± SD, 3.1 ± 4.0 mm vs. 5.4 ± 4.2 mm, P = 0.026). The mean difference of localization errors was −2.3 mm (95% CI: − 4.2 to −0.3 mm, P < 0.001 for non-inferiority). Compared to the CT-guided group, the AR-guided group demonstrated significantly lower radiation exposure (mean ± SD, 421 ± 168 vs. 694 ± 229 mGy × cm, P < 0.001) and shorter localization procedure duration (mean ± SD, 8.8 ± 2.3 vs. 14.1 ± 1.8 minutes, P < 0.001), with no statistical difference in complications. Conclusions: The accuracy of the AR-guided approach is comparable to that of the CT-guided approach in localizing small lung nodules. Furthermore, the utilization of AR technology has been demonstrated to reduce procedural time and minimize radiation exposure for patients.

OBJECTIVES: Prior studies have reported a high mortality and incidence of post-repair pulmonary venous obstruction (PVO) in mixed total anomalous pulmonary venous connection (TAPVC). This study sought to review the surgical outcomes in this entity. METHODS: A review of 61 patients undergoing surgical repair of mixed TAPVC was conducted. Patients with a single ventricle were excluded. Patients were subdivided into 3 groups according to Chowdhury’s classification. Predictors for death and postoperative PVO were explored by Cox regression model. RESULTS: This study trended towards an older cohort with a median age of 88 days (interquartile range, 56.5–177). Twelve patients belonged to ‘2 + 2’ type, 40 belonged to ‘3 + 1’ type and the remaining 9 belonged to bizarre type. There were no early death and 7 late deaths. Follow-up was available in 96.7% of the patients after discharge with a median duration of 53 months (range, 1–177). Nineteen patients developed post-repair PVO among whom 2 required reintervention. Patients with preoperative PVO had a 4-fold higher risk (95% confidence interval, 1.36–12.38) of postoperative PVO than those without and were more likely to die (P = 0.009). No statistical difference was observed among the 3 subgroups in terms of mortality (P = 0.058) and postoperative PVO (P = 0.186). CONCLUSIONS: Preoperative PVO was significantly associated with postoperative PVO. There was no statistical difference in terms of death and postoperative PVO among the 3 subtypes of mixed TAPVC. Mid-term results favoured a complete rechanneling of pulmonary veins in ‘3 + 1’ type.

Background: Lung cancer (LC) is a leading cause of morbidity and mortality worldwide. Cardiovascular disease is the primary cause of non‐cancer‐related death among cancer survivors. Frailty, characterized by a decline in physiological reserves, has been identified as a predictor of poor outcomes in cancer. However, the relationship between frailty, pre‐frailty, and long‐term cardiovascular outcomes in LC patients remains insufficiently explored. Methods: This retrospective analysis of a cohort study utilized prospectively collected data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow‐up until October 31, 2022. Frailty was defined using the frailty phenotype according to five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). Participants were categorized as non‐frail, pre‐frail or frail. The outcome was defined as major adverse cardiac and cerebrovascular events (MACCE). Cox proportional hazards models adjusted for confounders including age, sex, obesity, smoking status, socioeconomic status, diabetes, hypertension, COPD, and tumor type were employed to estimate hazard ratios (HR) for MACCE. Results: Of the 500,530 participants in this cohort, 6095 were diagnosed with LC after recruitment. Among LC patients, 43.79% were non‐frail, 48.20% pre‐frail, and 8.01% frail. Frail individuals had a significantly higher risk of MACCE (HR = 1.21, 95% CI: 1.07–1.38, p = 0.002) compared to non‐frail patients, while pre‐frail individuals also exhibited an elevated risk (HR = 1.10, 95% CI: 1.02–1.18, p = 0.010). Specific frailty components, particularly low physical activity and slow gait speed, were strongly associated with increased risks of both MACCE and all‐cause mortality. In contrast, low grip strength did not show a significant association with adverse outcomes. Conclusions: LC participants had a higher prevalence of pre‐frailty and frailty. The presence of frailty and pre‐frailty significantly increased the risk of MACCE in long‐term LC survivors. Notably, slow gait speed and low physical activity were strongly associated with MACCE compared to other frailty components.

To investigate the prevalence and prognostic impact of pulmonary hypertension (PH) in lung cancer (LC) and assess its association with long-term mortality and major adverse cardiac and cerebrovascular events (MACCE). A total of 500,530 participants enrolled in the UK Biobank between 2006 and 2010 were prospectively followed through October 31, 2022. Incident LC cases were identified during follow-up. Overall survival (OS) and MACCE were assessed according to PH status. Time-dependent Cox regression models were used to estimate adjusted hazard ratios (HRs) after controlling for demographic characteristics, smoking status, comorbidities, and histological subtype. During a median follow-up exceeding 12 years, 6,095 participants developed LC. PH was significantly more prevalent among participants with LC than among those without LC. Among patients with LC, PH was associated with significantly increased risks of mortality and MACCE. After multivariable adjustment, PH remained independently associated with adverse outcomes, with progressively greater prognostic impact over time. At 10 years, adjusted HRs were 2.88 for OS and 3.45 for MACCE. PH is an important adverse cardiopulmonary comorbidity in LC and is independently associated with worse long-term survival and cardiovascular outcomes. These findings support the potential value of early recognition and longitudinal cardiopulmonary surveillance for risk stratification and management in patients with LC.

In the originally published version of this manuscript, the listed affiliation was erroneous and provided as: Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. This has now been corrected to: Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.