ABSTRACT

The evaluation and management of congenital heart diseases (CHDs) in neonates are piv- otal aspects of pediatric care given the substantial prevalence of this condition. This review emphasizes the urgency of timely recognition and intervention, as a notable proportion of affected neonates face critical illness shortly after birth. The multidisciplinary approach in- volving neonatologists, pediatricians, and obstetricians is essential to address the diagnostic and therapeutic challenges inherent in neonatal cardiac emergencies. The insights presented herein aim to guide medical practice, enhance early recognition, and ultimately improve out- comes for newborns grappling with critical heart conditions. Key proactive measures advo- cated include prenatal screening, facilitating early identification of potential cardiac anom- alies. Advanced imaging techniques, such as fetal echocardiography, have a crucial role in enabling detailed examinations, contributing to the prenatal diagnosis of major CHDs. The review underscores the importance of preparing medical teams during the prenatal period for potential postnatal complications, emphasizing the necessity of a holistic approach to the care of neonates who survive critical episodes. Continued research and clinical advancements remain imperative to refine strategies and optimize care for this vulnerable patient popula- tion. The provided data serve as a valuable guide for healthcare professionals and could im- prove the outcomes of neonates confronting the challenges of CHD.

ABSTRACT

Acute limb ischemia (ALI) and chronic limb-threatening ischemia (CLTI) are severe vascular conditions that can be lethal. The inflammatory response in these diseases, characterized by increased levels of neutrophils and platelets, highlights the importance of prompt manage- ment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a useful biomarker during the COVID-19 pandemic and high NLR levels were found to be associated with an increased risk of ALI and other thromboembolic events. The aim of this systematic review was to ana- lyze the prognostic role of the NLR regarding the risk of amputation and mortality in patients diagnosed with ALI and CLTI. We included 12 studies (five for ALI, with 1,145 patients, and seven for CLTI, with 1,838 patients), following the PRISMA guidelines. Treatment results were evaluated, including amputation and mortality. We found that high NLR values were consis- tently associated with an increased risk of amputation and/or mortality, with pooled odds ra- tios ranging from 1.28 to 11.09 in patients with ALI and from 1.97 to 5.6 in patients with CLTI. The results suggest that NLR may represent an important tool for informed decision-making in the management of these patients.

ABSTRACT

Introduction: Abdominal aortic aneurysm (AAA) represents the increase of the diameter of the aorta by more than 50% in the absence of surgical or endovascular intervention. The risk of rupture and, therefore, mortality is increased significantly in AAA. The role of the mechan- ical characteristics of the AAA wall is poorly studied. The aim of this study was to determine the mechanical properties of each layer of the porcine abdominal aorta for a better under- standing of the role of the microstructural elements of the arterial wall in the development and risk of AAA rupture. Materials and methods: In this study, eight tubular segments of the abdominal porcine aorta were examined. From these segments, we processed 13 × 13 mm square samples for biaxial analysis and 15 × 5 mm samples for uniaxial analysis. At the biaxial analysis, the intact wall and each layer (intima, media, and adventitia) were stretched by 25% at a speed of 1% per s and we determined the mechanical characteristics of the samples at the point of failure. Results: In the circumferential axis, we found the adventitia (0.233 MPa) to be stronger than the media (0.182 MPa, p = 0.007), intima (0.171 MPa, p = 0.008), and the intact wall (0.192 MPa, p = 0.045). In the longitudinal axis, the adventitia (0.199 MPa) was stronger than the intima (0.117 MPa, p <0.001) and the intact wall (0.156 MPa, p = 0.045), but there was no statistically significant difference compared to the media. Additionally, the adventitia had a greater stiffness than the other two layers (p <0.05 for both layers and axes) and the intact wall (p <0.05 for both axes). Stretching until failure, the adventitia was the strongest compared to the other layers and the intact wall (p <0.001 for all), and it also presented better compliance, with the highest stretch ratio. Conclusions: The results indicate that the adventitia layer is the strongest and stiffest compared to the other two layers, being the last mechanical resistance structure of the arterial wall. It is crucial to avoid injuring and aggres- sively manipulating the adventitia during surgery to maintain the vascular wall’s resistance structure. By taking the measures mentioned above, it is possible to prevent postoperative complications like anastomotic pseudoaneurysm and anastomotic rupture.

ABSTRACT

Background: Coronary artery disease is one of the most common causes of death in the world. The outcome of patients with ST-elevation myocardial infarction is influenced by many fac- tors, and the time elapsed from symptom onset to diagnosis and reperfusion have a critical role in this regard. Aim: The aim of this study was to investigate the differences in the diag- nosis-to-needle times of patients with STEMI presenting to the hospital during and outside of working hours, and the effect of this relationship on in-hospital clinical events. Methods: This retrospective study analyzed the data of 50 patients admitted for emergency primary percutaneous coronary intervention. We assessed pain onset-to-diagnosis times and diag- nosis-to-needle times, and evaluated their relationship with troponin values at admission and after 48 h. Results: The mean age of the patients was 55.64 ± 13.72 years. In total, 60% of the patients presented outside of working hours. Mean patient delay time from the onset of chest pain to seeking medical help was 2.64 ± 2.47 h. Mean troponin values were 4.39 ± 5.26 ng/ml at admission and 36.50 ± 12.95 ng/ml after 48 h. Mean post-angiography ejection fraction values were 47.36 ± 6.53%. We found a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours. We found a positive correlation between diagnosis- to-needle times and the troponin values of patients, and a statistically significant differ- ence between pain onset-to-diagnosis times of patients who presented during and outside of working hours (p < 0.05). Although the relationship between the diagnosis-to-needle time and troponin elevation after 48 h was strong (97%), the relationship between pain onset-to- diagnosis time and troponin elevation after 48 h was weak (8%), suggesting that the duration of surgical intervention is much more important than the time until the first medical contact. Conclusions: In this study, there was a statistically significant difference in the pain onset- to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours.

ABSTRACT

Background: Time intervals related to ST-segment myocardial infarction (STEMI) revascu- larization are central determinants for patient outcomes. The current capability of the Ro- manian STEMI program to meet guideline-recommended time intervals is largely unknown. Aims: The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays. Materials and Meth- ods: This prospective study included 500 consecutive patients with STEMI at the “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints. Results: A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary isch- emic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients. Conclusions: Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre- hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.

ABSTRACT

The use of ventricular assist devices as bridge-to-transplantation therapy has a critical role in the management of end-stage heart failure in pediatric patients without available compat- ible organ donors. The HeartMate 3 is an intracorporeal centrifugal flow pump with a fully magnetically levitated motor currently approved for the management of advanced refractory left ventricular failure in pediatric patients, with positive early outcomes. We report the case of a 17-year-old adolescent girl with end-stage heart failure secondary to dilated cardio- myopathy of idiopathic etiology, with multiple failed attempts of weaning from inotropic support (PEDIMACS 3 profile), who successfully received a HeartMate 3 left ventricular assist device as bridge-to-transplantation therapy with no significant adverse events during the early follow-up period. This paper presents the first case of pediatric ventricular assist device implantation in Romania.