Rheumatoid arthritis (RA) is a systemic inflammatory disease that can rarely involve the aorta and remain clinically silent until severe complications occur. We report the case of an 80-year-old woman with no cardiovascular risk factors who presented with acute left-sided heart failure that led to the diagnosis of previously unrecognized rheumatoid arthritis. Transthoracic echocardiography demonstrated global left ventricular hypokinesia with a left ventricular ejection fraction of 34%, a structurally preserved tricuspid aortic valve, and moderate-to-severe functional aortic regurgitation related to ascending aortic dilation. The ascending aorta was markedly dilated, predominantly at the sinotubular junction and tubular segment. Computed tomography confirmed a giant ascending aortic aneurysm measuring 6.2 cm and revealed additional dilation of the right subclavian artery, suggesting multifocal large-vessel involvement. Laboratory investigations showed elevated inflammatory markers, and immunological testing supported the diagnosis of rheumatoid arthritis. These findings were highly suggestive of an underlying inflammatory aortopathy, although a definitive causal relationship could not be established. This case highlights that heart failure may be the presenting event revealing occult inflammatory aortopathy and underscores the importance of considering systemic inflammatory diseases in patients with unexplained aortic pathology, even in the absence of traditional cardiovascular risk factors.

Pulmonary endarterectomy (PEA) is a potentially curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH); however, decompensated right heart failure and concomitant cardiac procedures increase the risk of postoperative mortality. We report a case of operable CTEPH with severe mitral regurgitation causing right heart failure refractory to medical therapy. Emergent PEA combined with mitral valve plasty was considered unacceptably high risk. Although balloon pulmonary angioplasty (BPA) for CTEPH complicated by severe mitral regurgitation carries a risk of worsening pulmonary congestion, we assessed pulmonary artery wedge pressure by right heart catheterization and confirmed that it was not elevated after aggressive diuretic therapy. Therefore, a single BPA session was performed using undersized balloons, with treatment limited to a small number of lesions. This approach stabilized the patient's right heart failure without exacerbating pulmonary congestion and left-sided heart failure. Subsequently, elective PEA combined with mitral valve plasty was successfully performed, resulting in marked improvements in pulmonary hemodynamics and clinical symptoms. This case suggests that rescue BPA followed by elective PEA with mitral valve plasty may benefit selected patients with CTEPH complicated by severe mitral regurgitation and decompensated right heart failure refractory to medical therapy.

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to incomplete valve closure, TR leads to right heart dilation, systemic congestion, and eventually right-sided heart failure. Importantly, TR may contribute to the onset of atrial fibrillation (AF), the most common sustained arrhythmia, affecting approximately 59 million individuals worldwide. Despite its growing clinical importance, the pathophysiology of TR remains incompletely understood, and current animal models of TR, based on direct valve manipulation, limit translational applicability. We present a novel, minimally invasive porcine model of TR established via femoral/jugular vein catheterization with deployment of an inferior vena cava (IVC) filter. The filter partially impedes tricuspid valve closure, inducing TR without valvular injury. Validation was achieved through multimodal imaging, including fluoroscopy, echocardiography, and electrocardiography, confirming hallmark features of TR, including right atrial and ventricular enlargement and arrhythmic activity. This model provides a reproducible, minimally invasive platform for studying selected features of TR progression. Its minimally invasive nature and preservation of native valvular structure make it a useful preclinical platform for mechanistic and translational research.

Cardiac dysfunction secondary to manifest ventricular pre-excitation via accessory pathways (AP) in the absence of tachyarrhythmias is rarely studied. To evaluate pathophysiology, AP location impact, diagnostic approach, and role of catheter ablation (CA) in pre-excitation-related cardiac dysfunction without tachyarrhythmias. Electronic databases were queried for WPW/pre-excitation and cardiac dysfunction-related studies without age restrictions. A total of 34 studies met inclusion criteria, including 27 case reports/series (42 patients, 62% female) and 7 observational studies (412 participants, 41% female). Pediatric patients age ranged from infancy to 21 years and adults from 20 to 59 years. Right septal and right free-wall APs were most commonly associated with cardiomyopathy. Heart failure predominated in pediatric presentations, whereas adults most often exhibited asymptomatic LV dysfunction. Intra-LV dyssynchrony, particularly when accompanied by septal dyskinesia, emerged as a consistent pathophysiologic feature. Two-dimensional strain echocardiography (2D-STE) reliably identified LV dysfunction, localized AP, and assessed response to CA. Although cardiac function mostly normalized after successful AP ablation, irreversible myocardial changes have been reported. Preexcitation-related cardiac dysfunction in the absence of tachyarrhythmias, appears to be mediated primarily by intra-LV dyssynchrony and is most commonly associated with right-sided and septal APs. 2D-strain imaging is a useful diagnostic tool. CA typically restores cardiac function, however, irreversible myocardial changes can occur. Therefore, close surveillance and consideration of early ablation in patients with evidence of dyssynchrony are warranted. Large prospective cohort studies can further validate these findings.

Constrictive pericarditis (CP) typically primarily involves pericardial pathology, but mediastinal malignancies can create an identical hemodynamic profile through direct extrinsic encasement. We report a 58-year-old male patient with metastatic thymic squamous cell carcinoma presenting with refractory right-sided heart failure and anasarca. Although his history initially suggested radiation-induced or post-COVID-19 pericarditis, right heart catheterization and echocardiography revealed classic constrictive physiology, including a "septal bounce" and ventricular interdependence with a preserved ejection fraction. A four-month trial of corticosteroids and colchicine failed to improve his hemodynamics. Positron emission tomography-computed tomography (PET/CT) subsequently confirmed that the thymic mass had directly infiltrated the mediastinal pleura and pericardium, creating a rigid shell encasing the heart and compressing the inferior vena cava. Due to the tumor's surgical inaccessibility and the failure of medical treatment, the patient was transitioned to palliative care. This case of "malignant pseudo-constriction" emphasizes the diagnostic challenge of distinguishing reversible inflammatory pericarditis from irreversible malignant encasement. In patients with advanced mediastinal tumors, persistent constrictive symptoms despite anti-inflammatory therapy should raise high clinical suspicion for direct tumor infiltration. This condition, which can be diagnosed utilizing advanced imaging modalities, carries a poor prognosis and typically precludes surgical intervention.

Heterotaxy syndrome comprises a spectrum of laterality defects frequently associated with complex congenital heart disease and extracardiac anomalies. We report a 2-year-old male who presented with persistent cyanosis, recurrent respiratory infections, and failure to thrive. Cardiac computed tomography demonstrated ambiguous situs with dextrocardia, reversed atrial arrangement, L-looped ventricles, large atrial and ventricular septal defects, hypoplastic right ventricle, absent right ventricular outflow tract, and double-outlet left ventricle. Additional findings included polysplenia, right-sided aortic arch with mirror branching, aortopulmonary collaterals, and a left posterolateral Bochdalek hernia. This case highlights the value of comprehensive cross-sectional imaging in defining complex heterotaxy anatomy and underscores the clinical implications of associated extracardiac anomalies in surgical planning and prognosis.

Ventricular tachycardia (VT) ablation in patients with severely impaired left ventricular (LV) function remains challenging because mapping often requires VT induction or sustained arrhythmia that may not be tolerated. Temporary mechanical circulatory support (tMCS) can improve procedural stability in high-risk patients. We report a successful VT ablation in a 73-year-old man with non-ischemic dilated cardiomyopathy, severe biventricular failure, and recurrent VT, performed under fully percutaneous biventricular support using Impella CP and Impella RP (Abiomed) via transfemoral access. Hemodynamic stability was achieved only after the addition of right-sided support. The procedure reduced VT burden without device- or access-related complications.

Carcinoid heart disease (CHD) commonly affects right-sided heart valves, often leading to progressive right heart failure (RHF) and structural valve deterioration.