Coronary artery embolism is an uncommon cause of acute myocardial infarction (MI). We present a patient with pulmonary atresia and severe right heart hypoplasia who underwent a lateral tunnel Fontan procedure in childhood and presented with an acute ST-segment elevation MI at 19 years of age. In addition to the known risk of thrombotic complications associated with a Fontan circulation, potential predisposing factors to thromboembolism in this patient included a right ventricle to left anterior descending coronary connection and a Fontan baffle leak. The patient was treated with device closure of the baffle leak and anticoagulation. This is one of the first reports of an embolic MI in a patient with a Fontan circulation. The optimal method of reducing thromboembolic risk in this patient, and those with a Fontan circulation in general, is complicated and no consensus exists.

Partial anomalous pulmonary venous return (PAPVR) comprises a group of congenital cardiovascular anomalies associated with pulmonary venous flow directly or indirectly into the right atrium. Scimitar syndrome is a variant of PAPVR in which the right lung is drained by right pulmonary veins connected anomalously to the inferior vena cava. Surgery is the definitive treatment for scimitar syndrome. However, it is not always necessary as many patients are asymptomatic, have small left-to-right shunts, and enjoy a normal life expectancy without surgery. We report multimodality imaging in four adults with scimitar syndrome and the implications for management of this rare syndrome.

Background Diet is a modifiable risk factor for cardiovascular disease; however, dietary patterns are historically difficult to capture in the clinical setting. Healthcare providers need assessment tools that can quickly summarize dietary patterns. Research should evaluate the effectiveness of these tools, such as Rate Your Plate (RYP), in the clinical setting. Hypothesis RYP diet quality scores are associated with measures of body adiposity in patients referred for coronary angiography. Methods Patients without a history of coronary revascularization (n = 400) were prospectively approached at a tertiary medical center in New York City prior to coronary angiography. Height, weight, and waist circumference (WC) were measured; body mass index (BMI) and waist‐to‐height ratio (WHtR) were calculated. Participants completed a 24‐question RYP diet survey. An overall score was computed, and participants were divided into high (≥58) and low (≤57) diet quality groups. Results Participants in the high diet quality group (n = 98) had significantly lower measures of body adiposity than did those in the low diet quality group (n = 302): BMI (P < 0.001), WC (P = 0.001), WHtR (P = 0.001). There were small but significant inverse correlations between diet score and BMI, WC, and WHtR (P < 0.001). These associations remained significant after adjustment for demographics, tobacco use, and socioeconomic factors. Conclusions Higher diet quality scores are associated with lower measures of body adiposity. RYP is a potential instrument to capture diet quality in a high‐volume clinical setting. Further research should evaluate the utility of RYP in cardiovascular risk‐factor control.

Introduction: Dietary patterns play a significant role in the development of obesity and atherosclerotic heart disease. Healthcare providers need tools to quickly and easily assess diet quality. Hypothesis: The objective of this study was to examine the association between self-reported diet quality and measures of body adiposity in adults presenting for coronary angiography. We assessed the hypothesis that there is an association between diet quality and measures of body adiposity including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Methods: This prospective study enrolled subjects (n=185) who presented for coronary angiography at a tertiary medical center in New York City between February and September 2015. Potential subjects were approached in the waiting room prior to their scheduled procedure. Subjects who had previously undergone coronary revascularization, presented for emergent revascularization, or spoke languages other than English or Spanish as their primary language were excluded. Enrolled subjects completed an interview-administered Rate Your Plate - Heart survey, a 24-question tool designed to capture qualitative information related to fat intake, animal protein/dairy, servings of fruit, vegetables, whole grains, snacks, and sweets in 10 minutes. Scores range from 24 to 72, and higher scores indicated better diet quality. Height, weight, and waist circumference were measured by trained personnel to calculate BMI and WHtR. Participants were divided into two groups based on their survey scores (≥58 or ≤57): high (n=47) and low (n=138) diet quality. Measures of adiposity were compared using independent sample t test and correlations between diet score and measures of adiposity were examined using Pearson correlation test. Level of significance was set at p<0.05. Results: Of the 185 subjects, 114 were men (62%) and average age was 60.6 ± 11.8 years, BMI 29.2 ± 6.6 kg/m2, WC 103.9 ± 15.8 cm, and WHtR 0.61 ± 0.09. Subjects in the high diet quality group had significantly lower markers of body adiposity than participants in the low diet quality group. (BMI: 26.6 ± 4.0 kg/m2 vs 30.2 ± 7.1 kg/m2, p<0.001; WC: 97.9 ± 11.5 cm vs 105.9 ± 16.6 cm, p<0.001; WHtR: 0.58 ± 0.07 vs 0.63 ± 0.09, p<0.001). There were significant negative correlations between diet score and measures of body adiposity (BMI: r= -0.30, p<0.001; WC: r= -0.29, p<0.001; WHtR r= -0.24, p=0.001). Conclusions: Higher diet quality scores correlate with lower measures of body adiposity. Rate Your Plate - Heart survey is an appropriate instrument to capture diet quality prior to coronary angiography in a high-volume clinical setting. Further research to test the validity of this tool as a marker of atherosclerotic heart disease is warranted.

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