Search Results (380)

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an interfascial regional technique, offers promising analgesic benefits in thoracic wall procedures but remains underutilized in cardiac electrophysiology. Materials and Methods: We conducted a prospective, controlled, non-randomized clinical study including 106 patients undergoing de novo CIED implantation. Patients were assigned to receive either a PECS II block (n = 53) or standard lidocaine-based local anesthesia (n = 53). Pain intensity was assessed using the numeric rating scale (NRS) intraoperatively and at 1, 6, and 12 h postoperatively. Secondary outcomes included the need for rescue analgesia, procedural duration, length of hospitalization, and patient satisfaction. Results: Patients in the PECS II group reported significantly lower NRS scores at all time points (mean intraoperative score: 2.1 ± 1.2 vs. 5.7 ± 1.6, p < 0.001; at 1 h: 2.5 ± 1.5 vs. 6.1 ± 1.7, p < 0.001). Rescue analgesia (metamizole sodium) was required in only four PECS II patients (7.5%) vs. 100% in the control group within 1 h. Hospital stay and procedural time were also modestly reduced in the PECS II group. Patient satisfaction scores were significantly higher in the intervention group. Conclusions: The ultrasound-guided PECS II block significantly reduces perioperative pain and the need for additional analgesia during CIED implantation, offering an effective, safe, and opioid-sparing alternative to conventional local infiltration. Its integration into clinical protocols for device implantation may enhance procedural comfort and recovery. Full article

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a rare, often fatal congenital disorder characterized by severe neonatal respiratory distress and associated with complex multisystem malformations. In approximately 90% of cases, the condition is linked to deletions or mutations affecting the FOXF1 gene or its upstream enhancer region on chromosome 16q24.1. This review analyzes reported prenatal cases with 16q24.1 deletion involving FOXF1, aiming to identify recurrent sonographic features and elucidate the underlying genomic and epigenetic mechanisms. We reviewed prenatal cases reported in the literature involving deletions of the 16q24.1 region, including the FOXF1 gene. Here, we expand the case series by reporting a fetus with increased nuchal translucency measuring 8 mm and a de novo 16q24.1 deletion. We identified nine prenatal cases with a 16q24.1 deletion, all involving the FOXF1 gene or its enhancer region. The main ultrasound findings included increased nuchal translucency and cystic hygroma during the first trimester, and cardiac, renal, and intestinal malformations from 20 weeks of gestation onward. Prenatal diagnosis of ACDMPV based solely on ultrasound findings is challenging. In most reported cases, the pregnancy was carried to term, with the diagnosis being confirmed by post-mortem histopathological examination. In the only case in which the pregnancy was terminated at 14 weeks’ gestation, histological examination of the fetal lungs, despite them being in the early stages of development, revealed misaligned pulmonary veins in close proximity to the pulmonary arteries and bronchioles. Evidence highlights the significance of non-coding regulatory regions in the regulation of FOXF1 expression. Differential methylation patterns, and possible contributions of parental imprinting, highlight the complexity of FOXF1 regulation. Early detection through array comparative genomic hybridization (array CGH) or next-generation sequencing to identify point mutations in the FOXF1 gene, combined with increased awareness of ultrasound markers suggestive of the condition, could improve the accuracy of prenatal diagnosis and genetic counseling. Further research into the epigenetic regulation of FOXF1 is crucial for refining recurrence risk estimates and improving genetic counseling practices. Full article

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article

Coronary plaque vulnerability, more than luminal stenosis, drives acute coronary syndromes. Optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA) visualize plaque morphology in vivo, but manual interpretation is time-consuming and operator-dependent. We performed a narrative literature survey of artificial intelligence (AI) applications—focusing on machine learning (ML) architectures—for automated coronary plaque segmentation and risk characterization across OCT, IVUS, and CCTA. Recent ML models achieve expert-level lumen and plaque segmentation, reliably detecting features linked to vulnerability such as a lipid-rich necrotic core, calcification, positive remodelling, and a napkin-ring sign. Integrative radiomic and multimodal frameworks further improve prognostic stratification for major adverse cardiac events. Nonetheless, progress is constrained by small, single-centre datasets, heterogeneous validation metrics, and limited model interpretability. AI-enhanced plaque assessment offers rapid, reproducible, and comprehensive coronary imaging analysis. Future work should prioritize large multicentre repositories, explainable architectures, and prospective outcome-oriented validation to enable routine clinical adoption. Full article

Background and Clinical Significance: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by pathogenic variants in TSC1 or TSC2. Cardiac rhabdomyoma is a common prenatal finding and can be associated with severe complications, including pericardial effusion. We administered prenatal sirolimus to mitigate pericardial effusion, which led to postnatal complications. Case Presentation: A 28-year-old pregnant woman with no significant family history underwent routine fetal ultrasound at 28.1 weeks of gestation, which identified a large right ventricular mass consistent with rhabdomyoma. Further fetal brain MRI revealed cortical-subcortical tubers and subependymal nodules, leading to a clinical diagnosis of TSC. At 30.4 weeks, oral sirolimus (3 mg/day) was started due to the significant pericardial effusion. The effusion remained after treatment, requiring pericardiocentesis at 33.6 weeks. The sirolimus dosage was raised to 6 mg/day at 35.6 weeks, reaching a plasma level of 3.76 ng/mL, but there was no discernible improvement because of the continued fluid accumulation. The mother did not experience any adverse side effects from the procedure. Genetic testing confirmed a pathogenic variant in TSC2 (c.1372C>T). After birth, the neonate received a single dose of sirolimus but subsequently developed necrotizing enterocolitis (NEC), highlighting the potential adverse effects and the need for cautious consideration of treatment options. Conclusions: This case illustrates the complexities of managing prenatal tuberous sclerosis complex (TSC). While sirolimus has been explored for fetal cardiac rhabdomyoma and associated complications, its effectiveness in resolving pericardial effusion remains uncertain. Additionally, the development of NEC postnatally raises concerns about the safety of mTOR inhibitors in this context. Further studies are necessary to assess the risks and benefits of this approach in fetal therapy. Full article

Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder primarily affecting motor neurons. Emerging evidence suggests it also involves multiple organs, including potential cardiac manifestations. This study aimed to evaluate cardiac abnormalities in pediatric SMA patients compared to age-matched healthy controls, providing insight into underlying cardiomyopathy in this population. A total of 126 children were included in the study, with 63 SMA patients and 63 age-matched controls. We conducted clinical examinations, standard electrocardiography (ECG), and cardiac ultrasound (CUS) in all patients. Electrocardiographic analysis revealed a higher prevalence of sinus tachycardia in the SMA group and significantly deeper Q waves, indicating possible myocardial involvement. Echocardiographic findings demonstrated a significant reduction in left ventricular mass and left ventricular mass index in SMA patients compared to controls, despite normal systolic function. Statistical analysis confirmed that SMA diagnosis was an independent predictor of reduced myocardial mass, suggesting a distinct cardiac phenotype in SMA patients. This study provides new evidence of subclinical cardiac involvement in SMA, characterized by reduced myocardial mass, altered electrocardiographic parameters, and increased sinus tachycardia. These findings suggest a previously unrecognized form of cardiomyopathy in SMA that differs from cardiac manifestations typically seen in other neuromuscular disorders. Full article

Ultrasound enhancing agents (UEAs, formerly called contrast agents) for assessments of the left heart have improved the applicability of echocardiography and the accuracy of echocardiographic measurements. UEAs have been recommended for several diagnostic echocardiographic procedures by national and supernational agencies. The increased use of UEAs during the last years provided more evidence and experience in clinical practice data which is helpful for optimizing the UEA procedures and which will be useful for both newcomers to UEA in echocardiography and sonographers/physicians with experience in echocardiography with UEAs. In two parts, this review focuses on the “how to do” for the approved UEA applications. This is part 1, covering the available UEAs and providing specific guidance on the assessment of global and regional LV function. Part 2 covers the imaging of myocardial disease and masses as well as myocardial perfusion. Recommendations include the application of UEAs in two-dimensional echocardiography as there is limited data on three-dimensional echocardiography. A step-by-step approach is proposed for each of the procedures as well as guidance on how to interpret recordings and how to report them. Full article

Background: Over the past decade, few echocardiographic investigations have assessed myocardial strain parameters in women with a history of hypertensive disorders of pregnancy (HDP), and their findings have been inconsistent. Moreover, no study has comprehensively evaluated deformation indices of all biventricular and biatrial chambers in women post-HDP. This study aimed to examine the structural and functional myocardial properties of all cardiac chambers in a cohort of women with prior HDP at six years after delivery. Methods: We analyzed a consecutive cohort of women with previous HDP and compared them with a control group of normotensive healthy women matched for age and body mass index (BMI). Both groups underwent standard transthoracic echocardiography (TTE) supplemented by a detailed speckle tracking echocardiography (STE) evaluation of biventricular and biatrial myocardial deformation, along with carotid ultrasound, at six years postpartum. The primary endpoint was subclinical myocardial dysfunction, defined by impaired left ventricular global longitudinal strain (LV-GLS < 20%), while the secondary endpoint was early carotid atherosclerosis, defined by common carotid artery intima-media thickness (CCA-IMT) ≥ 0.7 mm. Results: The study included 31 women with previous HDP (mean age 42.3 ± 5.9 years) and 30 matched controls without HDP history (mean age 40.8 ± 5.0 years). The average follow-up duration was 6.1 ± 1.3 years postpartum. Despite preserved and comparable systolic function on conventional TTE, most myocardial strain and strain rate measures in both ventricles and atria were significantly reduced in the HDP group compared to controls. Subclinical myocardial dysfunction was detected in 58.1% of women with prior HDP, and 67.7% exhibited increased CCA-IMT (≥0.7 mm). A history of pre-eclampsia (PE) was independently associated with subclinical myocardial dysfunction (HR 4.01, 95% CI 1.05–15.3, p = 0.03). Both third-trimester BMI (HR 1.21, 95% CI 1.07–1.38, p = 0.003) and PE (HR 6.38, 95% CI 1.50–27.2, p = 0.01) independently predicted early carotid atherosclerosis. Notably, a third-trimester BMI above 27 kg/m² showed optimal sensitivity and specificity for identifying the secondary outcome. Conclusions: A history of PE is independently associated with a higher risk of subclinical myocardial dysfunction and early carotid atherosclerosis at six years postpartum. Full article

Introduction: This study aims to elucidate the impact of AQP1 on cardiac function and the intestinal microbiota in mice with chronic heart failure and to further investigate the broad effects of AQP1 on the gut microbiota composition in these mice. Methods: AQP1 knockout mice were used as the experimental group, with wild-type mice serving as the control group. The study evaluated the effects of AQP1 on various physiological parameters, including blood pressure, heart rate, cardiac function, cardiac color Doppler ultrasound, and 24 h urine collection. Additionally, the high-throughput sequencing of gut microbiota was performed to identify key microbial communities. Results: The deletion of the AQP1 gene did not significantly alter key cardiovascular metrics such as systolic blood pressure (SBP), mean blood pressure (MBP), or left ventricular mass (LV mass). However, we found that AQP1 knockout affected 24 h urine output in mice. Echocardiography results showed that AQP1 expression influenced LV mass, LVAW; d, and LVPW; s. Moreover, substantial differences were observed in the intestinal microbiota profiles between AQP1 knockout mice with heart failure and their wild-type counterparts. These findings suggest that AQP1 may contribute to cardiac dysfunction in mice with chronic heart failure through the regulation of gut microbiota. Conclusion: Our investigation provides initial insights into the role of AQP1 in modulating the intestinal microbiota in a murine model of heart failure. However, the precise mechanisms underlying this association require further exploration and detailed analysis. Full article

Background/Objectives: Sternal pain after cardiac surgery results in considerable discomfort and may contribute to the development of chronic postoperative sternal pain syndrome. Parasternal intercostal plane blocks have been shown to improve postoperative sternal pain and can be an essential part of enhanced recovery after cardiac surgery (ERACS). This cohort study evaluated the postoperative impact of a single-shot deep parasternal intercostal plane block (PIPB) on the requirement of analgesic medication and pain sensation up to 48 h. Methods: This retrospective single-center analysis evaluates the postoperative acute pain in 157 patients undergoing off-pump coronary artery bypass (OPCAB) with median sternotomy. The additive analgesic effects of deep PIPB (38 patients) were compared to a group with standard therapy but without PIPB (119 patients). To strengthen the findings, a propensity score matching analysis was performed. Outcomes included the consumption of emergency pain agents (piritramide), the requirement of the total morphine equivalent (ME), time to extubation, and ICU length of stay. Furthermore, we examined pain sensation with evaluation by using the behavioral pain score (BPS) and numeric rating score (NRS) up to 48 h after extubation. Results: The deep PIPB reduced the piritramide administration 24 h and 48 h after OPCAB surgery. Moreover, the requirement of ME was 24 h and 48 h after bypass surgery also significantly decreased. The one-to-one propensity score matching confirmed our primary findings and showed a decreased requirement for intravenous agents. Additionally, we observed a reduced time for extubation and a decreased NRS rating. However, no significant changes were observed in ICU length of stay, incidence of nausea, and vomiting. Conclusions: Our data suggests that an ultrasound-guided single-shot deep PIPB can be a valuable tool for a multimodal analgesic protocol on patients undergoing OPCAB surgery. Full article

Background/Objectives: Two-dimensional echocardiography (2D echo) is widely used for assessing left ventricular ejection fraction (LVEF). This single-center comparative study aims to evaluate the accuracy of LVEF measurements obtained using the AI-assisted handheld ultrasound device Kosmos against cardiac magnetic resonance (CMR), the current gold standard. Methods: A total of 49 adult patients undergoing clinically indicated CMR were prospectively enrolled. AI-based LVEF measurements were compared with CMR using the Wilcoxon signed-rank test, Pearson correlation, multivariable linear regression, and Bland–Altman analysis. All analyses were performed using STATA v18.0. Results: Median LVEF was 57% (CMR) vs. 55% (AI-Echo), with no significant difference (p = 0.51). Strong correlation (r = 0.99) and minimal bias (1.1%) were observed. Conclusions: The Kosmos AI-based autoEF algorithm demonstrated excellent agreement with CMR-derived LVEF values. Its speed and automation make it promising for bedside assessment in emergency departments, intensive care units, and outpatient clinics. This study aims to fill the gap in current clinical evidence by evaluating, for the first time, the agreement between LVEF measurements obtained via Kosmos’ AI-assisted autoEF and those from cardiac MRI (CMR), the gold standard for ventricular function assessment. This comparison is critical for validating the reliability of portable AI-driven echocardiographic tools in real-world clinical practice. However, these findings derive from a selected population at a single Italian center and should be validated in larger, diverse cohorts before assuming global generalizability. Full article

Chronic total occlusions (CTOs), defined as complete coronary artery blockages persisting for over three months, are frequently encountered in up to 25% of coronary angiograms. Although percutaneous coronary intervention (PCI) for CTO remains technically challenging, advancements in guidewires, microcatheters, re-entry devices, and intravascular imaging, along with the expertise of specialized operators, have significantly improved procedural success rates, now exceeding 90% in expert centers. While recent evidence, such as the SYNTAX II study, emphasizes the importance of complete revascularization, over half of CTO cases continue to be managed conservatively with optimal medical therapy (OMT), partly due to the limited high-quality randomized evidence supporting revascularization. Observational studies have demonstrated that successful CTO-PCI is associated with improved angina relief, quality of life, left ventricular function, and possibly long-term survival. Extended observational follow-up, such as the Korean and Canadian registries, suggests long-term reductions in cardiac and all-cause mortality with CTO revascularization. However, randomized controlled trials (RCTs) have primarily shown symptomatic benefit, with no consistent reduction in major adverse cardiac events (MACE) or mortality, likely due to limited sample sizes, short follow-up, and treatment crossovers. Various strategies, including the hybrid algorithm, guide CTO interventions by balancing antegrade and retrograde techniques based on lesion complexity. Imaging modalities such as coronary CT angiography and intravascular ultrasound play a pivotal role in planning and optimizing these procedures. Future innovations, such as real-time fusion imaging of CCTA with coronary angiography, may enhance lesion visualization and guidewire navigation. While current guidelines recommend CTO-PCI in selected symptomatic patients with demonstrable ischemia or viable myocardium, the decision should be individualized, incorporating anatomical feasibility, comorbidities, patient preferences, and input from a multidisciplinary Heart Team. Looking ahead, adequately powered RCTs with extended follow-up are essential to determine the long-term clinical impact of CTO-PCI on hard outcomes such as mortality and myocardial infarction. Full article

Cardiac allograft vasculopathy (CAV) is a leading cause of allograft dysfunction and failure. CAV prevention, early detection, and management are essential to increasing allograft survival. In this comprehensive review, we discuss various invasive and non-invasive modalities that are being utilized for CAV detection. Invasive coronary angiography provides a visualization of vascular anatomy but is limited in detecting the microvasculature and diffuse and early structural changes. The addition of intracoronary assessment techniques, including intravascular ultrasound, optical coherence tomography, and coronary flow reserve assessment, offer(s) superior sensitivity in identifying CAV. Non-invasive imaging modalities, such as cardiac magnetic resonance imaging, computed tomography angiography, and positron emission tomography, provide complementary insights into CAV with myocardial perfusion and allograft function while reducing procedural risks. Our aim is to guide clinicians in selecting appropriate imaging strategies tailored to individual recipients, to improve detection, monitoring, and outcomes in CAV. Full article

Background: A vascular access blood flow (Qa) to cardiac output (CO) ratio greater than 0.3 increases the risk of high-output heart failure (HOHF). This study analyzed the characteristics and risk factors associated with a high Qa/CO ratio and effective CO (COef) in these patients over one year. Methods: This prospective study enrolled 142 hemodialysis (HD) patients, divided by the Qa/CO ratio. Baseline and one-year hemodynamics were measured: volume by bioimpedance, CO by echocardiography, Qa and brachial flow by transonic and ultrasound. Risk factors for HOHF were analyzed using receiver operating characteristic (ROC) curves and multivariable regression. Results: The study population was 66% male, mean age of 65, with 71% using arteriovenous fistulae (AVF) for vascular access. In the high Qa/CO group, cases of younger ages (62 vs. 67 years, p = 0.040) with upper arm access (73.1% vs. 32.8%, p < 0.001) were more prevalent, and diastolic blood pressure (DBP) was higher (76.8 ± 15.1 vs. 66.7 ± 14.4 mmHg, p = 0.002). Independent risk factors for high Qa/CO were elevated DBP (odds ratio [OR]: 1.080; 95% confidence interval [CI]: 1.028–1.134), upper arm access (OR: 8.113; 95% CI: 1.842–35.741), low resistive index (RI) (OR: 0.000; 95% CI: 0.000–0.417), and COef (OR: 0.164; 95% CI: 0.065–0.416). After one year, the high Qa/CO group showed significant increases in CO and COef (4.82 ± 1.25 L/min vs. 6.16 ± 2.05 L/min, p = 0.007, and 2.84 ± 0.95 L/min to 4.40 ± 1.89 L/min, p = 0.001, respectively). A baseline Qa cutoff value of 1.4 L/min demonstrated high diagnostic efficacy in identifying the high Qa/CO group. Conclusions: High Qa/CO ratios increase overt HOHF risk due to cardiac strain. This study reveals AV access-driven cardiac adaptations in patients with high Qa/CO and low COef, emphasizing the necessity for ongoing clinical and hemodynamic monitoring. Full article