Tetralogy of Fallot (TOF) is the commonest cyanotic congenital cardiac defect. Uncorrected TOF in adults, especially during pregnancy, is uncommon and presents significant hazards to both mother and fetus. We present a case of a 28-year-old lady with uncorrected cyanotic TOF, gravida 4, para 1 + 3 at 22 weeks of gestation, who presented to our multidisciplinary cardio-obstetric team. She presented with cyanosis, exertional dyspnea, and oxygen saturation in the range of 70% to 80%. Echocardiography revealed the classic features of TOF, such as a large ventricular septal defect and severe pulmonary stenosis. An emergency preterm birth was performed at 28 weeks due to maternal instability. The baby, admitted to the neonatal intensive care unit, was released after 14 days. Uncorrected TOF seldom allows for survival to reproductive age. Research indicates worse maternal-fetal outcomes in such cases. This instance underscores the significance of prompt diagnosis and diligent management by a multidisciplinary cardio-obstetric team for a better prognosis. Uncorrected TOF during pregnancy is uncommon but can be effectively managed with prompt, multidisciplinary cardio-obstetric collaborative intervention.

Cardiovascular toxicity has emerged as a major determinant of long-term outcomes in cancer survivors as advances in oncologic therapies continue to improve survival. Conventional cardiac surveillance strategies predominantly rely on functional and structural changes, often identifying myocardial injury after clinically significant damage has occurred. The aim of this narrative review is to critically evaluate the role of nuclear imaging in advancing precision cardio-oncology by enabling earlier, mechanism-based detection and characterization of cancer therapy-related cardiotoxicity. We summarize current clinical applications of PET- and SPECT-based imaging, examine molecular and tracer-level innovations, and discuss emerging hybrid imaging and analytic approaches relevant to individualized cardiovascular risk stratification. Current literature indicates that nuclear imaging provides unique insights into myocardial perfusion, metabolism, inflammation, and microvascular dysfunction, facilitating detection of subclinical injury across diverse anticancer therapies, including anthracyclines, targeted agents, and immune checkpoint inhibitors. By integrating molecular imaging with conventional modalities, nuclear techniques support more personalized surveillance and management strategies. This narrative review highlights nuclear imaging as an emerging complementary modality within precision cardio-oncology supporting earlier detection and risk stratification, and outlines future directions required to optimize its clinical integration and impact on cardiovascular outcomes across the cancer care continuum.

Background Fournier’s gangrene is associated with high morbidity and mortality, and optimal postoperative wound management remains uncertain. This study compared negative pressure wound therapy (NPWT) with conventional wound care following surgical debridement. Methods A systematic review and meta-analysis of observational studies was conducted according to PRISMA guidelines. PubMed, Embase, and Scopus were searched to September 2025. Outcomes were pooled using random-effects models and reported as mean differences (MD) or risk ratios (RR) with 95% confidence intervals. Results Eighteen studies (691 patients) were included. NPWT significantly reduced postoperative analgesic use (MD − 2.16; 95% CI − 3.63 to − 0.70; p = 0.004) and time to wound closure (MD − 10.17; 95% CI − 24.98 to 4.29; p = 0.17). There were no significant differences in mortality (RR 0.66; 95% CI 0.44–1.31), number of debridements (MD − 0.83; 95% CI − 2.42 to 0.76), or length of hospital stay (MD − 1.03; 95% CI − 4.28 to 2.21). Heterogeneity was high across outcomes. Conclusions NPWT is associated with reduced postoperative analgesic consumption following debridement for Fournier’s gangrene. However, based on low-to-moderate certainty observational evidence, it does not significantly reduce mortality, surgical debridement frequency, length of stay, or overall time to wound closure. Consequently, NPWT should be considered a supportive adjunct rather than a replacement for standard surgical management. Further high-quality, prospective comparative studies are required to define its cost-effectiveness and optimal clinical indications.

Objective: The purpose of this narrative review is to synthesize and discuss the various exercise testing modalities used to assess right ventricular (RV) function in pulmonary hypertension (PH), given that accurate and prompt assessment of RV function is crucial for both diagnosing the disease and predicting patient prognosis. Methods: A comprehensive literature search was conducted using electronic databases, including PubMed and Google Scholar. Keywords used included “pulmonary hypertension,” “right ventricular function,” “exercise testing,” “cardiopulmonary exercise testing,” “CPET,” “RV dysfunction,” “hemodynamic assessment,” “right heart failure,” and “exercise limitation”. Results: The review identified that RV dysfunction in PH results from complex pathophysiological mechanisms, including hemodynamic stress that leads to maladaptive remodeling, characterized by eccentric hypertrophy and compromised systolic and diastolic function. Exercise testing reveals multiple parameters reflecting RV dysfunction, including reduced VO ₂ max, altered O ₂ pulse, and decreased RV stroke volume during exercise. Ventilatory abnormalities such as elevated VE/VCO2 slope and reduced petCO ₂ serve as important markers of impaired RV output and gas exchange. The concept of RV-arterial coupling (Ees/Ea ratio) provides valuable insights into the efficiency of RV-pulmonary artery collaboration. Exercise-induced changes in pulmonary artery systolic pressure (PASP) demonstrated prognostic significance, with lower survival rates associated with reduced PASP increases following physical activity. Conclusion: Exercise testing provides a comprehensive evaluation of RV function in PH patients, offering both diagnostic and prognostic value. The integration of hemodynamic, functional, and ventilatory parameters during exercise stress testing enables clinicians to better assess RV reserve capacity and guide therapeutic decision-making in pulmonary hypertension management.

Background: Hypoplastic Left Heart Syndrome (HLHS) is a severe congenital heart disease characterized by underdevelopment of the left heart structures, often requiring staged surgical palliation. Despite improvements in surgical management, HLHS is associated with high mortality and long-term morbidity. Stem cell-based therapies have emerged as a promising adjunct to improve cardiac function and outcomes in these patients. Objectives: This systematic review evaluates the long-term safety and efficacy of stem cell therapy, particularly cardiosphere-derived cells (CDCs) and umbilical cord blood-derived mononuclear cells (UCB-MNCs), in the treatment of HLHS. Methods: Following PRISMA guidelines, a comprehensive search was conducted across major databases. Seven studies met the inclusion criteria, comprising randomized controlled trials, observational cohorts, and in vitro analyses. Quality appraisal was performed using RoB2, Newcastle–Ottawa, and SYRCLE tools. Results: Stem cell therapy was associated with improvements in right ventricular ejection fraction, somatic growth, heart failure status, and psychosocial quality of life. CDCs showed favorable outcomes in both early and long-term follow-up, with reductions in scar burden, ventricular volume, and adverse events. Importantly, no major adverse effects such as arrhythmias, systemic infections, or tumor formation were reported. The use of allogeneic cells could extend beyond HLHS to other forms of congenital heart disease with right ventricular dysfunction, including tetralogy of Fallot, pulmonary atresia, and other single-ventricle variants. In vitro studies confirmed the regenerative capacity of pediatric-derived stem cells, with the highest potential in the first year of life. Conclusion: Stem cell therapy demonstrates safety, feasibility, and potential efficacy in improving cardiac outcomes in HLHS. Larger, multicenter trials such as the APOLLON trial are warranted to validate these findings and support integration into standard clinical care.

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all global heart failure cases. Historically viewed as a left‐centric diastolic disorder, emerging evidence identifies right ventricular (RV) dysfunction and impaired ventriculo‐arterial (RV‐PA) coupling as central drivers of exercise intolerance, functional decline, and adverse clinical outcomes. Objectives: This review synthesizes current evidence on the pathophysiological mechanisms, advanced diagnostic modalities, prognostic implications, and phenotype‐specific therapies for RV dysfunction in HFpEF, advocating for a transition to systematic biventricular evaluation. Methods: A structured, PRISMA‐informed search of PubMed and Scopus (2015–2024) identified 74 eligible studies evaluating RV structure, function, and hemodynamics in HFpEF cohorts. Results: RV dysfunction is prevalent in 19% to 33% of HFpEF patients and independently predicts all‐cause mortality and heart failure hospitalizations. Key pathophysiological drivers include post‐capillary pulmonary hypertension, impaired RV lusitropy, systemic inflammation, and inter‐ventricular dependence. Non‐invasive markers notably speckle‐tracking echocardiography, 4D‐flow cardiac magnetic resonance (CMR), and the TAPSE/PASP ratio enable early identification of subclinical RV‐PA uncoupling. While traditional heart failure therapies show limited efficacy, emerging options including SGLT2 inhibitors, interatrial shunt devices, GLP‐1 receptor agonists, and targeted pulmonary vasodilators demonstrate potential to preserve RV strain and restore hemodynamics across distinct clinical phenotypes. Conclusions: RV dysfunction is a major prognostic marker in HFpEF. Routine inclusion of RV‐PA coupling indices in diagnostic and risk‐stratification algorithms is essential to guide precision‐based, phenotype‐guided management and improve clinical trajectories.