Conduction disturbances remain one of the most common complications occurring post TAVI. We aim to determine the predictors of cardiac conduction disturbances after Transcatheter Aortic Valve Implantation (TAVI) and propose a relevant predictive model. We included 70 consecutive patients with severe symptomatic AS who underwent TAVI using the self-expanding valve Evolut R or the balloon expandable Sapien XT valve. All patients were subjected to electrocardiographic evaluation pre- and post-TAVI and at 30 days. Clinical, echocardiographic, CT-derived, and procedural parameters were collected and analyzed. Conduction disturbances affected 28 patients (40%): 16 patients (22.9 %) developed Left Bundle Branch Block (LBBB), 7 patients (10%) experienced transient Complete Heart Block (CHB), and 5 patients (7.1%) experienced permanent CHB requiring Permanent Pacemaker Implantation (PPI). We classified predictors into preprocedural and procedural predictors. Multivariate logistic regression analysis of pre-procedural predictors showed that the presence of basal septal calcification is the most powerful independent predictor (OR: 28.63, 95% CI: 4.59-178.68, p < 0.001). Multivariate logistic regression analysis for pre and post procedural predictors showed that the relationship between depth of implantation at the septum and membranous septum expressed in percentage (sDIMS) with cut-off >70.42% is the most powerful independent procedural predictor (OR: 1.11, 95% CI: 1.03-1.2, p 0.006). Conduction disturbances remain a common complication of TAVI. Presence of basal septal calcification is a non-modifiable risk factor that increase patient propensity of development such complication after TAVI. A depth of implantation exceeding 70% of the membranous septal length has been found to strongly predict conduction disturbances post TAVI. sDIMS can be used in planning the depth of implantation to reduce incidence of conduction disturbances post TAVI.

To determine the value of Myocardial Performance Index (MPI) as an echocardiographic predictor of early in-hospital heart failure (HF) during first acute anterior ST-Elevation Myocardial Infarction (STEMI). Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. The ejection fraction (EF) and transmitral flow, the most frequently used methods for evaluation of systolic and diastolic functions respectively, both have considerable limitations. The MPI is a single parameter, capable of estimating combined systolic and diastolic performance and lacks such limitations. We enrolled 60 patients presented with a first acute anterior STEMI who have undergone primary PCI. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time "ICT" + relaxation time "IRT")/Ejection time "ET". Besides, clinical and echocardiographic variables were analyzed and CHF was defined as Killip class ≥ II. Early in-hospital HF occurred in 23 of patients (38%). Ejection fraction was found to have a highly significant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly significant positive correlation (p = .0001). A cut-off point of MPI > 0.73 showed a very high specificity (94.6%) and sensitivity (78.3%) for identifying patients with HF. On the other hand, a cut-off point of EF ≤ 33% has shown 94.6% specificity and 56.5% sensitivity for HF prediction. The MPI might be a strong predictor of in-hospital HF after first acute anterior STEMI.

The circumflex (Cx) coronary artery is more vulnerable to injury than other coronary arteries during procedures such as radiofrequency ablation, left atrial appendage closure, mitral valve repair, and coronary sinus-based mitral valve intervention. Furthermore, a lower success rate was also observed in the Cx artery during chronic occlusion recanalization. Additionally, injury to the great cardiac vein during Cx artery interventions can occur due to the highly variable and often unpredictable relationship between the great cardiac vein and the Cx artery, which occurs in approximately 30% of cases. Imaging information on the Cx artery and the associated relationship with surrounding cardiac structures is crucial for understanding spatial orientation. This knowledge aids preventive measures, accurate prediction, prompt recognition, and understanding of injury mechanisms, thereby facilitating appropriate therapeutic interventions. We present a comprehensive literature review of the clinical implications, complexities, and challenges associated with the Cx artery, which could help in management strategies and improve outcomes.

Background and purpose: Coronary artery disease (CAD) remains one of the leading causes of death worldwide. Its relationship with epicardial adipose tissue (EAT) is still not yet fully established. This study aimed to investigate the correlation between EAT thickness as measured by two-dimensional (2D) echocardiography and the presence of CAD. Methods: This comparative cross-sectional study included 100 patients presenting with chest pain who underwent echocardiography and coronary angiography. Patients with a history of ischemic heart disease, chronic liver disease, or familial hypercholesterolemia were excluded. Participants were divided into two groups; Group A (50 patients) with significant coronary artery stenosis (>70%) on angiography, and Group B (50 patients) with normal coronary findings on angiography. Results: Our study has shown that EAT thickness was significantly greater in Group A compared to Group B, with an average EAT thickness of 8.5 ± 2.2 mm and 5.4 ± 1.7 mm respectively (P < 0.001). A cut-off value of 6.6 mm thickness for EAT thickness was closely associated with significant CAD, demonstrating 94% sensitivity and 90% specificity. Multivariate analysis, adjusting for confounding factors, showed that EAT thickness (odds ratio [OR]: 29.16, P < 0.001) was independently correlated to the presence of significant CAD. Conclusions: EAT thickness measured by echocardiography correlates with the presence of obstructive CAD in patients presenting with acute coronary syndrome (ACS). A cut-off value of 6.6 mm is strongly linked with this condition.

Right pulmonary artery (RPA) to left atrium fistula (LA) is an extremely rare congenital malformation with less than 100 cases of PA-to-LA fistula reported. It causes central cyanosis and may present with heart failure. This is the first case to be closed under 2D and 3D TEE guidance inside cath lab. We present a case of a 12-year-old student who complained of exertional dyspnea and easy fatigability over the past few months. His mother reported mild cyanosis since birth which increased with exertion. On examination, he had central cyanosis with grade II clubbing in both fingers and toes, silent precordium with no audible murmur over his back). ECG showed normal sinus rhythm with no abnormality. CXR showed an abnormal shadow related to right cardiac border with prominent pulmonary artery and otherwise normal pulmonary vasculature. His complete blood count showed erythrocytosis with hemoglobin concentration of 16.4 g/dl and hematocrit value of 69.2%. Transthoracic echocardiography showed dilated left atrium with dilated right pulmonary artery. Patient was diagnosed to have a right pulmonary AV malformation. Invasive cardiac catheterization was done to identify size and number of this pulmonary AV malformation. Right pulmonary angiography showed a right pulmonary artery to left atrium fistula (type I) measuring 11 mm in its narrowest diameter with free shunting of blood. TEE guidance inside our cath lab showed normal pulmonary venous drainage into the left atrium, dilated right pulmonary artery opening into left atrium through an opening 10 mm with systolic flow across of low gradient (15 mmHg). A balloon was advanced across the fistula for sizing. Stretched diameter of fistula measured 13 mm. An Amplatzer ventricular septal occluder 14 was successfully positioned across the fistula. Right pulmonary angiography assured patent right lower pulmonary artery. TEE assured normal pulmonary veins flow into the left atrium. Patient saturation rose from 75% to 95%. Complete cure can be accomplished by transcatheter closure of direct pulmonary artery to left atrium communication. Systematic approach in assessment of patients with rare congenital anomalies can help their management despite of difficult clinical diagnosis. 2D and 3D TEE can guide RPA to LA fistula transcatheter closure as in ASD closure.

Background: Transcatheter aortic valve implantation (TAVI) has become an appealing option in managing patients with severe aortic stenosis (AS) after demonstrating better survival rates, reduction in symptom burden, and improvement in the quality of life (QOL). However, some patients fail to demonstrate benefits after TAVI, whether in terms of survival or QOL. Objective: This study opted to investigate the predictors of poor clinical outcomes following TAVI from a real-world national registry Patients and Methods: This prospective observational study was derived from an Egyptian single-center registry through the duration from November 2022 to May 2023. It included 122 patients who were treated with TAVI. The participants’ QOL was evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire at baseline and 6 months follow-up after TAVI. Participants were subdivided into two groups: Group A (good improvement) reported survival and >20% improvement from baseline and group B (poor improvement) reported mortality or ≤ 20% improvement. Results: The mean age of our patients was 73.67 ± 7.04 years, 47.5% were males. A total of 106 patients (86.9%) showed good outcomes in the form of survival and QOL improvement >20%. Three patients (2.5%) experienced periprocedural mortality and 13 patients (10.6%) did not show an improvement in QOL of >20%. The independent predictors correlated to poor outcomes were: DM (P=0.028), creatinine clearance ≤ 46 ml/min (P=0.002), and pre-existing intraventricular conduction delay (IVCD) (P=0.017) and post-procedural CrCl ≤ 49ml/min (P= 0.011). Conclusions: Our study concluded that certain preoperative risk factors and postoperative complications can predict patients' outcomes after TAVI. The independent predictors of poor outcomes were pre-procedural factors (pre-existing DM, chronic kidney disease (CKD) with CrCl ≤ 46 ml/min, and pre-existing IVCD) and a post-procedural factor which was CrCl ≤ 49 ml/min.