Clinical characteristics and prognostic factors of myocarditis associated with the mRNA COVID-19 vaccine.

To analyze the clinical presentation and outcomes of myocarditis after administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccine. Nine case series and 15 case reports (74 patients) of myocarditis after administration of the BNT162b2 or mRNA-1273 vaccine were reviewed from PubMed, Scopus, Embase, and Web of Science. We analyzed clinical manifestations, diagnostic findings, and outcomes. In addition, we performed a pooled analysis and investigated risk factors leading to admission to the intensive care unit and recovery with conservative care. Most patients were male (94.6%), and the median age (range) was 17.6 (14-70) years. Patients who received the BNT162b2 (n = 58, 78.4%) vaccine presented fewer systemic symptoms and left ventricular dysfunction than mRNA-1273 recipients. Although patients under 20 years experienced more fever and myalgia, they had better ejection fraction and less prominent myocardial inflammation in magnetic resonance imaging than older patients. The clinical course of all patients was favorable without mortality, and one-third of patients resolved with conservative care alone. Risk factor analyses revealed that patients with gastrointestinal symptoms required intensive care (odds ratio: 20.3, 95% confidence interval 1.90-217, p = 0.013). The risk of fatality in myocarditis subjected to mRNA vaccination seems to be low. However, patients with gastrointestinal symptoms received more intensive care, and a significant proportion of patients recovered with conservative management.

Time course of the changes in right and left ventricle function and associated factors after transcatheter closure of atrial septal defects.

OBJECTIVE: The purpose of this study was to evaluate the changes in right ventricle (RV) and left ventricle (LV) function after transcatheter atrial septal defect (ASD) closure and to assess the influence of the age and the amount of shunt. DESIGN: Retrospective study PATIENTS: Fifty-three adult patients who underwent transcatheter closure were enrolled, then divided into subgroups according to the age (< 40 years vs ≥ 40 years), and the amount of shunt flow (QpQs < 2.5 vs QpQs ≥ 2.5). OUTCOME MEASURES: Two-dimensional tissue Doppler imaging was performed in a four-chamber view at the basal ventricular septum (VS) and tricuspid valve annulus (TVA) before and at 1 month and 6 months after closure. Myocardial velocities, the myocardial performance index (MPI), and isovolumic acceleration (IVA) were assessed. RESULTS: At the TVA, the MPI decreased slightly and then greatly increased at 6 months after closure (P = .002). The IVA improved in all patients (P < .001), and the E'/A' ratio decreased, especially in the old age group (P = .031) and larger shunt group (P = .035). At the VS, S' and the IVA decreased and had not recovered until 6 months in the old age (P = .02) and larger shunt (P = .02). The Qp/Qs showed a significant reverse correlation with a decrease in the E'/A' at the TVA (r = -0.37, P = .008), and age of patient was correlated with a decrease in the IVA at the VS (r = -0.32, P = .019). The age at closure (ß = -0.36, P = .002), the Qp/Qs ratio (ß = -0.45, P = .01), and RV MPI changes (ß = -7.64, P < .001) were found to be associated factors with IVA decrease at the VS. CONCLUSIONS: After ASD closure, RV global function might be impaired. In elderly patients and patients with a large shunt, impairment of LV contractility developed until 6 months after closure. Close long-term observation is required after closure, especially in old-age patients with a large shunt.

Relation of left ventricular diastolic function as measured by echocardiography and pulmonary capillary wedge pressure to rejection in young patients (< or = 31 years) after heart transplantation.

To investigate the association of catheter-derived and newer echocardiographically derived measures of diastolic function with rejection in heart transplant recipients, 48 transplant recipients had Doppler and Doppler tissue imaging assessment along with catheter-measured pulmonary capillary wedge pressure (PCWP) at the time of endomyocardial biopsy. Of echocardiographic measures, propagation velocity (Vp), mitral E-wave velocity (E)/Vp, and E/annular mitral E-wave velocity (Em) were significantly associated with rejection (p <0.02), and an elevated PCWP was associated with rejection (p = 0.023) but with poor sensitivity. Weak but insignificant correlations with PCWP were found for E/Vp (r = 0.28) and E/Em (r = 0.37).

Controlled ultrasound tissue erosion.

The ability of ultrasound to produce highly controlled tissue erosion was investigated. This study is motivated by the need to develop a noninvasive procedure to perforate the neonatal atrial septum as the first step in treatment of hypoplastic left heart syndrome. A total of 232 holes were generated in 40 pieces of excised porcine atrial wall by a 788 kHz single-element transducer. The effects of various parameters [e.g., pulse repetition frequency (PRF), pulse duration (PD), and gas content of liquid] on the erosion rate and energy efficiency were explored. An Isppa of 9000 W/cm2, PDs of 3, 6, 12, and 24 cycles; PRFs between 1.34 kHz and 66.7 kHz; and gas saturation of 40-55% and 79-85% were used. The results show that very short pulses delivered at certain PRFs could maximize the erosion rate and energy efficiency. We show that well-defined perforations can be precisely located in the atrial wall through the controlled ultrasound tissue erosion (CUTE) process. A preliminary in vivo experiment was conducted on a canine subject, and the atrial septum was perforated using CUTE.