Gottsegen Hungarian Institute of Cardiology

What Is New in Critical Congenital Heart Defects?

<abstract xmlns="http://www.w3.org/1999/xhtml">Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.</abstract>

Center of Advanced Research in Multimodality Cardiac Imaging

Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background:</bold> Cardiac arrhythmias and conduction abnormalities are frequently identified by emergency medical service staff in patients requesting emergency services.<bold>Methods:</bold> We conducted a prospective observational study that aimed to analyze the characteristics of rhythm and conduction abnormalities in prehospital settings, in patients who requested emergency medical assistance for symptoms indicative for an arrhythmia or conduction abnormalities.<bold>Results:</bold> From 180 patients included in the study (90 from a tertiary and 90 from a non-tertiary medical center), 92.78% presented an arrhythmia and 15.56% a conduction abnormality. A clear etiology was found in only 29.44% of cases. Ischemic patients presented a higher rate of atrial fibrillation (AF) (p &lt;0.0001), while sinus tachycardia was more common in non-ischemic subjects (p = 0.02). Patients younger than 50 years of age presented higher rates of sinus tachycardia (p &lt;0.0001) and right bundle branch block (p = 0.001), while those older than 50 years presented higher rates of AF (p &lt;0.0001) and ventricular extrasystole (p = 0.014). There were no differences regarding the type of arrhythmia diagnosed in emergency settings, neither between genders or provenance environments, nor between regions served by a tertiary versus non-tertiary base station hospital.<bold>Conclusions:</bold> The most frequently diagnosed arrhythmias in prehospital settings were atrial fibrillation and sinus tachycardia, while atrioventricular blocks were the most frequent conduction disturbances. Young patients more frequently present sinus tachycardia or right bundle branch blocks, while older subjects are more prone to develop ischemia-related AF and ventricular extrasystole. The lack of any significant differences between systems served by a tertiary vs. non-tertiary medical center indicates an efficient emergency system of care regardless of the geographical region.</abstract>

Clinic of Pediatrics 2, Department of Pediatric Cardiology

“Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Department of Intensive Care

“Iuliu Hațieganu” University of Medicine and Pharmacy

Characteristics of Cardiac Rhythm and Conduction Abnormalities Diagnosed in Mobile Emergency Units in Central Romania

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background:</bold> Simple transposition of the great arteries (TGA) is a cyanotic critical congenital heart defect representing a neonatal cardiovascular emergency, which requires surgery early after birth. In case of inadequate mixing between systemic and pulmonary circulations, creating an unrestrictive interatrial communication is mandatory. The aim of the present study was to identify the most important echocardiographic parameters that can predict the need for balloon atrial septostomy (BSA) in TGA neonates.<bold>Material and methods:</bold> We retrospectively reviewed the echocardiographic recordings of newborns with TGA referred to our emergency room during a 6-year period. We measured the following echocardiographic parameters: atrial septal defect (ASD) size, interatrial septum (IAS) length, peak/mean inter-atrial pressure gradient, transverse diameter of the left atrium (LA), and transverse diameter of the right atrium (RA). Also, the ratio between ASD/IAS, the ratio between LA/RA, the ratio between mitral/tricuspid annulus, the ASD peak gradient/ASD diameter and the ASD diameter/(LA:RA ratio) were calculated.<bold>Results:</bold> There were 37 neonates with simple TGA presented to the emergency room, split into two groups: those with BAS (n = 21) and those without BAS (n = 16). Besides significant differences between the two groups in ASD size, peak/mean interatrial pressure gradient, and LA:RA ratio, we found that ASD peak gradient/ASD diameter was significantly higher, but ASD diameter/(LA:RA ratio) was significantly lower in the group that required BAS compared with the group without BAS. Multivariate analysis showed that ASD diameter/(LA:RA ratio) was an independent predictor of septostomy requirement, with a cut-off value of 2.58.<bold>Conclusion:</bold> ASD diameter/(LA/RA ratio) is a useful echocardiographic parameter that can provide supplementary information regarding inadequate mixing and the need for BAS in neonates with TGA.</abstract>

Emergency Institute of Cardiovascular Diseases and Transplantation

Predictors of Inadequate Mixing in Transposition of the Great Arteries — a Critical Neonatal Condition

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction:</bold> Cardiac arrhythmias caused by electrical injuries are rare among emergency service admittances. We present a case of ventricular fibrillation (VF) with a rare etiology, confirmed by speckle-tracking imaging.<bold>Case presentation:</bold> A 38-year-old man was addressed to our hospital to evaluate the etiology of an episode of VF, promptly resuscitated in a territorial hospital. On admission, his 12-lead electrocardiogram revealed a sinus rhythm, without any ST-T changes or atrioventricular conduction disorders. Transthoracic echocardiography and coronary angiography were normal, and the electrophysiological study did not induce VF. Anamnesis showed that the arrhythmia occurred after an electrical injury, resulting from the contact with a domestic low-voltage source. Speckle-tracking imaging revealed closure of the electric arc within the heart, which could explain the absence of skin-burn injuries in this case. The patient was discharged after seven days of hospitalization, without any complication.<bold>Conclusions:</bold> VF can occur after an unexpected electrical shock during a household accident. This case report underlines the need for a complex interdisciplinary approach in such difficult cases, when the absence of any electrical injuries on the skin makes it difficult to recognize the electrical shock that triggered the ventricular fibrillation.</abstract>

“Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute

“Grigore T. Popa” University of Medicine and Pharmacy

“Victor Babeş” University of Medicine and Pharmacy

A Rare Cause of Ventricular Fibrillation Confirmed by Speckle-Tracking Imaging

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction:</bold> The majority of patients with Marfan syndrome undergo Bentall procedure. Several periprocedural complications may arise; cardiac complications play the most dominant role.<bold>Case presentation:</bold> A patient with Marfan syndrome developed symptoms two years after the Bentall procedure. Coronary CT angiography revealed bilateral coronary ostial stenosis. Percutaneous coronary intervention was performed, and two drug-eluting stents were implanted.<bold>Conclusions:</bold> Coronary CT angiography is a valuable tool for the examination of symptomatic patients following surgical aortic root replacement.</abstract>

MTA-SE Cardiovascular Imaging Research Group

Bilateral Coronary Ostial Stenosis after Bentall Procedure in a Patient with Marfan Syndrome

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction:</bold> The no-reflow phenomenon has been described in 20–40% of patients with acute ST-segment elevation myocardial infarction, despite restoration of TIMI 3 myocardial flow. It is associated with adverse left ventricular remodeling and an unfavorable long-term prognosis.<bold>Case presentation:</bold> A 45-year-old gentleman was admitted one hour after the onset of an acute anterior ST-segment elevation myocardial infarction. Emergency coronary angiography was performed, and a severe stenosis of the left anterior descending artery was identified. The lesion was crossed with a pressure-wire, and a drug-eluting stent was directly implanted, with restoration of TIMI 3 epicardial flow. Predilatation was not performed. Coronary wedge pressure was measured during stent deployment. The mean pressure value was 27 mmHg. However, a tall systolic wave was identified in the morphology of the pressure curve. Myocardial blush grade and ST-segment resolution were concordant with early micro-vascular obstruction. Similarly, at transthoracic Doppler echocardiography, the flow in the left anterior descending artery revealed the same pattern. An apical left ventricular aneurysm was echocardiographically detected. The MRI described extensive interstitial edema that affected the anterior, septal, and apical regions of the left ventricle. Areas of intramyocardial hemorrhage and microvascular obstruction were also detected. According to recent literature data, the morphology of the coronary wedge pressure wave suggested at least the presence of pre-procedural distal embolization.<bold>Conclusions:</bold> In the setting of acute myocardial infarction, the integrity of coronary microvasculature is an important issue. The distal coronary pressure wave pattern before primary percutaneous revascularization can be a deciding factor for an early therapeutic approach.</abstract>

“Iuliu Haţieganu” University of Medicine and Pharmacy

“Carol Davila” University of Medicine and Pharmacy

Microvascular Obstruction in Acute Myocardial Infarction

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Journal of Cardiovascular Emergencies

 The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular pathology. The journal will mainly focus on recent advances in the field of diagnosis and treatment of the most common causes of cardiovascular emergencies, including acute coronary syndromes, acute heart failure, acute aortic diseases, pulmonary embolism, peripheral arterial diseases or cardiac arrhythmia. Interdisciplinary approaches will be extremely welcomed, presenting new advances in the approach of different other pathologies (i.e. stroke) from the cardiovascular perspective.  The Journal of Cardiovascular Emergencies will publish high-quality basic and clinical research related to these topics, in a common approach that will integrate the clinical studies with the pre-clinical work dedicated to discovery of new mechanisms involved in the development and progression of acute cardiovascular conditions.  Especially in the case of acute coronary syndromes, the journal will try to provide the entire cardiology community with the perspective of the regional cardiology networks in Central and Eastern European countries, reflecting the regional model of care in cardiovascular acute conditions.  The journal will primarily focus on publishing original research papers, but also other types of materials (such as review articles, case reports, state of the art papers, comments to editor, etc) will be extremely welcomed.  Rejection Rate   30%   Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 

Journal of Cardiovascular Emergencies

Volume 3 (2017): Issue 4 (December 2017)

Editorial

What Is New in Critical Congenital Heart Defects?

Review

Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

Original Research

Characteristics of Cardiac Rhythm and Conduction Abnormalities Diagnosed in Mobile Emergency Units in Central Romania

Predictors of Inadequate Mixing in Transposition of the Great Arteries — a Critical Neonatal Condition

Case Report

A Rare Cause of Ventricular Fibrillation Confirmed by Speckle-Tracking Imaging

Bilateral Coronary Ostial Stenosis after Bentall Procedure in a Patient with Marfan Syndrome

Microvascular Obstruction in Acute Myocardial Infarction

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