Among the evaluated clinical and anatomical characteristics, patient developmental age emerged as a strong independent predictor of symptoms, whereas ostial stenosis demonstrated the strongest unadjusted association with symptom status; however no anatomical variable remained independently associated with symptoms after multivariable adjustment.
Abstract
Background Anomalous aortic origin of the right coronary artery (AAORCA) is increasingly identified in children, yet risk stratification remains controversial. This study aims to identify key anatomical predictors of clinical symptoms and evaluate real-world management patterns in a large pediatric cohort. Methods We conducted a single-center retrospective cohort study in pediatric patients ≤18 years diagnosed with AAORCA between November 2021 and December 2025. Clinical presentation, imaging findings, management strategies, and follow-up outcomes were analyzed. Integrated anatomical features were derived using a predefined hierarchical approach incorporating surgical findings, CTA, and echocardiography. Multivariable logistic regression analysis was performed to identify factors associated with symptomatic presentation. Results A total of 151 patients were included (mean age 7.40 ± 4.87 years; 60.9% male), of whom 51.7% presented with symptoms. High-risk anatomical features were frequently identified but showed incomplete concordance with clinical symptoms. In multivariable analysis, patient age was independently associated with symptom presentation. Although ostial stenosis showed a stronger unadjusted association with symptoms than other anatomical features, no anatomical variable remained independently associated with symptom status after adjustment. A real-world decision pathway revealed substantial heterogeneity in management strategies among patients with high-risk anatomical findings. No sudden cardiac death or major adverse cardiovascular events were observed during available follow-up. Conclusion Pediatric AAORCA demonstrates marked heterogeneity in clinical presentation, anatomical features, and management strategies. Clinical symptoms show incomplete concordance with high-risk anatomical features, highlighting the complexity of risk stratification in children. Among the evaluated clinical and anatomical characteristics, patient developmental age emerged as a strong independent predictor of symptoms, whereas ostial stenosis demonstrated the strongest unadjusted association with symptom status; however no anatomical variable remained independently associated with symptoms after multivariable adjustment. Real-world management strategies varied substantially and reflected individualized decision-making in the setting of limited pediatric evidence. Future studies may benefit from phenotype-oriented rather than anatomy-only risk classification frameworks.
Resumo Fundamento A utilidade prognóstica da classificação angiográfica de Hata para desfechos em longo prazo na arterite de Takayasu (AT) permanece incerta. Objetivos Avaliar o valor prognóstico da classificação de Hata na predição de eventos cardiovasculares adversos maiores (ECAM) e da necessidade de intervenções vasculares em pacientes com AT. Métodos Este estudo de coorte retrospectivo, de centro único, incluiu pacientes diagnosticados com AT entre 2000 e 2025. Análises de regressão logística multivariada foram realizadas para identificar preditores independentes, considerando-se significância estatística quando p < 0,05. Resultados Dos 203 pacientes inicialmente identificados, 18 foram excluídos. A coorte final foi composta por 185 pacientes, dos quais 80,0% eram do sexo feminino, com mediana de idade ao diagnóstico de 29 anos. O Tipo V foi o padrão angiográfico predominante (64,9%). Durante um seguimento mediano de 10,8 anos, ECAM ocorreram em 35,7% dos pacientes, enquanto 37,3% necessitaram de intervenção vascular. A classificação de Hata não apresentou associação com a ocorrência de ECAM. Os preditores independentes de ECAM incluíram sexo feminino, associado a efeito protetor (odds ratio [OR], 0,38; intervalo de confiança de 95% [IC 95%], 0,17-0,86; p = 0,021), e maior intervalo entre o início dos sintomas e o diagnóstico, associado a aumento do risco (OR, 1,10; IC 95%, 1,03-1,18; p = 0,006). Em contraste, a classificação de Hata foi preditora independente da necessidade de intervenção vascular. O Tipo I de Hata apresentou forte associação protetora em comparação ao Tipo V (OR, 0,10; IC 95%, 0,01-0,53; p = 0,029). Além disso, insuficiência aórtica basal associou-se independentemente a maior probabilidade de intervenção (OR, 2,54; IC 95%, 1,18-5,60; p = 0,018) (Figura Central). Conclusões A classificação de Hata demonstrou ser um preditor robusto de necessidade de intervenção vascular, mas não de ECAM, em pacientes com AT. Maior extensão anatômica da doença (Tipo V) e insuficiência aórtica basal associaram-se a maior risco de procedimentos vasculares, enquanto o risco de ECAM esteve relacionado a atraso diagnóstico e sexo masculino. A dissociação observada em longo prazo entre elevadas taxas de remissão clínica (92,4%) e progressão contínua da doença reforça a importância do acompanhamento baseado em métodos de imagem e destaca a necessidade de estudos prospectivos multicêntricos para validação desses achados.
A. Santana, S. Shinjo· Arquivos Brasileiros de Card...· 0 citations
Abstract Background The prognostic utility of the Hata angiographic classification for long-term outcomes in Takayasu arteritis (TAK) remains unclear. Objectives To evaluate the prognostic value of the Hata classification for predicting major adverse cardiovascular events (MACE) and the need for vascular interventions in patients with TAK. Methods This single-center, retrospective cohort study included patients diagnosed with TAK between 2000 and 2025. Multivariate logistic regression analyses were performed to identify independent predictors, with statistical significance defined as p < 0.05. Results Of 203 patients initially identified, 18 were excluded. The final cohort included 185 patients, of whom 80.0% were women, with a median age at diagnosis of 29 years. Type V was the predominant angiographic pattern (64.9%). During a median follow-up of 10.8 years, MACE occurred in 35.7% of patients, while 37.3% required vascular intervention. The Hata classification was not associated with MACE occurrence. Independent predictors of MACE included female sex, which was protective (odds ratio [OR], 0.38; 95% CI, 0.17-0.86; p = 0.021), and longer symptom onset-to-diagnosis time, which increased risk (OR, 1.10; 95% CI, 1.03-1.18; p = 0.006). In contrast, the Hata classification independently predicted the need for vascular intervention. Hata Type I showed a strong protective association compared with Type V (OR, 0.10; 95% CI, 0.01-0.53; p = 0.029). Baseline aortic insufficiency was also independently associated with a higher likelihood of intervention (OR, 2.54; 95% CI, 1.18-5.60; p = 0.018) (Central Illustration). Conclusions The Hata classification appears to be a robust predictor of vascular intervention but not MACE in TAK. Greater anatomical disease extension (Type V) and baseline aortic insufficiency were associated with increased procedural risk, whereas MACE risk was associated with diagnostic delay and male sex. The observed long-term dissociation between high rates of clinical remission (92.4%) and continued disease progression underscores the importance of imaging-based surveillance and highlights the need for prospective multicenter studies to validate these findings.
A. Santana, S. Shinjo· Arquivos Brasileiros de Card...· 0 citations
Background: Spontaneous Coronary Artery Dissection (SCAD) is an important non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger females. Despite increasing recognition, data on gender-based differences in SCAD presentation and outcomes remain limited, particularly in South Asian populations.
Methods: This retrospective case series included 24 patients diagnosed with SCAD at Abbas Institute of Medical Sciences (AIMS) between January 2022 and March 2025. Patient demographics, clinical presentation, angiographic findings, management strategies, and outcomes were analyzed with a focus on gender-based differences.
Results: Of the 24 patients, 17 were female (70.8%) and 7 were male (29.2%). Females were younger and had fewer traditional cardiovascular risk factors. Chest pain was the most common symptom (91.7%), and NSTEMI was the predominant ACS type. Conservative management was favored in females, while PCI was significantly more common in males (71.4% vs 11.8%, p = 0.004). All patients survived the acute episode; two experienced recurrent SCAD. No 30-day mortality was observed.
Conclusion: SCAD predominantly affects younger females with minimal risk factors and generally has favorable short-term outcomes. However, males may present with more severe forms requiring intervention. These gender differences highlight the need for individualized diagnostic and therapeutic approaches.
Abdul Nadeem Akhtar, Fnu Aisha, Aimen Binte Moazzam et al.· Journal of Community Hospita...· 0 citations
To characterize the clinical features, imaging findings, and management patterns of pediatric right-sided colonic diverticulitis (rsCD), identify common diagnostic pitfalls, and summarize institutional experience that may improve diagnostic accuracy and clinical decision-making. This retrospective study reviewed pediatric patients diagnosed with rsCD at a tertiary pediatric medical center between January 2018 and December 2025. Demographic, clinical characteristics, laboratory and imaging findings, management, pathologic diagnosis and outcomes were summarized. Patients with uncomplicated appendicitis (UA) and complicated appendicitis (CA) were included as clinical reference cohorts for exploratory comparisons. A total of 26 pediatric patients with rsCD were included in the main analytic cohort. Most patients had no symptoms other than abdominal pain. Diarrhea was observed in only three patients (11.5%). Preoperative diagnostic accuracy was low, with rsCD suspected in only three patients (11.5%). Modified Hinchey classification showed localized inflammation (type Ia/Ib) in 21 patients (80.8%). Laparoscopic diverticulectomy was performed in 13 patients (50.0%), laparoscopic conversion to open ileocecal resection in 4 (15.4%), and laparoscopic peritoneal lavage in 5 (19.2%). Appendectomy was performed in 17 patients (65.4%). All patients recovered without major postoperative complications. In exploratory comparative analysis, rsCD patients were similar to UA patients in inflammatory markers, pediatric appendicitis score (PAS) (P = 0.219), and fecalith prevalence (P = 0.279). Compared with CA patients, rsCD patients had lower inflammatory markers (P < 0.05), a lower PAS category (P = 0.032), fewer associated symptoms (P < 0.001), and a shorter length of stay (9.6 ± 2.6 vs. 12.3 ± 2.1 days, P < 0.001). Pediatric rsCD is a rare condition with nonspecific clinical manifestations that frequently overlap with common causes of pediatric acute abdomen. Therefore, rsCD should be considered in the differential diagnosis of children presenting with right lower quadrant abdominal pain.
Hao Shi, Jing Xiong, Qiongqiong Ji et al.· Pediatric surgery internatio...· 0 citations
Background
Myocardial bridging (MB) is a congenital anomaly where an epicardial coronary artery tunnels intramuscularly. Though traditionally considered a benign variant, its clinical relevance remains controversial, particularly regarding the risk of early hospital readmission and symptom burden in patients with non-obstructive coronary artery disease.
Methods
We conducted a retrospective cohort study at a 700-Bedded Hospital in Pyin Oo Lwin, reviewing 600 consecutive diagnostic coronary angiograms performed from January 2021 to December 2024. Patients with isolated MB—defined as systolic compression of 50% or greater without concomitant atherosclerosis—were evaluated against a propensity-matched control group. The primary endpoint was the incidence of Major Adverse Cardiovascular Events (MACE) at 12 months.
Results
Isolated MB was identified in 21 patients (3.5% prevalence). The cohort was predominantly male (81%) with a mean age of 49 ± 11 years. The left anterior descending artery was involved in 95% of cases. At 12 months, the MB group exhibited a significantly higher MACE incidence compared to controls (14.3% vs. 2.4%; p=0.04). Crucially, this difference was driven entirely by recurrent hospitalizations for unstable angina (14.3% vs. 2.4%; p=0.03). There were zero cases of cardiovascular death, non-fatal myocardial infarction, or revascularization. Multivariable Cox regression identified bridge length exceeding 25 mm as an independent predictor of symptom recurrence.
Conclusions
Isolated MB demonstrates excellent short-term survival but notable morbidity. The high rate of recurrent angina requiring hospitalization within one year indicates routine reassurance is insufficient. Symptomatic patients necessitate optimized medical therapy and close monitoring to effectively prevent early readmissions.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
To investigate surgical outcomes and prognostic factors in elderly patients (≥ 60 years) with valvular heart disease (VHD) undergoing surgery, and to provide evidence for optimizing clinical decision-making.
A retrospective analysis was conducted on 347 elderly VHD patients who underwent valve surgery across three Chinese centers from December 2021 to June 2025. Baseline characteristics, comorbidities, preoperative cardiac function, surgical details, complications, and follow-up data were collected. Cumulative survival was estimated using Kaplan–Meier method, with subgroup comparisons by log-rank test. Independent prognostic factors were identified using multivariable Cox regression.
Among 347 patients (53.9% male, mean age 68.8 ± 5.5 years), hypertension (62.0%), diabetes (28.0%), and COPD (15.0%) were common. Multi-valvular disease (58.8%) was the predominant lesion. Postoperative complications occurred in 28.0%, most frequently pulmonary infection (12.1%), arrhythmia (8.1%), and acute kidney injury (4.9%). In-hospital mortality was 2.9% (
n
= 10). At median 24-month follow-up, 66 patients died. The 1-, 2-, and 3-year survival rates were 91.9%, 85.9%, and 81.0%, respectively. Multivariable analysis identified age ≥ 75 years (HR = 3.25, 95%CI:1.28–8.23,
P
= 0.014), reduced preoperative LVEF (HR = 2.89, 95%CI:1.15–7.26,
P
= 0.024), and postoperative complications (HR = 4.12, 95%CI:1.65–10.28,
P
= 0.002) as independent risk factors for poor prognosis.
Elderly VHD patients achieve favorable outcomes with acceptable mortality. This is one of the few contemporary multicenter studies specifically reporting 3-year medium-term survival outcomes among Chinese elderly patients with valvular heart disease, filling a regional evidence gap in this population. Comprehensive preoperative evaluation, individualized planning, and rigorous perioperative care are essential, particularly for those aged ≥ 75 years, with reduced LVEF, or developing complications.
Yan Wang, Da-Liang Yan, Zi-Long Tang et al.· BMC Surgery· 0 citations
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