Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement. This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients.

Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty‐five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow‐up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%–90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease‐associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA‐to‐aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end‐diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre‐capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA‐to‐aorta, RV end‐diastolic area and PH etiology) and long‐term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

Background: Atrial septal defect (ASD) is the most common congenital heart defect diagnosed in adulthood, causing a left-to-right shunt with subsequent right ventricle (RV) volume overload, increased pulmonary flow and overloading of the pulmonary circulation. Surgical or percutaneous closure of ASD is associated with reverse right heart remodelling, improved functional class and exercise capacity, irrespective of age. In the present study we aimed to assess the short and mid-term outcomes of ASD closure in terms of hemodynamic response, cardiac remodelling and clinical data in a population of adult patients with ostium secundum ASD eligible for percutaneous closure. Methods: Patients with ostium secundum ASD referred to our institution from November 1^st 2017 to September 30^th 2021 were assessed for percutaneous closure within the National Program for percutaneous procedures in adults with congenital heart disease. All patients underwent a clinical and echocardiographic evaluation; demographics and biological data were collected. A transo esophageal echocardiography was available for all patients in order to assess the feasibility of percutaneous closure. Results: The study population included 37 adult patients (29 women, mean age 43.5 ± 14.4 years) and 33 age- and gender-matched healthy volunteers. Eight patients had a history of supraventricular arrhythmias. The ASD patients had a significant RV and right atrial (RA) dilation, a higher pulmonary artery (PA) size and systolic pressures, a smaller left ventricle diastolic diameter. At least 1 follow-up visit data was available in 23 patients and the mean follow-up was 12 ± 8 months. The functional class significantly improved after ASD closure; 4 patients presented with supraventricular arrythmias after ASD closure. Data showed a significant decrease in RV and RA size after the ASD closure, the RV longitudinal function parameters also decreased. At the follow-up visit, the PA trunk diameter and the systolic PAP were significantly lower (p <0.001) compared with the pre-procedural values. The LV end-diastolic diameter increased after ASD closure. The reverse remodelling of the right chambers was similar in patients aged less and more or equal to 60 years, but the decrease in estimated systolic PAP was higher in older patients. Conclusion: In adult patients with ostium secundum ASD, percutaneous closure leads to significant changes in functional class and echocardiographic parameters of right and left heart size and RV function and in pulmonary artery size and pressure. The beneficial effect seems to be similar in patients younger and older than 60 years.

Background: Surgical correction of aortic coarctation (CoAo) has been successfully performed for over half of the century but life expectancy of these patients remains reduced due to increased aortic stiffness leading to adverse left ventricular remodeling and end-organ damage. The role of tissue doppler imaging (TDI), in particular assessment of long axis dysfunction (LAD) defined as septal mitral annulus pulsed-wave early diastolic velocity E’≤8cm/s, in the evaluation of left ventricle diastolic dysfunction has been proved.