To identify factors that influence the severity of clinical signs associated with ventricular septal defect (VSD) in calves, the clinical and pathological findings of 143 confirmed cases in animals under 12 months of age were retrospectively reviewed. Observed clinical signs included emaciation (92.3%), reduced vitality (83.9%), respiratory signs (77.6%), anorexia (74.1%), exercise intolerance (69.9%), cyanosis or pallor (50.3%), standing with assistance (32.9%), collapse (14.7%), death prior to euthanasia (11.9%), and signs of congestion (7.7%). Cardiac murmurs were detected in all cases and holosystolic murmurs in 86.0% of cases, while ejection murmurs, other systolic murmurs, and diastolic murmurs were detected in a small number of cases. The 143 cases were divided into two groups, the severe group (66 cases) and the mild group (77 cases), based on clinical scores, and their findings were compared. Statistically, there were no significant differences between the two groups in hematological parameters and the diameter of the septal defect. However, the blood urea nitrogen levels were significantly higher, and total cholesterol concentrations were significantly lower, in the severe group than in the mild group. In addition, the prevalence of concurrent malformations, including double outlet right ventricle, pulmonary stenosis, and patent ductus arteriosus, was significantly higher in the severe group than in the mild group. Although the defect diameter in the severe group (median: 2.0 cm) was larger than that in the mild group (median: 1.5 cm), the difference was marginal (P=0.0517).

A three-year-old female Devon Rex was referred for postpartum complications. On presentation, physical examination revealed depression, hypothermia, pale mucous membranes and a grade II/VI left apical systolic murmur. Laboratory tests showed severe non-regenerative anaemia, moderate leucocytosis and increased cardiac troponin I (4.16 ng/mL; upper hospital limit <0.2 ng/mL). Transthoracic echocardiography showed no remodelling or dysfunction of either cardiac chamber and no valvular abnormalities. However, a 6-mm echogenic structure with well-defined margins was identified in the left atrial (LA) cavity, apparently adherent to the mural endocardium. Differential diagnosis initially included a LA mural endocarditis and a LA thrombus. The cat was hospitalized and treated with packed red blood cells, ampicillin-sulbactam, enoxaparin and clopidogrel. On day 2, the cat developed acute aortic thromboembolism, rapidly followed by cardiac arrest. The owner consented to a partial postmortem examination limited to the heart. Gross and histological findings were consistent with multisite infective endocarditis (IE) without valvular involvement, featuring LA mural vegetation and pulmonary venous thrombosis, complicated by coronary embolism and an acute left ventricular myocardial infarction. These findings appear to be unique according to the existing feline literature, as in previously described cats with IE, the pathological process involved the mitral and/or aortic valves and primarily led to congestive heart failure or arrhythmias. However, they are consistent with IE cases described in human medicine. This report therefore provides additional insight into feline IE, indicating that, in cats - as already documented in humans - the condition can also present with atypical manifestations and complications.

Daily apparel could enable continuous, noninvasive monitoring of cardiopulmonary health for the early detection and treatment of cardiopulmonary diseases, the leading causes of death and disability worldwide. Here we develop an all-fiber wireless auscultation system seamlessly integrated into garments. An ~150-μm-diameter fiber contact microphone is sewn, knitted or woven into clothing to capture deep-body acoustic signals while overcoming acoustic impedance mismatch and electromagnetic noise. An ~500-μm knitted fiber computer enables real-time signal processing and Bluetooth transmission to a mobile device. A clinical study in 10 patients with heart failure and 20 neonates demonstrated cardiopulmonary sound capture, including qualitative examples of pathological acoustic features such as cardiac murmurs, S3 gallops and crackles. Comparative validation against a digital stethoscope confirms the garment's ability to suppress environmental noise for high-fidelity cardiopulmonary sound capture. In addition, the fiber integrated within the garment array enables spatial sound mapping of cardiac and pulmonary abnormalities for localized diagnostics.

A 25-year-old asymptomatic 64 kg female with an incidental heart murmur was found, on echocardiography, to have a 2 cm echogenic mass beneath the pulmonary valve, with a peak gradient of 11 mmHg and mild pulmonic regurgitation. Gated computed tomography angiogram showed that the mass was located within the infundibulum of the right ventricle, beneath the non-adjacent leaflet of the pulmonary valve. The tumour had a broad base attachment to the interventricular septum and was in close proximity to the left anterior descending artery. The patient underwent median sternotomy via a limited skin incision. Cardiopulmonary bypass was initiated via aortic, superior vena cava and femoral vein cannulation. After diastolic cardioplegic arrest, a transverse infundibulotomy was made. A firm, multilobulated tumour was excised en bloc with a shallow cuff of septal muscle, including a white pedunculated base and gelatinous yellow stalk. A feeding septal artery was oversewn. The infundibulotomy was closed in two layers with 5/0 polypropylene sutures. The heart was de-aired, the cross-clamp removed, and the procedure completed routinely.

Catheter ablation of monomorphic premature ventricular contractions (PVCs) in symptomatic or haemodynamically compromised patients has a Class I recommendation in cardiomyopathy and a Class IIa recommendation in patients comprising non-outflow tract PVC morphology and a physiologic anatomy according to current ESC guidelines. It is therefore widely performed and generally considered safe. Rare but clinically significant complications can occur and may present considerable diagnostic and therapeutic challenges.

Lutembacher syndrome is a rare clinical entity, characterized by the coexistence of atrial septal defect and mitral stenosis. The hemodynamic interplay between these lesions often delays symptom onset, making late presentations uncommon. Advanced disease may result in severe pulmonary hypertension, right heart failure, and poor clinical outcomes, especially when compounded by superimposed infections. A 68-year-old female presented with progressive breathlessness for 2 years, recently worsening, along with cough with expectoration and bilateral pedal edema. Clinical examination revealed raised jugular venous pressure, loud pulmonary component of second heart sound, pansystolic murmur, and bilateral crepitations. Investigations demonstrated leukocytosis, elevated inflammatory markers, and type II respiratory failure on arterial blood gas analysis. Chest imaging showed bilateral patchy consolidation suggestive of lower respiratory tract infection. Two-dimensional echocardiography confirmed Lutembacher syndrome with severe pulmonary arterial hypertension, severe tricuspid regurgitation, and right-sided chamber dilation. The patient was managed with oxygen therapy, noninvasive ventilation, intravenous antibiotics, diuretics, and supportive care. Despite intensive management, her condition progressively deteriorated, culminating in cardiopulmonary arrest. This case highlights the rare occurrence of late-presenting Lutembacher syndrome in the elderly and underscores the adverse impact of advanced pulmonary hypertension and superimposed respiratory infection. Early diagnosis and timely intervention are critical to prevent irreversible hemodynamic changes and improve the outcomes in such patients.

Follow-up echocardiograms are not recommended for small and small to moderate size muscular ventricular septal defects (mVSDs). Our purpose in this single center retrospective cohort study was to describe practice variation in echocardiogram utilization in the follow-up of small and small to moderate mVSDs diagnosed at ≤ 6 months of age and assess factors associated with variation. Demographic and provider data were collected. Patients with ≥ 1 follow-up echocardiogram formed the Overutilization Group and those with no follow-up echocardiogram the Appropriate Utilization Group. Of 414 patients, 153 (37%) had ≥ 1 follow-up echocardiogram (overutilization). There were no significant differences in sex, race, ethnicity, or preferred language. The Overutilization Group was marginally more likely to have private insurance (68% vs. 55%, p = 0.06) and a higher National Child Opportunity Index (56% vs. 44% high or very high, p = 0.02). In the Overutilization Group, VSD murmurs were documented in 45% and a VSD was still present on echocardiogram in 56%. Based on costs of echocardiograms at our institution and distribution of private vs. publicly insured patients, which both vary by institution, the estimated annual expenditure in the U.S. would exceed 20 million dollars on imaging that does not impact clinical course or outcomes. Echocardiography was overutilized in the follow-up of over 1/3 of patients, with documented planned echocardiograms increasing this to almost ½ of the cohort. Decreasing overutilization of echocardiograms in the follow-up of these patients could result in significant savings to the healthcare system without compromising patient outcomes.

Tricuspid valve dysplasia (TVD) is a congenital cardiac malformation in dogs characterized by abnormal tricuspid valve morphology, leaflet tethering, impaired leaflet coaptation, and right atrial and ventricular remodelling. This report describes cone reconstruction for severe TVD in a dog. A three-year-and-10-month-old female Labrador retriever presented with a grade IV/VI systolic murmur and exercise intolerance. Echocardiography revealed severe tricuspid regurgitation, a right atrial-to-left atrial ratio of 1.57, malformed and tethered tricuspid valve leaflets, impaired leaflet coaptation, and marked right-sided cardiac enlargement, consistent with severe TVD. Surgery involved tricuspid valve leaflet mobilization, delamination of adherent leaflet tissue and abnormal subvalvular attachments, annular reduction, and reconstruction of the available leaflet tissue into a cone-like valve with leaflet rotation and reattachment. A small, thin, dysplastic portion of the right ventricular free wall was also excluded from the functional right ventricular cavity by longitudinal plication. The dog was discharged on postoperative day seven without other major complications. On postoperative day 294, echocardiography showed a reduction in the colour Doppler tricuspid regurgitant jet, a decrease in the right atrial-to-left atrial ratio to 0.50, and a reduction in right atrial size. Exercise intolerance resolved, although a grade III/VI systolic murmur persisted. Cone reconstruction, adapted from the technique used in human patients with Ebstein's anomaly, may improve tricuspid valve function and clinical signs in selected dogs with severe TVD. However, its indications, reproducibility, and long-term durability in dogs remain unestablished. Further studies are needed to evaluate patient selection, long-term benefits, and potential complications.

Aorto-left ventricular tunnel (ALVT) is a rare congenital cardiac defect consisting of an extracardiac communication between the ascending aorta and the left ventricle. It may mimic aortic regurgitation, particularly when an eccentric diastolic jet and a systodiastolic murmur are present. Accurate anatomical delineation is essential to distinguish tunnel flow from valvular regurgitation and to guide intervention.