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Background and Objective: Surgical treatment of severe secondary ischemic mitral regurgitation (IMR) may improve symptoms and functional capacity, however there are few data on its effect on long-on the evolution of heart failure.... more
Background and Objective: Surgical treatment of severe secondary ischemic mitral regurgitation (IMR) may improve symptoms and functional capacity, however there are few data on its effect on long-on the evolution of heart failure. Time-course changes in brain natriuretic peptide (BNP) are a good marker of the heart failure status and outcomes. We investigated the association between the exercise stress echocardiographic (ESE) parameters and the changes in brain natriuretic peptide (BNP) following surgery for secondary IMR. Methods: We prospectively analyzed data on 50 patients (median age: 67, 61-64 y; EF: 35, 34-40%), undergoing mitral valve annuloplasty or replacement and coronary artery bypass graft (CABG). A valve annuloplasty with undersized ring was performed in 20 patients (40%) and a replacement in 30 (60%). A six minute walking test (6-MWT), BNP levels and ESE were performed at 1 year and at median follow-up (FU) of 6 years (4-7). Results: BNP level was: 388 (329-441) pg/ml before surgery, 175 (142-743) pg/ml at 1 y, and 123 (100-979) pg/ml at last FU (p=0.2). The relative changes of BNP from baseline to last FU significantly correlated with exercise tricuspid annulus plane systolic excursion (TAPSE) at last FU (r= -0.7, p<0.001), with preoperative and FU exercise LVEF, respectively ( r=-0.7 p= 0.01) (r=-0.93, p<0.001).On multivariable analysis, preoperative exercise EF was strongly and independently associated with independent BNP levels at last FU and with the changes in BNP from baseline to last FU. Conclusions: Despite surgical treatment of severe secondary IMR, BNP levels progressively increased over time in nearly 50% of the patients. Lower preoperative and 1-year FU exercise-stress EF was associated with increased levels of BNP during FU..
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Total anomalous pulmonary venous drainage (TAPVD) encompasses a wide spectrum of anatomical variants. The infradiaphragmatic type is almost always obstructive owing to the interposition of intrahepatic resistances; since almost... more
Total anomalous pulmonary venous drainage (TAPVD) encompasses a wide spectrum of anatomical variants. The infradiaphragmatic type is almost always obstructive owing to the interposition of intrahepatic resistances; since almost invariable, the vertical vein inserts on the portal venous system. On correction of this variant, the vertical vein might not be ligated to avoid postoperative pulmonary hypertension. We hereby describe an unusual case of infradiaphragmatic TAPVD, with a vertical vein connected to ductus venosus. Since vertical vein was not ligated, it realized an unrestrictive pathway between the left atrium and the suprahepatic veins which resulted in persistent chylous peritoneal drainage. The patient successfully underwent catheter occlusion of the vertical vein which led to complete resolution of the clinical picture.
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Ellis-van Creveld syndrome (EVC) is a rare autosomal recessive disorder, the features of the syndrome are: chondral and ectodermal dysplasia characterized by short ribs, polydactyly, growth retardation resulting in dwarfism, teeth and... more
Ellis-van Creveld syndrome (EVC) is a rare autosomal recessive disorder, the features of the syndrome are: chondral and ectodermal dysplasia characterized by short ribs, polydactyly, growth retardation resulting in dwarfism, teeth and craniofacial abnormalities and heart defects (mostly endocardial cushions and atrial septal defects). We describe the first case reported of COVID-19 infection in a 24-years-old girl, diagnosed with EVC syndrome. The patient suffered only from a mild illness, she remained stable with normal saturation without need of neither respiratory support nor specific therapy and she was rapidly discharged. This case appraises the pathophysiological interplay between different specific prognostic variable in a syndromic patient with congenital heart disease and COVID-19. In patients with congenital heart disease, comorbidities related to syndromic picture may affect the clinical course of COVID-19 infection regardless of the anatomic complexity.
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Research Interests: Cardiology, Treatment Outcome, Medicine, Electrocardiology, Humans, and 15 moreInternal Medicine, Male, Atrial Fibrillation, Athletes, Clinical Sciences, Physical Fitness, Middle Aged, Adult, Public health systems and services research, Athletic performance, Catheter ablation, Atrial Flutter, Disabled Persons, Recovery of Function, and Cardiovascular medicine and haematology
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Vascular involvement in neurofibromatosis type 1 has been described, although coronary artery disease is rare. Data about clinical presentation and natural history are anecdotal. This is the first case of myocardial infarction due to... more
Vascular involvement in neurofibromatosis type 1 has been described, although coronary artery disease is rare. Data about clinical presentation and natural history are anecdotal. This is the first case of myocardial infarction due to coronary aneurysms in a 13-year-old boy with neurofibromatosis type 1. We discuss pathophysiology, diagnostic images, and therapeutic management of this rare association.
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Introduction: Sleep disordered breathing (SDB) is common among patients with cardiovascular disease, but its impact on physiologic responses to exercise remains unclear. Hypothesis: We sought to determine the functional significance of... more
Introduction: Sleep disordered breathing (SDB) is common among patients with cardiovascular disease, but its impact on physiologic responses to exercise remains unclear. Hypothesis: We sought to determine the functional significance of SDB and low nocturnal oxygen saturation (SaO2) on hemodynamic responses to exercise. Methods: We investigated subjects who underwent invasive cardiopulmonary exercise tests (iCPET) to evaluate dyspnea of unclear etiology who had evidence of SDB defined as an apnea hypopnea index (AHI) > 5 events/hour during a formal sleep study done within 3 years of the iCPET. Mean pulmonary artery pressure (mPAP) and mean wedge pressure (mPW) were indexed to cardiac output (CO) during exercise, with a mPAP-CO slope > 3 mmHg·min·L(-1) and a mPW-CO slope > 2 mmHg·min·L(-1) indicating an abnormal pulmonary vascular (PV) response to exercise. Results: A total of 120 patients (mean±SD age 58.2 ± 12.6 years, body mass index 31.6 ± 7.5) with SDB (mean AHI 18.9 ± 21.3) and reduced SaO2 during the sleep study (minimal SaO2: 83± 7%, percentage of sleep-time with SaO2 Conclusions: The magnitude and duration of reduced SaO2 during sleep is related to degree of impairment in exercise capacity and pulmonary hemodynamic responses to exercise among patients with dyspnea on exertion. Persistent low nocturnal SaO2 correlates better than AHI with impaired PV response to exercise.
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Introduction: Athletes may have electrocardiographic (ECG) repolarization abnormalities during stress test suggestive for ischemia in the absence of ischemic coronary artery disease. These alterations can be related to a certain degree of... more
Introduction: Athletes may have electrocardiographic (ECG) repolarization abnormalities during stress test suggestive for ischemia in the absence of ischemic coronary artery disease. These alterations can be related to a certain degree of septal hypertrophy often associated to intensive training. Global longitudinal strain (GLS) by speckle tracking is a novel technique able to detect segmental alterations in myocardial contractility even in presence of a preserved ventricular function. Hypothesis: GLS might be altered in athletes with ECG repolarization abnormalities at the stress test compared to hypertensive patients with the same degree of septal hypertrophy. Methods: 735 consecutive subjects (mean age 53±12.5 yrs) were enrolled. At the screening stress test, 23 (19 M, 4 F) were found to have ECG repolarization abnormalities suggestive for ischemia in the presence of normal coronary vessels at the multi-slice computed tomography. They were compared to a control group of 10 hypertensive patients (9 M, 1...
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The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally... more
The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the function...
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There is limited information about coronavirus disease 2019 (COVID-19) in the pediatric population. Preliminary data suggest a not insignificant prevalence of cardiac involvement. Here, we report our early experience with COVID-19 in the... more
There is limited information about coronavirus disease 2019 (COVID-19) in the pediatric population. Preliminary data suggest a not insignificant prevalence of cardiac involvement. Here, we report our early experience with COVID-19 in the pediatric population. These patients display exceptionally high levels of acute-phase reactants. The clinical syndrome in these patients is somewhat similar to Kawasaki disease with or without myocardial involvement. In some cases, the presentation mimics typical myocarditis. Severe myocardial involvement is associated with transient electrocardiographic and echocardiographic abnormalities. These findings may be due to the cardiotropic nature of the virus or may be the result of an immunologic response to the infection.
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Introduction: Physical activity is recognised as an important intervention in patients with CHD. However, more data on the actual magnitude of physical training impact on functional capacity in this group of patients are still warranted.... more
Introduction: Physical activity is recognised as an important intervention in patients with CHD. However, more data on the actual magnitude of physical training impact on functional capacity in this group of patients are still warranted. We aim to assess effort tolerance in a contemporary cohort of patients with congenital heart disease, regularly following a training programme, in comparison with a matched control group. Methods: Patients with CHD followed at the sports medicine department, who had undergone cardiopulmonary exercise test between 2011 and 2019, were included. Variables recorded were maximum workload, absolute and indexed maximum oxygen consumption, maximum heart rate, absolute and indexed maximum O2 pulse, ventilatory equivalent of CO2 and oxygen consumption/Work. Trend of cardiopulmonary parameters was analysed over time. Maximal workload, maximum oxygen consumption and ventilatory equivalent of CO2 were compared with a control group of patients with a more sedenta...
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The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The... more
The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All ...
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Introduction: Data on the exercise hemodynamic performance of the right ventricle (RV) in patients undergoing mitral valve surgery (MVS) for chronic ischemic mitral regurgitation (CIMR) are sparse....
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Research Interests: Management, Surgery, Mortality, Medicine, Classification, and 15 moreGuidelines, Clinical Sciences, Valvular Heart Disease, Respiratory System, Science Technology, Aneurysm, Aortic Valve, HUMAN MEDICINE, Thoracic and cardiovascular surgery, Mitral regurgitation, Valve replacement, Life Sciences & Biomedicine, Aortic Valve Replacement, Cardiovascular medicine and haematology, and ascending aorta
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Research Interests: Cardiology, Cardiac Surgery, Heart Failure, Humans, Chronic Disease, and 15 moreFemale, Clinical Sciences, Aged, C reactive protein, Chronic Heart Failure, Circulation, Albuminuria, Ejection Fraction, Cardiac failure, Creatinine, Brain Natriuretic Peptide, Central Sleep Apnea, excretion, Apnea hypopnea index, and Cardiovascular medicine and haematology
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Research Interests: Philosophy and Medicine
Introduction: mitral valve replacement (MVR) with chordal-sparing represents a valuable alternative surgical option for the treatment of chronic ischaemic mitral regurgitation (CIMR). However, the long-term hemodynamic performance and... more
Introduction: mitral valve replacement (MVR) with chordal-sparing represents a valuable alternative surgical option for the treatment of chronic ischaemic mitral regurgitation (CIMR). However, the long-term hemodynamic performance and functional capacity of biological versus mechanical prostheses in patients treated for CIMR is still unknown.The purpose of this study was to compare, in patients undergoing MVR and coronary revascularization, the hemodynamics and functional capacity between the two types of prostheses, using exercise stress echocardiography and six-minute walking test (6-MWT). Methods: we analyzed 86 consecutive patients who received MVR with either biological (n=41) or mechanical (n=45) prostheses, for CIMR. All patients underwent both preoperative and postoperative (at 32±13 months) resting and exercise stress echocardiography and 6-MWT. The mean age was 63.5±3.8 years. There was no significant difference between the 2 groups regarding baseline demographic, clinical...
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AimsWe aim to assess the reproducibility of QRS fragmentation (fQRS) on a multi‐centre dataset of patients with acute myocarditis (AM), including a histopathological validation in a subgroup with biopsy‐proven disease. Electrocardiogram... more
AimsWe aim to assess the reproducibility of QRS fragmentation (fQRS) on a multi‐centre dataset of patients with acute myocarditis (AM), including a histopathological validation in a subgroup with biopsy‐proven disease. Electrocardiogram (ECG) in patients with myocarditis is usually considered aspecific. ST changes and conduction anomalies have been commonly reported so far. We have previously described fQRS in patients with AM.Methods and resultsPatients admitted between 2008 and 2019 in two centres with a diagnosis of AM were included. Standard ECG, echocardiography, and cardiac magnetic resonance (CMR) findings were recorded at baseline and at follow‐up (FU). Eighty patients were analysed, 66 men (82%), with median age of 34 (26–43) years. Twenty‐two patients had biopsy‐proven AM. At presentation, 61 patients (76%) displayed fQRS. Median ejection fraction (EF) was 55% (43–60). Seventy‐two patients (90%) underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showe...
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We are currently in an era of change in management and shared decision-making for heart valve disease. Aortic valve surgery in non-elderly patients represents a very challenging patient population. Their high level of physical activity... more
We are currently in an era of change in management and shared decision-making for heart valve disease. Aortic valve surgery in non-elderly patients represents a very challenging patient population. Their high level of physical activity places haemodynamic demands on the valve. Their post-operative quality of life is extremely important, and must be compatible with their professional and personal lifestyle. More importantly, the younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be. This fact alone poses the biggest challenge to any aortic valve procedure - i.e. longer anticipated life expectancy means longer exposure to valve-related complications such as degeneration, need for re-operation, bleeding and thromboembolism. Unlike what is found in older patients, aortic insufficiency (AI) is very common in the younger aortic valve patients. More than 50% of AI cases are in patients under the age of 50 years, and these patients with AI have an impaired survival compared to those with aortic stenosis.1.
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The aim is to investigate autonomic nervous system imbalance in hypertrophic cardiomyopathy (HCM) by combining echocardiographic morphological and functional parameters with the analysis of the autonomic responses to orthostatic stress. A... more
The aim is to investigate autonomic nervous system imbalance in hypertrophic cardiomyopathy (HCM) by combining echocardiographic morphological and functional parameters with the analysis of the autonomic responses to orthostatic stress. A 10-min tilting test and a transthoracic echocardiogram focused on ventricular septal systolic (S wave) and diastolic function (isovolumic relaxation time) were performed. Low frequency on high frequency ratio (LF/HF) and RR variation (variation of beat to beat intervals) in response to passive orthostatism were used as measures of sympathetic reflex activation [delta LF/HF (D-LF/HF) and delta RR (DRR), respectively]. Brain natriuretic peptide was measured. A total of 50 HCM patients were categorized in two groups: D-LF/HF more than 0 (group 1, sympathetic response) and D-LF/HF 0 or less (group 2, parasympathetic response). Patients in group 2 had higher New York Heart Association class, a more frequent history of atrial fibrillation (38 versus 9% P...
Research Interests: Cardiology, Biomarkers, Medicine, Cardiovascular Medicine, Autonomic Nervous System, and 15 moreHumans, Internal Medicine, Female, Male, Heart rate, Heart, Posture, Middle Aged, Adult, Reflex, Sympathetic Nervous System, Hypertrophic Cardiomyopathy, Predictive value of tests, Orthostatic intolerance, and Diastole
Introduction: mitral valve replacement (MVR) with chordal-sparing represents a valuable alternative surgical option for the treatment of chronic ischaemic mitral regurgitation (CIMR). However, the long-term hemodynamic performance and... more
Introduction: mitral valve replacement (MVR) with chordal-sparing represents a valuable alternative surgical option for the treatment of chronic ischaemic mitral regurgitation (CIMR). However, the long-term hemodynamic performance and functional capacity of biological versus mechanical prostheses in patients treated for CIMR is still unknown.The purpose of this study was to compare, in patients undergoing MVR and coronary revascularization, the hemodynamics and functional capacity between the two types of prostheses, using exercise stress echocardiography and six-minute walking test (6-MWT). Methods: we analyzed 86 consecutive patients who received MVR with either biological (n=41) or mechanical (n=45) prostheses, for CIMR. All patients underwent both preoperative and postoperative (at 32±13 months) resting and exercise stress echocardiography and 6-MWT. The mean age was 63.5±3.8 years. There was no significant difference between the 2 groups regarding baseline demographic, clinical...
The ductus arteriosus is a physiological structure allowing shunt of blood from the pulmonary artery to the descending aorta during fetal life (unventilated lung). The incidence of isolated patent ductus arteriosus (PDA) in children born... more
The ductus arteriosus is a physiological structure allowing shunt of blood from the pulmonary artery to the descending aorta during fetal life (unventilated lung). The incidence of isolated patent ductus arteriosus (PDA) in children born at term is about 1 per 2000 live births, accounting for 5-10% of all congenital heart defects. The pathophysiological significance and management of PDA vary according to the clinical context (isolated anomaly or as part of complex congenital heart disease), magnitude of the shunt, and stadium within the natural history. This review summarizes the embryogenetic, pathophysiological, clinical and therapeutic basic concepts for an updated approach to this particular heart disease commonly seen even by the cardiologist of the adult.
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Research Interests: Cardiology, Evidence Based Medicine, Critical Appraisal, Medicine, Multivariate Analysis, and 15 moreHeart Failure, Humans, Chronic Disease, Female, Male, Prognosis, Intensive Care Medicine, Risk Assessment, Proportional Hazards Models, Logistic Models, Area Under Curve, Combined Modality Therapy, Acute Disease, Randomized Controlled Trials as Topic, and Cardiovascular medicine and haematology
Research Interests: European Union, Medicine, Comorbidity, Humans, Female, and 15 moreMale, Risk factors, Diagnostic Imaging, Aged, Middle Aged, Percutaneous Coronary Intervention, Coronary Angiography, Coronary heart disease, Angina pectoris, Prognosis, Coronary Circulation, Risk Factors, Disease Management, Angina, and physical exertion
A 25-year-old woman with drug-refractory permanent junctional reciprocating tachycardia (PJRT) and a previous failed ablation, was referred to our institution. Electrophysiological study confirmed the diagnosis of orthodromic... more
A 25-year-old woman with drug-refractory permanent junctional reciprocating tachycardia (PJRT) and a previous failed ablation, was referred to our institution. Electrophysiological study confirmed the diagnosis of orthodromic atrioventricular reentry tachycardia using a slowly conducting accessory pathway. This accessory pathway was successfully ablated by conventional radiofrequency at the left anteroseptal region using a transseptal approach. Catheter ablation of this accessory pathway (Coumel type) at the mitral annulus-aorta junction offers insights on a rare anatomical location of PJRT.
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The review aims to discuss the role of nerve growth factor (NGF) as a potential novel biomarker in post-myocardial infarction (MI) and in heart failure (HF), with a specific focus on neural remodeling and sprouting processes occurring... more
The review aims to discuss the role of nerve growth factor (NGF) as a potential novel biomarker in post-myocardial infarction (MI) and in heart failure (HF), with a specific focus on neural remodeling and sprouting processes occurring after tissue damage. Many experimental data show that MI induces nerve sprouting, leading to increased sympathetic outflow and higher risk of ventricular arrhythmias and sudden cardiac death. In this framework, cardiac and circulating NGF might be an indicator of the innervation process and neural remodeling: it dramatically increases after MI, while it declines along with advanced HF and ventricular dysfunction. The bimodal behavior of NGF in acute and chronic settings leads to the speculation that NGF modulation may be a pharmacological target for intervention in different stages of the ischemic heart disease. Specifically, a fascinating possibility is to support or to inhibit NGF receptors, in order to prevent negative cardiac remodeling after MI and consequent ventricular dysfunction.
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In this paper, we present an exploratory study on the potential impact of holographic heart models and mixed reality technology on medical training, and in particular in teaching complex Congenital Heart Diseases (CHD) to medical... more
In this paper, we present an exploratory study on the potential impact of holographic heart models and mixed reality technology on medical training, and in particular in teaching complex Congenital Heart Diseases (CHD) to medical students. Fifty-nine medical students were randomly allocated into three groups. Each participant in each group received a 30-minute lecture on a CHD condition interpretation and transcatheter treatment with different instructional tools. The participants of the first group attended a lecture in which traditional slides were projected onto a flat screen (group “regular slideware”, RS). The second group was shown slides incorporating videos of holographic anatomical models (group “holographic videos”, HV). Finally, those in the third group wore immersive, head-mounted devices (HMD) to interact directly with holographic anatomical models (group “augmented reality”, AR). At the end of the lecture, the members of each group were asked to fill in a multiple-choi...
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