Young hearts at risk: Unveiling novel factors in myocardial infarction susceptibility and prevention.

The increasing incidence of acute myocardial infarction (AMI) among the young population represents a significant and emerging health concern, contributing substantially to both mortality and morbidity. Unlike myocardial infarctions occurring in older individuals, traditional risk factors such as diabetes and hypertension exhibit a weaker association in the younger demographic. Consequently, there is a pressing need for a deeper understanding of novel risk factors that contribute to AMI in young patients. In this review, we explore distinct risk factor profiles associated with young-onset AMI in comparison to older patients. Special attention is given to novel risk factors, examining their susceptibility factors and exploring preventive measures. The comprehensive risk profile of extremely young South Asians who develop early coronary arterial disease is not yet fully understood. There are many novel evolving risk factors associated with young AMI which need intervention to reduce morbidity and mortality. It has been seen that established inflammatory markers like lipoprotein (a), dyslipidaemia, long COVID, and new emerging risk factors like air pollution (micro- and nanoplastics), periodontitis, acute stress, energy drinks, misuse of recreational drugs may increase risk and influence treatment, and outcomes of AMI in this young population. Screening of emerging novel risk markers and their optimization is important in preventing young patients with AMI. The role of conventional risk factors should not be overlooked and should be treated aggressively. Sex and geographic-specific base approaches are required to reduce risk factors and prevent AMI in young. More prospective studies are needed to evaluate the increasing incidence of young AMI and its associated novel risk factors.

Sutureless valves versus aortic root enlargement for aortic valve replacement in small aortic annulus: A systematic review and pooled analysis.

BACKGROUND: Very few studies provide direct comparisons between aortic root enlargement and sutureless valve implantation in patients with a small aortic annulus who underwent aortic valve replacement. This study aims to provide comparative outcomes between the two in such a subset of patients, through a systematic review and pool analysis. METHODS: The PubMed, Scopus and Embase databases were searched using the appropriate terms. The data from original articles mentioning aortic root enlargement and sutureless valves in a single or comparative study with another group of patients with a small aortic annulus were pooled and analyzed using descriptive statistics. RESULTS: Both cardiopulmonary bypass (68.4 vs. 125.03 min, p < 0.001) and aortic cross-clamp times were significantly shorter in the sutureless valve group, along with a concomitantly higher number of minimally invasive surgeries. The incidence of permanent pacemaker implantation (9.76% vs. 3.16%, p < 0.00001), patient prosthesis mis-match and paravalvular leak was significantly higher in the sutureless valve group. In comparison, the incidence of re-exploration for bleeding was higher in the aortic root enlargement group (5.27% vs. 3.16%, p < 0.02). The two groups had no differences in the duration of hospital stays or mortality. CONCLUSIONS: Sutureless valves demonstrated a comparable hemodynamic outcome with aortic root enlargement in patients with a small aortic annulus. In addition to this, it greatly facilitated minimally invasive surgery. However, the high incidence of pacemaker implantation is still a concern for the widespread recommendation of sutureless valves, especially in young patients with a small aortic annulus.

Capillary haemangioma of the tricuspid valve annulus: A rare presentation.

INTRODUCTION AND IMPORTANCE: To the best of our knowledge, very few tricuspid valves (TV) haemangiomas have been reported to date in the literature due to the avascular nature of the cardiac valve. We report the case of an otherwise healthy male presented with unexplained shortness of breath who was found to have tricuspid valvular haemangioma. CASE PRESENTATION: 52-year-old male who presented with progressive dyspnoea on exertion for 6 months. Echocardiography revealed an echo-dense mass attached to the heart's anterior leaflet of the tricuspid valve. A cardiac MRI suggested it as pulmonary fibroelastoma, but a surgical excision biopsy revealed it to be a capillary haemangioma. Patient symptoms improved after surgery. CLINICAL DISCUSSION: Cardiac valve tumour-like haemangiomas are rare, with the involvement of the tricuspid valve even rarer. Most TV haemangiomas are detected incidentally, however, they may present with a range of symptoms. Echocardiography is the mainstay of diagnosis however definitive diagnosis is by histopathology. Surgical excision is the treatment of choice, though surgery in asymptomatic patients is still controversial. CONCLUSION: Cardiac haemangiomas are rare, with the involvement of the tricuspid valve even rarer. They should undergo surgical excision due to the risks of embolism, rupture, and sudden death.