Cardiology Commons^™

Ruptured Sinus Of Valsalva Aneurysm In A Patient With Mixed Connective Tissue Disease: Case Report, Kenzo Adhi Wiranata, Pramadya Vardhani Mustafiza, Enrico Ananda Budiono

Journal of the Saudi Heart Association

Sinus of Valsalva aneurysm is a rare cardiac anomaly, affecting approximately 0.09% of the population. Its rupture represents a life-threatening event that can rapidly lead to heart failure. We report a 32-year-old woman with mixed connective tissue disease presenting with right-sided heart failure. Echocardiography demonstrated a ruptured right coronary cusp sinus of valsalva aneurysm into the right ventricle with moderate aortic regurgitation. Surgical repair was successfully performed, and histopathology supported an autoimmune-mediated etiology. To our knowledge, this is the first reported case of ruptured sinus of valsalva aneurysm occurring in a patient with autoimmune mixed connective tissue disease.

Anthracyclines And The Heart: A Double-Edged Sword With Therapeutic Hopes, Tariq Majed Alotaibi, Ahmad Mohammad Samman, Abdullah Abdulaziz Al Ghamdi,, Fisal Salah Alkhamis, Faisal Abdulaziz Alnuwaiser, Abdulrhman Bin Abdullah Alabdulgader, Ahmed Hamad Al Jazirri

Journal of the Saudi Heart Association

Background: Anthracyclines, notably doxorubicin, are potent cytotoxic agents that substantially improved outcomes across numerous malignancies. However, their use is restricted by their cardiotoxicity, a dose-dependent adverse effect that manifests acutely, during treatment, or years post-therapy. It encompasses a spectrum of phenotypes including asymptomatic ventricular dysfunction, heart failure, arrhythmias, and cardiomyopathy, contributing to considerable morbidity and mortality as cancer survival rates improve. Objective: This narrative review summarises current insights into anthracycline-induced cardiotoxicity pathophysiology and evaluates pharmacologic strategies for its prevention and management. Methods: A comprehensive literature search was conducted through August 2025, prioritizing randomised controlled trials, meta-analyses, observational studies, and guideline …

Unilateral Pulmonary Edema Following Minimally Invasive Valve Surgery Via Right Thoracotomy: A Word Of Caution, Arifi Aa, Ahmed Munir Metwaly, Fayez F. Al Mutairi, Bandar Zamzami, Islam Shalaby

Journal of the Saudi Heart Association

We report the first case of unilateral pulmonary edema (UPE) in our series of 150 patients undergoing minimally invasive mitral and tricuspid valve surgery via right thoracotomy. A 30-year-old female with rheumatic heart disease developed UPE requiring temporary extracorporeal membrane oxygenation (ECMO) support postoperatively. The patient recovered uneventfully and was discharged on postoperative day 15. This case underscores the importance of recognizing and mitigating UPE in minimally invasive cardiac surgery (MICS).

What Did We Learn About Vads In 2024-2025?, Maya Guglin

The VAD Journal

This is our 11th annual literature review on left ventricular assist devices (LVADs). Our previous reports were well received by readers.^1-10 In prior years, we also included other forms of mechanical circulatory support (MCS); however, this year, we present a separate review focused exclusively on temporary MCS.

In this article, we summarize the most interesting, from our standpoint, publications from 2024 and 2025, with some inclusion of late 2023 studies that were initially released online before print. For the first time, we provide an independent review on short-term MSC devices, including the intra-aortic balloon pump, Impella (Abiomed), and extracorporeal …

Cardiac Implantable Electronic Device Infections In Saudi Arabia: Incidence, Timing, Causative Organisms, And Outcomes – A Multicenter Study, Saad Albogami, Wael Alqarawi, Ahmed Alfagih, Hiatham Alenzi, Mohammad Alshehri, Mossab Aljuaid, Saeed Alqahtani, Norah Alswaidan, Mohammad Alharbi, Norah Alkaltham, Lama Alasmri, Rghd Sadkh, Muna Albashari, Nour Alhouda, Imad Tleyjeh

Journal of the Saudi Heart Association

Background: Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited. Methods: We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes. …

Commentary On “Ultrasound Evaluation Of Left Ventricular Function In Coronary Artery Ectasia: The Added Value Of 2d Speckle-Tracking Echocardiography”, Eman Aslam, Maryam Amjad

Journal of the Saudi Heart Association

No abstract provided.

Two Faces Of Mitral Stenosis: Uncovering Structural And Hemodynamic Signatures Of Rheumatic And Mitral Annular Calcification-Induced Disease, Mohammad S. Hashemi, Peter Abdelmaseeh, Atif Nehvi, Gregg S. Pressman, Arash Kheradvar

Einstein Health Papers

BACKGROUND: Mitral annular calcification (MAC) is common and associated with increased cardiovascular risk and, when severe, mitral stenosis (MS). MAC-related MS differs anatomically and hemodynamically from rheumatic MS (RMS), challenging standard diagnostic methods. This study compares structural and flow characteristics, including  kinetic energy losses, across MAC-related MS, RMS, and normal mitral valves, and evaluates the applicability of conventional diagnostic metrics in MAC.

METHODS: Three-dimensional transesophageal echocardiographic data sets from 70 patients (22 normal mitral valves, 26 RMS valves, 22 MAC valves) were used to obtain linear, area, and volumetric measurements for valve comparison. Representative valves from each group were converted …

Exercise Performance In Ordinary Children And Adolescents: Baseline, Pandemic, And Post-Pandemic, Abby Skiena, Gina D'Aloisio, Ms, Takeshi Tsuda, Md

Alpha Omega Alpha Research Symposium Posters

Background: The COVID-19 pandemic might have created considerable negative impacts on the physical fitness of ordinary adolescents, which may pose a major threat to long-term cardiovascular health.

Methods: Healthy adolescents (ages 11 to 18) who underwent cardiopulmonary exercise testing (CPET) were grouped into baseline (~ 3/2020), pandemic (4/2020 ~12/2022), and post-pandemic (1/2023~ 5/2024) periods. Data are shown as mean ± standard deviation.

Results: Peak oxygen consumption (VO2/kg) and peak work rate (WR/kg) were significantly reduced during pandemic in both sexes and did not improve during post-pandemic in males (Table 1). The decline of peak oxygen pulse (OP/kg) …

Neck Circumference As A Novel Predictor Of Cardiovascular Risk Assessed Using Framingham And Prevent Equations, Stephen Garrova, Roshaan Gilani, Steven Muller, Jean Pierre Charpentier, Brian Fedgchin, Glenn Cooper, Cindy Cheng

Alpha Omega Alpha Research Symposium Posters

Purpose: While body mass index (BMI) and waist circumference (WC) are standard clinical tools for anthropometric cardiovascular risk assessment, they are limited by measurement variability and patient discomfort. Neck circumference (NC) may offer a novel, convenient, and accurate alternative anthropometric measure for assessment of cardiovascular risk.

Methods: Standardized anthropometric measurements (NC, WC, BMI) were obtained by trained medical students from eligible patients (n = 110, 68% female, 75% African American) from primary care and cardiology offices in an IRB-approved cohort study with retrospective chart review. Electronic medical record data extraction via double data entry was used to calculate cardiovascular …

Jefferson Heart Health (Jhh): A Successful Student-Delivered Motivational Interviewing Pilot Program To Lower Cardiovascular Disease (Cvd) Risk, Nicholas Tomasko, Bs, Cindy Cheng, Md, Phd, Rafael Hernandez, Bs, Alessandra Sapon, Bs

Alpha Omega Alpha Research Symposium Posters

Purpose: The Jefferson Heart Health (JHH) program utilizes student health coaching by trained undergraduate and medical students supporting patients to sustain lifestyle changes and subsequently determine: how can we effectively educate patients by improving adherence to lifestyle recommendations? Also, what is the effectiveness of student-delivered health coaching for reducing patient cardiovascular risk? With our unique student-delivered program, we promote cost-effective lifestyle interventions for lowering overall cardiovascular disease (CVD) burden.

Methods: We successfully completed a four-week pilot with consistent patient attendance. Certified student JHH coaches, supervised by the certified obesity-management specialist and principal investigator, met weekly with 23 patients: 82.6% female/17.4% …

Elucidating The Binding Site Of The Arrestin-Biased Agonist Icl1-20, Kesara Wein, Roger Armen, Jeffrey L. Benovic, Charles P. Scott

Alpha Omega Alpha Research Symposium Posters

Background and Purpose: 6.7 million Americans live with congestive heart failure (CHF). In CHF, catecholamines are released into cardiac tissue, bind β-adrenergic receptors (βARs), and activate G-protein signaling cascades, causing ischemia and apoptosis. Accordingly, β-blockers are used to antagonize catecholamine binding to βARs and suppress apoptotic downstream effects. However, β-blockers have dose-limiting hypotension, bradycardia and fail to stimulate the cardioprotective β-arrestin signaling pathway. These limits create opportunities for the development of drugs that selectively stimulate β-arrestin signaling while suppressing cardiotoxic G protein signaling. We have previously reported a biased agonist of the β-arrestin pathway (ICL1-20) that selectively stimulates β-arrestin recruitment …

Evidence Based Management Of High Ldl-C For Prevention Of Atherosclerotic Cardiovascular Disease In Adult Patients In Resident Run Clinic: A Qi Project, Astha Prasai, Sahej Manesh Singh Arora, Hafsa Jawaid, Aakriti Jain, Omofolarin Babayale, Nauman Naeem, Hina Ukrani, Nawid Latifi, Binita Neupane, Soon-Il Song, Gaurav Sharma

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide and in the United States, with significant healthcare and economic burden. Despite clear guideline recommendations, the implementation of ASCVD risk assessment and statin use for primary prevention remains suboptimal.

Methods:

A quality improvement project was conducted at a resident run clinic with an objective to improve ASCVD risk documentation and guideline-based lipid management. A total of 600 patients aged 40-75 years without a history of cardiovascular disease were randomly selected- 300 in the pre-intervention group and 300 in the post-intervention group. The intervention included didactic sessions and quick …

Late Bioprosthetic Valve Migration- A Rare Entity After Tavi, Sahej Arora, Ghazi Khan, Jeremiah Depta

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve …

A Rare Case Of Lithium Toxicity Inducing Complete Heart Block And Nephrogenic Diabetes Insipidus, Rohail A. Baig, Gurtej Dhaliwal, Nimra Shafi, Omar Siddiqui, Michelle L. Malnoske

Advances in Clinical Medical Research and Healthcare Delivery

Lithium is a commonly utilized mood stabilizer for the treatment of bipolar disorder. Although it is efficacious, elevated levels may lead to neurologic, cardiac, nephrogenic, and gastrointestinal side effects. Management of severe lithium toxicity has been an evolving topic of debate in terms of its clinical management. We report a case of a 23-year-old female who presented to the emergency department with severe lithium toxicity, who needed intensive intervention and a critical level of care. This case provides an example of how utilizing standardized care algorithms may provide great benefit to clinicians managing lithium toxicity in emergencies and critical care …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

‘Is The Patient Clear For Surgery?’ Takotsubo Cardiomyopathy Presenting As T-Wave Inversions In A Pre-Operative Ekg: A Case Report, Muhammad Hammad Sharif, Madeeha Khaleeque, Syed Faiz Abbas, Gaurav Sharma, Aditya Sanjeevi, Muhammad Hassan Jan, Atif Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for …

Artificial Intelligence In Cardiology: An Updated Systematic Review With Ethical Considerations And Challenges In Implementing Artificial Intelligence Models, Dev Patel, Reshmitha Kantamneni, Jabez David John, Tirath Patel, Arnesh Shukla, Ayesha Salma, Nikhilesh Anand

School of Medicine Publications

The integration of artificial intelligence (AI) in cardiovascular medicine presents a transformative opportunity to enhance diagnostic accuracy and improve patient outcomes. This systematic review evaluates the impact of AI on cardiovascular diagnostics with a focus on its ability to surpass traditional methods in accuracy, efficiency, and predictive capabilities. Machine learning and deep learning have demonstrated significant advancements in areas such as echocardiography, electrocardiography, computed tomography angiography, and predictive analytics.

AI algorithms have demonstrated superior performance in identifying subtle patterns and anomalies. Additionally, AI has shown promise in predictive analytics, forecasting disease progression and tailoring treatment plans, thereby improving patient outcomes. …

Performance Of The Grace Acs Risk Score In Predicting In-Hospital And Six-Month Mortality In Patients With Acs: A Single Center Retrospective Cohort Study, Albert Nyanga, Jeilan Mohamed, Miriam Msunza, James Orwa, Mzee Ngunga

Internal Medicine, East Africa

Introduction: The incidence of coronary heart disease (CHD) is rising globally. Despite the high burden of CHD in Africa, little is known about appropriate risk stratification systems that can be used to predict outcomes in patients with acute coronary syndromes (ACS) in this region.

Methodology: This was a single-center retrospective cohort study conducted at the Aga Khan University hospital. Data was explored descriptively by summarizing categorical variables using frequencies/percentages and continuous variables using medians and interquartile ranges. Risk groups and mortality were compared using Fisher’s exact test or the chi-square test. The area under the receiver operating characteristic curve (AUROC), …

Quantitative Echocardiography Markers To Denote Severity Of Tricuspid Regurgitation Compared To Cardiac Mri In Single Right Ventricle Variants, Tony Zunica, Daniel Forsha, Janelle Noel-Macdonnell, Anmol Goyal

Posters

Background: Single right ventricle and Hypoplastic Left Heart Syndrome (HLHS) are congenital heart diseases that require multiple palliative surgeries to create a single right ventricular system. 25-30% of these patients develop significant tricuspid regurgitation (TR), which is associated with worse outcomes among all stages of palliation. Echocardiography remains the cornerstone imaging modality for serial evaluation in these patients. However, estimating tricuspid regurgitation is highly subjective in the pediatric population, necessitating need for reliable and reproducible quantitative echocardiography markers. Currently, cardiac magnetic resonance (CMR) is considered the gold standard for quantification of tricuspid regurgitation with good accuracy and reproducibility. Objectives/Goal: Our …

Age And Sex Impact The Role Of Thrombospondin-2 And Thrombospondin-5 In Response To Hindlimb Ischemia, Irene Helenowski, Ashley Peters, Melissa Rangel, Corinne Bunn Md, Xuerong Wang, Kristopher Maier, Vivian Gahtan

Biostatistics Collaborative Core: Faculty Publications and Other Works

Peripheral arterial disease progression to critical limb ischemia remains a significant burden in the aged, necessitating revascularization. Therapies to enhance neovascularization, such as angiogenesis or arteriogenesis, may provide an option for patients not suitable for surgery. The thrombospondins (TSPs) are secreted matricellular glycoproteins, with TSP-1, TSP-2, and TSP-5 implicated in neovascularization. Currently, there is little data regarding the effects of TSP-2, TSP-5, sex, and aging on angiogenesis and arteriogenesis. In vitro, the effect of TSP-2 or TSP-5 on early or late passage endothelial cell (EC) tubule formation or disruption was assessed. In vivo, angiogenesis, and arteriogenesis in male and female, …