Medicine and Pharmacology

Abstract: Background/Objectives: In the United States, HF prevalence is projected to progressively rise by 2030. Prior research suggests a strong association between reduced sleep duration and increased cardiovascular disease and HF risk. This study introduces an alternative parameter, the Weekend Sleep Recovery (WSR), measured by the weekend-to-weekday Sleep Duration Ratio (SDR), to evaluate its association with HF risk. Methods: We conducted a cross-sectional analysis of NHANES (National Health and Nutrition Examination Survey) 2017–2023 to examine self-reported sleep patterns. Participants were classified as WSR (SDR > 1) or non-WSR (SDR ≤ 1). Multivariate logistic regression assessed the association between WSR and HF, adjusting for demographics and comorbidities. Results: Among 14,311 participants, WSR was associated with 23% lower odds of HF (adjusted OR 0.77; 95% CI 0.62–0.94; P = 0.012) versus non-WSR. This inverse association persisted in hypertensive, non-dyslipidemic, smoking, and Class III obese individuals, but was not modified by diabetes, coronary disease, or prior myocardial infarction. Conclusions: Although adequate sleep duration is crucial, weekend sleep duration reflecting WSR was associated with lower odds of HF, particularly in those with risk factors. Further studies are needed to explore these associations and potential implications for high-risk populations.

Abstract: The synchronous occurrence of aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) is becoming increasingly common, largely due to rising life expectancy. There are no clear recommendations or consensus regarding the optimal treatment sequence. However, the development of minimally invasive techniques—transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR)—has reshaped the therapeutic landscape, enabling treatment of both conditions either simultaneously (same day) or in staged procedures (different days). This study aims to expand the available evidence on the simultaneous treatment of AS and AAA. A literature review (2011–2016), conducted according to PRISMA criteria, identified 25 publications encompassing 337 patients. The review examines: a) the benefits and advantages of the simultaneous strategy compared with staged treatment, and b) the optimal first procedure within the simultaneous approach. The case of an asymptomatic patient with a large AAA (11.5 cm maximal transverse diameter) and severe AS is also presented, treated simultaneously with TAVI followed by EVAR, achieving a satisfactory outcome, with long‑term follow‑up available. Conclusion: Simultaneous treatment of both conditions is feasible, effective, and safe when supported by detailed preoperative planning and a multidisciplinary team capable of determining the optimal procedural sequence. Based on the available evidence, the simultaneous approach has evolved from an option reserved for selected patients to the preferred strategy in most cases.

Abstract: Background/Objectives: High-sensitivity cardiac troponin (hs-cTn) assays are used in routine diagnostics to detect myocardial injury. However, a fraction of circulating cardiac troponin T (cTnT) enclosed within extracellular vesicles (EVs) goes widely undetected. This study introduces a combined lysis- and sonication-based protocol to release and quantify EV-bound cTnT in a time-efficient manner using a state-of-the-art hs-cTnT immunoassay. Methods: Plasma samples from patients with non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina, pulmonary embolism, decompensated aortic stenosis, atrial fibrillation, myocarditis, and healthy controls were treated with lysis buffer and subsequently sonicated. Treated and untreated samples were assessed and compared to a conventional EV isolation method. Results: Following combined lysis and sonication, cTnT levels were significantly higher compared to native, unprocessed samples across all cohorts. Median increase post-processing ranged from 10% in decompensated aortic stenosis to 34% in healthy controls. In NSTEMI, EV-bound cTnT accounted for 15% of plasma cTnT and remained stable over 72 hours. EV cTnT/plasma cTnT ratios were comparable between the combined lysis and sonication approach and the conventional EV isolation method. Processing time prior to cTnT measurement was reduced from approximately 2.5 hours to approximately 10 minutes using combined lysis and sonication compared to the established EV isolation method. Conclusions: Our method allows for rapid liberation of a previously inaccessible EV-bound fraction of cTnT without the need for time-consuming and resource-intensive EV isolation workflows. The resulting total cTnT signatures indicate differential cTnT compartmentation depending on the underlying myocardial pathophysiology, enabling early differentiation of the mechanisms underlying troponin elevation. This approach is readily implementable alongside standard hs-cTnT testing at minimal additional time expense and may improve diagnostic sensitivity and specificity in acute clinical settings.

Abstract: The 12-lead electrocardiogram is essential for cardiovascular diagnosis but limited by inter-observer variability, low sensitivity for subclinical disease, and labor-intensive telemonitoring analysis. Artificial intelligence (AI), particularly deep learning, addresses these constraints by extracting high-dimensional patterns that correlate with arrhythmias, structural abnormalities, and systemic conditions. This review synthesizes recent AI-enabled ECG advances, covering technical foundations—including foundation models and validation strategies—and clinical applications such as arrhythmia detection, structural heart disease identification, and digital biomarker derivation. We discuss emerging trends like self-supervised learning, multimodal integration, generative models, and explainability techniques. Furthermore, we address critical challenges regarding generalizability, algorithmic bias, privacy, and regulatory frameworks. Finally, we outline research priorities, including curated open datasets, personalized continuous-learning systems, and deployment in resource-limited settings. With rigorous validation, transparent governance, and human-centered design, AI-ECG has the potential to democratize cardiovascular diagnostics and improve clinical outcomes across diverse environments.

Abstract: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality. Structural remodeling of the left atrium, particularly myocardial fibrosis, plays a key role in AF pathogenesis. Matrix metallo-proteinases (MMPs) are critical regulators of extracellular matrix remodeling and may contribute to atrial fibrosis through genetic variation. This case–control study included 179 patients with AF and 56 controls. Eight polymorphisms across five MMP genes (MMP1, MMP2, MMP3, MMP9, and MMP12) were analyzed using PCR-based methods. Associations between single nucleotide polymorphisms (SNPs), AF susceptibility, recurrence, haplotypes, and gene–gene interactions were assessed. The study population was ethnically ho-mogeneous (Polish), minimizing population stratification bias. No significant differences in allele frequencies were observed between AF and control groups in univariate analysis. However, multivariable logistic regression revealed significant associations for MMP1 rs1799750 and MMP2 rs243864 under recessive inheritance models. Haplotype analysis demonstrated a significant global association with AF (p = 0.027), with specific haplotypes showing markedly increased risk. Multifactor dimensionality reduction identified significant gene–gene interactions, particularly involving SNPs in MMP1, MMP2, MMP3, and MMP12. These findings support a polygenic model of AF susceptibility involving extra-cellular matrix remodeling pathways and highlight the importance of multi-locus genetic analyses.

Abstract: Point-of-care testing (POCT) for cardiac troponin is increasingly used to support rapid clinical decision-making, particularly in resource-limited settings. However, while many central laboratories, including those in Sri Lanka, now use high-sensitivity cardiac troponin I (hs-cTnI) assays, commonly available POCT platforms continue to use conventional methodologies with different analytical characteristics and decision thresholds. We evaluated the analytical agreement and clinical concordance of two POCT troponin assays against a central laboratory hs-cTnI assay using paired samples obtained during routine clinical care in a Sri Lankan hospital. Both POCT devices demonstrated strong correlation with the laboratory assay (Pearson r ≈ 0.90). However, Bland–Altman analysis showed substantial positive bias and wide limits of agreement, indicating poor interchangeability at the individual sample level, with proportional bias observed in one device. Clinically relevant discordance was also identified, with 26.9% and 30.4% of samples classified as negative by POCT despite being positive by the reference assay. Regression-based recalibration did not significantly improve concordance. These findings highlight that strong correlation does not ensure diagnostic agreement, emphasizing the need for local validation before integrating POCT troponin assays into established hs-cTnI diagnostic pathways.

Abstract: Background: This study evaluated the use of circulation time (Tcirc) calculated from polysomnogram (PSG) with pulse oximetry to identify poor cardiac function with low left ventricular ejection fraction (EF). Methods: Subjects over 18 years with sleep apnea (apnea-hypopnea index (AHI) >5/hr) diagnosed by PSG who had transthoracic echocardiography (TTE) within 1 year of PSG were included in this retrospective study. Tcirc of each sleep stage (N2, N3, and REM) were measured and averaged and EF was recorded. Statistical analysis was done using Wilcoxon rank sum test, logistic regression and Youden index. Results: There were 89 sub-jects who met inclusion criteria, 14 with EF ≤45% (Group A) and 75 with EF ≥ 50% (Group B). All 14 Group A subjects had prolonged overall Tcirc with a median time of 27.8 seconds (range 14.1 - 39.6 sec), compared to Group B subjects with median Tcirc of 23.5 seconds (range 14.3 – 37.6 sec), p = 0.311. The op-timal cut-point for overall sleep Tcirc with moderate discrimination (AUC = 0.6) was 28.6 sec. Those with to-tal sleep Tcirc > 28.6 sec were 2.5 x more likely to have low EF with OR =2.56 (95% CI, 0.55-11.16). Con-clusions: In sleep apnea patients, total sleep Tcirc > 28.6 seconds is associated with low ejection fraction with specificity = 0.78.

Abstract: Mitral valve regurgitation is the second most common valvular heart disease in Europe, and an estimated 10% of individuals older than 75 years have severe mitral regurgitation. Mitral valve repair is the preferred strategy to treat mitral regurgitation and is associated with better outcomes than mitral valve replacement. Despite the proven efficacy of surgical repair, available data in functional aetiologies reported a not negligible rate of echocardiographically detected severe mitral regurgitation within ten years of the index procedure, in some cases resulting in redo interventions. Data on the optimal management of patients with failed mitral repair remain limited. The aim of this review is to present the available approaches for treating failed mitral valve repair and to describe criteria for selecting the most appropriate strategy on the basis of the underlying mechanism of repair failure, with respect to possible surgical re-repair and novel transcatheter edge-to-edge repair techniques in presence of favourable mitral valve anatomies.

Abstract: Background: Drug-coated balloons (DCBs) have emerged as a "leave-nothing-behind" strategy in percutaneous coronary intervention (PCI), with potential advantages over drug-eluting stents (DES) in selected patients with acute coronary syndrome (ACS).Methods: We performed a narrative review of randomized controlled trials, registries, and meta-analyses evaluating DCB therapy in ACS, including PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2, AGENT IDE, REC-CAGEFREE I/II, and the ongoing TRANSFORM II trial. Articles were identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL covering January 2005 to February 2026.Results: Across published studies, DCBs have shown outcomes that are non-inferior to those of DES in selected ACS subsets, together with a lower risk of major bleeding attributable to shorter dual antiplatelet therapy (DAPT) requirements. Advances in intravascular imaging and lesion preparation, alongside emerging applications of artificial intelligence (AI) and robotic-assisted PCI, may further improve DCB performance, although evidence specific to DCB use in ACS remains limited for these adjunctive technologies. Conclusions: DCBs are a reasonable alternative to DES in selected patients with ACS, particularly those at high bleeding risk or with lesion subsets in which DES perform less well (small vessels, in-stent restenosis, bifurcations, diffuse disease). Adequately powered randomized trials with long-term follow-up are required before broader recommendations can be made.

Abstract: Background: Transradial access has become a preferred strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) because of lower access-site complication rates and increasing feasibility for complex CTO techniques using large-bore slender or sheathless systems. However, long-term outcomes after successful transradial CTO recanalization and their predictors remain incompletely defined. We aimed to identify long-term clinical and procedural predictors of major adverse cerebrovascular and cardiac events (MACCE) after successful transradial CTO PCI. Methods: We performed a prospective dual-center cohort study including 227 consecutive patients who underwent successful transradial CTO PCI at two high-volume catheterization laboratories with dedicated CTO programs. A total of 405 CTO PCI procedures were screened; all femoral-access cases were excluded and only transradial cases were eligible. Baseline clinical characteristics, left ventricular ejection fraction (LVEF), lesion complexity including J-CTO score, coronary disease extent, and procedural variables were prospectively collected and/or verified from institutional databases. The primary endpoint was MACCE, defined as a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization, and stroke/transient ischemic attack. Event rates were estimated using Kaplan-Meier methods. Predictors were explored using Cox proportional hazards regression with clinically relevant covariates and procedural characteristics entered into multivariable models. Results: Among 227 patients with successful transradial CTO recanalization and complete 5-year follow-up among survivors, cumulative MACCE and all-cause mortality were 44.0% and 21.5%, respectively. In multivariable Cox analysis, prior myocardial infarction, right coronary artery target vessel, and a higher number of implanted stents were independently associated with increased MACCE risk, whereas previous PCI and preserved LVEF (≥40%) were associated with lower MACCE risk. For all-cause mortality, preserved LVEF was independently protective, while right coronary artery target vessel intervention was associated with increased mortality risk; severe chronic kidney disease showed a significant univariable association and remained a strong signal after multivariable adjustment. Conclusions: After successful transradial CTO PCI, long-term MACCE appears to be driven primarily by baseline comorbidity and coronary disease burden rather than by access-related factors. Integrating clinical risk markers with anatomic and procedural markers may improve long-term prognostication and guide secondary prevention and follow-up after transradial CTO recanalization.

Abstract: Complex percutaneous coronary intervention (PCI) represents a growing proportion of contemporary coronary revascularization, driven by aging populations, increasing comorbidity burden, and advances in interventional techniques. Complex PCI encompasses a spectrum of anatomically and procedurally challenging lesions, including left main disease, bifurcation lesions requiring two-stent strategies, chronic total occlusions, long stent lengths, severe calcification requiring atherectomy, and multivessel revascularization. Antithrombotic therapy, comprising antiplatelet and anticoagulant agents, is essential for preventing stent thrombosis and other ischemic events in both the early and long-term phases after PCI. While antithrombotic therapy mitigates ischemic risks associated with complex PCI, these patients frequently carry high-bleeding risk, thus making the choice of antithrombotic regimen challenging. Recent guideline recommendations emphasize balancing ischemic and bleeding risks rather than relying solely on procedural complexity. This review synthesizes contemporary evidence, guideline recommendations, and clinical considerations for antithrombotic therapy after complex PCI.

Abstract: Extracellular cold-inducible RNA-binding protein (eCIRBP) is a key driver of sterile inflammation following ischemia/reperfusion (I/R) injury, such as during cardiac surgery. While eCIRBP’s interaction with the TLR4/MD2 complex is known to activate the NF-κB pathway, its role in activating the JAK/STAT3 pathway via the IL-6 receptor is less understood. To investigate this, human THP-1-derived macrophage-like cells were stimulated with a recombinant human active CIRBP peptide (rhCIRBP) with or without Stattic pre-treatment, a selective STAT3 phosphorylation (Y705) inhibitor. Activation of IκBα/NF-κB and JAK/STAT3 was assessed by Western blotting, while gene expressions of inflammatory markers were measured via RT-qPCR. LPS stimulation significantly induced all inflammatory targets investigated (IL-6, IL-1β, TNF-α, MCP-1, ICAM, and SOCS3), while rhCIRBP only significantly induced IL-1β, TNF-α, and ICAM in the THP-1 macrophages. Interestingly, Stattic inactivated both STAT3 and NF-κB pathways, thus resulting in the attenuation of all induced inflammatory responses observed. Our findings confirm eCIRBP as a potent inflammatory mediator, corresponding with reported elevated concentrations of circulatory eCIRBP in patients after cardiac surgery and those suffering from hemorrhagic shock and sepsis. Additionally, we also highlight the crosstalk between the STAT3/ NF-κB pathways that may offer a novel therapeutic strategy for managing both sterile and non-sterile inflammation.

Abstract: Background: Transthyretin amyloidosis (ATTR) is a rare, often underdiagnosed and undertreated, autosomal dominantly inherited, progressive disease that affects multiple systems of the body. It results from the extracellular accumulation of misfolded transthyretin (TTR) protein as insoluble amyloid fibrils, predominantly causing cardiomyopathy, polyneuropathy or mixed phenotypes. It can occur in a hereditary form (ATTRv) and in a wild-type form (ATTRwt), with over 150 different pathogenic mutations having been identified worldwide. The clinical presentation is highly variable, leading to a diagnostic delay of 2–5 years. Transthyretin (TTR) amyloidosis is an inherited disease for which recent advances in pathogenesis, diagnosis and treatment have revolutionized its management. Objectives: The aims of this review are to provide an update on the epidemiology and genotype-phenotype correlation, on current diagnostic techniques and on emerging and individualized treatments for this rare hereditary disease. Particular attention will be given to the early diagnosis Methods: A systematic literature search was conducted across major databases to identify studies addressing clinical characteristics, diagnostic modalities, and treatment outcomes in hereditary and wild-type ATTR amyloidosis. Registry data from THAOS and other multinational cohorts were analyzed to evaluate phenotypic variability across genotypes and geographic regions. Results: Clinical presentation of TTR related amyloidosis (h-Amyloid) can range from early onset to late onset with late onset having worse neurological and cardiac involvement at time of diagnosis. The Val30Met mutation is the most common TTR mutation worldwide, however patients with non-V30M mutations can have very different presentations of h-amyloidosis. Identifying “red flag” symptoms in a patient with suspicious clinical presentation can initiate correct diagnostic pathway. Non-invasive imaging, especially bone scintigraphy, has greatly facilitated the diagnosis of patients with Transthyretin related cardiac amyloidosis (ATTR-CM). First generation h-amyloid treatments or TTR stabilizers such as tafamidis have been shown to significantly improve survival in patients with h-amyloidosis. The second generation treatments such as RNA silencers (patisiran, vutrisiran, inotersen, eplontersen) have been shown to halt the disease progression. Present data from small to moderate-sized patient cohorts demonstrate that TTR-targeting therapy is associated with reduction of cardiovascular events and improvement in survival compared with current standard of care. Early recognition of key clinical features and application of a diverse diagnostic strategy, in conjunction with timely initiation of disease-modifying therapy, are critical to optimal management of patients with hereditary transthyretin (ATTR) amyloidosis. Conclusions: The therapeutic options have evolved and improved in recent years, and with current diagnostic tools, the opportunity to alter the natural history of a disease that was once invariably fatal is better than ever. Because the disease is systemic, a thorough, multidisciplinary approach to patient management is ideal.

Abstract: Background: The prognostic value of serial coronary artery calcium (CAC) progression remains uncertain in Asian populations, particularly among patients receiving statin therapy. We evaluated whether CAC progression predicts major adverse cardiovascular events (MACE) in a Taiwanese cohort and whether this association differs by statin use. Methods: We retrospectively studied 1,942 individuals who underwent two cardiac computed tomography scans for CAC scoring at a tertiary medical center in Taiwan between 2006 and 2021. CAC progression was defined as an annualized Agatston score increase of ≥20 units/year. The primary outcome was MACE, defined as acute myocardial infarction, stroke, or cardiovascular death. Predictors of CAC progression were assessed using logistic regression. Associations between CAC progression and MACE were evaluated using Cox models with propensity score–based inverse probability weighting; 1,621 participants with complete covariate data were included in weighted analyses. Results: CAC progression occurred in 397 participants (20.4%). Independent predictors included male sex, hypertension, fasting glucose, lipid parameters, and baseline CAC score. CAC progression was associated with a higher risk of MACE, with increasing event rates across higher categories of annualized CAC change (p for trend < 0.0001). This association was consistent across clinical subgroups and was observed in both statin and non-statin users, without a significant CAC progression × statin interaction (p = 0.163). Conclusions: In this Asian serial CAC cohort, CAC progression was strongly associated with future MACE and may serve as a marker of residual cardiovascular risk, including among statin-treated patients. Serial CAC assessment may support dynamic risk stratification, but prospective studies are needed to determine whether progression-guided management improves outcomes.

Abstract: Coronary Artery Disease (CAD) is the leading cause of death worldwide, highlighting the need for more reliable and efficient diagnostic tools beyond conventional methods. Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), has shown strong potential for detecting obstructive CAD by learning complex patterns from Electrocardiogram (ECG) and Coronary Computed Tomography Angiography (CCTA) data. This rapid systematic review assesses and compares the diagnostic performance and methodological quality of AI models built for CAD prediction using ECG and CCTA data. A systematic search following PRISMA 2020 guidelines was conducted for primary studies published between 2021 and 2025. Eleven studies were included, six using ECG data and five using CCTA data. Methodological quality was evaluated using the PROBAST+AI tool. ECG-based models achieved AUC (0.72--0.961); however, only 33\% of these studies used external validation cohorts. CCTA-based models showed slightly stronger top-end performance, with AUC (0.77--0.97), and were more methodologically rigorous, with 80\% applying external validation. Despite these strong results, PROBAST+AI assessment revealed a high risk of bias in 90.9\% of the included studies, largely due to weaknesses in the analysis domain, including poor handling of missing data and the absence of model calibration reporting. AI models show strong diagnostic accuracy for CAD, with CCTA-based approaches demonstrating greater validation maturity. However, the widespread methodological bias means these tools should currently support clinical decision-making rather than replace standard diagnostic methods. Future studies should focus on prospective multi-centre validation and the use of multimodal data

Abstract: Carcinoid heart disease is a progressive right-sided valvulopathy caused by serotonin and other vasoactive mediators released by metastatic neuroendocrine tumours. As oncological therapies have extended survival, cardiac disease has become a leading determinant of mortality. Operative mortality has decreased to 5–6% in contemporary high-volume centres, and long-term survival appears increasingly determined by tumour biology rather than cardiac disease when surgery is appropriately timed. The principal determinant of operative outcome is preoperative right ventricular function; symptom-based referral alone is insufficient because many patients remain compensated until ventricular dysfunction is advanced. This review synthesises the evidence on surgical timing, operative strategy, prosthesis selection, perioperative endocrine management, and emerging transcatheter options. Tricuspid valve replacement is required in the majority of patients, with concomitant pulmonary valve replacement advocated where concurrent disease is present. Bioprosthetic valves are preferred. Continuous perioperative octreotide infusion has substantially reduced the incidence of carcinoid crisis. Structured multidisciplinary decision-making integrating echocardiographic surveillance, biomarker monitoring, and oncological status assessment is essential.

Abstract: Infective endocarditis (IE) is a severe pathology with recent changes in its epidemiological profile, characterised by older patients with more comorbidities. The objective of this study is to describe the clinical and microbiological characteristics, as well as potential relations with mortality, of patients with IE in a tertiary academic centre. Material and Methods: Descriptive, retrospective, and observational study of patients over 18 years of age with a confirmed diagnosis of IE, conducted between 2021 and 2023 at the Dr Hernán Henríquez Aravena Hospital in Temuco, Chile. Biodemographic variables, risk factors, microbiology, echocardiographic findings, and complications were analysed using descriptive statistics and logistic regression models. Results: 119 patients were included (average age 60 years; 65.5% male; 28.5% rural). The most frequent risk factors were arterial hypertension (55%) and diabetes mellitus (29%). 18% were on haemodialysis (HD). Microbiological isolation was achieved in 78.1% of cases, with Streptococcus gallolyticus the most frequent isolate (16.8%), followed by Staphylococcus aureus (15.1%) and coagulase-negative Staphylococcus (15.1%). Complications were present in 69% of cases, mainly emboli (43%) and septic shock (23%)—59.6% required surgery. Global mortality was 44.5%, with a decreasing annual trend (from 58% in 2021 to 33% in 2023). Independent predictors of mortality were chronic renal failure on HD (OR 5.76; p = 0.001), heart failure (OR 3.13; p = 0.025), and septic shock (OR 3.31; p = 0.016). Conclusions: IE in this centre presents an aggressive profile and a high burden of comorbidities. The prevalence of S. gallolyticus stands out, possibly associated with high regional rurality. Mortality remains high, although it is improving.

Abstract: Background/Objectives: Adults with single ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgery (NCS). However, perioperative outcomes in this group remain poorly characterized. This study aimed to evaluate perioperative complications and mortality in adults with SVP undergoing NCS. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent NCS requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 hours, 30 days, and one year, analyzed per procedure. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation (67.6%). Common comorbidities included arrhythmias (56.1%), liver disease (52.6%), and heart failure (20.2%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 0.9% at 24 hours, 1.8% at 30 days and 3.5% at one year. Adverse outcomes were more frequent in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing NCS are acceptable when procedures are elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation.

Abstract: The association of a major aortopulmonary collateral artery (MAPCA) with simple trans-position of the great arteries (TGA) is uncommon. Such high-flow lesions in the postoper-ative period following arterial switch operation (ASO) may lead to pulmonary hyperten-sion, pulmonary hemorrhage, heart failure (HF), failure to thrive and prolonged mechan-ical ventilation. We report a neonate who developed pulmonary overcirculation and HF in the early postoperative period due to a hemodynamically significant MAPCA. Although the association of MAPCA with simple TGA is infrequent, such lesions should be considered in cases of unexplained cardiovascular compromise following ASO. Fol-lowing transcatheter occlusion of the MAPCA with a vascular coil, rapid hemodynamic stabilization and subsequent extubation of the patient were achieved.

Abstract: Background/Objectives: Transradial access (TRA) is the preferred route for coronary catheterization, yet its consequences for radial artery vasoreactivity and hemodynamic parameters remain incompletely characterized. We prospectively quantified TRA-induced functional impairment, its clinical determinants, and the predictive val-ue of baseline parameters. Methods: Ninety-four consecutive patients undergoing elective TRA were assessed at baseline, 24 hours, and one month using high-resolution Doppler ultrasound. Nine vascular parameters were measured: flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), peak systolic velocity (PSV), resistive index (RI), pulsatility index (PI), resting and hyperemic velocity-time integral, hyper-emic blood flow volume, and lumen diameter. Non-parametric methods were applied throughout. Results: FMD declined at 24 hours (−31.2%; p< 0.001) and showed no sig-nificant recovery at one month (p=0.08 vs 24 hours). NMD showed a greater acute de-cline (−36.6%; p< 0.001) with partial but statistically significant recovery at one month (p< 0.001). PSV recovered fully by one month; RI fell below baseline, consistent with compensatory microvascular vasodilation. Radial artery lumen diameter remained significantly below baseline at one month. Radial artery occlusion occurred in 4 patients (4.3%), all with spontaneous recanalization. Female sex selectively predicted greater NMD reduction (ΔNMD −8.3% vs −5.8%; p=0.005) without a corresponding FMD difference (p=0.40). Older age correlated with impaired FMD recovery at one month (ρ=−0.62; p< 0.001) but not with NMD outcomes. Baseline PSV demonstrated the highest discriminatory performance for significant FMD decline (AUC=0.73). Conclu-sions: TRA causes multidomain, persistent radial artery functional impairment at one month, with distinct recovery trajectories for endothelial and smooth muscle function. Female sex and advanced age are selective determinants of injury and recovery, re-spectively. A pre-procedural phenotype comprising baseline diameter, PSV, RI, and age predicts post-procedural outcomes and supports further investigation of pre-procedural phenotyping for risk stratification.