Papers by AMALIA FAGARASAN
Journal of Cardiovascular Emergencies, Mar 1, 2020
Congenital aortic stenosis (AS) occurs in around 0.2-0.5% of newborns, and its clinical severity ... more Congenital aortic stenosis (AS) occurs in around 0.2-0.5% of newborns, and its clinical severity is quite variable. Some of the newborns with AS require urgent medical care: prostaglandin infusion, balloon aortic valvuloplasty, or surgical intervention. Despite having a severe clinical evolution in neonates, the prenatal diagnosis of congenital AS is quite low. We present the case of a fetus with critical AS, who had been prenatally diagnosed at 35 weeks of gestation, via fetal cardiac ultrasound. The echocardiographic parameters revealed a severely depressed left ventricular systolic function, with dilated chambers, and a severe aortic stenosis. Offline speckle-tracking analysis was performed in order to aid in deciding the optimal methods and timing of delivery. Left ventricular analysis revealed a severely impaired global longitudinal strain of 2.1%, left ventricular ejection fraction 18.4%, increased LV volumes, while the right ventricular function was only mildly depressed. Therefore, the decision was to delay the premature delivery, and the fetus was born at a gestational age of 38 weeks, in a hospital with a neonatal cardiovascular surgery department. The patient had undergone surgical repair of the cardiac anomaly at 3 days after birth.
Journal of Cardiovascular Emergencies, Sep 1, 2020
International Journal of Molecular Sciences, Apr 30, 2022
Revista română de pediatrie, Mar 31, 2020
Progresele realizate în domeniile imagisticii şi a geneticii moleculare au permis implemementarea... more Progresele realizate în domeniile imagisticii şi a geneticii moleculare au permis implemementarea unui sistem nou, descriptiv, de clasificare a cardiomiopatiilor, cunoscut sub acronimul MOGE(S), întrucât informaţiile furnizate de testările moleculare genetice au permis o mai bună cunoaştere a bazei fiziopatogenice, o implementare a unui fenotipgenotip nosologic descriptiv şi stabilirea unui diagnostic precis clinic şi genetic. Cardiomiopatia dilatativă (CMD) la copil rămâne cea mai frecventă formă de cardiomiopatie, cauză de deces în primii 2 ani, iar impactul acesteia în perioada neonatală este grefat de numărul redus de studii, care să ajute la cunoaşterea incidenţei reale, şi de rata mare a deceselor (10% dintre decesele neonatale de cauză cardiacă). Ecocardiografia ajută în egală măsură la stabilirea diagnosticului, la monitorizarea evoluţiei şi a terapiei. Metodele moderne ecocardiografice (Doppler tisular sau speckle tracking), precum şi ecocardiografia 3 D oferă date de mai mare acurateţe. Examinările paraclinice, cum ar fi dozarea neuropeptidelor (BNP, NT-proBNP), au rol dual diagnostic şi prognostic. Tratamentul medicamentos recomandat pentru ameliorarea simptomelor insuficienţei cardiace congestive este compus din inhibitori ai enzimei de conversie (se preferă cei cu acţiune de lungă durată-Lisinopril), blocanţi ai receptorilor mineralocorticoizi şi betablocante (Bisoprolol), care acţionează prin scăderea postsarcinii, limitarea procesului de remodelare ventriculară şi oferă, în egală măsură, o modalitate facilă de administrare (fiind administrate într-o priză unică). Au apărut modalităţi inovative terapeutice, aşa-numita terapie regenerativă a cardiomiocitelor. Transplantul cardiac rămâne o opţiune terapeutică limitată de numărul mic de donatori. Concluzii. Abordarea diagnostică şi terapeutică a CMD a cunoscut îmbunătăţiri substanţiale, integrarea în practica curentă a noilor metode de diagnostic şi abordările terapeutice regenerative putând schimba perspectiva prognostică a bolii.
Journal of Interdisciplinary Medicine, Dec 1, 2016
The Journal of Critical Care Medicine, Apr 1, 2022
Revista română de pediatrie, Mar 31, 2021
Applied sciences, May 28, 2022
Frontiers in Pediatrics, Jun 16, 2023
Romanian Journal of Laboratory Medicine, 2013
International Journal of Molecular Sciences
Galectin-3 (Gal-3) is a novel pro-fibrotic biomarker that can predict both right and left cardiac... more Galectin-3 (Gal-3) is a novel pro-fibrotic biomarker that can predict both right and left cardiac dysfunction caused by various cardiovascular conditions. Its expression seems to be progressively altered with evolving cardiac remodeling processes, even before the onset of heart failure. Hence, Gal-3 has been found to be an individual predictor of acute and chronic heart failure or to serve as part of an integrated biomarker panel that can foresee adverse cardiac outcomes. In congenital heart disease (CHD), Gal-3 correlates with cardiac mortality and complications in both children and adults and is proposed as a therapeutic target in order to reverse the activation of pro-fibrosis pathways that lead to heart failure. Positive associations between serum Gal-3 levels, post-operatory hospitalization rates, complications and ventricular dysfunction have also been reported within studies conducted on patients with CHD who underwent corrective surgery. Thus, this review tried to address th...
Frontiers in Pediatrics
ObjectivesTo study changes in heart function and hemodynamics during the transitional period in s... more ObjectivesTo study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts.DesignA hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery.ResultsEighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p < 0.05, respectively]. Maternal weight and body mass index was higher among non-affected pregnancies, 61% infants were born vaginally, and no differences in cord blood pH at birth were noted. SGA infants had higher systolic and mean blood pressure at both time points, lower indices of right ventricular (RV) performance [TAPSE (tricuspid annular peak systolic excursion) 7.4 ± 2.8 vs...
Frontiers in Cardiovascular Medicine
IntroductionGeneralized arterial calcification of infancy (GACI) is a rare cause of infantile hea... more IntroductionGeneralized arterial calcification of infancy (GACI) is a rare cause of infantile heart failure and systemic hypertension with a poor prognosis, characterized by extensive calcification and proliferation of the intimal layer of large and medium sized arteries.Case reportWe present the first case report of successful surgical treatment of severe aortic arch obstruction by calcified plaques mimicking severe coarctation of the aorta and the outcome (of bisphosphonate therapy) in a newborn with GACI. Furthermore, we report the identification of a variant in ATP Binding Cassette Subfamily C, Member 6 (ABCC6) gene, possibly associated with severe early-onset manifestations of GACI.ConclusionThis case report highlights the importance of considering GACI in an infant with heart failure, systemic hypertension, and evidence of increased echogenicity of the arterial vessels. We noted the favorable outcome in improving the aortic calcification in our patient after surgical treatment...
Journal of Interdisciplinary Medicine
We present the case of a neonatal patient with atrial tachycardia with unusual characteristics – ... more We present the case of a neonatal patient with atrial tachycardia with unusual characteristics – abrupt onset and cessation, non-responsiveness to overdrive, termination by direct cardio-version – in association with an ostium secundum-type atrial septal defect and a large inter-atrial septum aneurysm. Electrocardiographic recordings showed P waves with characteristics suggesting a right low septal origin, which suggested a possible involvement of the septal aneurysm. In dealing with arrhythmias, a thorough echocardiographic evaluation is mandatory to identify underlying structural malformations and to evaluate the hemodynamic status. Further research should be made concerning mechanisms of arrhythmias in patients with an associated atrial septum aneurysm.
Applied Sciences
Pulmonary arterial hypertension is a severe, progressive disease in children, that causes right v... more Pulmonary arterial hypertension is a severe, progressive disease in children, that causes right ventricular dysfunction over time. Tissue motion annular displacement is a novel speckle-tracking derived echocardiographic parameter used in assessing ventricular function. The aim of our study was to determine the prognostic value of this echocardiographic parameter in children with pulmonary arterial hypertension. We conducted a case-control study by assessing twenty children with pulmonary arterial hypertension (idiopathic or secondary) and twenty age- and sex-matched controls, using clinical (WHO functional class, 6-min walking test), laboratory (brain natriuretic peptide level) and echocardiographic parameters (conventional and speckle-tracking derived tissue motion annular displacement) at enrolment and after one year of follow-up. According to their WHO functional class altering after one year, the pulmonary arterial hypertension patients were divided into two groups: non-worsenin...
Romanian Journal of Pediatrics, 2013
Introducere. Infecţiile respiratorii cauzate de virusul sinciţial respirator la copiii cu malform... more Introducere. Infecţiile respiratorii cauzate de virusul sinciţial respirator la copiii cu malformaţii cardiace congenitale reprezintă o importantă cauză de decompensare, care determină spitalizări repetate, cu durată prelungită. Prezentăm experienţa centrului nostru privind utilizarea profi lactică a Palivizumab la copiii sub 24 de luni, internaţi cu malformaţii cardiace congenitale semnifi cative hemodinamic. Material şi metodă. În conformitate cu recomandările ghidurilor privind profi laxia cu Palivizumab, 28 de copii cu vârsta medie de 2,6 luni, internaţi în Clinica Cardiologie II Copii a Spitalului Clinic Judeţean de Urgenţă Târgu-Mureş, au fost incluşi în programul de vaccinare, în perioada octombrie 2010 – februarie 2012. Pe perioada spitalizării s-au monitorizat parametrii hemodinamici, s-a notat orice reacţie adversă apărută, precum şi rata infecţiilor respiratorii. Părinţii au semnat un consimţământ informat privind acordul pentru vaccinare. A fost selectat un grup control ...
Journal Of Cardiovascular Emergencies, 2020
Congenital aortic stenosis (AS) occurs in around 0.2–0.5% of newborns, and its clinical severity ... more Congenital aortic stenosis (AS) occurs in around 0.2–0.5% of newborns, and its clinical severity is quite variable. Some of the newborns with AS require urgent medical care: prostaglandin infusion, balloon aortic valvuloplasty, or surgical intervention. Despite having a severe clinical evolution in neonates, the prenatal diagnosis of congenital AS is quite low. We present the case of a fetus with critical AS, who had been prenatally diagnosed at 35 weeks of gestation, via fetal cardiac ultra-sound. The echocardiographic parameters revealed a severely depressed left ventricular systolic function, with dilated chambers, and a severe aortic stenosis. Offline speckle-tracking analysis was performed in order to aid in deciding the optimal methods and timing of delivery. Left ventricular analysis revealed a severely impaired global longitudinal strain of 2.1%, left ventricular ejection fraction 18.4%, increased LV volumes, while the right ventricular function was only mildly depressed. Th...
Journal of Personalized Medicine, 2022
Our aim was to compare the global longitudinal and regional biventricular strain between infants ... more Our aim was to compare the global longitudinal and regional biventricular strain between infants with severe and critical pulmonary stenosis (PS), and controls; to compare pre- and post-procedural strain values in infants with severe and critical PS; and to assess the correlations between echocardiographic strain and conventional parameters. We conducted a retrospective single-center study. The comparisons of echocardiographic variables were performed using separate linear mixed models. The overall mean right ventricle (RV) regional strains measured before intervention in PS patients was significantly different when compared to the control group (p = 0.0324). We found a significant change in the left ventricle, RV, and inter-ventricular septum strain (IVS) values from basal to apical location (p < 0.05). IVS strain values showed a higher decrease in mean strain values from basal to apical in PS patients. There was no significant difference in means of baseline and post-interventi...
International Journal of Environmental Research and Public Health, 2021
The clinical course of COVID in the pediatric population is considered to be much milder when com... more The clinical course of COVID in the pediatric population is considered to be much milder when compared to adults; however, the occurrence of severe and fatal forms of the disease in children is non-negligible, especially in patients with comorbidities such as prematurity or cardiac disease. We report a case of a newborn with sotalol-controlled fetal ventricular tachycardia, who was postnatally diagnosed with COVID infection. The myocardial injury was sustained on the basis of pericardial effusion, left ventricular dysfunction, rapid progression to coronary artery dilation, and an arrhythmic storm. We believe that, in our case, there is a significant overlap between fetal ventricular tachycardia, associated with impaired left ventricular function, and COVID infection, diagnosed after birth; both factors contribute to the myocardial dysfunction with a fulminant clinical evolution. To our knowledge, this is the first case describing neonatal myocardial dysfunction associated with SARS-...
Children, 2021
Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive... more Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta ...
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Papers by AMALIA FAGARASAN