In transcatheter closure of patent foramen ovale (PFO) associated with cryptogenic stroke (CS), a small coexisting atrial septal defect (ASD) can serve as a potential source of residual shunting if not adequately addressed. We conducted a retrospective study of 14 patients with PFO and coexisting ASD who underwent transcatheter closure between December 2019 and May 2025. The first five patients treated with Amplatzer™ PFO Occluder demonstrated residual right-to-left shunting graded ≥ 3 at one-year follow-up. Following the introduction of the GORE® CARDIOFORM Septal Occluder (GSO) and GORE® CARDIOFORM ASD Occluder (GCA) in Japan, nine additional patients were treated. Among the eight patients who completed one-year follow-up, seven exhibited no significant residual right-to-left shunting (i.e., grade < 3). No recurrent strokes or device-related complications occurred in any of the 14 patients. This single-center study highlights the importance of appropriate device selection in managing PFO and coexisting ASD. In this anatomically complex subset, the use of GSO and GCA was associated with more favorable anatomical closure outcomes. However, these results should be interpreted cautiously in light of the limited number of cases and the non-comparative study design.

Purpose: To evaluate the prevalence and cardiac CT features of inferior left atrial diverticula (ILAD) communicating with the right atrium (RA) or inferior vena cava (IVC), a novel type of interatrial communication. Materials and Methods: This retrospective study included 11,512 consecutive patients who underwent cardiac CT. CT features and prevalence of ILAD communicating with the RA or IVC were analyzed. Shunts were defined as anatomical defects between the two structures with or without visible contrast flow. In a subset of the patients we compared interatrial septal aneurysm (n = 20) and ILAD without shunt (n = 66), assessing the involvement of a wedge-like fatty space bordered by both atria, IVC and coronary sinus. Results: There were 33 patients (19 males and 14 females; aged 59.8 ± 11.2 years; age range, 18-87 years) with ILAD with shunts (ILADSs). The prevalence of ILADSs was 4.2% (33/783) among ILAD and 0.3% (33/11,512) among all patients. Maximal dimensions of ILAD were 17.6 ± 9.9 mm (range, 5.3-41.0 mm). Mean ostial diameters of ILAD and mean sizes of shunts were 6.2 ± 5.6 mm and 3.2 ± 2.9 mm, respectively. Shunts were larger than 5 mm in 6 patients (15.2%) and larger than 3 mm in 10 patients (30.3%). In 30 patients who underwent transthoracic echocardiography, ILADSs were not identified at echocardiography. CT showed involvement of the wedge-like fatty space for all ILAD and for no cases with interatrial septal aneurysm. Conclusions: Cardiac CT enables detection of incidental ILADSs unrecognized at echocardiography.

Pulmonary arteriovenous malformations (PAVMs) cause right-to-left shunting with risks of hypoxemia and paradoxical embolization. Endovascular embolization is the standard treatment, but long-term durability depends on anatomy, flow characteristics, device selection, embolization strategy, and follow-up definitions. This narrative review synthesizes contemporary evidence on embolic devices-including coils, vascular plugs, microvascular plugs, low-profile braided occluders, and liquid embolics-along with adjunctive techniques such as balloon occlusion, nidus-directed embolization, and cone-beam CT guidance. Available retrospective data suggest that plug-based strategies may be associated with lower persistence in anatomically suitable lesions, whereas coils, liquid embolics, and hybrid approaches remain important for complex, recurrent, or anatomically constrained lesions. Emphasis is placed on an anatomy-, flow-, and imaging-based decision framework, cautious interpretation of heterogeneous evidence, and structured long-term surveillance to minimize persistence and optimize clinical outcomes.

Giant coronary artery aneurysms (CAAs), defined as dilatations exceeding 20 mm or four times the reference vessel diameter, are rare and risk rupture or thrombosis. Coronary pulmonary artery fistulas may lead to grow aneurysm formation via chronic high-flow shunting. Their coexistence is rare in elderly patients without prior Kawasaki disease.

Left ventricular noncompaction (LVNC) is a rare cardiomyopathy marked by excessive myocardial trabeculations and profound intertrabecular recesses, frequently identified incidentally, yet occasionally linked to significant cardiac dysfunction and adverse outcomes. It is uncommon for LVNC to coexist with other congenital cardiac anomalies, and the concurrent occurrence of LVNC, patent ductus arteriosus (PDA), and bicuspid aortic valve has not been previously reported. We report a 7-month-old female infant who exhibited exertional cyanosis and an episode of syncope in early infancy. Transthoracic echocardiography revealed that the left ventricle was not functioning correctly and that the aorta was too narrow. Therefore, a cardiac computed tomography angiography (CTA) was performed to gather further information. The CTA showed a significant PDA with flow in both directions, predominantly right-to-left shunting. This was caused by pulmonary arterial hypertension, which caused the pulmonary arteries (PAs) and descending thoracic aorta to have different levels of contrast opacification. There was significant dilation in all the heart's chambers and PAs. In addition, classic imaging features of LVNC were identified, including prominent trabeculations and deep intertrabecular recesses, with a noncompacted to compacted myocardial ratio > 3. The aortic valve had two cusps and thickened leaflets and raphes, which caused severe valvular stenosis. These three congenital defects probably worked together to cause early heart failure, pulmonary hypertension, and a high risk of death. This case exemplifies an extraordinarily rare congenital cardiac triad that manifests in infancy, emphasizing the critical importance of CTA in thorough anatomical and functional evaluation. Early identification of intricate associations is essential for risk stratification, multidisciplinary management, and prognostication in affected infants.

Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular malformation in which one or more pulmonary veins drain abnormally into the right atrium or systemic venous circulation, producing a pretricuspid left-to-right shunt. In anatomic terms, this condition is more precisely described as a partial anomalous pulmonary venous connection, whereas PAPVR refers to the physiological consequence of anomalous venous drainage. Historically, these anomalies were most often diagnosed during childhood; however, with increasing use of cross-sectional imaging modalities such as cardiac computed tomography and cardiovascular magnetic resonance, the condition is increasingly identified in adults. Adult presentations are heterogeneous, ranging from incidental imaging findings to clinically significant disease characterized by right ventricular volume overload, atrial arrhythmias, and pulmonary arterial hypertension. Recognition of PAPVR/partial anomalous pulmonary venous connection in adults remains clinically important, as delayed diagnosis may allow progressive right-sided cardiac remodeling and pulmonary vascular changes. This narrative review aims to move beyond classic anatomical descriptions and provide a clinically oriented overview of PAPVR in adults. We summarize the embryologic basis, anatomic variants, epidemiology, clinical manifestations, and hemodynamic consequences of this condition. Particular emphasis is placed on multimodality imaging-including transthoracic echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance-for accurate diagnosis and procedural planning. The review also discusses hemodynamic evaluation with right-heart catheterization, risk assessment for pulmonary hypertension, and indications for intervention. Management strategies are reviewed in detail, including surgical techniques such as intracardiac baffling, single-patch and 2-patch repairs, and the Warden procedure, as well as the evolving role of transcatheter and hybrid approaches in carefully selected adult patients. Special clinical scenarios-including late presentation, pregnancy, and coexisting pulmonary hypertension-are also addressed. By integrating diagnostic, therapeutic, and longitudinal follow-up perspectives, this review provides a practical framework for the evaluation and management of adults with PAPVR in modern cardiology practice.