Transseptal access in patients with prior atrial septal defect (ASD) closure devices is technically challenging, particularly when large-bore sheaths are required. We report a 59-year-old woman with longstanding persistent atrial fibrillation (AF) and prior ASD closure who underwent concomitant pulsed-field ablation (PFA) and left atrial appendage (LAA) occlusion. Preprocedural cardiac computed tomography identified a narrow (~5 mm) inferior native septal window. A multimodality imaging approach incorporating intracardiac echocardiography, transesophageal echocardiography, fluoroscopy, and CT integration enabled precise inferior transseptal puncture directed toward the LAA. This strategy allowed safe delivery of large sheaths and optimal coaxial alignment for Watchman implantation. Pulmonary vein isolation, posterior wall isolation, and cavotricuspid isthmus ablation were performed, followed by successful LAA occlusion without residual leak. To our knowledge, this is the first reported case of concomitant PFA and LAA occlusion performed through a single transseptal access in a patient with a prior ASD closure device. A focused multi-database literature search identified no previously reported case of this specific combination.

We report the case of a 19-year-old woman with partial anomaly of pulmonary venous return (PAPVR) associated with a secundum atrial septal defect(ASD). She initially presented with dyspnea during a febrile episode and was diagnosed with ASD but was lost to follow-up. One year later, she developed progressive exertional dyspnea. Contrast-enhanced computed tomography (CT) demonstrated anomalous drainage of the right upper pulmonary vein into the superior vena cava, confirming the diagnosis of PAPVR. Elective surgical repair using the double-decker technique was performed. Postoperative recovery was uneventful, and she was discharged without complications.

Window ductus (WD) is a very rare and anatomically distinct variant of patent ductus arteriosus, also known as a type B patent ductus arteriosus. We report the case of a neonate who was born with a rare triad of congenital heart defects including a large WD, multiple ventricular septal defects (VSD), and an atrial septal defect (ASD). The child had significant left-to-right shunting and pulmonary hypertension, and successfully underwent complete surgical repair. At 11 years of follow-up, the patient is doing well with good flow in both the aortic arch and the pulmonary arteries. To the best of our knowledge, this is the first case of WD diagnosis associated with multiple VSDs and an ASD that has been described in the literature.

Propranolol (Prop), a classic non-selective β-adrenergic receptor antagonist, has long played a significant role in the treatment of cardiovascular diseases such as hypertension and arrhythmias. Compared with its peripheral regulatory effects, the potential therapeutic value of Prop in neurological disorders such as post-traumatic stress disorder (PTSD), memory dysfunction, autism spectrum disorder (ASD), anxiety, migraine prophylaxis, and essential tremor is gradually being re-evaluated.

Background: Ischemia-related optical coherence tomography angiography (OCTA) signal degradation complicates cerebral vessel segmentation and quantitative analysis. We developed a structure-aware segmentation framework and applied it to exploratory longitudinal vascular quantification. Methods: Six adult male C57BL/6 mice were imaged at baseline and 0.5-10 h after photothrombotic induction. After geometric transformation, 345 image instances were separated by animal into training, validation, and test subsets of 240, 30, and 75 images from four, one, and one mouse; the 75 test instances originated from 25 source images. A separate sixfold subject-level cross-validation generated out-of-sample masks for longitudinal analysis. Results: The proposed method achieved a Dice coefficient of 0.887, a centerline Dice (clDice) of 0.953, a branch-point F1 score of 0.739, and an average surface distance (ASD) of 0.564 pixels, with significant improvements in Dice, clDice, and branch-point F1. Vascular perfusion density (VPD) and vessel length (VL) decreased significantly over time, vessel average diameter (VAD) remained stable, and average curvature (AC) and branch-point density (BPD) showed significant overall temporal effects. Conclusions: The framework improved technical segmentation performance and supported exploratory analysis of OCTA-derived vascular measurements in experimental ischemic stroke.

Paradoxical embolism through an atrial septal defect (ASD) is a rare but important cause of acute coronary syndrome (ACS) in patients without conventional cardiovascular risk factors. We report the case of a 40-year-old male with no history of hypertension, diabetes, smoking, dyslipidemia, or family history of premature coronary artery disease who presented with acute chest pain and ischemic electrocardiographic changes. Basic thrombophilia profile screening was nonaffirmative. Troponin-T testing using a point-of-care and quantitative assay was positive. Coronary angiography revealed angiographically normal epicardial coronary arteries. Transthoracic and transoesophageal echocardiography demonstrated a large ostium secundum ASD measuring 22 mm × 24 mm, with a prominent Eustachian valve and significant right-to-left shunting on contrast study, accentuated during the Valsalva maneuver. The patient underwent successful transcatheter ASD closure with complete abolition of shunting. This case highlights paradoxical coronary embolism as a potential mechanism of ACS in young, low-risk individuals and underscores the importance of evaluating intracardiac shunts in patients presenting with ACS and nonobstructive coronaries.

Transcatheter device closure is the preferred treatment for secundum atrial septal defect (ASD) in young adults with suitable anatomy. In this population, routine coronary angiography is generally not recommended in the absence of ischemic symptoms or conventional cardiovascular risk factors. However, coronary imaging is selectively performed during ASD intervention to delineate anomalous coronary anatomy at risk of device-related compression, and emerging evidence indicates that clinically significant coronary artery disease may occasionally coexist silently in younger adults. We report the case of a 28-year-old asymptomatic woman undergoing transcatheter closure of a large secundum ASD with deficient rims, in whom coronary angiography performed during invasive catheterization unexpectedly revealed critical left main coronary artery stenosis. Intravascular ultrasound (IVUS) confirmed severe luminal compromise, and successful IVUS-guided left main coronary stenting was performed, followed by device-assisted ASD closure in the same procedural session. Retrospective clinical assessment revealed a history of premature sudden cardiac death in a first-degree relative. This case illustrates the potential for occult yet prognostically significant coronary artery disease in young adults undergoing congenital heart interventions and supports a selective, individualized, and context-driven approach to coronary evaluation, consistent with contemporary adult congenital heart disease guidelines.