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Introduction: The management of in stent restenosis represents a topic of great actuality and interest, especially since the interventional treatment with stent implantation became largely accepted as the metod of choice in patients with acute coronary syndromes. Identification of certain risk factors that could predict the development of an in stent restenosis and its severity could be extremely useful for the clinical management of these patients. Methods: We retrospectively analyzed a total of 60 stent restenoses encountered in 57 patients admitted and treated in the Cardiology Clinic of Tirgu Mures. The interval of occurrence of restenosis ranged between 2 months and 37 months postintervention. We monitored the demographic characteristics (age, gender, colesterol, presence of renal insufficiency) and we realized a descriptive qualitative analysis of the angiographic procedural aspects. The in stent restenosis occurred most frequently on left anterior descending artery (63%), followed by the circumflex artery (22.15%) and right coronary artery (14.8%), regardless of the degree of stenosis prior to revascularization. Results: Statistical analysis using Chi square test revealed no statistically significant differences in terms of the correlation between the incidence of restenosis and gender (p=0.14), treatment with ACE inhibitors (p=0.16), implanted stent diameter (p=0.22) or the type of procedure (ram crossing over a secondary branch being considered as a procedure involved in the genesis of severe restenosis) (p=0.2). We used the t-student test for comparative analysis of the correlation between the continuous variables related to initial native lesion diameter and the degree of restenosis, without finding any a statistically significant correlation between them (p=0.226). However, a statistically significant correlation was found between cholesterol levels and the degree of stenosis (p=0.039). Descriptive analysis of restenosis lesions did not find any statistically significant correlation with the type or degree of stenosis in the native vessel, but showed statistically significant differences when evaluating the geometric assumption of restenosis by intraluminal diameter or intraluminal area (p=0.0018), suggesting that assessment of the degree of restenosis should be performed only by planimetric area. Conclusions: We can conclude that in stent restenosis represents a plurifactorial phenomenon, that is not conditioned by the severity of the native lesion or by the administration of ACE inhibitors or Spironolactone, however it depends directly on the control of cholesterol values afther the coronary revascularization.

Background: Hypertrophic cardiomyopathy is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because it’s late gene expression. Hypertrophic cardiomyopathy presenting in infancy has been shown to have a very high mortality. Methods: Thirty-nine patients diagnosed with hypertrophic cardiomyopathy in the IIIrd Pediatric Cardiology Department from Tîrgu Mureş were included in this study. Patients were divided into two groups: group 1 – patients diagnosed during infancy, group 2 – patients diagnosed after 1 year of age. Data regarding familial and personal history, and echocardiographic findings were compared between these two groups. Results: Group 1 included 17 patients and group 2 - 22 patients. Positive familial history was found in both groups (group 1 – 6 cases, group 2 – 3 cases), all of them in obstructive forms. Syncope was found in four cases, all of them in group 1 (p=0.02; odds ratio 15; 95% CI, 0.7473 to 301.1). While in group 1, asymmetric septal hypertrophy was predominant (64.7%), in group 2 – concentric left ventricular hypertrophy predominated (54.5%). Obstructive hypertrophic cardiomyopathy was found in 14 patients in group 1 (82.4%) compared to 13 patients in group 2 (59.1%). Diastolic function was impaired more predominantly in group 1 (p=0.0274; odds ratio 11.67; 95% CI, 1.526 to 89.17). Conclusions: hypertrophic cardiomyopathy has an extensive clinical variability with regard to age of onset, severity and progression of disease.

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT. Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis. Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

Aortic intramural hematoma frequently appear in elderly hypertensive patients who suffered a vasa vasorum rupture into the media, presenting clinical symptoms similar to aortic dissection. The current available data suggest a similar treatment strategy as in aortic dissection, although intramural hematoma is a different pathophysiological entity. The issue of the vulnerable contact of the intraaortic plaque, which is prone to rupture and to trigger the formation of an intramural hematoma, has not been elucidated so far. We present a brief literature review regarding complex plaque analysis, which opens a new area in identification of vulnerable patients with intramural hematoma, important for management of these patients and optimization of their treatment in order to avoid complications.

Background: Hypertrophic cardiomyopathy, one of the most common inherited cardiomyopathies, is a heterogeneous disease resulting from sarcomeric protein mutations, with an incidence in the adult population of 1:500. Current information on the epidemiology and outcomes of this disease in children is limited. Methods: Thirty-four children diagnosed with hypertrophic cardiomyopathy in the Pediatric Cardiology Department from Tîrgu Mureș were evaluated concerning familial and personal history, clinical, paraclinical and therapeutic aspects. Hypertrophic cardiomyopathy was defined by the presence of a hypertrophied, non-dilated ventricle, in the absence of a cardiac or systemic disease that could produce ventricular hypertrophy. Results: The youngest diagnosed child was a neonate, a total of 10 patients being diagnosed until 1 year of age. In 6 cases a positive familial history was found. Noonan syndrome was found in 2 cases. Only 21 patients were symptomatic, the predominant symptoms being shortness of breath on exertion with exercise limitations. Left ventricular outflow tract obstruction was present in 21 cases (61.7%). Twenty-four patients were on β-blocking therapy, while 4 patients underwent septal myectomy. Conclusions: Hypertrophic cardiomyopathy is a heterogeneous disorder in terms of evolution, age of onset, type and extent of hypertrophy, and the risk of sudden death. It can affect children of any age. There is a need for a complex evaluation, including familial and personal anamnesis, clinical examination, electrocardiogram and echocardiography of all patients. It is highly important to develop screening strategies, including genetic testing, for an early diagnosis, especially in asymptomatic patients with a positive familial background

Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 - 19 patients with Ca score below 400HU, Group 2 - 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed. Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p

Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event. Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p

Introduction: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF). Material and methods: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring. Results: Calcium score was lower than 100 in 62 patients (50.22%), between 100 and 400 in 11 patients (8.91%), and higher than 400 in 8 patients (6.48%). Mean LVEF was 53.52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55.29%, while in coronary arteries with extensive calcifications (calcium score > 400), the LVEF was significantly lower, 50.5% (p = 0.004). Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction