<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Patient-prosthesis mismatch (PPM) is the situation in which the area of an artificial valve is smaller than that of a healthy native valve it replaces. By this definition, all artificial valves demonstrate PPM, but large observational studies and several meta-analyses suggest that it is present in 30-50% of patients after surgical aortic valve replacement (SAVR). PPM has an impact on outcomes only when the indexed aortic valve area (AVAi) is ≤0.85cm2/m2 (moderate PPM) or 0.65cm2/m2 (severe PPM), particularly in patients with reduced LVEF. In transcatheter aortic valve replacement, the prevalence of PPM may be as low as 0.1%, and its impact on hard outcomes is not clear. We present a review of the relevant literature together with a framework for the differential diagnosis of increased pressure gradient and reduced area in prosthetic aortic valves and different strategies to reduce the risk of PPM with SAVR.</p>
</abstract>

Aortic patient-prosthesis mismatch - does it matter? A review for cardiologists and cardiac surgeons

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Objective</h3>
<p>Chronic heart failure (CHF) is a clinical syndrome that encompasses individuals who either have received a definitive diagnosis of heart failure or display a gradual escalation of symptoms as time elapses. Echocardiography, particularly evaluating left ventricular function, is crucial for diagnosis and prognosis. However, 24-hour Holter monitoring, focusing on heart rate variability (HRV), provides insights into autonomic dynamics and vulnerability. Recent HRV parameters offer nuanced information, enhancing risk stratification and guiding personalized interventions in CHF. The interplay between echocardiography and HRV enables a comprehensive approach, refining the management of CHF by considering both cardiac structure and autonomic regulation.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>This prospective study at “St. Spiridon” County Hospital involved 80 patients with left ventricular ejection fraction (LVEF) &lt; 50%. The diagnosis was according to standard clinical echocardiography, laboratory panel, and Holter ECG monitoring.</p>
</sec>
<sec>
<h3>Results</h3>
<p>Unexpectedly, no statistically significant relationship was found between commonly used HRV parameters and echocardiographic parameters. Further analyses showed statistically significant associations between non-traditional HRV parameters and E/A ratio, E/E’, and S’ lateral and septal. Additionally, modifications in HRV parameters were correlated with mitral valve deceleration time, left atrial volume index, estimated pulmonary artery systolic pressure, and cardiac output.</p>
</sec>
<sec>
<h3>Conclusions</h3>
<p>Less commonly used Holter ECG parameters, such as acceleration capacity, deceleration capacity, and triangular index, demonstrated significant diagnostic efficacy, especially when conventional HRV parameters were normal. This highlights the importance of incorporating non-traditional HRV parameters in CHF patient risk stratification, urging further exploration through comprehensive multicenter studies for long-term prognostic implications.</p>
</sec>
</abstract>

Heartbeat Chronicles: Decoding the Interplay of Echocardiography and Heart Rate Variability in Chronic Heart Failure Patients – Unraveling the Mysteries with Traditional and Advanced 24-Hour Holter ECG Parameters

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Introduction</h3>
<p>The feasibility of the conduction system pacing combined with atrioventricular node ablation was demonstrated in patients with atrial fibrillation in whom rate control can’t be achieved with medication and heart failure.</p>
</sec>
<sec>
<h3>Clinical case</h3>
<p>We present a case of an 82-year-old man with a personal history of permanent atrial fibrillation, admitted with symptoms of heart failure. The resting electrocardiogram showed a very fast ventricular response, and the echocardiography showed a depressed left ventricular function, raising the suspicion of a tachycardia-mediated cardiomyopathy. Since the patient was on maximum doses of atrioventricular nodal-blocking drugs, we opted for a physiological pacing and atrioventricular node ablation strategy. First, the His bundle capture was achieved at low pacing thresholds, and ablation of the atrioventricular node was attempted. Unfortunately, after several failed attempts, an acute increase in the His bundle capture threshold was noted, suggesting inadvertent tissue ablation beneath the pacing lead. In this scenario, we removed the lead from the His bundle area and achieved optimal left bundle branch area pacing. With the lead in this position, atrioventricular node ablation was performed during the first attempt. At the six-month follow-up, there was no recovery of atrioventricular node conduction. Device interrogation revealed stable pacing and sensing parameters, and there was a significant improvement in clinical status and left ventricular function.</p>
</sec>
<sec>
<h3>Conclusions</h3>
<p>Mastering both His bundle pacing and left bundle branch area pacing offers the potential to overcome intraprocedural challenges, giving alternative strategies to achieve physiological pacing. These approaches can be used interchangeably based on the evolving dynamics of the procedure and the patient’s specific needs.</p>
</sec>
</abstract>

Complementary use of conduction system pacing techniques for the “pace and ablate” strategy in permanent atrial fibrillation - a case report

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Atrial standstill is a rare arrhythmogenic condition characterized by the absence of electrical and mechanical activity in the atria. The therapeutic options for these patients described in the current literature, in which no reversible cause is detected, are permanent cardiac pacing, anticoagulant, and heart failure treatment when the latter exists. We present a case of a young male with no personal or family history of cardiovascular disease, diagnosed with atrial standstill after multiple syncopal episodes, in whom, because of the high expected ventricular pacing percentage, we opted for conduction system pacing with left bundle branch area pacing.</p>
</abstract>

Atrial standstill in a young patient treated with left bundle branch area pacing

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.</p>
</abstract>

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Bifurcation lesions are the cause of 20% of all percutaneous coronary interventions, representing a complex category associated with lower procedure success rates and higher restenosis rates. However, the optimal approach to bifurcation needs further research. This paper aims to determine the optimal method for implementing a two-stent strategy in bifurcation cases. It desires to identify the characteristics that can guide our approach and the outcomes that can be expected. This paper also highlights relevant trials that support the findings.</p>
<p>In nontrue bifurcation cases (Medina 1-1-0, 1-0-0, 0-1-0, 0-0-1), a one stent strategy, eventually with the provisional approach, is preferable. When treating a left main or non-left main bifurcation in a Medina classification of 1-1-1, 1-0-1, or 0-1-1 without meeting at least one major and two minor criteria and of DEFINITION II Classification (simple true bifurcation), the layered provisional approach is the appropriate strategy.</p>
<p>In cases of left main or non-left main complex true bifurcation (Medina 1-1-1, 1-0-1, 0-1-1) meeting the Definition II Classification criteria, a two-stent strategy could be a suitable option in cases where the SB is more than 2.5 mm and has a lesion length of more than 16 mm.</p>
</abstract>

A Perspective on a Two-stent Approach in Bifurcation Cases

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Objective</h3>
<p>Multidetector computed tomography is considered a reliable, non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridges varies greatly based on the technique used to identify the anomaly. We aimed to evaluate the frequency and morphological features of myocardial bridging in patients who underwent ECG-gated 640 slice Multidetector computed tomography coronary angiography at Shahid Gangalal National Heart Centre.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>A retrospective cross-selectional study was conducted at Shahid Gangalal National Heart Centre. From 1 January 2021 to 30 June 2021, 1068 consecutive patients were enrolled, and the frequency and morphological features of myocardial bridging among those patients were evaluated.</p>
</sec>
<sec>
<h3>Results</h3>
<p>Among the 1068 patients examined, 141 had one or multiple Myocardial bridging (13.2%). Out of 141 patients, 94.3% of bridging was superficial, while only 5.7% was deep. 97.9% of myocardial bridging was located in the left anterior descending artery, and 86.2% was present in the mid-segment of the left anterior descending artery.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>Multidetector computed tomography is an effective noninvasive method for the diagnosis of myocardial bridging. The frequency of myocardial bridging in our study was 13.2%.</p>
</sec>
</abstract>

Morphological features of myocardial bridging in patients who underwent CT coronary angiography in the National Heart Centre of Nepal

AHEAD OF PRINT

Volume 34 (2024): Issue 1 (March 2024)

Volume 33 (2023): Issue 4 (December 2023)

Volume 33 (2023): Issue 3 (September 2023)

Volume 33 (2023): Issue 2 (June 2023)

Volume 33 (2023): Issue 1 (March 2023)

Volume 32 (2022): Issue 4 (December 2022)

Volume 32 (2022): Issue 3 (September 2022)

Volume 32 (2022): Issue 2 (June 2022)

Volume 32 (2022): Issue 1 (March 2022)

Volume 31 (2021): Issue 4 (December 2021)

Volume 31 (2021): Issue 3 (September 2021)

Volume 31 (2021): Issue 2 (June 2021)

Volume 31 (2021): Issue 1 (March 2021)

Romanian Journal of Cardiology

The Romanian Journal of Cardiology (RJC) is the official journal of the Romanian Society of Cardiology (Societatea Romana de Cardiologie) and is published quarterly.   The aim of the Romanian Journal of Cardiology was stated from the moment of its foundation in 1991: to provide an open forum for exchange of ideas and a strong connection between basic and clinical cardiology. The journal serves the interest of both practicing clinicians and researchers.   The Romanian Journal of Cardiology is an international, English language, peer-reviewed journal publishing original scientific articles in a wide range of basic, clinical, and experimental research areas. It covers all aspects of cardiology and its related specialties. The Journal publishes articles relevant to adult and pediatric cardiologists, cardiac surgeons, internists, and professionals from other areas of medicine interested in cardiovascular diseases.   The Romanian Journal of Cardiology publishes a diverse and high-quality selection of review articles, clinical trials, case reports, short communications, points of view, letters to the editor, editorials and Images in Cardiology. A letter of transmittal must accompany the submission of a manuscript, indicating that all the authors have contributed to the paper and that they have reviewed and agree with the content of the article.   The journal is based on independent and unbiased blind peer-reviewed principles. The Journal accepts for submission only unpublished papers that are not under review for publication elsewhere.   There is no charge for authors to submit articles to the Romanian Journal of Cardiology, which is an Open Access Journal. This allows the interested reader to search, access, download, or print the full-text articles and use them for any other lawful purpose.   All statements and opinions are solely the responsibility of the authors.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 