Search Results (239)

Background and Clinical Significance: Bilateral carotid-cavernous fistulas are rare clinical entities characterized by heterogeneous clinical presentations and variable outcomes. Case presentation: We report the case of a 69-year-old woman with a three-month history of progressive bilateral conjunctival hyperemia, proptosis, intermittent diplopia, and a left eye abduction deficit. Her systemic history included long-standing arterial hypertension and previous thyroidectomy with stable substitutive therapy. Comprehensive ophthalmologic, neurologic, and endocrine evaluations excluded more common causes of orbital congestion, including thyroid eye disease, orbital cellulitis, cavernous sinus thrombosis, and idiopathic orbital inflammation. The patient denied any history of recent trauma. Digital subtraction angiography (DSA) confirmed a bilateral, low-flow, indirect Barrow type D carotid–cavernous fistula (CCF) supplied by dural branches of both the internal and external carotid arteries, with marked reflux into dilated superior ophthalmic veins. DSA was essential, as prior CT and MRI studies did not identify any vascular abnormalities. The patient was scheduled for transvenous embolization; however, during the follow-up she noted gradual improvement in her condition. Repeat pre-procedural angiography performed approximately two months later demonstrated complete spontaneous closure of all shunts, accompanied by full clinical resolution. Conclusions: Owing to the exceptional rarity of bilateral indirect CCFs and the added occurrence of spontaneous closure, this case expands the limited existing literature and emphasizes the diagnostic challenges and the need for individualized treatment timing supported by multidisciplinary evaluation in low-flow dural carotid–cavernous fistulas. Full article

Post-infarction ventricular septal defect (VSD) represents a rare but frequently fatal mechanical complication of ST-elevation myocardial infarction (STEMI), associated with high morbidity and mortality despite advances in reperfusion strategies. The optimal timing of surgical repair remains a matter of ongoing debate, particularly in patients presenting with hemodynamic instability and evolving right ventricular failure. Two main strategies have been proposed: an early surgical approach aimed at preventing progressive hemodynamic deterioration and right ventricular dysfunction, and a delayed strategy that allows for infarct maturation and fibrotic remodeling of the septal margins, thereby facilitating more secure patch anchoring and reducing the risk of residual shunting. We report the case of a 39-year-old male with multiple cardiovascular risk factors who presented to the emergency department after seven days of persistent chest pain and was diagnosed with an inferior STEMI. Urgent percutaneous coronary intervention was performed, with successful stent implantation in the right coronary artery. Seven days later, transthoracic echocardiography identified an inferior post-infarction ventricular septal defect. In the context of clinical deterioration characterized by progressive right ventricular failure, urgent surgical repair was undertaken. The postoperative course was complicated by severe pulmonary hypertension and refractory cardiogenic shock, necessitating veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for five days. The patient was subsequently weaned successfully from mechanical circulatory support and discharged on postoperative day 12. At one- and three-month follow-up, he remained asymptomatic, with significant recovery of left ventricular ejection fraction. This case underscores the critical importance of timely surgical intervention in post-infarction VSD, particularly in the setting of right ventricular failure, and highlights the essential role of temporary mechanical circulatory support in the management of severe postoperative cardiogenic shock. Full article

Background: Right heart failure (HF) and tricuspid regurgitation (TR) are closely interrelated conditions, linked by a bidirectional and self-perpetuating pathophysiological relationship. Alterations in right-ventricular (RV) loading conditions, pulmonary vascular impedance, and ventriculo-arterial (VA) coupling play a central role in the development and progression of TR, which in turn exacerbates RV volume overload and end-organ dysfunction. Methods: This review provides a comprehensive overview of the pathophysiology of right HF and TR, focusing on the mechanisms underlying RV dysfunction, pressure–volume (PV) relationships, and pulmonary vascular load. We further examine the clinical implications of this interaction and summarize current strategies for risk stratification, with particular emphasis on disease-specific risk models. Results: TR emerges both as a consequence and a driver of RHF. Conditions such as pulmonary hypertension (PH) and left-sided heart disease promote annular dilation and leaflet tethering, leading to functional TR. Conversely, TR increases RV volume overload, worsening chamber dilation, reducing effective forward stroke volume (SV), and accelerating disease progression. This vicious cycle results in progressive RV impairment, impaired left-ventricular filling through ventricular interdependence, and systemic venous congestion affecting renal and hepatic function. Traditional risk scores fail to capture this complex pathophysiology. In this context, TRISCORE integrates clinical, biological, and echocardiographic (TTE) parameters reflecting RV dysfunction and systemic involvement, providing a more comprehensive assessment of disease severity and prognosis. Conclusions: TR should be considered not only a marker but also a key determinant of right HF progression. A multiparametric approach integrating pathophysiology and disease-specific risk stratification is essential to identifying the optimal therapeutic window and guiding clinical decision making. Full article

Background and Objectives: The presence of comorbidities in both the pre- and post-diagnostic periods is a critical consideration in the diagnosis and management of patients with cancer. This study aimed to investigate the prevalence and burden of pulmonary and extrapulmonary comorbidities in patients diagnosed with lung cancer (LC) and malignant pleural mesothelioma (MPM). Materials and Methods: The data were obtained from official patient records of the Turkish Ministry of Health. Patients diagnosed with either lung cancer (LC) or malignant pleural mesothelioma (MPM) between 2015 and 2018 were included in the study. Comorbidities were classified as pulmonary or extrapulmonary. Results: A total of 74,835 patients with LC and 1678 patients with MPM were included. The burden of comorbid conditions increased significantly in the post-diagnostic period in both males and females across both cancer types. When the two cancer groups were compared with respect to diagnostic periods, comorbidities such as hypertension (HT), phlebitis/venous thrombosis/thrombophlebitis, pulmonary embolism, pneumothorax, and pleural effusion were significantly more prevalent in the MPM group (p < 0.05). Compared with the pre-diagnostic period, the comorbidity risk in LC was highest for pulmonary embolism, ARF, and pneumonia in the post-diagnostic period, whereas renal failure was the most frequent comorbidity in the MPM group (p < 0.001 and p = 0.024). When comparing changes in comorbidity burden between sexes in the lung cancer group, male patients had higher frequencies of pulmonary embolism, pneumonia, pneumothorax, and coronary artery disease than females. In contrast, in the female lung cancer group, the prevalence of chronic renal failure was higher than in males (OR = 2.14 vs. 2.00), whereas acute renal failure was more prominent in the male patient group (OR = 2.64 vs. 1.94). In gender-based comparison of comorbid conditions among patients with MPM, the risk of renal failure was higher in females than in males (CRF and ARF respectively: OR = 2.63 vs. 2.16 and OR = 6.80 vs. 5.44). Additionally, increased rates of COPD were observed in male patients within this group (OR = 1.93 vs. 1.81). Conclusions: Patients with LC and MPM are burdened not only by their primary malignancies but also by a wide spectrum of comorbidities, particularly in the post-diagnostic period. Comprehensive knowledge of comorbid conditions is essential for clinicians to guide clinical decision-making, anticipate disease progression, and optimize treatment strategies, thereby informing national healthcare policies. Future studies incorporating matched control groups or longitudinal designs with standardized surveillance protocols may help conduct better research. Full article

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

Background and Objectives: Percutaneous coronary intervention (PCI) has markedly improved outcomes in coronary artery disease through the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). However, in-stent restenosis (ISR) remains a significant complication, often necessitating repeat interventions. This study aimed to identify risk factors associated with ISR in patients with ST-elevation myocardial infarction (STEMI) who underwent PCI. Materials and Methods: We conducted a retrospective, non-randomized observational study of 107 STEMI patients treated with PCI between January 2016 and December 2019 who subsequently underwent clinically indicated (predominantly symptom-driven) follow-up coronary angiography within 12 months. ISR was defined as ≥50% luminal narrowing at follow-up angiography. Time-to-event analysis was performed using Cox regression models, incorporating clinical, biochemical, and angiographic variables. Results: In this selected cohort of patients undergoing follow-up angiography, ISR of any degree was identified in 87% of patients, and 52% had restenosis >70%. Advanced age, prior cardiovascular events, diabetes mellitus, chronic kidney disease, and history of stroke significantly increased the hazard of ISR. Smoking, dyslipidemia, and hypertension were prevalent in patients with severe ISR. Women presented with more severe clinical profiles (higher Killip class and troponin levels). DES showed slightly better TIMI flow than BMS, but stent type, dimensions, and number did not significantly impact restenosis risk. Thrombolytic therapy was associated with a significantly reduced ISR hazard. Mortality was 6% in patients with severe ISR. The highest restenosis incidence occurred in the LAD and RCA territories. Conclusions: ISR is a multifactorial process influenced by demographic, clinical, and procedural factors. Despite technological advances, ISR remains a prevalent issue, particularly in high-risk groups undergoing clinically indicated follow-up angiography. Secondary prevention strategies, optimized stent deployment, and targeted therapies addressing inflammation and vascular remodeling are essential to improving long-term PCI outcomes. Full article

Background/Objective: Continuous blood pressure (BP) monitoring is essential in clinical settings, where rapid hemodynamic changes influence patient management. While intra-arterial measurement remains the reference standard, non-invasive volume-clamp systems offer a potential alternative. We assessed the accuracy of finger-cuff-based continuous BP monitoring compared to invasive measurement in patients with pulmonary hypertension (PH). Methods: This post hoc analysis from a crossover RCT included PH patients who underwent repetitive hemodynamic assessments at rest and during exercise. The participants had simultaneous invasive BP monitoring via the radial artery and a non-invasive finger-cuff device (Finapres^® NOVA Basic). The mean blood pressure (mBP) was compared at rest, 50% of the maximal workload, and at the end of exercise using Bland–Altman and Taffé analysis. Results: In the study, 24 patients (seven female; 59 ± 14 years) contributed 385 paired mBP measurements. The invasive and non-invasive methods showed similar values at rest (96.1 ± 16.7 vs. 96.4 ± 17.2 mmHg) and during maximal exercise (106.8 ± 18.6 vs. 111.8 ± 21.6 mmHg). The overall Bland–Altman bias was 2.8 mmHg with wide limits of agreement (−39.6 to 45.3 mmHg), which remained broad across all exercise intensities. The Taffé analysis revealed a non-uniform, directionally dependent bias: the non-invasive system overestimated the mBP at low pressures and underestimated it at higher pressures. The measurement variability was substantially greater for the non-invasive method than for the invasive reference. Conclusions: In PH patients, finger-cuff-based continuous BP monitoring demonstrated acceptable group-level agreement but insufficient individual-level accuracy for clinical decision-making. Full article

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning. Full article

Background: Manganese (Mn) is an essential trace element with antioxidant properties; however, excessive exposure may contribute to inflammation and vascular dysfunction. Hair analysis provides an indicator of long-term Mn exposure. This study evaluated the relationship between hair Mn levels, acute coronary syndrome (ACS), coronary artery disease (CAD) severity, and cardiovascular risk factors, with particular emphasis on metabolic status in a cardiometabolic population. Methods: Hair Mn concentration was measured using inductively coupled plasma optical emission spectrometry (ICP-OES) in 80 patients (mean age 67 ± 11 years; 28.8% women) undergoing coronary angiography for suspected ACS. Final diagnoses included stable CAD (N = 42) and ACS [ST-elevation myocardial infarction (STEMI) N = 17, non-ST-elevation myocardial infarction (NSTEMI) N = 12, and unstable angina (UA) N = 9]. CAD severity was quantified using the SYNTAX score and the Coronary Artery Surgery Study Score (CASSS). Associations with clinical variables were assessed using non-parametric tests and Spearman correlations. The median SYNTAX score was 13.8 (range 0.0–68.5), and the median hair Mn concentration was 0.22 ppm (range 0.01–1.65). Results: SYNTAX scores were higher in ACS than in stable CAD (p = 0.027), with the highest values observed in NSTEMI. Hair Mn levels did not differ among diagnostic groups and showed no association with CASSS or SYNTAX (R = −0.11; p = 0.348). No differences were detected with respect to sex, smoking, prior myocardial infarction, hypertension, hyperlipidemia, or type 2 diabetes. A modest inverse correlation was observed between hair Mn and body mass index (BMI) in unadjusted analysis (R = −0.25; p = 0.03), but this association was not robust after correction for multiple comparisons, suggesting a potential exploratory link between manganese homeostasis and cardiometabolic status. Conclusions: Although hair Mn concentration was not associated with angiographic indices of CAD severity or ACS subtypes, the observed relationship with BMI may indicate a role of Mn homeostasis in cardiometabolic regulation. Larger prospective studies are required to clarify these associations. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Telemedicine, driven by the Internet of Things (IoT) and wireless connectivity, is essential for managing cardiovascular diseases, where hypertension remains the primary risk factor. In preclinical research, rabbits are superior biological models compared to rodents due to their human-like lipid metabolism. However, continuous blood pressure monitoring in this species remains challenging. The gold-standard technique (direct carotid catheterization) requires terminal procedures, and indirect methods (Doppler, oscillometric) show limited agreement with direct measurements. Furthermore, commercially available implantable telemetry platforms, while enabling real-time monitoring in freely moving animals, require costly surgical implantation, specialized proprietary hardware, and post-operative recovery periods that may confound early hemodynamic data. To address these limitations, this study presents a low-cost, customizable, and minimally invasive monitoring system utilizing a pressure transducer in the central auricular artery. The device integrates an ESP32 microcontroller with IoT technology for digital signal processing and seamless wireless data transmission to the ThingSpeak cloud platform. Unlike implantable telemetry, the proposed approach avoids surgical implantation and its associated costs and recovery time, while still enabling continuous, real-time hemodynamic tracking throughout the experimental period. A pilot evaluation against the BIOPAC MP100 reference (carotid artery) demonstrated relative errors of 1.60% for mean arterial pressure, 8.58% for systolic blood pressure, and 2.43% for diastolic blood pressure. By reducing invasiveness and enhancing remote data accessibility, this system provides a promising framework for the preclinical evaluation of antihypertensive agents and cardiovascular mechanisms, bridging the gap between edge computing and remote clinical diagnostics. Full article

Cardiologists consider degenerative or infectious causes when evaluating valvular heart disease. However, the role of autoimmune disorders, though less frequent, remains clinically significant. This report describes a young male patient presenting with persistent coronary disease and a suspected valvular cusp perforation initially attributed to infective endocarditis, which ultimately proved to be a manifestation of IgG4-related disease. IgG4-related disease is a rare condition, more prevalent in Asian populations, that typically affects the pancreas, salivary glands, lacrimal glands, and the retroperitoneum. Cardiac involvement, although uncommon, can present in various ways, including pericarditis, pulmonary arterial hypertension, valve dysfunction, cardiac pseudotumor, and coronary disease. Diagnosing and managing IgG4-related cardiac involvement requires heightened clinical suspicion, serological and histopathological assessment, and prompt interdisciplinary collaboration. Notably, involving rheumatologists in the management of these rare yet impactful autoimmune cardiac diseases is essential. Full article

Background: Essential hypertension (EH) refers to elevated arterial blood pressure with unknown etiology, which becomes more prevalent with age. Although the D allele of the ACE (I/D) polymorphism has been linked to EH, this association is not consistent across global populations. This systematic review and meta-analysis examined the relationship between the ACE (I/D) polymorphism and EH in diverse populations to determine the comparability of effect sizes and explore potential implications for public health planning. Methods: Case–control and cohort studies published in the last 20 years were reviewed from the main databases (PubMed, Scopus and Embase) using specific inclusion and exclusion criteria. Genotype data were used in meta-analyses using different genetic models. Results: Twenty-two studies with 7690 participants (3886 cases and 3804 controls) were included. Significant associations were observed between the ACE D allele and EH across allelic (OR = 1.37, 95% CI: 1.14–1.63), recessive (OR = 1.61, 95% CI: 1.21–2.13), dominant (OR = 1.37, 95% CI: 1.13–1.67), and homozygote (OR = 1.79, 95% CI: 1.31–2.45) models. Subgroup analyses showed significant associations in Indian and European populations, while African, Middle Eastern and Hispanic groups showed no statistically significant associations. Conclusions: The findings support a significant association between the ACE D allele and EH in several populations, though associations vary by ethnicity. Full article

This case report highlights the coexistence of two rare coronary artery anomalies assessed by computed coronary tomography angiography (CCTA). We present the case of a 51-year-old hypertensive patient with a type II double left anterior descending artery (LAD) and an anomalous infundibular branch originating from the pulmonary artery (partial ARCAPA). This association may have contributed to a limited ischemic burden, explaining the patient’s asymptomatic state. Knowledge of these rare coronary anatomies is essential for accurate diagnosis and management. Full article

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by endothelial dysfunction, vascular remodeling, and a sustained increase in pulmonary vascular resistance, causing cardiopulmonary damage. The apelin receptor (APJ), a member of the G protein-coupled receptor family, has emerged as an essential modulator of vascular homeostasis. Clinical and preclinical studies have demonstrated that its activation exerts beneficial effects on the progression of PAH. Its main actions include the restoration of endothelial function, reactivation of the BMPR2/SMAD axis, induction of nitric oxide-mediated vasodilation, inhibition of autophagy and the migration of the pulmonary artery smooth muscle cells (PASMCs). Furthermore, its expression and functionality are modulated by epitranscriptomic mechanisms, particularly by microRNAs involved in the post-transcriptional regulation of key genes for vascular homeostasis. These findings position the APJ as a relevant therapeutic target in PAH. However, the clinical application of its agonists still faces pharmacokinetic limitations that restrict their therapeutic use. Therefore, the aim of this review is to gather current information on APJ in the pathophysiology of PAH and focus attention on its potential as a therapeutic target. Full article