Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide. When bleeding and the resulting hemodynamic instability become refractory to medical and conservative surgical measures, peripartum hysterectomy (PH) is performed as a last-resort, life-saving intervention and is recognized as a maternal near-miss criterion. Severe PPH has also been linked to long-term cardiovascular risk. Romanian data on PH are limited to single-center reports. Objective: To estimate the prevalence of PH in Romanian tertiary maternity units and to describe its indications, the management preceding hysterectomy, and short-term maternal and neonatal outcomes. Methods: Retrospective multicenter study in six level III university maternity units (Brașov, Bucharest, Cluj-Napoca, Craiova, Iași, and Târgu Mureș) between 1 January 2019 and 31 December 2023. All hysterectomies performed during pregnancy or within 42 days postpartum were identified. Prevalence was expressed per 10,000 births; individual-level data were analyzed descriptively. Results: A total of 231 PH were performed among 88,932 births, corresponding to 26.0 per 10,000 births (95% CI 22.7–29.6), with center-specific rates ranging from 14 to 46 per 10,000. Individual-level data were available for 108 women: 93 (86.1%) underwent hysterectomy after caesarean delivery and 42 (38.9%) had a previous caesarean section. Placenta accreta spectrum disorders (~50%) and uterine atony (~30%) accounted for about 80% of indications. In 49 women (45.4%), hysterectomy was performed without previous conservative measures. Blood transfusion was required in 79% of cases; no maternal deaths occurred, whereas neonatal mortality was 12%. Conclusions: PH prevalence in Romanian tertiary units is approximately five times the pooled European population-based estimate and is driven mainly by caesarean-associated PAS disorders and uterine atony. The high proportion of primary hysterectomy suggests rapid hemodynamic deterioration and/or limited access to conservative options. A national obstetric surveillance system and structured long-term cardiovascular follow-up of survivors are warranted.

Introduction: Ischemic heart disease remains a leading cause of morbidity and mortality worldwide. Coronary computed tomography angiography (CCTA) is recommended by current European guidelines as a first-line test for suspected obstructive coronary artery disease, but data on its economic impact in Romania remain limited. We evaluated a CCTA-first diagnostic strategy compared with a hypothetical strategy of invasive coronary angiography (ICA) in all patients with intermediate pretest probability. Material and methods: We conducted a retrospective cohort study of 248 patients with intermediate pretest probability (15–50%; RF-CL model) who underwent CCTA as a first-line test. CCTA findings were classified according to CAD-RADS 2.0, and patients with obstructive stenoses or non-diagnostic examinations were referred for ICA. Diagnostic performance, ICA avoidance, and costs were evaluated and compared with a hypothetical ICA-for-all strategy. Results: The mean age was 58.5 ± 9.1 years, 41.9% of patients were women, and the mean pretest probability was 31.0 ± 9.8%. Confirmed obstructive coronary artery disease was present in 63 patients (25.4%). CCTA had a sensitivity of 95.2%, specificity of 82.7%, negative predictive value of 98.1%, and overall accuracy of 85.9%. The CCTA-first strategy avoided ICA in 151 patients (60.9%) and reduced the average cost per patient from 4,249 to 2,525 RON, representing a 40.6% reduction and total savings of 427,600 RON. The cost per correct diagnosis was 2,940 RON with the CCTA-first strategy. Conclusions: In patients with intermediate pretest probability, a CCTA-first diagnostic strategy substantially reduced costs and the need for invasive testing while providing high sensitivity and negative predictive value. These findings support the use of CCTA as a diagnostic gatekeeper in cardiology practice in Romania.

Background: Congenital heart defects (CHDs) are the most prevalent birth anomalies and result from complex genetic and environmental factors. Beyond structural abnormalities, adverse intrauterine conditions may influence fetal development and contribute to long-term health outcomes. This study aimed to evaluate clinical and hematological markers of developmental vulnerability in a cohort of patients with CHD. Materials and Methods: A retrospective clinical analysis was conducted in 52 pediatric patients at the Institute of Cardiovascular Diseases (IBCV), Iași, Romania. Maternal clinical histories, hematological parameters (hemoglobin [Hb] and white blood cell [WBC] count), and neonatal parameters (birth weight, Apgar score, and birth Z-score) were analyzed. Results: Mean birth weight was 3,043.46 ± 642.34 g. Patients with cyanotic CHD had higher mean Hb concentrations than those with non-cyanotic CHD (13.82 vs. 12.82 g/dL), although the difference was not statistically significant (p = 0.170). Patients with identified genetic syndromes had significantly lower mean birth Z-scores than those without identified genetic syndromes (−1.26 vs. −0.57; p = 0.028). Conclusions: The lower birth Z-scores observed in patients with identified genetic syndromes suggest an association between genetic abnormalities and impaired fetal growth. The higher Hb concentrations observed in patients with cyanotic CHD, although not statistically significant, may reflect a compensatory response to chronic hypoxia. These readily available clinical parameters may provide additional information on developmental vulnerability in patients with CHD. Larger prospective studies are needed to clarify their potential role in long-term risk assessment and clinical follow-up.

Background: Major vascular trauma requires immediate restoration of perfusion, yet conduit options for large-vessel reconstruction are limited. Autologous veins are poorly matched to the caliber of the aorta and iliac arteries and may be unavailable in polytrauma, whereas synthetic grafts are biologically inert, prone to neointimal hyperplasia, and vulnerable to infection in contaminated fields. Decellularized xenogeneic scaffolds have been proposed as tissue-engineered vascular grafts (TEVGs) but remain underexplored for large-diameter applications. This study aimed to develop a rapid perfusion-based decellularization protocol for porcine aortic scaffolds, evaluate the effects of glutaraldehyde (GA) crosslinking, and characterize the resulting mechanical properties as a first step toward a large-diameter TEVG for emergency vascular reconstruction. Material and Methods: Twelve porcine thoracic aortic segments were processed into three paired groups: untreated, decellularized, and decellularized plus GA-crosslinked. Decellularization used recirculating perfusion with sequential 1% Triton X-100 and 1% sodium dodecyl sulfate and was confirmed by hematoxylin and eosin staining. Results: Decellularization significantly decreased the ultimate tensile stress compared to native tissue (4.09 ± 0.25 MPa vs. 5.34 ± 0.41 MPa, p < 0.0001) and also lowered Young’s modulus (p = 0.0024), but it did not affect failure strain (p = 0.7881). GA crosslinking brought the ultimate stress back to levels similar to native tissue (5.16 ± 0.71 MPa, p = 0.8352) and increased Young’s modulus beyond native values (5.93 ± 0.84 MPa, p = 0.0005), although it significantly reduced failure strain (p = 0.0006). Histological analysis confirmed complete nuclear removal with preserved fibrillar matrix structure. Conclusions: Rapid perfusion-based decellularization followed by GA crosslinking yielded large-diameter porcine aortic scaffolds with tensile strength restored to native levels and increased stiffness, at the cost of reduced extensibility. These findings establish a biomechanical basis for further development of decellularized porcine aortic conduits as off-the-shelf large-diameter TEVGs, pending in vivo evaluation of remodeling, patency, and infection resistance.

Background: Acute coronary syndrome (ACS) includes ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), each with distinct clinical profiles and outcomes. While STEMI is typically associated with more extensive infarcts, emerging data suggest NSTEMI may carry a greater burden of comorbidities and anatomical complexity. Objective: To compare the incidence of ventricular arrhythmias and hemodynamic instability in patients with STEMI vs. NSTEMI and to analyze the distribution of culprit coronary lesions. Methods: This retrospective single-center study included 172 patients who underwent coronary revascularization between April and July 2021. Clinical outcomes, arrhythmias, and hemodynamic instability were compared between groups with STEMI (n = 108) and NSTEMI (n = 64). Culprit lesions were evaluated by angiography and categorized by vessel. Results: Hemodynamic instability was significantly more common in patients with NSTEMI (10.93%) compared to STEMI (0.18%) (p = 0.005). Ventricular arrhythmias occurred in 12.03% of patients with STEMI and 7.81% of patients with NSTEMI, with no significant difference. Left main coronary artery lesions were notably more frequent in NSTEMI (47.4% vs. 2.04%; p < 0.0001), whereas right coronary artery involvement was higher in STEMI (40.81% vs. 7.4%; p < 0.0001). Ventricular arrhythmias were significantly associated with circumflex artery lesions in patients with NSTEMI (p = 0.0001). Conclusions: Despite often being perceived as lower risk, patients with NSTEMI exhibited a higher rate of hemodynamic instability and more complex coronary involvement, particularly left main disease. These findings highlight the need for vigilant monitoring and individualized treatment strategies in populations with NSTEMI.

Background: Pulmonary embolism (PE) is a major cause of cardiovascular death and was increasingly diagnosed during and after the COVID-19 pandemic, highlighting the role of inflammation alongside genetic and acquired risk factors. Despite effective therapies, PE remains underdiagnosed. This study analyzed patient characteristics, risk factors, inflammatory markers, and management strategies. Materials and Methods: We conducted a retrospective study of 97 patients with PE admitted to the Cardiology Department of the County Emergency Clinical Hospital Brașov between March 2021 and April 2022. Clinical, biological, and therapeutic data were systematically evaluated. Results: The mean age was 66.8 years, with near-equal sex distribution. The most frequent symptoms were dyspnea, unilateral lower limb edema, and chest pain; hemodynamic instability was rare. Major risk factors included age >60 years, hypertension, and obesity. One-third of patients had recent SARS-CoV-2 infection or vaccination (<4 months). Inflammatory and thrombotic markers (leukocytosis, CRP, fibrinogen, D-dimer) were frequently abnormal. Most patients received low-molecularweight heparin; thrombolysis was used selectively. Conclusions: PE management during the pandemic emphasized the importance of inflammation in risk stratification, monitoring, and prognosis. Identifying patient-specific risk factors and refining treatment strategies remain essential for improving outcomes in this high-risk population.

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 Iași, 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.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Accurate assessment of coronary lesion severity is essential for guiding revascularization. Fractional flow reserve (FFR) is the gold standard for functional evaluation of coronary stenoses, but data on intracoronary hemodynamic assessment in patients with acute myocardial infarction are limited. Optical coherence tomography (OCT) provides highresolution intravascular imaging and may offer additional insights into lesion severity. Aim: To investigate the correlation between OCT-derived measurements and FFR values in patients with acute myocardial infarction. Methods: The study included 114 patients with acute myocardial infarction (STEMI or NSTEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion. Intermediate stenoses in non-culprit vessels (151 lesions) were evaluated during staged procedures with OCT and FFR. Minimal luminal area (MLA) and percent luminal area stenosis (PAS) were analyzed in relation to FFR values. Results: OCT-derived parameters showed good correlation with FFR values. In multivariable logistic regression, MLA and PAS were independent predictors of FFR <0.80. The optimal cut-off values were 2.08 mm2 for MLA and 76.85% for PAS. Conclusions: OCT-derived parameters may help identify functionally significant non-culprit lesions in patients with acute myocardial infarction and can complement physiological assessment in clinical practice.