Background Advances in neonatal cardiac care have improved survival in infants with congenital heart disease (CHD), shifting clinical attention toward early neurological morbidity. While cardiac anatomical complexity has traditionally been considered a major determinant of brain injury, emerging evidence suggests that genetic and systemic factors may play a more important role. Transfontanellar ultrasound (TFUS) is widely used as a bedside screening tool for early detection of neonatal brain abnormalities.Aim To assess the incidence of abnormal TFUS findings in neonates with CHD and identify clinical and genetic predictors of early neurological vulnerability independent of cardiac anatomy.Materials and Methods We conducted an observational cohort study including 138 neonates with CHD who underwent TFUS evaluation at a tertiary care center in Iasi, Romania. Demographic, perinatal, clinical, genetic, and therapeutic data were collected retrospectively. CHD complexity was classified using the Bethesda classification. Univariate and multivariate logistic regression analyses were performed to identify predictors of abnormal TFUS findings.Results Abnormal TFUS findings were identified in 42 neonates (30.4%), most commonly ventricular dilatation, intracranial hemorrhage, and choroid plexus cysts. In multivariate analysis, positive genetic testing was the strongest independent predictor (OR 3.9, 95% CI 1.5-10.2), followed by mechanical ventilation dependence (OR 2.7, 95% CI 1.1-6.5) and high Bethesda risk category (OR 2.2, 95% CI 1.0-4.8). Cardiac anatomical classification and gestational age were not independently associated with abnormal TFUS findings.Conclusions In neonates with CHD, early TFUS abnormalities appear to be driven mainly by genetic and systemic factors rather than cardiac anatomy alone, supporting integrative risk stratification approaches for targeted neurological surveillance.
Introduction Commotio cordis (CC), or concussion of the heart, is typically characterized by a sudden impact to the chest wall precipitating ventricular fibrillation arrest. There have been very few documented cases of atrial fibrillation (AF) resulting from this mechanism. A relative consensus exists in the crucial nature of the timing of a blow at the vulnerable ventricular repolarization in the cardiac cycle, with suggestion of the impact occurring during atrial repolarization, triggering paroxysmal atrial fibrillation.Case Presentation We present the case of a 17-year-old male patient who sustained two significant chest wall blows over the course of 8 months with initial electrocardiogram evidence of both atrial and ventricular irritability, subsequently developing AF, which did not spontaneously resolve.Conclusions Although the focus of CC has been management of immediate and lethal ventricular arrhythmias, atrial arrhythmias such as atrioventricular block, atrial flutter, or AF can occur from abnormal depolarization or occult damage to the conduction system. Detection of these rhythms may be delayed due to lack of initial collapse. Clinicians in the emergency department need to consider the possibility of late complications even in patients who do not exhibit immediate ventricular arrhythmia.
Coronary computed tomography angiography (CCTA) has evolved significantly over the past decade, expanding from stable coronary artery disease (CAD) assessment to diverse cardiovascular applications. However, its role in non-ST-elevation acute coronary syndromes (NSTE-ACSs) remains incompletely defined despite excellent diagnostic accuracy. This review synthesizes current evidence on the performance of CCTA in NSTE-ACS, examining diagnostic capabilities, advanced plaque characterization, clinical outcomes, and knowledge gaps requiring future investigation. CCTA demonstrates high negative predictive value (>90%) for ruling out obstructive CAD in NSTE-ACS, particularly in low-to-intermediate risk patients. Despite this diagnostic performance, contemporary evidence reveals a persistent disconnect between anatomical accuracy and clinical benefit, with CCTA-guided strategies failing to demonstrate improvements in major adverse cardiovascular events or reductions in healthcare costs when compared to standard invasive approaches. Advanced plaque characterization techniques offer potential refinement in risk stratification. Pericoronary adipose tissue analysis via fat attenuation index correlates with vulnerable plaque features and inflammatory markers in NSTE-ACS populations. Critical evidence gaps persist regarding optimal patient selection algorithms, timing strategies across risk stratification, and cost-effectiveness analyses. Future research must prioritize outcome-driven investigations demonstrating that CCTA-guided management improves clinical endpoints, prospective validation of advanced imaging biomarkers, and integration into personalized algorithms to bridge the gap between diagnostic capability and meaningful clinical impact.
Background: Acute limb ischemia (ALI) is a vascular emergency characterized by a sudden reduction in limb perfusion, most commonly resulting from thromboembolism or thrombosis at the site of an atherosclerotic plaque. This study aimed to analyze and identify risk factors associated with major amputation and in-hospital mortality in patients with ALI. Material and methods: We retrospectively analyzed 177 patients diagnosed with upper or lower limb ALI admitted to the Vascular Surgery Clinic between January 2019 and December 2024. Data collected from electronic medical records included demographic variables, cardiovascular comorbidities, chronic kidney disease, diabetes mellitus, malignancies, preoperative laboratory parameters (within the first 12 h of admission), type of surgical intervention, and anesthesia type. Results: Patients with lower limb ischemia were significantly older than those with upper limb involvement (p = 0.041). Lower limb ischemia was also associated with a higher prevalence of ischemic heart disease (p = 0.030), chronic heart failure (p = 0.013), and peripheral arterial disease (p < 0.001). Laboratory findings revealed lower red blood cell counts (p = 0.034), hemoglobin (p = 0.010), and hematocrit (p = 0.011), along with higher creatine kinase (p = 0.013), neutrophil (p = 0.017), and monocyte levels (p = 0.034) in patients with lower limb ALI. While surgical intervention types did not differ significantly, lower limb ALI patients underwent local anesthesia less frequently (p < 0.001) and general anesthesia more frequently (p < 0.001). Univariate analysis identified peripheral arterial disease (OR: 2.45, p = 0.046) as a predictor of major amputation, while chronic heart failure (OR: 2.77, p = 0.033), prior myocardial infarction (OR: 3.85, p = 0.024), and diabetes mellitus (OR: 3.23, p = 0.012) were significantly associated with in-hospital mortality. Conclusions: These findings highlight the critical role of aggressive cardiovascular risk factor management in patients with ALI to improve outcomes following surgical revascularization.
Introduction Left ventricular pseudoaneurysm (LVP) is a rare complication of myocardial infarction associated with very high mortality. Patients with LVP may present with heart failure, ventricular arrhythmias, or even cardiac tamponade. If left untreated, the risk of rupture may reach up to 45% within the first year.Case presentation We present the case of a 76-year-old patient with a recent myocardial infarction, diabetes, renal failure, stroke, and tetraparesis, admitted to the Neurology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca. A cardiology consultation was requested for sudden-onset dyspnea, palpitations, and deterioration of the general condition. Clinical examination showed SpO2 79% and HR 100/min, without cardiac murmurs. Echocardiography revealed mildly reduced LVEF, a giant posterior LVP, dilated right heart chambers with signs of right ventricular overload, and bilateral pleural effusion. CT angiography excluded pulmonary embolism and confirmed the presence of LVP. The symptoms were interpreted as acute heart failure. Surgical closure was considered, but the Heart Team decided on conservative management due to the extremely high perioperative risk. During hospitalization, the patient developed multiple complications and eventually died following pseudoaneurysm rupture and cardiac arrest.Conclusion Left ventricular pseudoaneurysm is a rare but life-threatening complication of myocardial infarction that requires early diagnosis and prompt management. This case highlights the challenges of treating patients with multiple comorbidities and very high surgical risk, in whom the lack of definitive treatment options may lead to a fatal outcome.
