Background: Surgical closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension in adults carries higher risk than in children. Objectives: To investigate the application of self-expandable occluders for transcatheter closure of PDA associated with severe pulmonary arterial hypertension in adults, and the assessment of immediate and short-term results. Methods: 29 adult patients (6 men, 23 women) underwent attempted transcatheter closure of PDA at a mean (standard deviation (SD)) age of 31.1 (11.4) years (range 18–58 years) and a mean (SD) weight of 54.1 (7.1) kg (range 42–71 kg). On the basis of haemodynamic and clinical data obtained before and after trial occlusion, the final duct occlusion was determined and carried out. Radiographs of the chest, electrocardiograms and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month and 3–6 months after successful closure. Results: 20 of the 29 patients had successful occlusion (group 1), and 9 patients failed (named group 2). In group 1, in which occlusion was successful, mean (SD) pulmonary arterial pressures decreased markedly after trial occlusion: 78 (19.3) mm Hg (range 50–125 mm Hg) before occlusion and 41 (13.8) mm Hg (range 23–77 mm Hg) after occlusion. Systemic arterial oxygen saturation was found to be >90% in 19 patients and 95% during inhalation of oxygen or after occlusion in all 20 patients. In group 2, the occlusion was not successful, because in two patients the device was not available; another two patients showed worsening of symptoms. The other five patients showed increased pulmonary arterial pressures after trial closure; their mean (SD) pulmonary arterial pressures increased by 10.3 (6) mm Hg (4–16 mm Hg) after trial occlusion, and systemic arterial oxygen saturation was 85.5% (2.6%) (range 82.6–88%) before inhalation of oxygen and 94.7% (1.7%) (range 90.7–99.1%) during inhalation of oxygen. In group 1, the dimensions of the left atrium, left ventricle and pulmonary artery increased considerably in 3–6-months of follow-up compared with those of preocclusion. Conclusions: Transcatheter closure is an effective treatment for adults with PDA associated with reversible severe pulmonary arterial hypertension. Further research is needed for the evaluation of long-term results.

Background—: Cardiovascular magnetic resonance has provided important information on the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM) in adults; however, comparable data are absent for HCM in children. The study was performed to evaluate cardiovascular magnetic resonance characteristics in children with idiopathic HCM. Methods and Results—: Cardiovascular magnetic resonance was performed in 71 consecutive children with idiopathic HCM (age, 12.8±4.1 years; 46 boys and 25 girls). The left ventricular (LV) parameters indexed by body surface area were calculated and compared with those in 71 healthy children (age, 13.1±3.3 years; 51 boys and 20 girls). Among those with HCM, concentric LV hypertrophy occurred in 9 patients (12.7%): in 2 children, it progressed into end-stage phase. The prevalence of late gadolinium enhancement (LGE) was 73%, and the extent of LGE was 10.4±8.3% of LV mass. Children with HCM with LGE had greater LV mass indexed (112.7±57.9 versus 70.3±37.4 g/m ² ; P =0.025) but had no significant difference in maximal LV wall thickness indexed (19.4±6.3 versus 18.1±7.9 mm/m ² ; P =0.513). In addition, the hazard ratio of adverse events for the extent of LGE was 1.1 ( P =0.004). The follow-up (2.4±1.6 years) demonstrated that LGE was associated with adverse events in children with HCM (log-rank; P =0.029). Conclusions—: The prevalence and extent of LGE in children with HCM approximate to those in adults with HCM. Furthermore, children with HCM with LGE tend to have adverse events, and larger researches with longer follow-up are required.

The differentiation of constrictive pericarditis (CP) from restrictive cariomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders. Twenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM. The maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects. CMR with LGE and RAR can facilitate differentiation of CP from RCM.

Background: High-resolution optical coherence tomography can detect in situ thrombi within patent foramen ovale (PFO), which can become a dangerous embolic source. This study aimed to investigate the frequency and size of in situ thrombus within PFO using optical coherence tomography. Methods: The cross-sectional study was conducted at Fuwai Hospital (Beijing, China) between 2020 and 2021. From 528 consecutive patients with PFO, 117 (age, 34.33 [SD, 11.30] years) without known vascular risk factors were included; according to PFO-related symptoms, they were divided into the stroke (n=43, including 5 patients with transient ischemic attack), migraine (n=49) and asymptomatic (n=25) groups. Optical coherence tomography was used to evaluate in situ thrombi and abnormal endocardium within PFO. Univariable analysis and a logistic model were used to evaluate the association between stroke and in situ thrombus; age, sex, body mass index, and antithrombotic therapy were included as covariates. Results: Antithrombotic therapy was used more frequently in the stroke group than in the migraine group (76.7% versus 12.2%; P <0.001). In situ PFO thrombi were detected in 36 (83.7%), 28 (57.1%), and 0 (0.0%) patients from the stroke, migraine, and asymptomatic groups, respectively ( P <0.001). Between the stroke and migraine groups, there was no significant difference in the median (interquartile range) thrombus number per patient (7 [3–12] versus 2 [0–10]; P =0.199), maximum thrombus diameter (0.35 [0.20–0.46] versus 0.21 [0–0.68] mm; P =0.597), or total thrombus volume (0.02 [0.01–0.05] versus 0.01 [0–0.05] mm ³ ; P =0.386). Additionally, in situ thrombus was significantly associated with stroke risk (odds ratio, 4.59 [95% CI, 1.26–16.69]). Abnormal endocardium within PFO occurred in patients with in situ thrombi (71.9%) but not in those without. During optical coherence tomography examination, migraine occurred in 2 patients with in situ thrombi. Conclusions: The frequency of in situ thrombus was extremely high in stroke and migraine groups, while none of the asymptomatic individuals presented with an in situ thrombus. In situ thrombus formation may play a role in patients with PFO-associated stroke or migraines and have therapeutic implications. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04686253.

Patent foramen ovale (PFO) is present in 27.3% of the adult population¹ and is associated with a number of pathological conditions, most importantly ischemic stroke.^2,3 Although paradoxical embolism is the main hypothesized mechanism (from venous to systemic circulation), PFO itself has been suspected to be a site of thrombus formation.^2-4 However, there is no definitive clinical evidence supporting this mechanism. High-resolution optical coherence tomography (OCT) is an excellent imaging technology for assessing the microstructure of vessels.^5,6 We used OCT to detect in situ thrombus within PFOs of patients with and without stroke.