Introduction Transcatheter mitral valve repair (TMVR) creates an iatrogenic atrial septal defect (iASD) that may persist and affect hemodynamics. Although the MITHRAS (Closure of Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Repair) trial showed no benefit of routine closure, its small size and selective population limit generalizability, and observational data remain conflicting. We hypothesized that percutaneous iASD closure (PC-iASD) would be associated with differences in in-hospital clinical and hemodynamic outcomes compared with no closure. Methods Using the National Inpatient Sample (NIS), we evaluated national prevalence, baseline characteristics, and in-hospital outcomes of PC-iASD among patients undergoing TMVR from 2020 to 2022. Results We identified 4,965 weighted TMVR hospitalizations; 431 (8.7%) underwent PC‑iASD closure during the same admission. Compared with TMVR only, the closure cohort had a higher prevalence of pulmonary hypertension (245 (56.9%) vs. 1735 (40.5%), p = 0.0034) and heart failure (411 (95.4%) vs. 3767 (87.9%), p = 0.0396). There were no significant differences in chronic obstructive pulmonary disease, coronary artery disease, end-stage renal disease, or tricuspid regurgitation between the two groups. After multivariate adjustment, there was no difference in in‑hospital mortality, cardiogenic shock, acute heart failure, acute right heart failure, cardiac tamponade, or need for mechanical circulatory support among the two cohorts. Conclusion There have been conflicting results over numerous retrospective and prospective studies regarding the outcomes of post-TMVR iASD closure. Potential benefits of right-sided volume overload may be offset by higher left-atrial pressures after closure. The wide confidence (albeit nonsignificant) toward the development of acute right heart failure, pericardial effusion, and cardiac tamponade raises the possibility of better patient selection or some iASD closure procedural modifications that can help improve outcomes.

Background/Objectives: Pericardial effusion (PEf) is a frequent finding after cardiac surgery. Progression to cardiac tamponade (CT) is a rare but life-threatening complication. Current evidence remains limited due to insufficient data on prevalence, progression predictors and management strategies. Methods: We retrospectively analyzed anamnestic, clinical, laboratory, echocardiographic and therapeutic data from 2662 patients (74 ± 11 years) admitted to the Cardiac Rehabilitation ward between 2022 and 2024. Results: Among 2152 (81%) cardiac surgery patients, 382 (18%) developed PEf: 58% mild, 38% moderate, and 4% severe. Patients developing PEf tended to be younger and more frequently male. In addition, PEf development was seen more commonly after aortic and combined surgeries. All patients with severe PEf or CT had undergone surgery via sternotomy, whereas minithoracotomy was inversely associated with PEf severity. Postoperative complications occurred in 92% of PEf patients, mainly due to arrhythmia, hemodynamic deterioration, or heart failure. Overall outcome was favourable in 98% of patients. CT occurred in eight patients (2%). Anticoagulation therapy was more frequent among patients who developed PEf or CT. Preventive colchicine was prescribed in only 16% of cases. No PEf-specific therapy was administered in 56% of PEf patients, while corticosteroids and nonsteroidal anti-inflammatory drugs were used in 28% and 8% of cases, respectively, without surgical wound complications. No PEf recurrences were observed during follow up (517 ± 424 days). Conclusions: PEf is a common complication after cardiac surgery, more frequently in young males, usually of mild or moderate severity. The majority of these cases resolve using either a conservative or pharmacological approach, predominantly via corticosteroids. Patients undergoing aortic surgery, experiencing postoperative complications (especially arrhythmias), and receiving anticoagulation therapy were associated with severe PEf or CT. Despite guideline recommendations, colchicine remains markedly underutilized.

Traditional transseptal puncture (TSP) relies on x-ray imaging and anatomical landmarks, which poses challenges in patients with atrial structural variations or overweight. Furthermore, emerging interventional techniques demand precise puncture site localization. This feasibility study evaluates the safety and efficacy of a novel biplane positioning method guided by left atrial (LA) 3D-CT reconstruction for TSP.

Acute aortic dissection (AAD) is a time-critical cardiovascular emergency that classically presents with abrupt chest or back pain; however, atypical presentations may lead to misdiagnosis, delayed treatment, and worse outcomes. We report a case of AAD presenting with isolated abdominal pain and ultrasound findings mimicking acalculous cholecystitis. A 53-year-old male patient with poorly controlled hypertension and hypercholesterolemia presented with acute-onset epigastric and right upper quadrant pain associated with nausea. Lab evaluation showed direct bilirubin elevation and mild acute kidney injury. Abdominal ultrasound demonstrated gallbladder wall thickening and pericholecystic fluid without gallstones, raising a provisional concern for acalculous cholecystitis. ECG and initial troponin were unremarkable; however, serial troponin elevations prompted further assessment with transthoracic echocardiography (TTE), revealing an intimal flap in the ascending aorta with circumferential pericardial effusion. CT angiography confirmed Stanford type A dissection extending into the infrarenal abdominal aorta, associated with hemopericardium, inferior vena cava reflux, and preserved celiac perfusion. Emergent surgical repair demonstrated a contained rupture with sanguineous pericardial effusion consistent with low-grade tamponade. AAD may therefore present atypically with isolated abdominal symptoms driven by early tamponade physiology and venous congestion rather than visceral malperfusion. In patients with abrupt-onset pain and unexplained serial troponin elevations, timely consideration of dissection is paramount, even in the absence of chest pain.

Pericarditis is the most frequent manifestation of pericardial disease and accounts for up to 5% of emergency department visits for chest pain. Although traditionally considered a benign and self-limited condition, it is a heterogeneous syndrome with a broad aetiological spectrum and potentially significant morbidity. While mortality is low, the burden of complications like recurrent disease, cardiac tamponade or constrictive pericarditis, and the frequent need for hospitalisation underscore its clinical relevance. The growing availability of multimodality imaging and the publication of updated international guidelines in 2025 have recently renewed attention to pericardial diseases, refining diagnostic criteria, risk stratification and therapeutic approaches. In high-income settings, idiopathic or presumed viral pericarditis remains the most common presentation. However, a substantial proportion of patients harbour alternative aetiologies that carry distinct prognostic implications and require tailored diagnostic and management strategies. In this review, we use the ABCDE mnemonic as a pragmatic framework to highlight five clinically important and often under-recognised forms of pericardial disease. Pericarditis associated with autoimmune and systemic inflammatory diseases is typically characterised by recurrent or refractory inflammatory courses and frequent extracardiac involvement. Bacterial pericarditis, although rare, represents a life-threatening condition requiring rapid aetiological identification and aggressive therapy. Cancer-related pericardial disease often presents with large pericardial effusions or cardiac tamponade and is associated with a poor prognosis largely determined by the underlying malignancy. Damage-related and drug-related pericarditis encompasses postcardiac injury syndromes and pharmacological toxicity. Finally, endocrine and metabolic disorders, including uraemia, hypothyroidism and infiltrative conditions such as amyloidosis, are associated with pericardial disease that manifests with atypical features and effusion. Early recognition of these entities is critical, as management extends beyond standard anti-inflammatory therapy and often requires correction of the underlying cause and close multidisciplinary collaboration. This ABCDE approach can aid clinicians in identifying these uncommon high-risk forms of pericarditis and optimising patient-centred care.

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and complications such as pericardial effusion or tamponade, contributing to diagnostic delays and higher pre-hospital mortality. Beyond clinical factors, biological differences may influence disease expression in women. Menopause-associated vascular aging, hormonal modulation of extracellular matrix remodeling, and pregnancy-related hemodynamic and connective tissue changes may alter aortic wall integrity and susceptibility to dissection. Notably, women often experience dissection at smaller absolute aortic diameters, highlighting the potential importance of body-size indexing in risk stratification and surgical thresholds. In type A AAD, women are less likely to undergo extensive surgical repair in some cohorts, and although contemporary in-hospital mortality differences are narrowing, long-term survival disparities may persist. In type B AAD, women are more frequently managed conservatively, while outcomes following thoracic endovascular aortic repair appear broadly comparable between sexes. Pregnancy and the postpartum period represent particularly vulnerable windows, especially among patients with underlying heritable aortopathies. Greater awareness of sex-specific biological and clinical characteristics, incorporation of indexed aortic dimensions, and improved multidisciplinary management strategies are essential to optimize outcomes for women with acute aortic dissection.