OBJECTIVE: This study aims to present the midterm outcomes of surgical correction of the anomalous left coronary artery from the pulmonary artery (ALCAPA).
METHODS: This is a retrospective study of patients undergoing anomalous origin of the LCA from the pulmonary artery repair between 2010 and 2019.
RESULTS: Forty-nine patients (20 boys and 29 girls) underwent ALCAPA repair. Patients were divided into two groups based on their age at ALCAPA repair: infant (< 1 year of age: n = 24) and non-infant ( ≧ 1 year of age: n = 25). Median age at time of repair was 23 months(7-60months). LCA reimplantation was performed in 47 patients, and Takeuchi repair was performed in 2 patients. Hospital mortality in the infant group was 8.2% (4 of 49). Infant group had significantly lower LVEF in pre-operation (p < 0.05), but there was not significantly different between the two groups about LVEF at discharge. The median follow-up duration was 43(18-85)months. The freedom from reoperation was not significantly different between two groups (infants vs. non-infants: 68.8% vs. 87.5% at 10 years; p = 0.096).
CONCLUSIONS: Surgical treatment of ALCAPA had an excellent early and midterm outcomes. Left ventricular dysfunction in pre-operation was the main risk of mortality in-hospital. The freedom from reoperation did not differ significantly between infant group and non-infant group.

Aims/Background Kawasaki disease is an acute inflammatory condition primarily affecting the young children. It can lead to coronary artery abnormalities, which can worsen the prognosis. Early diagnosis of coronary disease is crucial for the effective treatment and the prognosis evaluation. To explore the clinical significance of ultrasound examination characteristics, peripheral blood red cell distribution width, and changes in N-terminal pro-brain natriuretic peptide levels for the early detect coronary artery abnormality in children with Kawasaki disease. Methods The case-control study was conducted. 85 Kawasaki disease patients diagnosed in our hospital from January 2020 to December 2023 were selected as the Kawasaki disease group. 100 healthy children who received physical examination in the Department of Child Healthcare during the same period were selected as control group. The cardiac ultrasound indicators, erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, N-terminal pro-brain natriuretic peptide of two groups were compared. The Kawasaki disease group was further divided into the coronary artery lesion group and the non-coronary artery lesion group based on whether coronary artery lesions occurred in the Kawasaki disease patients. The differences of above indicators were compared. Results The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of the Kawasaki disease group were all higher than those of the control group (p < 0.05). There was no significant difference in left ventricular ejection fraction between Kawasaki disease group and control group (p > 0.05). The erythrocyte sedimentation rate, C-reactive protein, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease group were all higher than those of control group (p < 0.05). The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions (p < 0.05). The left ventricular ejection fraction of Kawasaki disease patients with coronary artery lesions was lower than that of Kawasaki disease patients without coronary artery lesions (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions, and the differences were statistically significant (p < 0.05). After treatment, the left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions significantly decreased (p < 0.05), and the left ventricular ejection fraction significantly increased (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with or without coronary artery lesions significantly decreased after treatment compared with before treatment in the same group (p < 0.05). Conclusion Kawasaki disease patients with coronary artery lesions exhibit significantly increased coronary artery vessel diameter, as well as elevated red cell distribution width and N-terminal pro-brain natriuretic peptide concentration. The combined use of ultrasound combined with red cell distribution width and N-terminal pro-brain natriuretic peptide examination can assist in determining whether Kawasaki disease patients have coronary artery lesions and assessing the clinical treatment effect.

UNASSIGNED: The level of mitochondrial DNA copy number (mtDNA-CN) in peripheral blood cells had been identified to be involved in several immune and cardiovascular diseases. Thus, the aim of this study is to evaluate the levels of mtDNA-CN in Kawasaki disease (KD) and to construct a nomogram prediction for coronary artery lesions in children with KD.
UNASSIGNED: One hundred and forty-four children with KD diagnosed from March 2020 to March 2022 were involved in the study. The clinical features and laboratory test parameters of these children were assessed between the KD and normal groups. Univariable and multivariable analyses were performed sequentially to identify the essential risk factors. Subsequently, a nomogram prediction was constructed.
UNASSIGNED: A total of 274 children were included in the analysis. Of these, 144 (52.6%) represented the KD group. Peripheral blood DNA mtDNA qPCR showed that the -log value of mtDNA-CN in the KD group (6.67 ± 0.34) was significantly higher than that in the healthy group (6.40 ± 0.18) (P<0.001). The area under the ROC curve for mtDNA-CN in distinguishing KD was 0.757. MtDNA-CN (OR = 13.203, P = 0.009, 95% CI 1.888-92.305), RBC (OR = 5.135, P = 0.014, 95% CI 1.394-18.919), and PA (OR = 0.959, P = 0.014, 95% CI 0.927-0.991) were identified as independent risk factors for coronary artery dilation in children with KD. Finally, the nomogram predictive was established based on the results of multivariable analysis, demonstrating the satisfied prediction and calibration values.
UNASSIGNED: The results of this study revealed that mtDNA-CN could be used as a biomarker in predicting the development of KD. Furthermore, the higher the mtDNA-CN was significantly associated with coronary artery dilation in KD.

OBJECTIVE: To analyze the impact of multiple protection model in the operating room on patients\' physiological stress and risk events after coronary artery stent implantation (CASI).
METHODS: During October 2021 to October 2022, 150 patients with coronary heart disease (CHD) were picked as the research subjects, all of whom underwent CASI. The clinical data were retrospectively analyzed, and the patients were divided into two groups according to different nursing methods, with 75 cases in each group. Patients in the intervention group received multiple protection model intervention in the operating room, and the patients in the control group adopted conventional care model. The patient satisfaction with nursing, postoperative recovery, psychological stress scores, physiological stress indicators, and adverse cardiac risk events were recorded.
RESULTS: Patients in the intervention group had much higher percentage of the patient satisfaction with nursing than those in the control group (P < 0.05). The time to get out of bed and hospital stay was significantly shorter and the 6-min walking distance was markedly longer in the intervention group than the control (P < 0.05). The Hamilton Anxiety (HAMA) scale and Hamilton Depression (HAMD) scale score of patients in two groups were sharply decreased after the intervention (P < 0.05), which were strongly lower in the intervention group than the control (P < 0.001). After the intervention, the heart rate, cortisol and epinephrine of patients were all sensibly elevated in two groups (P < 0.05), which were all memorably lower in the intervention group than the control (P < 0.001). The incidence of adverse cardiac risk events in the intervention group was 5.33%, which was dramatically lower than 16.00% in the control group (P < 0.05).
CONCLUSIONS: The application of multiple protection model in the operating room on patients undergoing coronary stent implantation promoted postoperative recovery, reduced patients\' psychological and physiological stress, maintained blood pressure and other vital signs, reduced the incidence of adverse cardiac risk events, and improved the patient satisfaction with nursing.

BACKGROUND: In recent years, transcatheter aortic valve implantation (TAVI) has become a widely used treatment for low-risk elderly patients. As an alternative to TAVI via the femoral artery, transapical TAVI (TA-TAVI) is a better surgical choice for patients with severe vascular diseases. The J-Valve assists doctors in completing valve implantation easily using its positioning locator device, which prevents the self-leaflet from approaching the sinus wall. This function acts as coronary artery protection to avoid coronary occlusion. However, the clinical prognosis of J-Valve implantation for patients with aortic valve stenosis and low coronary openings is unclear.
METHODS: A retrospective analysis was performed on 30 patients with aortic stenosis (AS) and coronary openings measuring ≤ 10 mm in height. All patients underwent TA-TAVI with J-Valve implantation. Patients were screened using preoperative computed tomography three-dimensional imaging of the aortic root, and the safety and efficacy of the procedure were evaluated. The collected indexes included patients\' general data, cardiac function, preoperative imaging parameters, intraoperative data and postoperative short-term prognosis.
RESULTS: Of the 30 patients in the study successfully underwent TA-TAVI and J-Valve implantation. Two patients required temporary cardiopulmonary bypass assistance during the operation due to heart failure. The implant success rate was 100%, and there were no deaths within 30 days postoperatively. No patients experienced intraoperative or postoperative coronary artery occlusion. Postoperative echocardiography, physiological state and laboratory test results indicated that all patients recovered well. The electrocardiograms remained normal after TA-TAVI, and heart function improved within 30 days.
CONCLUSIONS: Transapical TAVI with J-Valve implantation is a safe and effective treatment option for patients with AS and a low coronary artery opening. Preoperative coronary artery evaluation and the locators of the J-Valve are crucial in preventing coronary artery occlusion. This treatment regimen provides beneficial outcomes and warrants further multi-centre clinical research in the future.

BACKGROUND: Woven coronary artery (WCA) is a rare and underdiagnosed congenital anomaly that involves multiple thin and tortuous epicardial arterial conduits reassembling distally into a single lumen. Recanalized thrombus may present as woven-like coronary arteries, appearing similar to WCA on angiographic images.
METHODS: A 58-year-old female patient with intermittent chest pain for 5 years and polycythaemia vera (PV) for 8 years. The left anterior descending artery was presented like WCA on coronary angiography and finally confirmed as recanalized thrombus by optical coherence tomography(OCT), which might have been caused by PV. Given the patient\'s high thrombotic risk of PV and thrombotic changes in the left circumflex artery (LCX), we ultimately chose a conservative treatment without stenting.
CONCLUSIONS: OCT would be needed for the diagnosis and differential diagnosis of woven-like coronary arteries. And physicians should take an appropriate treatment in a personalized way in patients with PV.

This study introduces a novel self-supervised learning method for single-frame subtraction and vessel segmentation in coronary angiography, addressing the scarcity of annotated medical samples in AI applications. We pretrain a U-Net model on a large dataset of unannotated coronary angiograms using an image-to-image translation framework, then fine-tune it on a limited set of manually annotated samples. The pretrained model excels at comprehensive single-frame subtraction, outperforming existing DSA methods. Fine-tuning with just 40 samples yields a Dice coefficient of 0.828 for vessel segmentation. On the public XCAD dataset, our model sets a new state-of-the-art benchmark with a Dice coefficient of 0.755, surpassing both unsupervised and supervised learning approaches. This method achieves robust single-frame subtraction and demonstrates that combining pretraining with minimal fine-tuning enables accurate coronary vessel segmentation with limited manual annotations. We successfully apply this approach to assist physicians in visualizing potential vascular stenosis sites during coronary angiography. Code, dataset, and a live demo will be available available at: https://github.com/newfyu/DeepSA .

Smooth muscle cell (SMC) phenotypic modulation, primarily driven by PDGFRβ signaling, is implicated in occlusive cardiovascular diseases. However, the promotive and restrictive regulation mechanism of PDGFRβ and the role of protein tyrosine phosphatase non-receptor type 14 (PTPN14) in neointimal hyperplasia remain unclear. Our study observes a marked upregulation of PTPN14 in SMCs during neointimal hyperplasia. PTPN14 overexpression exacerbates neointimal hyperplasia in a phosphatase activity-dependent manner, while SMC-specific deficiency of PTPN14 mitigates this process in mice. RNA-seq indicates that PTPN14 deficiency inhibits PDGFRβ signaling-induced SMC phenotypic modulation. Moreover, PTPN14 interacts with intracellular region of PDGFRβ and mediates its dephosphorylation on Y692 site. Phosphorylation of PDGFRβY692 negatively regulates PDGFRβ signaling activation. The levels of both PTPN14 and phospho-PDGFRβY692 are correlated with the degree of stenosis in human coronary arteries. Our findings suggest that PTPN14 serves as a critical modulator of SMCs, promoting neointimal hyperplasia. PDGFRβY692, dephosphorylated by PTPN14, acts as a self-inhibitory site for controlling PDGFRβ activation.

OBJECTIVE: Janus kinase 2 (JAK2) triggers endothelial pyroptosis and is associated with a multitude of pathological cardiovascular manifestations, including atherosclerosis. However, the associated transcriptional regulatory mechanisms remain unclear. In this study, we investigated a novel transcriptional regulator upstream of JAK2.
METHODS: We validated the binding and regulation of Forkhead box C1 (FOXC1) and JAK2 using chromatin immunoprecipitation and luciferase reporter assays. Immunofluorescence was used to detect protein localization in cells and tissues. Immunohistochemistry, hematoxylin-eosin (HE), Masson\'s trichrome, and Oil Red O staining were used to identify tissue lesions. Transcriptional functions were investigated using in vitro and in vivo coronary artery disease (CAD) atherosclerosis models.
RESULTS: The mRNA levels of JAK2 were considerably higher in both the cardiac tissues of mice and the peripheral blood of patients with CAD than in equivalent controls. JAK2 expression increased markedly in the coronary arteries of ApoeKO mice, whereas FOXC1 expression exhibited a decreasing trend. In vitro, FOXC1 bound to the JAK2 promoter region and inversely regulated the expression of JAK2. Mechanistic studies have revealed that the FOXC1-JAK2 pathway regulates pyroptosis and participates in the pathogenesis of human coronary artery endothelial cells (HCAECs). In vivo, the suppression of FOXC1 was confirmed to stimulate the levels of JAK2 and pyroptosis, contributing to the pathological progression of aortic and coronary artery damage.
CONCLUSIONS: We established the FOXC1-JAK2 regulatory pathway and verified its reverse-regulatory function in CAD pyroptosis. Our data emphasizes that FOXC1 is critical for the treatment of pyroptosis-induced injury in patients with CAD.

Coronary artery segmentation is crucial for physicians to identify and locate plaques and stenosis using coronary computed tomography angiography (CCTA). However, the low contrast of CCTA images and the intricate structures of coronary arteries make this task challenging. To address these difficulties, we propose a novel model, the DFS-PDS network. This network comprises two subnetworks: a discriminative frequency segment subnetwork (DFS) and a position domain scales subnetwork (PDS). DFS introduced a gated mechanism within the feed-forward network, leveraging the Joint Photographic Experts Group (JPEG) compression algorithm, to discriminatively determine which low- and high-frequency information of the features should be preserved for latent image segmentation. The PDS aims to learn the shape prototype by predicting the radius. Additionally, our model has the consistent ability to guarantee region and boundary features through boundary consistency loss. During training, both subnetworks are optimized jointly, and in the testing stage, the coarse segmentation and radius prediction are produced. A coronary-geometric refinement method refines the segmentation masks by leveraging the shape prior to being reconstructed from the radius map, reducing the difficulty of segmenting coronary artery structures from complex surrounding structures. The DFS-PDS network is compared with state-of-the-art (SOTA) methods on two coronary artery datasets to evaluate its performance. The experimental results demonstrate that the DFS-PDS network performs better than the SOTA models, including Vnet, nnUnet, DDT, CS2-Net, Unetr, and CAS-Net, in terms of Dice or connectivity evaluation metrics.