Search Results (119)

Background: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72–0.92) and 1-year mortality (OR 0.76, 95% CI 0.61–0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes. Full article

Background/Objectives: The aim of this study was to evaluate the usefulness of selected predictive parameters obtainable from cardiac multidetector computed tomography for assessing the severity of aortic valve stenosis in patients scheduled for transcatheter aortic valve implantation (TAVI). Methods: A detailed retrospective analysis was performed on 105 patients with a bicuspid aortic valve (BAV), selected from a cohort of 1000 patients with BAV confirmed on ECG-gated CT, and on 105 patients with a tricuspid aortic valve (TAV) matched for sex and age. All patients included in both groups had significant aortic stenosis confirmed on transthoracic echocardiography. Results: Across the entire cohort, a trend toward higher aortic valve calcium scores was observed in patients with bicuspid compared to tricuspid aortic valves (4194.8 ± 2748.7 vs. 3335.0 ± 1618.8), although this difference did not reach statistical significance (p = 0.080). However, sex-stratified analysis showed higher calcium scores in males with BAV than with TAV (5596.8 ± 2936.6 vs. 4061.4 ± 1659.8, p = 0.002), with no significant difference observed among females (p > 0.05). Univariate regression analysis showed that the aortic valve calcium score was the strongest statistically significant predictor of aortic stenosis severity in both groups, with R² = 0.224 for BAV and R² = 0.479 for TAV. In the multiple regression model without interaction terms, the explanatory power increased to R² = 0.280 for BAV and R² = 0.495 for TAV. Conclusions: In patients scheduled for TAVI, linear regression models assess the severity of aortic stenosis more accurately than any individual predictive parameter obtainable from ECG-CT, with the aortic valve Agatston score emerging as the most reliable single CT-derived predictor of stenosis severity in both TAV and BAV subgroups. Full article

Background: The ex vivo evaluation of the aortic wall aims to identify potential risk factors predictive of acute aortic syndrome. The comparison of aortic wall properties in patients with bicuspid aortic disease versus those with tricuspid aortic disease has been the subject of many studies. However, the heterogeneity of aortic wall characteristics in individual patients has never been thoroughly investigated. In this study, we focused on comparing the heterogeneity of aortic wall characteristics in patients with bicuspid (BAV) and tricuspid (TAV) aortic valve disease. Materials and Methods: Out of 113 patients enrolled in our cumulative study on the ex-vivo evaluation of the aortic wall, in patients with dilated ascending aorta, 56 patients with >3 specimens taken from the anterior wall were selected for the present study. The heterogeneity of anatomical characteristics (aortic wall thickness) was assessed by measuring the coefficient of variability (cV). In 35 patients, furthermore, mechanical (uniaxial ultimate stress–strain test) characteristics heterogeneity was also evaluated. Intra-patient mechanical and anatomical variability was then compared between the BAV and TAV groups. Results: Heterogeneity of aortic wall thickness was significantly less important compared to heterogeneity of mechanical properties: peak strain (Pstr p = 0.0042), peak stress (PS p = 0.001) and maximum elastic modulus (EM p = 0.001). Only EM heterogeneity was significantly reverse-correlated to patient’s age (p = 0.0005), and this correlation was peculiar for patients with BAV. In BAV patients, furthermore, age > 66 was associated with a significantly superior EM heterogeneity (p = 0.008). A direct comparison of anatomical and mechanical intra-patient variability between BAV and TAV groups, however, did not show significant differences. Discussion: Our study clearly demonstrates that the anatomical and mechanical characteristics of the aortic wall in patients with aortic dilation are not homogeneous. The heterogeneity of aortic wall thickness appears to be less significant than that of mechanical properties, thus confirming a limited correlation between anatomical and mechanical characteristics. The comparison between the BAV and TAV groups revealed limited peculiarities, further suggesting a preservation of the mechanical properties of the aortic wall in patients with bicuspid aortic disease and, therefore, without a peculiar mechanical properties-related increased risk of acute aortic syndrome. Full article

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article

Background and Objectives: Postoperative atrial fibrillation (POAF) remains one of the most frequent complications after cardiac surgery, increasing the risk of morbidity, prolonged hospitalization, and adverse long-term outcomes. Although several clinical and echocardiographic factors have been associated with POAF, the integrated contribution of atrial conduction delay, biatrial mechanics, and atrioventricular coupling to arrhythmogenesis remains unclear. Materials and Methods: This retrospective study included 131 adult patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Preoperative echocardiography within one week before surgery provided detailed assessment of atrial phasic function, valvular motion, and total atrial conduction time (TACT). Univariate analysis was followed by multivariable modeling using penalized logistic regression (Elastic Net) to identify the most robust predictors of POAF. Discriminative performance and calibration were evaluated via receiver operating characteristic (ROC) and calibration analysis. An exploratory Extreme Gradient Boosting (XGBoost) model with SHapley Additive exPlanations (SHAP) analysis was used to confirm the stability and directionality of nonlinear feature interactions. Results: POAF occurred in 47 (36%) patients. The Elastic Net model identified prolonged TACT, reduced right atrial active emptying fraction (RAAEF), increased indexed minimal left atrial volume (MIN LA/BSA), and lower tricuspid annular plane systolic excursion (TAPSE) as the most informative predictors. The model demonstrated excellent internal discrimination (AUC = 0.95; 95% CI 0.91–0.99) and satisfactory calibration (Hosmer–Lemeshow p = 0.41). Exploratory XGBoost analysis yielded concordant feature hierarchies, confirming the physiological consistency of the results. Conclusions: POAF arises from an identifiable electromechanical substrate characterized by atrial conduction delay, biatrial mechanical impairment, and reduced atrioventricular coupling. A parsimonious, regularized statistical model accurately delineated this profile, while complementary machine-learning analysis supported its internal validity. These findings underscore the potential of echocardiographic electromechanical parameters for refined preoperative risk stratification, pending prospective multicenter validation. Full article

Severely burned patients are at high risk of local and systemic infections due to skin barrier loss. Their clinical management is complex and requires coordinated intensive care and infection prevention strategies. Diagnosing infective endocarditis (IE) in this population is particularly difficult due to overlapping symptoms and limited diagnostic specificity. Common pathogens include Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. We conducted a retrospective cohort study on 543 patients with burns affecting >18% of total body surface area (TBSA), admitted to our Burn Intensive Care Unit (BICU) from 2019 to 2024. The incidence of infective endocarditis was 1.47%, involving aortic (75%), mitral (12.5%), and tricuspid (12.5%) valves. Pathogens identified included S. aureus, Klebsiella pneumoniae, A. baumannii, and P. aeruginosa. This incidence is significantly higher than that in the general population. Mortality reached 50%, with an overall 3-month mortality of 75%. The literature on IE in burn patients is scarce, and the role of antibiotic prophylaxis remains controversial. Infective endocarditis in burn patients, although rare, represents a severe complication with high mortality. Early diagnosis and coordinated multidisciplinary care are essential to improve patient outcomes. Full article

Background/Objectives: To report our single-centre experience with the first 100 patients who underwent transcatheter aortic valve replacement (TAVR) with the new balloon-expandable Myval system. We report 3-year outcomes in low- to high-risk TAVR patient populations. Methods: From November 2019 to July 2021, 100 consecutive patients underwent TAVR, and their outcomes were classified according to the Valve Academic Research Consortium 3 definitions. Device performance was assessed using transthoracic echocardiography. Data collection was approved by the local ethical committee. Results: Among the 100 patients, most were male (n = 63), the mean age was 74.7 years, the mean EuroSCORE II score was 4.8 ± 4.9, and the mean Society of Thoracic Surgeons score was 5.6 ± 3.9. All patients were followed up for three years or until death. The rates of all-cause mortality, cardiac mortality and stroke were 28%, 7% and 5%, respectively. After three years, residual moderate aortic regurgitation was detected in eight patients without severe grade, and bioprosthetic valve dysfunction was observed in 17: structural valve deterioration in 10 (only stage 2), non-structural valve deterioration in three (paravalvular leak in one, patient–prosthesis mismatch in two), and endocarditis in four. Definite transcatheter heart valve thrombosis (hypoattenuated leaflet thickening) was not observed. Bioprosthetic valve failure was detected in four patients (stage 1: 1, stage 2: 0, stage 3: 3). After three years of follow-up, survival analysis revealed no significant differences in all-cause mortality, cardiac mortality, or the composite endpoint (including cardiac mortality, stroke and valve-related dysfunction) between patients with bicuspid (BAV) and tricuspid (TAV) aortic valve morphology and across annulus sizes (small, intermediate and large). Conclusions: TAVR resulted in significant and sustained improvements in valve haemodynamics with low rates of valve dysfunction and adverse clinical outcomes over a three-year follow-up period. Valve morphology (BAV vs. TAV) and annulus size did not significantly impact survival, haemodynamic performance, or valve durability. These results support the expanded use of TAVR in diverse patient populations, although extended follow-up is essential to fully establish long-term durability. Full article

Bicuspid aortic valve (BAV) is the most common congenital valvular anomaly, affecting roughly 1–2% of the population and predisposing to premature aortic stenosis and thoracic aortopathy. Surgical aortic valve replacement (SAVR) remains the standard therapy, while transcatheter aortic valve implantation (TAVI) is increasingly adopted across a broader range of risk profiles due to accumulating evidence and advancements in device technology. Observational registries and early trial data indicate that TAVI is technically feasible in selected BAV anatomies, with device-success rates exceeding 90%. Nonetheless, bicuspid morphology is still technically demanding, with several possible pitfalls during transcatheter procedure and pre-procedural planning compared with tricuspid valve. The rates of moderate-to-severe paravalvular leak (PVL), permanent pacemaker implantation (PPI), and annular complications remain high, especially in the presence of extensive calcifications with raphe or tapered roots, underscoring the importance of meticulous multimodality imaging, dedicated sizing algorithms, and device-specific strategies. Long-term durability signals are encouraging but remain limited, underlining the need for prospective trials with extended follow-up. This review summarizes current knowledge on BAV anatomy and its management, exploring the available evidence supporting the role of transcatheter approach in this challenging and unique scenario. Full article

Background and Objectives: Enhancing recovery after cardiac surgery involves minimally invasive procedures, early extubation/mobilization, and swift discharge. While mechanical ventilation is often essential post-operation, prolonged invasive ventilation (IMV) increases mortality risk. Duration is influenced by patient factors (age and comorbidities), surgical complexity, and complications. Prognostic scores like EuroSCORE II, sequential organ failure assessment (SOFA), the Charlson Comorbidity Index (CCI), and the vasoactive–inotropic score (VIS) help to predict ventilation needs. The aim of this study is to analyze the effect of pre-/post-operation factors and procedure type as predictors of ventilation time. Materials and Methods: This is a retrospective cohort observational study analyzing factors affecting the duration of postoperative mechanical ventilation in elective cardiac surgical patients treated between 1 January and 31 December 2024 in a tertiary center in continental Croatia. Patients were stratified into two groups according to the duration of IMV: normal (first three quartiles) and prolonged (upper quartile). In total, 493 elective cardiac surgical patients operated on under general endotracheal anesthesia with sternotomy or mini-sternotomy were admitted postoperatively to the cardiovascular ICU and mechanically ventilated during the observed period, and 463 patients were included in the final analysis after the exclusion criteria had been applied. Results: The mean age was 64.7 ± 9.8 years, and 28.7% of the cohort were females while 71.3% were males. The median Charlton Comorbidity Index was 4 (IQR 3–5), the VIS was 2 (IQR 0–3), the SOFA score at ICU admission was 5 (IQR 3–6), and the adjusted SOFA score was 3 (IQR 2–4). In the multivariate logistic regression model, a significant effect of female sex (OR 1.98), age (OR 1.05), VIS (OR 1.05), and history of previous cardiac surgery (OR 6.67) on the duration of mechanical ventilation was observed. In the time-to-extubation multivariate analysis, there was a significant effect of re-do surgery (HR 3.70), corrected SOFA score (HR 1.14), and VIS (HR 1.05) on the duration of mechanical ventilation. There was no significant effect of the type of surgery (CABG, aorta, aortic valve, mitral/tricuspid valve, or other) or the amount of chest tube drainage on the duration of mechanical ventilation. Conclusions: A history of previous cardiac surgery and the vasoactive–inotropic score during the first 24 postoperative hours in the ICU are the strongest predictors of the duration of mechanical ventilation after elective cardiac surgery, with a statistically significant effect present in both the logistic regression model and hazard ratio analysis. Further analyses with more variables are warranted in the future to refine the prognostic model. Full article

Background and Objectives: Prosthetic valve thrombosis (PVT) represents a rare but critical complication after heart valve replacement surgery. This study aimed to evaluate patient characteristics, treatment modalities (medical vs. surgical), and clinical outcomes in patients with PVT over a 15-year period, with a particular focus on the impact of New York Heart Association (NYHA) functional class on mortality. Materials and Methods: We retrospectively analyzed 76 patients with confirmed PVT (54 mitral, 20 aortic, and 2 tricuspid; 97.4% mechanical) treated at a single tertiary center between 2005 and2020. The treatment comprised intravenous unfractionated heparin (UFH) alone (n = 29), low-dose tissue plasminogen activator (t-PA) (n = 27), or surgical re-operation (n = 20). Primary endpoints were treatment success, in-hospital mortality, and complications. Results: Overall, the treatment success was 60.5% (46/76) with a 25.0% (19/76) in-hospital mortality. UFH therapy achieved a 67.6% success with a 24.3% mortality. Low-dose t-PA demonstrated a 59.3% success with a significantly lower mortality (7.4%, p = 0.004). The surgery showed a 50% success with a 50% mortality. Patients in the NYHA class III-IV had markedly higher mortality (68.2% vs. 11.1%, p < 0.001) and lower treatment success (27.3% vs. 81.5%, p < 0.001) compared to the NYHA class I-II. A multivariate analysis revealed NYHA III–IV as the strongest predictor of mortality (OR 12.639, 95% CI: 1.905–83.849, p = 0.009). Conclusions: The low-dose t-PA (25 mg total dose) therapy showed the lowest mortality among treatment modalities. The NYHA functional class emerged as the most significant predictor of outcomes, with the class III-IV patients having >12-fold increased mortality risk. These findings support early intervention and suggest that t-PA is a viable first-line option in selected patients. Full article

Background: Aortic stenosis (AS) is a prevalent acquired heart valve disease with increasing incidence, particularly among older adults. Gender-specific differences in AS presentation, comorbidities, and outcomes remain underexplored, necessitating further investigation to optimize personalized treatment strategies. Objective: To evaluate the clinical and demographic characteristics, comorbidities, and survival outcomes of patients with AS, stratified by gender and aortic valve morphology. Methods: A retrospective analysis of 145,454 echocardiographic examinations (2009–2018) at the Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” identified 84,851 patients meeting the inclusion criteria (Vmax ≥ 2.0 m/s, age ≥ 18 years). Patients were stratified by gender and valve morphology (bicuspid aortic valve [BAV] vs. tricuspid aortic valve [TAV]). Survival was assessed in 475 pts with AS over a 16-year period (2009–2025) using Kaplan–Meier analysis. Statistical comparisons utilized STATISTICA v. 10.0, with p-values derived from P-tests. Results: Of the cohort, 4998 men and 6322 women had AS. Men with AS were older (median 64 vs. 57 years, p < 0.0001) and had higher systolic blood pressure (140 vs. 130 mmHg, p < 0.0001) than men without AS. Women with AS were also older (median 70 vs. 58 years, p < 0.0001) with higher systolic (140 vs. 130 mmHg, p < 0.0001) and diastolic blood pressure (80 vs. 80 mmHg, p < 0.0001). Men with AS had higher rates of hyperlipidemia (HLP) (26.3% vs. 10.3%, p < 0.0001), while women with AS had increased coronary artery disease (CAD) (35.7% vs. 26.4%, p < 0.0001), diabetes mellitus (DM) (13.4% vs. 10.2%, p < 0.0001), and obesity (10.9% vs. 10.2%, p = 0.06). Chronic heart failure (CHF) was more frequently reported in patients with AS, regardless of gender, compared to patients without AS (in men 53.4% vs. 41.8%, p < 0.0001; in women 54.5% vs. 37.5%, p < 0.0001). BAV was associated with higher AS prevalence (54.5% in men, 66.4% in women). Survival analysis revealed higher mortality. Over the 16-year follow-up period, the mortality rate was 21.7%. Conclusions: Mortality in a representative AS cohort reached 21.7%, underscoring the progressive nature of the disease and its long-term impact. Survival was negatively affected by age over 68.5 years, as well as the presence of aortic regurgitation (AR), increased peak aortic jet velocity, and enlarged maximum aortic diameter. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. Beta-blocker therapy in patients with varying degrees of aortic AS severity has not only demonstrated its safety but has also shown a positive effect on reducing mortality (improving survival). In contrast, the combination of angiotensin II receptor blockers (ARBs) with calcium channel blockers (CCBs) is quite dangerous for patients with AS and reduces their survival. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. In contrast, the absence of fibrinolytic therapy and anticoagulant treatment is associated with an improved prognosis. Conversely, the administration of antiarrhythmic agents and statins is correlated with enhanced survival outcomes, potentially attributable to their influence on coexisting comorbidities. Further research is required to delineate their precise mechanisms and contributions. These results emphasize the importance of early identification, comprehensive risk assessment, and individualized management strategies in improving outcomes for patients with AS. Full article

Background and Objectives: Despite significant advances in surgical techniques and perioperative care, major adverse cardiovascular events (MACE) remain a leading cause of postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Accurate preoperative risk stratification is essential yet often limited by models that overlook atrial mechanics and underutilized biomarkers. Materials and Methods: This study aimed to develop an interpretable machine learning model for predicting perioperative MACE by integrating clinical, biochemical, and echocardiographic features, with a particular focus on novel physiological markers. A retrospective cohort of 131 patients was analyzed. An Extreme Gradient Boosting (XGBoost) classifier was trained on a comprehensive feature set, and SHapley Additive exPlanations (SHAPs) were used to quantify each variable’s contribution to model predictions. Results: In a stratified 80:20 train–test split, the model initially achieved an AUC of 1.00. Acknowledging the potential for overfitting in small datasets, additional validation was performed using 10 independent random splits and 5-fold cross-validation. These analyses yielded an average AUC of 0.846 ± 0.092 and an F1-score of 0.807 ± 0.096, supporting the model’s stability and generalizability. The most influential predictors included total atrial conduction time, mitral and tricuspid annular orifice areas, and high-density lipoprotein (HDL) cholesterol. These variables, spanning electrophysiological, structural, and metabolic domains, significantly enhanced discriminative performance, even in patients with preserved left ventricular function. The model’s transparency provides clinically intuitive insights into individual risk profiles, emphasizing the significance of non-traditional parameters in perioperative assessments. Conclusions: This study demonstrates the feasibility and potential clinical value of combining advanced echocardiographic, biochemical, and machine learning tools for individualized cardiovascular risk prediction. While promising, these findings require prospective validation in larger, multicenter cohorts before being integrated into routine clinical decision-making. Full article

Background/Objectives: Although cardiac resynchronization therapy (CRT) plays an established role in the management of heart failure, a significant proportion of patients do not respond despite appropriate candidate selection. The optimization of CRT pacing is one strategy to enhance response. Fusion pacing algorithms aim to synchronize intrinsic right ventricular (RV) conduction with paced left ventricular (LV) activation, resulting in a more physiological ventricular depolarization pattern. This approach may improve electrical synchrony and enhance left ventricular contraction compared to conventional simultaneous biventricular pacing. The aim of this study was to compare the acute, beat-to-beat effects of standard biventricular pacing versus fusion pacing on myocardial function, using both conventional and speckle-tracking echocardiography in heart failure patients with left bundle branch block (LBBB). Methods: In total, 27 heart failure patients (21 men and 6 women) with reduced ejection fraction (EF < 35%), left bundle branch block (QRS > 150 ms), and newly implanted CRT-D systems (Abbott) underwent echocardiographic assessment immediately after device implantation. Echocardiographic parameters—including left atrial strain, left ventricular strain, TAPSE, mitral and tricuspid valve function, and cardiac output—were measured at 5 min intervals under three different pacing conditions: pacing off, simultaneous biventricular pacing, and fusion pacing using Abbott’s SyncAV^® algorithm. Results: In our study, CRT led to a significant shortening of the QRS duration from 169 ± 19 ms at baseline to 131 ± 17 ms with standard biventricular pacing, and further to 118 ± 16 ms with fusion pacing (p < 0.05). Despite the electrical improvement, no significant changes were observed in global longitudinal strain (GLS: −9.15 vs. −9.39 vs. −9.13; p = NS), left ventricular stroke volume (67.5 mL vs. 68.4 mL vs. 68.5 mL; p = NS), or left atrial parameters including strain, area, and ejection fraction. However, fusion pacing was associated with more homogeneous segmental strain patterns, improved aortic valve closure time, and enhanced right ventricular function as reflected by tissue Doppler-derived S’. Conclusions: Immediate QRS narrowing observed in CRT patients—particularly with fusion pacing optimization—is associated with a more homogeneous pattern of left ventricular contractility and improvements in selected measures of mechanical synchrony. However, these acute electrical changes do not translate into immediate improvements in stroke volume, global LV strain, or left atrial function. Longer-term follow-up is needed to determine whether the electrical benefits of CRT, especially with fusion pacing, lead to meaningful hemodynamic improvements. Full article

Background and Clinical Significance: The deer horn sign is an ultrasonographic (US) finding suggesting congestive hepatopathy. It is composed of dilated intrahepatic inferior vena cava (IVC) representing the deer’s head and dilated hepatic veins (HVs) representing its horns. Case Presentation: A 72-year-old female patient presented with a one-week history of dull pain in the right upper abdominal quadrant. Her medical records showed that she had previously experienced cardiovascular problems; however, she is without any recent heart failure symptoms. The transabdominal US demonstrated the deer horn sign and hemodynamic changes in the hepatic venous drainage, which is suggestive of congestive hepatopathy. An echocardiogram revealed congestive heart failure with a preserved ejection fraction, mild-to-moderate mitral and tricuspid valve insufficiency, and severe aortic valve stenosis with mild aortic valve insufficiency. Conclusions: The definite diagnosis of heart failure is based on clinical and laboratory features; however, this sign may be helpful for diagnosis in emergency settings. Full article

Background: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. Methods: Patients undergoing TAVR were divided into two groups according to TR severity: none/mild TR (low-grade) and moderate/severe TR (significant). Data were analysed and compared. Primary endpoint was the mortality 1-year. Secondary endpoints were re-hospitalization and the degree of postoperative and 1-year TR. Results: TAVR procedures were performed in 345 patients between September 2011 and February 2020. Median STS score was 4.3% (IQR: 2.6–7.2), median LVEF was 59.0% (IQR: 45.0–62.0), median aortic area was 0.70cm² (IQR: 0.60–0.86), median mean gradient was 43.0mmHg (IQR: 36.0–53.0). Before TAVR, 297 patients (86.1%) had low-grade TR and 48 (13.9%) significant TR. Mean age was 82.4 ± 5.7 and 83.8 ± 6.2 years in low-grade and significant TR group, respectively (p = 0.109), with 47.5% (low-grade TR) and 56.3% (significant TR) of female patients (p = 0.279). Patients showed differences in EuroSCORE-II (3.2% (IQR: 1.9–5.7) in low-grade TR vs. 5.6% (IQR: 3.7–8.1) in significant TR; p < 0.001), impaired right ventricular function (3.0% vs. 20.8%; p < 0.001) and pulmonary hypertension (9.1% vs. 39.6%; p < 0.001). Mean valve size was 27.7 ± 2.9 mm. Hospital mortality was 2.0% in low-grade TR and 4.2% in significantTR patients (p = 0.308). Among discharged patients (n = 337), seven patients died within 30 days (2.0% low-grade TR; 2.1% significant TR; logrank test p = 0.154) and 40 were re-hospitalized for heart failure (11.1% low-grade TR; 14.6% significant TR; p = 0.470). After one year, 26 patients died, corresponding to a mortality of 7.9 deaths per 100-person year (95% CI 5.2–12.0) in low-grade TR group and 9.1 deaths per 100-person year (95% CI 3.4–24.3) in significant TR group (logrank test p = 0.815), with HR (low grade vs. significant TR) of 0.87, 95% CI 0.26–2.89. Re-hospitalization for heart failure was 16.5% and 19.6% for low-grade and significant TR, respectively (p = 0.713). Echocardiographic and functional changes over time showed no significant interaction between TR and time. Conclusions: In our experience, patients undergoing TAVR showed similar 30-day and 1-year outcome and re-hospitalization rate, regardless of the degree of concomitant tricuspid regurgitation. Full article