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Zheng WC, Buratto E, Caldaroni F, Ishigami S, Konstantinov IE, d'Udekem Y. T-Remodeling of the Pulmonary Artery Bifurcation for Pulmonary Artery Origin Stenosis. World J Pediatr Congenit Heart Surg 2023; 14:716-722. [PMID: 37933694 DOI: 10.1177/21501351231181109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Various surgical techniques are utilized for reconstructing hypoplastic pulmonary arteries (PAs) in patients with conotruncal anomalies and at times, may be susceptible to restenosis and reoperation. We reviewed our experience with a simple technique of T-shaped remodeling of the PA bifurcation. METHODS Between 2005 and 2019, 31 patients underwent T-remodeling of central PAs by a single cardiac surgeon. The PA bifurcation was opened cranially, and the opening was augmented with an oval-shaped patch effectively transforming the V-shaped bifurcation into a T-shaped bifurcation. Both origins of the PAs were enlarged, even in the instance of single PA origin stenosis. RESULTS Median age at time of T-remodeling was 17 months (range: 7 weeks to 14 years). The following cardiac morphologies were observed: tetralogy of Fallot (n = 12, 39%), pulmonary atresia with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (n = 8, 26%), truncus arteriosus (n = 6, 19%), pulmonary atresia with VSD (n = 3, 9.7%), and transposition of the great arteries (n = 2, 6.5%). Thirteen patients (42%) had previous central shunt, and eight patients (26%) had previous modified Blalock-Taussig shunt. There were no operative mortalities. Immediately after T-remodeling, echocardiographic estimates of right ventricle to PA gradient decreased from 42 [interquartile range 28-58] mm Hg to 20 [12-36] mm Hg (P = .03). Freedom from reoperation on the PA bifurcation for the entire cohort was 100% at one year, 88% (95% CI 68%-96%) at five years and 82% (57%-93%) at ten years. CONCLUSIONS T-remodeling for PA origin stenosis is a safe procedure with excellent freedom from reoperation that is easily reproducible and applicable to patients with all cardiac morphologies.
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Affiliation(s)
- Wayne C Zheng
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Edward Buratto
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Federica Caldaroni
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Shuta Ishigami
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA
- Children's National Heart Institute, Washington, DC, USA
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Caldaroni F, Chessa M, Varrica A, Giamberti A. Multimodal Imaging with 3D-Holograms for Preoperative Planning in Pediatric Cardiac Surgery: A Unique Case Report. CONGENIT HEART DIS 2022. [DOI: 10.32604/chd.2022.019119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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3
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Giamberti A, Caldaroni F, Varrica A, Pace Napoleone C, Marianeschi SM, Uricchio N, Vanini V, Santoro F, Luciani GB, Stellin G, Gargiulo G, Murzi B, Filippelli S, Oppido G, Agati S, Galletti L, Frigiola A. Impact of COVID-19 Pandemic on the Italian Humanitarian Congenital Cardiac Surgery Activity: What No One Tells You. Front Cardiovasc Med 2021; 8:705029. [PMID: 34395564 PMCID: PMC8355370 DOI: 10.3389/fcvm.2021.705029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/25/2023] Open
Abstract
More than 4 millions of children with congenital heart disease (CHD) are waiting for cardiac surgery around the world. Few of these patients are treated only thanks to the support of many non-governmental organizations (NGOs). Starting in December 2019, the so-called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic and has dramatically impacted on all the international humanitarian activities for congenital heart disease. We analyzed data from all the Italian congenital cardiac surgery centers with the aim to quantify the impact of the pandemic on their charities. Fifteen Italian centers participated in the study and contributed to data collection. We analyzed and compared data regarding humanitarian activities carried out abroad and on site from two periods: year 2019 (pre-COVID-19) and year 2020 (COVID-19 pandemic). In 2019, 53 international missions were carried out by Italian congenital cardiac surgeons, resulting in the treatment of 471 CHD patients. In the same period 11 Italian cardiac centers operated on 251 foreign patients in Italy. In 2020, the pandemic led to a reduction of this activity by 96% for the surgery performed overseas and 86% for the interventions carried out in Italy. In conclusion our study shows the important quantitative impact of the pandemic on the Italian humanitarian cardiac surgical activity overseas and in Italy. This shocking result highlights the failure of the systems adopted so far to solve the problem of CHD in developing countries.
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Affiliation(s)
- Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Nicola Uricchio
- Cardiac Surgery, Aziende Socio Sanitarie Territoriali (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | | | - Francesco Santoro
- Missioni Cardio Chirurgiche Internazionali, Gaslini Pediatric Hospital, Genova, Italy
| | - Giovanni Battista Luciani
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gaetano Gargiulo
- Pediatric and Grown-up Congenital Cardiac Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guido Oppido
- Congenital Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Salvatore Agati
- Centro Cardiologico Pediatrico del Mediterraneo - Bambino Gesù, "San Vincenzo" Hospital, Taormina, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
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4
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Caldaroni F, Brizard CP, d'Udekem Y. Replacement of the Mitral Valve Under One Year of Age: Size Matters. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:57-61. [PMID: 34116783 DOI: 10.1053/j.pcsu.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
Surgical management of mitral valve disease in neonates and infants is challenging. When repair is no longer feasible, replacement may become inevitable, but should only be considered as an option of last resort due to the remarkably high rate of associated morbidity and mortality. Mechanical valves are the preferred choice in large annuli, while stented conduits seem promising in smaller ones. In patients with a preoperative mitral valve annulus equal or larger than 15-16 mm, an intra-annular placement of the smallest mechanical valve available should be attempted. In patients with smaller annuli, the placement of a stented valved conduit seems to display a lower mortality risk. Supra-annular implantation of prostheses should be reserved for exceptional cases and to those familiar with this technique because of the high rate of associated complications.
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Affiliation(s)
- Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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Caldaroni F, d'Udekem Y. Commentary: Spinach for Popeye, autogenous mitochondria for us!! J Thorac Cardiovasc Surg 2020; 162:e123-e124. [PMID: 33972117 DOI: 10.1016/j.jtcvs.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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d'Udekem Y, Caldaroni F. Commentary: Just Open the Restrictive Atrial Septum of Single Ventricles … Surgically Please! Semin Thorac Cardiovasc Surg 2020; 32:529-530. [PMID: 32376466 DOI: 10.1053/j.semtcvs.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
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Caldaroni F, d'Udekem Y. Commentary: Hands off the pulmonary veins! J Thorac Cardiovasc Surg 2020; 160:791-792. [PMID: 32241606 DOI: 10.1016/j.jtcvs.2020.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
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8
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Konstantinov IE, Caldaroni F, Ivanov Y. Commentary: Prediction of pulmonary root dilatation after Ross operation—The power of protein shake? J Thorac Cardiovasc Surg 2020; 159:635-636. [DOI: 10.1016/j.jtcvs.2019.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/15/2022]
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9
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d'Udekem Y, Caldaroni F. Commentary: No blame! Let us look at our work without pointing fingers. J Thorac Cardiovasc Surg 2020; 160:224-225. [PMID: 31926724 DOI: 10.1016/j.jtcvs.2019.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
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Varrica A, Caldaroni F, Saitto G, Satriano A, Lo Rito M, Chiarello C, Ranucci M, Frigiola A, Giamberti A. Outcomes and Quality of Life After Ross Reintervention: Would You Make the Same Choice Again? Ann Thorac Surg 2019; 110:214-220. [PMID: 31770502 DOI: 10.1016/j.athoracsur.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/27/2019] [Accepted: 10/02/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Ross procedure was introduced as a long-term if not definitive solution for aortic pathology. However, the rate of reoperation is not negligible. METHODS This single-center prospective study assessed the general outcome of Ross reoperation and patients' perceived quality of life compared with 2 control groups (Ross non-reoperation and mechanical aortic valve replacement). Patient's preference regarding the choice between mechanical aortic valve and Ross procedure was investigated in a subgroup that could theoretically have been directed to either of the 2 procedures. RESULTS Between 2005 and 2017, 64 consecutive patients underwent reoperation after Ross. Median age was 31 years. Median freedom from reoperation after the Ross procedure was 136 months. An autograft reoperation was required in 49, and 25 had homograft failure. No in-hospital death was recorded. Mean follow-up was 77 months (range, 6-164 months). Quality of life was assessed with the 36-Item Short Form Health Survey questionnaire. The Ross reoperation group showed a lower score involving psychological concerns compared with the other groups. In the reoperated-on patients group, 52 had adequate aortic annulus dimensions to receive a prosthetic valve instead of a Ross procedure. When asked whether they would make the same choice, only 31% confirmed the preference. CONCLUSIONS Reoperations after Ross procedure have low mortality and morbidity. Long-term follow-up showed a high quality of life, even after reoperations. However, owing to psychological concerns after the redo operation, when choosing a Ross procedure, it is our duty to thoroughly explain to patients that a high level of disillusion is predictable in case of reoperations.
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Affiliation(s)
- Alessandro Varrica
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy.
| | - Federica Caldaroni
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
| | - Guglielmo Saitto
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
| | - Angela Satriano
- Anesthesia and Intensive Care Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
| | - Carmelina Chiarello
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Ranucci
- Anesthesia and Intensive Care Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Donato, San Donato Milanese, Italy
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Agati S, Secinaro A, Caldaroni F, Calvaruso D, Manuri L, Gitto P, Ferro G, Anderson R, Vouhè PR, Zanai R, Campanella I. Perfusion Study Helps in the Management of the Intraseptal Course of an Anomalous Coronary Artery. World J Pediatr Congenit Heart Surg 2019; 10:360-363. [PMID: 31084306 DOI: 10.1177/2150135119829004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.
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Affiliation(s)
- Salvatore Agati
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Aurelio Secinaro
- 2 Imaging Department-"Bambino Gesù" Pediatric Hospital, Rome, Italy
| | | | - Davide Calvaruso
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Lucia Manuri
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Placido Gitto
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Giuseppe Ferro
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Robert Anderson
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pascal R Vouhè
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosanna Zanai
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Ivana Campanella
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
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Caldaroni F, Lo Rito M, Saracino A, Varrica A, Giugno L, Giamberti A, Frigiola A. Surgical Rescue After Failed Percutaneous Closure of an Aorto-Atrial Tunnel. World J Pediatr Congenit Heart Surg 2019; 11:NP232-NP234. [PMID: 31006348 DOI: 10.1177/2150135118802802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital sinus of Valsalva aneurysm is a rare disorder, mostly involving the right and noncoronary sinuses, in which intracardiac rupture is more likely foreseen into the right chambers. Because of the unfavorable prognosis, which includes heart failure and sudden death, detection itself is an indication for treatment, which may be performed either surgically or percutaneously. We present a case of a four-year-old patient with aorto-right atrial tunnel, in which a transcatheter attempt of closure was performed, complicated by new onset of aortic valve regurgitation, requiring surgical intervention.
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Affiliation(s)
- Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Antonio Saracino
- Department of Pediatric Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Luca Giugno
- Department of Pediatric Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
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13
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Padalino MA, Franchetti N, Sarris GE, Hazekamp M, Carrel T, Frigiola A, Horer J, Roussin R, Cleuziou J, Meyns B, Fragata J, Telles H, Polimenakos AC, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Vedovelli L, Protopapas E, Tumbarello R, Merola A, Pegoraro C, Motta R, Boccuzzo G, Sojak V, Rito ML, Caldaroni F, Corrado D, Basso C, Stellin G. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol 2019; 291:189-193. [PMID: 30772012 DOI: 10.1016/j.ijcard.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. METHODS This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. RESULTS Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). CONCLUSIONS Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
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Affiliation(s)
- Massimo A Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy.
| | - Nicola Franchetti
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - George E Sarris
- Athens Heart Surgery Institute and Iaso Children's Hospital, Athens, Greece
| | - Mark Hazekamp
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Jurgen Horer
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | - Regine Roussin
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jose Fragata
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Helena Telles
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Anastasios C Polimenakos
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta, GA, USA
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Jukka Salminen
- Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | | | - Matej Nosal
- Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases - Childrens Heart Center, Bratislava, Slovakia
| | - Luca Vedovelli
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | | | | | - Assunta Merola
- Division of Pediatric Cardiology, Ospedale Brotzu, Cagliari, Italy
| | - Cinzia Pegoraro
- Division of Sport Medicine, Ospedale Ca Foncello, Treviso, Italy
| | - Raffaella Motta
- Radiology Clinic, University of Padova, Medical School, Italy
| | - Giovanna Boccuzzo
- Department of Statistics, University of Padova, Medical School, Italy
| | - Vladimir Sojak
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Domenico Corrado
- Section of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Cristina Basso
- Section of Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Giovanni Stellin
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
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Caldaroni F, Lo Rito M, Chessa M, Varrica A, Micheletti A, Pappone C, Giamberti A. Surgical ablation of ventricular tachycardia in patients with repaired tetralogy of Fallot†. Eur J Cardiothorac Surg 2018; 55:845-850. [DOI: 10.1093/ejcts/ezy407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- Department of Pediatric Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Micheletti
- Department of Pediatric Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo Pappone
- Department of Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Caldaroni F, Rito ML, Varrica A, Chessa M, Micheletti A, Pappone C, Giamberti A. OC44 VENTRICULAR TACHYCARDIA SURGICAL ABLATION IN REPAIRED TETRALOGY OF FALLOT PATIENTS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549869.79943.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Caldaroni F, Nevvazhay T, Vladimir S, Hazekamp M. Subclavicular arteriovenous fistula for univentricular heart palliation. Multimed Man Cardiothorac Surg 2018; 2018. [PMID: 30070780 DOI: 10.1510/mmcts.2018.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Creation of a subclavicular arteriovenous fistula is a minimally invasive procedure that provides an additional source of arterial blood flow to the pulmonary arteries in patients who have a Glenn shunt but are unsuitable for or at high risk for Fontan completion.
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Irace FG, Rose D, D'Ascoli R, Caldaroni F, Andriani I, Piscioneri F, Vitulli P, Piattoli M, Tritapepe L, Greco E. Video assistance in mitral surgery: reaching the "Thru" port access. J Vis Surg 2015; 1:13. [PMID: 29075603 DOI: 10.3978/j.issn.2221-2965.2015.10.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20th. Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. METHODS Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. RESULTS Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or special atrial retractors all standard techniques are used in this setting. CONCLUSIONS The literature reports and our published results showed the technique is safe, easy to replicate and allows an excellent rate of valve repair even in more complex patients.
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Affiliation(s)
- Francesco G Irace
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - David Rose
- Department of Cardiothoracic, Lancashire Cardiac Centre, Blackpool Victoria Teaching Hospital, Blackpool FY3 8NR, UK
| | - Riccardo D'Ascoli
- Department of Cardiac Surgery, Ospedale dell'Angelo, Mestre, 30174 Venice, Italy
| | - Federica Caldaroni
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Ines Andriani
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Fernando Piscioneri
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Piergiusto Vitulli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - Matteo Piattoli
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Luigi Tritapepe
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
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Lorusso R, Centofanti P, Gelsomino S, Barili F, Di Mauro M, Orlando P, Botta L, Milazzo F, Actis Dato G, Casabona R, Casali G, Musumeci F, De Bonis M, Zangrillo A, Alfieri O, Pellegrini C, Mazzola S, Coletti G, Vizzardi E, Bianco R, Gerosa G, Massetti M, Caldaroni F, Pilato E, Pacini D, Di Bartolomeo R, Marinelli G, Sponga S, Livi U, Mauro R, Mariscalco G, Beghi C, Miceli A, Glauber M, Pappalardo F, Russo CF. Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience. Ann Thorac Surg 2015; 101:919-26. [PMID: 26518372 DOI: 10.1016/j.athoracsur.2015.08.014] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/31/2015] [Accepted: 08/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. METHOD From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. RESULTS Mean VA-ECMO support was 9.9 ± 19 days (range, 2 to 24 days). Cardiac recovery with ECMO weaning was achieved in 43 patients (75.5%), major complications were observed in 40 patients (70.1%), and survival to hospital discharge occurred in 41 patients (71.9%). After hospital discharge (median follow-up, 15 months) there were 2 late deaths. The 5-year actual survival was 65.2% ± 7.9%, with recurrent self-recovering myocarditis observed in 2 patients (at 6 and 12 months from the first AFM event), and 1 heart transplantation. CONCLUSIONS Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events.
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Affiliation(s)
- Roberto Lorusso
- Cardiac Surgery Unit, Spedali Civili Hospital, Brescia, Italy.
| | | | - Sandro Gelsomino
- Cardiovascular Research Centre, Careggi Hospital, Florence, Italy
| | - Fabio Barili
- Cardiac Surgery Unit, S. Anna Hospital, Cuneo, Italy
| | | | - Parise Orlando
- Cardiovascular Research Centre, Careggi Hospital, Florence, Italy
| | - Luca Botta
- Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gino Gerosa
- Cardiac Surgery Unit, University Hospital, Padua, Italy
| | | | | | | | | | | | | | | | | | | | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | | | - Antonio Miceli
- Pasquinucci Hospital Fondazione Monasterio, Massa, Italy
| | - Mattia Glauber
- Pasquinucci Hospital Fondazione Monasterio, Massa, Italy
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