Search Results (436)

Rupture of Intracranial Aneurysms (IAs) is the leading cause of non-traumatic intracranial hemorrhage. Early detection of aneurysms prior to rupture or their prompt identification in cases of intracranial hemorrhage is critical and guides treatment strategies. The development of artificial intelligence tools to automate the labor-intensive detection and analysis of IAs is an active research field, but it depends on the availability of large, well-curated datasets for robust model training, validation, and testing. Collaborative data sharing is essential for advancing this field, yet remains relatively uncommon. Here, we present a collection of 172 Computed Tomography Angiography (CTA) scan series—a widely available and commonly used modality for the diagnosis of IAs—supplemented with structured metadata. The dataset comprises 90 scans from healthy patients and 82 scans from patients with IAs of diverse shapes, sizes, and anatomical locations, annotated and validated by two experts. The annotations include 122 surface mesh models in STL format. This openly accessible dataset is intended to support the development of automated segmentation or classification tools, medical image analysis, and assessment of disease progression risks through morphometric and hemodynamic evaluations. Full article

The use of computational fluid dynamics (CFD) to study hemodynamics in arteries offers significant potential for addressing complex flow problems. Due to its enhanced performance hardware and software, CFD has become an important approach for studying hemodynamics in human arteries. This approach is utilized to investigate hemodynamics and forecast risk factors for atherosclerotic lesion development and progression, including circulatory flow, and to analyze local flow fields and flow profiles resulting from geometric changes. This foundational study will aid in analyzing blood flow behavior through the abdominal aorta and the origin and courses of renal arteries, as well as investigating the causes of disorders such as atherosclerosis and hypertension. The current study investigates three idealized abdominal aorta–renal artery junction models under varying blood pressure settings. Materialise software V19 was used to extract the geometry data to create idealized 3D abdominal aorta–renal branching models. Unsteady flow simulations were performed in ANSYS Fluent, utilizing rigid walls and Newtonian and Carreau–Yasuda viscosity conditions. Oscillatory shear index (OSI) and Time-averaged wall shear stress (TAWSS) were measured to enhance understanding of atherosclerotic plaque formation and progression. Also, the effect of geometric change at the bifurcation area was explored, and it was discovered that this location causes considerable vortex forming zones. The evident velocity reduction and backflow development were seen, reducing shear stress. The findings indicate that low TAWSS < 0.4 Pa and OSI > 0.15 areas within the bifurcation region are more susceptible to atherosclerosis development. Full article

Background: Cardiac implantable electronic device (CIED) lead perforation is a rare but potentially catastrophic complication. As global device implantations increase, understanding the clinical spectrum and optimal management of this complication is essential. This study characterizes the clinical presentation, diagnostic strategies, and outcomes of lead perforation over a 25-year period. Methods: A retrospective analysis was conducted on 32 patients diagnosed with CIED lead perforation between 2000 and 2025 at a high-volume center. Perforations were classified by timing: acute (<24 h), subacute (1–30 days), and chronic (>30 days). Data included demographics, comorbidities, imaging modalities, and procedural interventions. Results: The mean patient age was 76.0 ± 11.7 years, with a mean body mass index (BMI) of 25.5 ± 3.4 kg/m². Subacute presentation was the most frequent (59.3%, n = 19), followed by acute (28.1%, n = 9) and chronic (12.5%, n = 4) cases. The right ventricle was the primary site of perforation (90.6%). While chest X-rays served as an initial screening tool in 62.5% of cases, diagnosis relied on multimodal imaging, with Computed Tomography (CT) providing definitive confirmation in 31.3% of the cohort, particularly when lead parameters remained stable. Management was risk-stratified based on hemodynamic status. The majority of patients (71.9%, n = 23) underwent successful transvenous lead removal via simple traction. However, 25% (n = 8) presented with hemodynamic instability, and 21.9% (n = 7) suffered from cardiac tamponade. These high-risk cases required surgical intervention, including sternotomy (n = 4), thoracotomy (n = 2), or pericardiotomy (n = 3). Notably, 62.5% of hemodynamically unstable patients were on oral anticoagulants. All patients survived to discharge, with no in-hospital mortality. The median length of hospital stay was 3 days. Conclusions: CIED lead perforation often presents subacutely with subtle clinical signs. CT imaging has emerged as the gold standard for definitive diagnosis. While percutaneous transvenous removal is safe and effective for stable patients, immediate surgical backup is vital, as patients—particularly those on anticoagulation—can deteriorate rapidly. Full article

Objectives: This study aims to review short- to intermediate-term outcomes after transapical transcatheter mitral valve replacement (TMVR) using the Tendyne valve system in patients with mitral annular calcification (MAC), including off-label use in severe MAC. Methods: This retrospective sub-analysis of the multicenter Tendyne European Experience (TENDER) registry included fifty-three MAC patients who underwent commercial Tendyne-TMVR in 15 European heart centers between 01/2020 and 06/2022. Patients were assigned to the mild (n = 16), moderate (n = 17), and severe MAC (n = 20) cohorts according to Guerrero’s MAC score. Additionally, the predictive value of detailed computed tomography-derived, quantitative, and qualitative MAC characteristics on clinical outcome was tested. Results: In this overall multimorbid patient population, predominantly treated for severe mitral regurgitation (MR), technical success rates were comparable among cohorts (mild MAC: 93.8% vs. moderate MAC: 88.2%vs. severe MAC: 95%, p = 0.720). Complete MR abolishment was achieved in 88.7% of patients, with no significant difference between cohorts in the incidence of residual MR >1+ (n = 1 in moderate MAC; p = 0.350) or paravalvular leakage >1+ (PVL; n = 2 in moderate MAC, p = 0.118) at discharge. All three in-hospital deaths occurred in patients with moderate MAC (p = 0.034). There were no significant differences in 1-year cardiovascular mortality (mild MAC: 23.1% vs. moderate MAC: 6.3% vs. severe MAC: 0%, p = 0.085) and overall mortality (mild MAC: 38.5% vs. moderate MAC: 43.8% vs. severe MAC: 18.8%, p = 0.291) between the cohorts, including in patients with off-label severe MAC. The rate of heart failure hospitalization at 1 year was significantly higher in the moderate MAC cohort (mild MAC: 10% vs. moderate MAC: 61.5%, severe MAC: 21.4%, p = 0.017). Further quantitative and qualitative MAC parameters showed no significant impact on 1-year survival or hemodynamic prosthetic performance. Conclusions: This MAC-focused analysis suggests that Valve-in-MAC using the Tendyne valve system is safe, technically feasible, and associated with satisfying hemodynamic and clinical outcomes, irrespective of MAC morphology. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Background: Extrinsic compression of the left atrium (LA) is a rare and underrecognized condition that may result in significant hemodynamic compromise and atrial arrhythmias. The available evidence has been largely limited to isolated case reports and small case series, and clinical awareness has remained low. Methods: We performed a structured review of published case reports and case series indexed in PubMed between 2016 and 2026 describing extracardiac LA compression. A predefined and reproducible literature search strategy with explicit eligibility criteria was applied. The structured review included 22 publications reporting 23 individual cases of LA compression; in addition, two institutional cases with distinct etiologies were presented separately. Demographic characteristics, presenting symptoms, diagnostic modalities, complications, management strategies, and outcomes were synthesized descriptively. Results: The structured review identified gastroesophageal disorders, particularly hiatal hernia, as the most frequent etiology, followed by vascular, mediastinal, malignant, and musculoskeletal causes. Dyspnea was the most common presenting symptom, while hemodynamic compromise, pulmonary edema, and atrial arrhythmia represented the most frequent complications. Transthoracic echocardiography was the initial diagnostic modality in all reported cases, with computed tomography required for definitive etiological diagnosis. The two institutional cases illustrated both a common cause, hiatal hernia mimicking intracardiac mass, and a rare, aggressive malignant cause with extensive mediastinal involvement. Conclusions: Extrinsic LA compression arises from diverse extracardiac pathologies and may be clinically severe. Transthoracic echocardiography can serve as a pivotal first-line tool for early recognition and differentiation from intracardiac masses, while cross-sectional imaging is essential for etiological clarification. By integrating institutional experience with a structured synthesis of published cases, this review can provide practical insights to support timely diagnosis and management of this potentially life-threatening condition. Full article

The aim of this research was to calculate hemodynamics of intracaranial aneurysms using computational fluid dynamics. The hemodynamics research of intracranial aneurysms used patient-specific blood pressure data and anonymised DICOM images, from which aneurysm geometries were extracted. The following boundary conditions were established. At the inlet, a pulsatile velocity profile was enforced, and a pressure waveform was assigned at the outlet. Numerical simulations were performed to examine key hemodynamic parameters linked to aneurysm rupture, including wall shear stress, time-averaged wall shear stress, oscillatory shear index, and relative residence time, as well as flow distributions. On the basis of these hemodynamic indicators, the risk of rupture was connected with a geometric property of the aneurysm, the aspect ratio. The hemodynamics parameters obtained ranges with the results of other scientific studies. Finally, it was concluded that combining clinical data, aneurysm geometry, and hemodynamic characteristics can provide clinicians with valuable additional information to use in selection of the appropriate treatment strategy for intracranial aneurysms. 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

Understanding the hemodynamics of the carotid artery is essential for assessing atherosclerotic disease progression and identifying regions vulnerable to plaque formation. Background: Disturbed flow patterns and abnormal shear stresses, particularly near the carotid bifurcation, are known to influence endothelial dysfunction; therefore, this study aims to quantify the impact of patient-specific carotid artery geometry on key hemodynamic parameters associated with atherosclerotic risk. Methods: Four patient-specific carotid artery geometries were reconstructed from medical imaging data, processed using MIMICS, and analyzed using computational fluid dynamics in ANSYS Fluent, with blood modeled as an incompressible non-Newtonian fluid using the Carreau–Yasuda viscosity model under pulsatile flow conditions; velocity streamlines, pressure distribution, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) were evaluated at early systole, peak systole, and peak diastole. Results: The simulations revealed complex flow behaviour, including flow reversal, pressure build-up, and low-shear regions concentrated near the carotid bulb and bifurcation, with TAWSS consistently identifying low-shear zones (<1 Pa) across all geometries and OSI exhibiting pronounced directional oscillations in models with increased curvature and wider bifurcation angles. Conclusions: These findings demonstrate that geometric characteristics such as bifurcation angle, vessel tortuosity, and asymmetry play a critical role in shaping local haemodynamics, underscoring the utility of patient-specific CFD analysis as a diagnostic and predictive tool for atherosclerotic risk assessment and supporting more informed, personalized clinical decision-making. Full article

Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disorder characterized by steno-occlusive changes in the intracranial internal carotid arteries and the development of fragile collateral networks. Imaging plays a pivotal role in diagnosis, disease staging, and management, yet the expanding range of available imaging modalities has resulted in heterogeneous evidence that remains difficult to synthesize. This scoping review aimed to systematically map and critically appraise imaging-based diagnostic approaches used in MMD, summarizing their diagnostic performance, clinical utility, and limitations. A comprehensive literature search was conducted across major databases, and original studies evaluating imaging modalities in human MMD were included. Thirty-three studies published between 1995 and 2023 were analyzed, encompassing digital subtraction angiography, magnetic resonance imaging and angiography, perfusion and functional MRI, computed tomography-based techniques, nuclear medicine, ultrasound, neurophysiological methods, and emerging artificial intelligence applications. Digital subtraction angiography remains the diagnostic reference standard, particularly for disease confirmation and surgical planning. However, noninvasive modalities provide critical complementary information. Magnetic resonance-based techniques offer multiparametric assessment of vascular morphology, hemodynamics, vessel wall pathology, and parenchymal injury. Computed tomography angiography and perfusion imaging provide accessible alternatives with high sensitivity for vascular changes, while functional and neurophysiological methods contribute additional hemodynamic and regional assessments. Artificial intelligence applications show promising diagnostic performance but remain in early validation stages. The evidence base is limited by methodological heterogeneity, inconsistent reference standards, incomplete reporting of diagnostic accuracy metrics, and a scarcity of longitudinal and multimodal studies. Collectively, the findings support a multimodal imaging strategy in MMD, integrating structural and functional information to inform diagnosis and management. Future research should prioritize standardized protocols, longitudinal designs, and clinically validated imaging biomarkers to enable evidence-based diagnostic pathways. Full article

Background/Objectives: Pelvic injuries are frequently associated with severe hemorrhage and may contribute to early trauma-induced coagulopathy (TIC). Whether pelvic injury is independently associated with TIC beyond overall injury severity remains unclear. The objective of this study was to evaluate the association between pelvic injury and TIC in severe trauma patients. Methods: We conducted a retrospective single-center study including adult severe trauma patients (injury severity score > 15) admitted between January 2012 and July 2020. Patients with moderate to severe traumatic brain injury (because of its specific coagulopathy and mortality), inter-hospital transfer, pregnancy, or long-term anticoagulant or antiplatelet therapy were excluded. Pelvic injury was defined as any traumatic lesion involving the pelvic girdle identified on admission computed tomography. TIC was defined by an international normalized ratio (INR) > 1.2 and/or fibrinogen < 1.5 g/L and/or platelet count < 100 G/L. Multivariable logistic regression was performed to identify factors associated with TIC. Results: Among 388 included patients (79.6% male, median age 39 years), 114 (29.4%) had a pelvic injury. TIC was present in 160 patients (41.3%), and TIC prevalence was significantly higher in patients with pelvic injury (n = 73–64.0%) compared to those without (n = 87–31.8%) (p < 0.001). After multivariate analysis, TIC was independently associated with pelvic injury (OR 2.81, 95% CI 1.63–4.89), shock index > 0.9 (OR 1.94, 95% CI 1.12–3.37), hemoglobin < 10 g/dL (OR 4.27, 95% CI 1.77–11.49), and lower base excess values on admission (OR per unit increase 0.92, 95% CI 0.87–0.97). Injury severity score and number of lesions (AIS ≥ 3) were not independently associated with TIC. Conclusions: Pelvic injury was independently associated with TIC after adjustment for injury severity, number of severe injuries, and markers of hemodynamic and metabolic shock, including shock index, hemoglobin level, and base excess. These findings suggest that patients with pelvic injury may represent a high-risk subgroup for early coagulopathy, supporting the need for early recognition and adapted resuscitation strategies. Further prospective studies are required to explore underlying mechanisms. Full article

This study investigates the application of computational hemodynamic modeling, involving both FSI and CFD models, using SimVascular to simulate blood flow in the right pulmonary artery for patient-specific cardiovascular assessment. The artery’s three-dimensional geometry was reconstructed from a computed tomography (CT) image, and pressure measurements from a CardioMEMS™ device were used as clinical ground truth for validation. To represent the arterial hemodynamics, we initially formulated a fluid–structure interaction (FSI) approach to capture wall mechanics. However, given the high computational cost of fully patient-specific FSI simulations for routine clinical decision-making, we evaluated the validity of key simplifications by assuming rigid vessel walls coupled with a three-element Windkessel (3WK) model and applying a half-sine inflow waveform derived from the patient’s cardiac output. These simplifications yielded results with minimal error: the rigid-wall assumption introduced a 1.1% deviation, while the idealized waveform resulted in a 0.56 mmHg offset. Crucially, while wall rigidity was acceptable, we found that arterial compliance in the boundary conditions is non-negotiable; reducing the model to a pure resistance approach resulted in non-physiological pressures (130 mmHg). A subsequent parametric analysis examined how varying resistance (R) and compliance (C) distinctively alter the pressure waveform morphology. The results underscore the potential of combining remote monitoring data with validated computational simulations to deepen the understanding of cardiovascular dynamics and enhance diagnostic and therapeutic approaches for cardiovascular diseases. Full article

Sutureless aortic bioprostheses have become an established alternative for surgical aortic valve replacement, particularly in elderly and high-risk patients. The Perceval (Livanova) valve, the most widely studied sutureless device, offers favorable hemodynamic performance and reduced operative times but introduces specific challenges when prosthetic valve endocarditis (PVE) occurs. Although the incidence of Perceval PVE is low and comparable to that of conventional bioprostheses, this complication is associated with substantial morbidity and mortality. Diagnosis is often complex due to acoustic shadowing on echocardiography, making multimodality imaging with transesophageal echocardiography, cardiac computed tomography, and [18F]-FDG PET/CT essential. Microbiological profiles resemble those of other biological prostheses, but perivalvular extension and early mechanical instability are frequent. Management follows general PVE principles but often requires early surgical intervention because of the valve’s reliance on radial fixation. This review summarizes current evidence on epidemiology, microbiology, diagnostic strategies, treatment, and prognosis of endocarditis involving the Perceval valve, and identifies areas for future research. Full article

Background: Assessing aortic dissection (AD) in its early stages is crucial for cardiovascular surgeons to improve patient outcomes and avoid complications associated with surgical intervention for type A aortic dissection. Initial evaluations rely on patient referrals for computed tomography (CT) scans, which involve measuring the maximum aortic diameter. Objective: This study aimed to improve current diagnostic thresholds for type A aortic dissection by using computational fluid dynamics (CFD) modeling to correlate hemodynamic factors related to the wall shear stress with maximum aortic diameter growth rate, offering insights into predicting AD progression and reassessing current diameter-based diagnostic criteria. Methods: The pre- and post-AD scan data, with an average duration of three and a half years for the 15 patients, were converted into 3D geometries. These geometries were analyzed using the transitional-turbulent CFD model. Wall shear stress (WSS), its derivatives, and the pressure gradient from the pre-AD CT scans were compared across 15 patients, grouped according to the aortic diameter growth per year. Results: For patients in group 1 (nine patients with normal diagnosis), pre-AD time-average wall shear stress (TAWSS) was mostly 2–4 Pa, above physiologic levels. Post-AD, values dropped below 1.5 Pa (stagnant, thrombus-prone), with oscillatory shear index (OSI) elevated (0.24–0.32). In group 2 (n = 6, abnormal diagnosis), post-AD TAWSS was <3 Pa (thrombosis risk), with OSI 0.1–0.31 near tear sites. These findings confirm a dual-risk profile: low TAWSS promotes thrombosis, while high TAWSS drives dissection progression. Conclusions: WSS parameters, such as TAWSS and OSI, can be utilized to assess the development of a dilated ascending aorta, especially for extreme maximum aortic diameter. Pre-AD analysis for some patients revealed a strong negative correlation, indicating that high shear stress in the true lumen (TL) results in a drop in diastolic pressure post-AD at the upward-going section of the aorta. Full article

Background: Pancreatic trauma (PT) in children is rare and associated with significant morbidity. The optimal form of management—operative versus non-operative—remains controversial, particularly in the presence of acute post-traumatic peripancreatic fluid collection, which may later evolve into pancreatic pseudocysts. Isolated pancreatic injuries without associated organ damage are uncommon and pose diagnostic and therapeutic challenges. Case Presentation: We report a 5-year-old boy who sustained an isolated grade IB blunt pancreatic head contusion following blunt abdominal trauma after falling onto a wooden fence. He presented with epigastric pain, repeated emesis, and an abdominal wall bruise. Initial ultrasound (US) findings were subtle; however, serial imaging and contrast-enhanced computed tomography (CECT) revealed focal contusion of the pancreatic head/uncinate process with a small peripancreatic fluid collection. Pancreatic enzymes were markedly elevated, with peak serum lipase reaching approximately 6579 U/L. The child remained hemodynamically stable and was managed conservatively with bowel rest, intravenous fluids, octreotide, proton-pump inhibition, pancreatic enzyme replacement therapy (PERT), and antibiotics. Serial US demonstrated the dynamic evolution of an acute peripancreatic fluid collection (APFC) (~2 cm), which remained stable without complications. Clinical and biochemical parameters gradually improved, and no invasive intervention was required. The patient was discharged on hospital day 16 with planned outpatient imaging follow-up. Conclusions: This case demonstrates that isolated pediatric pancreatic contusions complicated by small, evolving peripancreatic fluid collections can be safely managed non-operatively in hemodynamically stable patients. Serial ultrasound plays a key role in monitoring lesion evolution and guiding management decisions. In accordance with current pediatric trauma guidelines, careful observation with structured follow-up may prevent unnecessary invasive interventions while achieving excellent clinical outcomes. Full article