Marcel A. M. Beijk

Background: Residual shunt is a known complication in percutaneous patent foramen ovale (PFO) closure, and moderate to large residual shunt has been associated with an increased risk of recurrent stroke. Device‐related factors, such as device size, have been associated with residual shunt, but comparative data per device type are scarce. Aims: We compared the prevalence of moderate to large residual shunt at 6 months between the Amplatzer and Occlutech devices. Methods: In this retrospective cohort study, patients undergoing successful percutaneous PFO closure with an Amplatzer or Occlutech dedicated closure device within the CAHAL centers Amsterdam UMC and Leiden UMC between 2018 and 2024 were included. The study population was divided into patients treated with an Occlutech and an Amplatzer device. The prevalence of moderate/large residual shunt at 6 months of follow‐up was compared between the two groups. As a sensitivity analysis, a logistic regression was conducted to determine the association between the treatment groups and moderate/large residual shunt. The logistic regression was conducted in a weighted population using inverse probability weighting (IPTW), correcting for age, sex, smoking status, shunt size at baseline, device size, and atrial septal aneurysm. Results: A total of 413 patients were included with an average age of 45.8 ± 11.3 years and 51.6% were male. Of the included patients, 279 were treated with an Amplatzer‐ and 134 with an Occlutech device. In the group treated with an Amplatzer, 22.2% of the patients had a moderate or large residual shunt at 6 months compared to 14.9% in the Occlutech group ( p = 0.11). The sensitivity analysis did not show an association between device type and moderate/large shunt OR 0.71 (95% CI: 0.39–1.28, p = 0.25). Conclusion: In this study, no significant difference was observed in moderate/large residual shunt prevalence at 6 months of follow‐up between the Occlutech and Amplatzer devices.

Background and Aims: Comprehensive evaluation by invasive coronary function test (CFT) of patients with angina and non-obstructive coronary artery disease is recommended in the current guidelines. The prognosis of patients with CFT-proven coronary vasomotor dysfunction (CVDys) is less well-known. Methods: Patients that provided consent for the previously published NL-CFT registry who underwent clinically indicated invasive CFT between 1 February 2019 and 1 June 2024 were included. Patients with CVDys, defined as an abnormal spasm provocation test and/or microvascular functional assessment, were compared to patients with normal CFT. The primary outcome of major adverse cardiovascular events and emergency room visits for angina (MACE-EA) was defined as a composite of all-cause death, acute coronary syndrome, stroke/transient ischaemic attack, revascularization, repeat angiography without intervention, heart failure hospitalizations, and unplanned hospitalizations or emergency room visits due to angina. Results: In total, 1355 patients were included. In 79.8%, CFT was abnormal, and vasospasm was the most prevalent endotype. In 1252 patients, follow-up of clinical events was complete. During a mean follow-up of 33 ± 13 months, CVDys patients had almost double the number of primary outcome events compared with patients with a normal CFT (31.2% vs 16.8%, P < .001), driven by emergency care visits for angina. Secondary clinical endpoints including death, myocardial infarction, stroke, or revascularization were low and comparable between the groups. Conclusions: The long-term risk of MACE-EA is doubled in ANOCA patients with CFT-confirmed CVDys compared with normal CFT results. Events are dominated by emergency room visits due to angina, illustrating the high disease burden of CVDys. Their (angina-related) health status is significantly worse at follow-up.

BACKGROUND: Coronary vasomotor dysfunction is diagnosed by a coronary function testing (CFT). However, protocols vary, and the influence of access site and concomitant vasodilator medication on the diagnostic yield and safety of CFT is unclear. This study assessed the diagnostic yield and safety of CFT by radial access with intraarterial calcium channel blockers compared with CFT by femoral access. METHODS: Data were obtained from the Netherlands Registry of Invasive Coronary Vasomotor Function Testing, a Dutch multicenter collaboration on CFT. Patients who underwent CFT between December 2020 and July 2025 were included. RESULTS: A total of 1885 patients were included, 1436 (76.2%) with primary radial access and 380 (20.2%) with primary femoral access. In 69 (3.7%) patients conversion from radial to femoral access was necessary. The conversion group was analyzed separately. The total diagnostic yield of coronary vasomotor dysfunction was 78.5%. There was no significant difference in the prevalence of coronary vasomotor dysfunction between patients with primary radial versus femoral access (79.2% versus 75.3%; P =0.1). There was also no difference in total diagnostic yield between the group without conversion and the conversion group (78.4% versus 82.6%; P =0.4); however, spasm was more prevalent in the conversion group (67.7% versus 79.4%; P =0.04). There were no differences in CFT complication rates between groups. CONCLUSIONS: Primary radial access with routine administration of calcium channel blockers was not associated with a lower diagnostic yield in CFT than primary femoral access. Procedural safety was comparable.

Background: Partial cor triatriatum sinistrum is a rare congenital heart disease and is usually considered for surgery in symptomatic patients. We describe three cases of partial cor triatriatum sinistrum, two cases of successful percutaneous balloon dilatation, and one case of conservative treatment in a patient without symptoms. Case summary: The first case describes a female patient with progressive dyspnoea on exertion in which the membrane was dilated with a balloon to relieve symptoms. The second case is about a young patient with chronic congestion of the right lung because of a partial cor triatriatum sinistrum which was also treated with dilatation. The third case describes a male patient with an incidental finding of a cor triatriatum sinistrum who did not experience any symptoms and was treated conservatively. Discussion: Percutaneous balloon dilatation is a safe and effective alternative to surgery in selected cases of (partial) cor triatriatum.