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Oliva OA, Giugno L, Moroni A, Sturla F, Piazza L, Saracino A, Micheletti A, d'Aiello AF, Reali M, Chessa M, Carminati M. Right disc thrombosis of the new Gore Cardioform ASD Occluder. Catheter Cardiovasc Interv 2024; 103:741-750. [PMID: 38451154 DOI: 10.1002/ccd.31002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The GCA is a well performing device in terms of efficacy despite complex anatomies (aortic rim <5 mm and ASD diameter >17 mm) with a good safety profile. AIMS To evaluate atrial septal defect (ASD) features impacting on right disc device thrombosis in patients who underwent Gore Cardioform ASD Occluder (GCA) implantation. METHODS A total of 44 consecutive patients undergoing percutaneous ASD with GCA device from January 2020 to September 2022 at our tertiary care Center were evaluated. The minimum follow-up was 6 months. RESULTS The patients were stratified in two groups according to a cut-off value of ASD diameter equal to 20 mm at sizing balloon, derived from ROC analysis (AUC = 0.894; p = 0.024). Baseline characteristics were comparable between groups in terms of age, sex, weight, height, and interatrial septum dimensions. Patients with ASD > 20 mm (n = 9) had a higher ASD/device dimension ratio, both at echocardiography (p = 0.009) and at sizing balloon (p = 0.001), longer fluoroscopic time (p = 0.022), and higher incidence of device thrombosis (0.006). Right disc thrombosis was observed in three patients of the ASD > 20 mm group, always in the inferior portion of the right disc. On univariate analysis, ASD diameter at sizing balloon (OR 1.360; p = 0.036) was the only positive predictor of device thrombosis. CONCLUSIONS Right disc thrombosis of the GCA device may be under-recognized at follow-up, hence deserving clinical attention, especially in those patients with larger ASD diameters.
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Affiliation(s)
- Omar A Oliva
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Giugno
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Moroni
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Luciane Piazza
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Micheletti
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Fabio d'Aiello
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Reali
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Hascoët S, Bentham JR, Giugno L, Betrián-Blasco P, Kempny A, Houeijeh A, Baho H, Sharma SR, Jones MI, Biernacka EK, Combes N, Georgiev S, Bouvaist H, Martins JD, Kantzis M, Turner M, Schubert S, Jalal Z, Butera G, Malekzadeh-Milani S, Valdeolmillos E, Karsenty C, Ödemiş E, Aldebert P, Haas NA, Khatib I, Wåhlander H, Gaio G, Mendoza A, Arif S, Castaldi B, Dohlen G, Carere RG, Del Cerro-Marin MJ, Kitzmüller E, Hermuzi A, Carminati M, Guérin P, Tengler A, Fraisse A. Outcomes of transcatheter pulmonary SAPIEN 3 valve implantation: an international registry. Eur Heart J 2024; 45:198-210. [PMID: 37874971 DOI: 10.1093/eurheartj/ehad663] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND AIMS Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract (RVOT) dysfunction related to congenital heart disease (CHD). Outcomes of TPVI with the SAPIEN 3 valve that are insufficiently documented were investigated in the EUROPULMS3 registry of SAPIEN 3-TPVI. METHODS Patient-related, procedural, and follow-up outcome data were retrospectively assessed in this observational cohort from 35 centres in 15 countries. RESULTS Data for 840 consecutive patients treated in 2014-2021 at a median age of 29.2 (19.0-41.6) years were obtained. The most common diagnosis was conotruncal defect (70.5%), with a native or patched RVOT in 50.7% of all patients. Valve sizes were 20, 23, 26, and 29 mm in 0.4%, 25.5%, 32.1%, and 42.0% of patients, respectively. Valve implantation was successful in 98.5% [95% confidence interval (CI), 97.4%-99.2%] of patients. Median follow-up was 20.3 (7.1-38.4) months. Eight patients experienced infective endocarditis; 11 required pulmonary valve replacement, with a lower incidence for larger valves (P = .009), and four experienced pulmonary valve thrombosis, including one who died and three who recovered with anticoagulation. Cumulative incidences (95%CI) 1, 3, and 6 years after TPVI were as follows: infective endocarditis, 0.5% (0.0%-1.0%), 0.9% (0.2%-1.6%), and 3.8% (0.0%-8.4%); pulmonary valve replacement, 0.4% (0.0%-0.8%), 1.3% (0.2%-2.4%), and 8.0% (1.2%-14.8%); and pulmonary valve thrombosis, 0.4% (0.0%-0.9%), 0.7% (0.0%-1.3%), and 0.7% (0.0%-1.3%), respectively. CONCLUSIONS Outcomes of SAPIEN 3 TPVI were favourable in patients with CHD, half of whom had native or patched RVOTs.
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Affiliation(s)
- Sebastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - James R Bentham
- Leeds Teaching Hospitals NHS Trust, Yorkshire Heart Centre, Leeds, UK
| | - Luca Giugno
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Pedro Betrián-Blasco
- Hospital Universitario Vall d'Hebron, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Aleksander Kempny
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Ali Houeijeh
- Centre Hospitalier Universitaire de Lille, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 2 Av. Oscar Lambret, 59000 Lille, France
| | - Haysam Baho
- King Faisal Specialist Hospital, Department of Paediatric Cardiology and Adults with congenital heart diseases, Jeddah, Saudi Arabia
| | - Shiv-Raj Sharma
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Matthew I Jones
- Evelina London Children's Hospital & St Thomas' Hospital, Departement of Paediatric Cardiology and Adults with Congenital Heart Diseases, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | - Elżbieta Katarzyna Biernacka
- Cardinal Stefan Wyszyński Institute of Cardiology, Department of Congenital Heart Diseases, Alpejska 42, 04-628 Warsaw, Poland
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Clinique Pasteur, Department of Cardiology, 31000 Toulouse, France
| | - Stanimir Georgiev
- Department of Congenital Heart Disease and Pediatric Cardiogy, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jose Diogo Martins
- Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central-EPE, Lisbon, Portugal
| | - Marinos Kantzis
- Glenfield Hosp, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Leicester, United Kingdom
| | - Mark Turner
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Stephan Schubert
- Centre for Congenital Heart Defects, Heart and Diabetes Centre Universitario North Rhine Westphalia, Department for Congenital Heart Defects, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Zakaria Jalal
- Pediatric and congenital heart diseases department, Bordeaux University Hospital, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, CRCTB INSERM U1045, Bordeaux, France
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - Clement Karsenty
- CHU Hôpital des enfants, Department of Paediatric Cardiology, Toulouse, France
| | - Ender Ödemiş
- Koç University Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Davutpaşa Cd, 34010 Istanbul, Turkey
| | - Philippe Aldebert
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, 278 rue Saint-Pierre, 13385 Marseille, France
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Ihab Khatib
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Rambam Healthcare Campus, Haifa, Israel
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israël
| | - Håkan Wåhlander
- Paediatric Heart Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital and Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gianpiero Gaio
- Paediatric Cardiology, Ospedali dei Colli, Luigi Vanvitelli University of Campania, Str. Vicinale Reggente, 66/82, 80131 Naples, Italy
| | - Alberto Mendoza
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Av de Cordoba s/n, 28041 Madrid, Spain
| | - Sayqa Arif
- University Hospital Birmingham NHS Trust, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Via VIII Febbraio, 2, 35122 Padua, Italy
| | - Gaute Dohlen
- University hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Oslo, Norway
| | - Ronald G Carere
- St Paul's Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Maria Jesus Del Cerro-Marin
- Department of Paediatric Cardiology and Adults Congenital Heart Disease, H. Ramón y Cajal University Hospital, Madrid, Spain
| | - Erwin Kitzmüller
- Vienna General Hospital (AKH), Vienna Medical University, Vienna, Austria
| | - Antony Hermuzi
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital Newcastle upon Tyne, Newcastle, United Kingdom
| | - Mario Carminati
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Patrice Guérin
- Centre Hospitalier Universitaire de Nantes, Department of Cardiology, 1 Pl. Alexis-Ricordeau, 44093 Nantes, France
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Alain Fraisse
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
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Giugno L, Formato GM, Chessa M, Votta E, Carminati M, Sturla F. Case report: Personalized transcatheter approach to mid-aortic syndrome by in vitro simulation on a 3-dimensional printed model. Front Cardiovasc Med 2023; 9:1076359. [PMID: 36704466 PMCID: PMC9871590 DOI: 10.3389/fcvm.2022.1076359] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
An 8-year-old girl, diagnosed with mid-aortic syndrome (MAS) at the age of 2 months and under antihypertensive therapy, presented with severe systemic hypertension (>200/120 mmHg). Computed tomography (CT) examination revealed aortic aneurysm between severe stenoses at pre- and infra-renal segments, and occlusion of principal splanchnic arteries with peripheral collateral revascularization. Based on CT imaging, preoperative three-dimensional (3D) anatomy was reconstructed to assess aortic dimensions and a dedicated in vitro planning platform was designed to investigate the feasibility of a stenting procedure under fluoroscopic guidance. The in vitro system was designed to incorporate a translucent flexible 3D-printed patient-specific model filled with saline. A covered 8-zig 45-mm-long Cheatham-Platinum (CP) stent and a bare 8-zig, 34-mm-long CP stent were implanted with partial overlap to treat the stenoses (global peak-to-peak pressure gradient > 60 mmHg), excluding the aneurysm and avoiding risk of renal arteries occlusion. Percutaneous procedure was successfully performed with no residual pressure gradient and exactly replicating the strategy tested in vitro. Also, as investigated on the 3D-printed model, additional angioplasty was feasible across the frames of the stent to improve bilateral renal flow. Postoperative systemic pressure significantly reduced (130/70 mmHg) as well as dosage of antihypertensive therapy. This is the first report demonstrating the use of a 3D-printed model to effectively plan percutaneous intervention in a complex pediatric MAS case: taking full advantage of the combined use of a patient-specific 3D model and a dedicated in vitro platform, feasibility of the stenting procedure was successfully tested during pre-procedural assessment. Hence, use of patient-specific 3D-printed models and in vitro dedicated platforms is encouraged to assist pre-procedural planning and personalize treatment, thus enhancing intervention success.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Maria Formato
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Facoltà di Medicina e Chirurgia, Vita Salute San Raffaele University, Milan, Italy,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, Netherlands
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy,*Correspondence: Francesco Sturla ✉
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Chessa M, Agnoletti G, Amici I, Egidy Assenza G, Butera G, Castaldi B, Donti A, d'Aiello AF, Gaio G, Giugno L, Guccione P, Limongelli G, Luciani GB, Mangia R, Marasini M, Rinelli G, Russo G, Santoro G, Saitta M, Soro L, Vairo U, Favilli S. [Proposal of a common model for informed consent for interventional procedures in congenital heart disease patients]. G Ital Cardiol (Rome) 2022; 23:433-436. [PMID: 35674033 DOI: 10.1714/3810.37939] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A multidisciplinary study group involving physicians and jurists was established to review and approve an informed consent about the most frequent interventional procedures for congenital heart diseases. METHODS The authors worked together with representatives of the Italian Society of Pediatric Cardiology and Congenital Heart Disease (SICP) Council and Jurist's expert in the field of health case-law. The final draft was shared with the major Italian centers involved in congenital interventional procedures and with AICCA, the Italian Patients Association of Congenital Heart Diseases - Adults and Children. RESULTS At the end of this review process, a final informed consent form was developed for the most frequent procedures performed in our catheterization laboratories. All of them consist of two parts: a general statement and a procedure-related one. CONCLUSIONS The work performed by this multidisciplinary study group, under the supervision of the SICP, resulted in a new dedicated informed consent about interventional procedures in the field of congenital cardiology, taking into account the new legal requests. This informed consent is intended to be both a document that can be used as such and a document from which to derive a specific document for each center. We believe that using similar informed consents in all Congenital Heart Disease Centers or at least have informed consents all inspired by the same setting, could be a further improvement in taking care of the patients and their families.
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Affiliation(s)
- Massimo Chessa
- Unità di Cardiologia del Congenito Adulto, Centro di Cardiologia Pediatrica e del Congenito Adulto, IRCCS Policlinico San Donato, San Donato Milanese (MI) - Università Vita Salute San Raffaele, Milano
| | - Gabriella Agnoletti
- S.C. Cardiologia Pediatrica e delle Cardiopatie Congenite, Città della Salute, Torino
| | - Ilaria Amici
- Studio Legale Associato Avv. Rocco Mangia, Milano
| | - Gabriele Egidy Assenza
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - U.O. Cardiologia Pediatrica e dell'Età Evolutiva, Centro per le Cardiopatie Congenite dell'Adulto Dipartimento Cardio-Toraco-Vascolare, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Gianfranco Butera
- U.O. Cardiologia Interventistica delle Cardiopatie Congenite, Dipartimento di Cardiologia, Cardiochirurgia, Trapianto Cardio-Polmonare, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Biagio Castaldi
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - U.O.C. Cardiologia Pediatrica, Azienda Ospedaliera, Università degli Studi, Padova
| | - Andrea Donti
- U.O. Cardiologia Pediatrica e dell'Età Evolutiva, Centro per le Cardiopatie Congenite dell'Adulto Dipartimento Cardio-Toraco-Vascolare, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Angelo Fabio d'Aiello
- Unità di Cardiologia del Congenito Adulto, Centro di Cardiologia Pediatrica e del Congenito Adulto, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Giampiero Gaio
- U.O.C. Cardiologia e UTIC Pediatrica, AORN dei Colli, Ospedale Monaldi, Università della Campania "L. Vanvitelli", Napoli
| | - Luca Giugno
- Unità di Cardiologia del Congenito Adulto, Centro di Cardiologia Pediatrica e del Congenito Adulto, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Paolo Guccione
- Dipartimento di Cardiologia, Cardiochirurgia, Trapianto Cardio-Polmonare, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Giuseppe Limongelli
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - U.O. Malattie Rare Cardiovascolari, AORN dei Colli, Ospedale Monaldi Università della Campania "L. Vanvitelli", Napoli
| | - Giovanni Battista Luciani
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - Unità di Cardiochirurgia Pediatrica e delle Cardiopatie Congenite, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Rocco Mangia
- Studio Legale Associato Avv. Rocco Mangia, Milano
| | | | - Gabriele Rinelli
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - Dipartimento di Cardiologia, Cardiochirurgia, Trapianto Cardio-Polmonare, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Giovannella Russo
- U.O.C. Cardiologia e UTIC Pediatrica, AORN dei Colli, Ospedale Monaldi, Università della Campania "L. Vanvitelli", Napoli
| | - Giuseppe Santoro
- U.O.C. Cardiologia Pediatrica e del Congenito Adulto, Dipartimento Pediatrico, Fondazione Monasterio, Massa
| | - Michele Saitta
- Centro Mediterraneo di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Taormina
| | - Laura Soro
- Studio Legale Associato Avv. Rocco Mangia, Milano
| | - Ugo Vairo
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - U.O.C. Cardiologia Ospedale Pediatrico Giovanni XXIII, Bari
| | - Silvia Favilli
- Società Italiana di Cardiologia Pediatrica e delle Cardiopatie Congenite - Unità di Cardiologia, Ospedale Pediatrico A. Meyer, Firenze
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Giordano M, Santoro G, Agnoletti G, Carminati M, Donti A, Guccione P, Marasini M, Milanesi O, Castaldi B, Cheli M, Formigari R, Gaio G, Giugno L, Lunardini A, Pepino C, Russo MG, Spadoni I. DATA in BRIEF of: Interventional Cardiac Catheterization in Neonatal Age: Results in a Multi-centre Italian Experience. Data Brief 2020; 31:105694. [PMID: 32490073 PMCID: PMC7256460 DOI: 10.1016/j.dib.2020.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
A comprehensive description of morbidity and mortality as well as risk factors of interventional cardiac catheterization performed in neonatal age was reported in our paper recently published on the International Journal of Cardiology (IJCA28502; PII: S0167-5273(20)30384-3; DOI: 10.1016/j.ijcard.2020.04.013). Eight Italian high-volume centres of Paediatric Cardiology were involved in this observational, retrospective data collection and analysis. In this dataset, clinical and procedural characteristics of 1423 newborns submitted to 1551 interventional cardiac catheterization procedures were analyzed. Primary outcomes were considered procedure and in-hospital mortality as well as major adverse event and procedural failure rates. Secondary outcomes were considered minor adverse events and need for blood transfusion. Targets of this data analysis were: 1) to evaluate the overall major risk factors of interventional cardiac catheterization; 2) to identify the most hazardous interventional procedures; 3) to assess possible trends of individual procedures as well as their outcome over time; 4) to find possible relationships between the volume activity of any centre and the procedure and follow-up outcome. In particular, this Data in Brief companion paper aims to report the specific statistic highlights of the multivariable analysis (binary logistic regression) used to assess the impact of any potential risk factors on the type of procedure over a short-term follow-up.
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Faccini A, Giugno L, Piazza L, d'Aiello AF, Pluchinotta FR, Chessa M, Carminati M. Evolving Technique for SAPIEN Pulmonary Valve Implantation: A Single-Center Experience. JACC Cardiovasc Interv 2020; 13:1500-1502. [PMID: 32553343 DOI: 10.1016/j.jcin.2020.02.039] [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] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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Caimi A, Pasquali M, Sturla F, Pluchinotta FR, Giugno L, Carminati M, Redaelli A, Votta E. Prediction of post-stenting biomechanics in coarcted aortas: A pilot finite element study. J Biomech 2020; 105:109796. [PMID: 32423542 DOI: 10.1016/j.jbiomech.2020.109796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/08/2019] [Revised: 03/06/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
Endovascular stenting has recently become a standard treatment for native coarctation of the aorta (CoA) in children and young adults, given the efficacy in relieving vessel obstruction with a low incidence of adverse events. Yet, despite the short-term success of the technique, late hypertension remains an endemic risk. To assess the impact of the percutaneous procedure on the aortic wall biomechanics, we designed a novel finite element (FE) protocol for the simulation of endovascular stenting in three patient-specific CoA anatomies, developing a remeshing procedure that allows for coping with different CoA severities. Our FE protocol was able to yield numerical results on stent distortions and stresses, as well as on changes in aortic wall stresses and distensibility. These results were consistent with intraprocedural in-vivo evidences and with previous findings from the literature, and they suggest that our numerical approach could be used to understand the role of patient specific anatomical features (CoA severity and arch type) on the post-stenting aortic biomechanics. If soundly validated on a vast cohort of patients, our approach could support patient selection for the procedure.
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Affiliation(s)
- Alessandro Caimi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Matteo Pasquali
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca R Pluchinotta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Luca Giugno
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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8
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Abstract
Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessia Faccini
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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9
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Abstract
Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessia Faccini
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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10
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Pluchinotta FR, Panebianco M, Piazza L, Tarzia P, Fusini L, Pepi M, Giugno L, Chessa M, Carminati M, Bussadori C. P6093D echocardiography versus cardiovascular magnetic resonance in the evaluation of the right ventricle in patients with congenital heart disease after pulmonary valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac MR (CMR) is the gold standard for right ventricular (RV) quantification. Three-dimensional echo (3DE) is a relatively new technique which may offer a rapid alternative for the examination of the right heart. The purpose of this study was to investigate the clinical significance and interchangeability of these modalities to evaluate patients with congenital heart disease (CHD) who underwent percutaneous pulmonary valve implantation (PPVI) for RV outflow tract dysfunction.
Methods
36 patients who underwent PPVI were evaluated with 3DE and CMR to quantify the RV. RV volumes and ejection fraction (EF) were measured for both imaging techniques with commercially available softwares (Tomtec-Germany for 3DE and Medimatic-Netherlands for CMR data). Paired t-test, Bland-Altman analysis, and Pearson's correlation analysis were used as most appropriate to compare both measured techniques with CMR regarded as the reference standard.
Results
86% of the patients (31 patients) had adequate image quality on 3DE and was included in the study. Patients underwent both 3D echo and CMR within a mean of 9 days of each other and at a mean time of 3 years after PPVI. Compared to CMR, 3D echo significantly underestimated volumes in all patients and overestimate RV ejection fraction (EF). Mean RV End-diastolic Volumes (EDV) and End-Systolic Volumes (ESV) were significantly greater when measured by CMR compared to 3D echo (EDV: 99 ml/m2 vs. 85 ml/m2; p<0.01, ESV: 52 ml/m2 vs. 41 ml/m2; p<0.01). Mean RV EF was lower when measured by CMR compared to 3D echo (48% vs 52%; p<0.05). Linear regression analysis showed high correlation coefficients between 3DE and CMR (r=0,68 for EDV, r=0,62 for ESV, and r=0,57 for EF; p<0.001). Bland-Altman analysis demonstrated that for both RV EDV and RV ESV there was a significant and systematic under-estimation of volume by 3D echo compared to CMR. Both 3DE and CMR measurements were found to be highly reproducible in terms of intra-observer variability.
Conclusions
Statistically significant and clinically meaningful differences in volumetric measurements were observed between 3DE and CMR in the evaluation of RV volumes and function in patients with CHD after PPVI. Despite linear regression and Bland-Altman analysis showed that the two techniques are related and present some degree of agreement, 3D Echocardiography systematically underestimates volumes and overestimates EF and this would have to be considered in the clinical practice.
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Affiliation(s)
- F R Pluchinotta
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - M Panebianco
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - L Piazza
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - P Tarzia
- IRCCS Polyclinic San Donato, Milan, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Giugno
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - M Chessa
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - M Carminati
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
| | - C Bussadori
- IRCCS Polyclinic San Donato, Department of Peditric and Adult Congenital Cardiology, Milan, Italy
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11
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Sturla F, Caimi A, Pluchinotta FR, Giugno L, Secchi F, Redaelli A, Votta E, Carminati M. P3734Feasibility of percutaneous pulmonary valve implantation in the native right ventricle outflow tract from in vivo dynamic regional strain analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients surgically treated for congenital heart disease (e.g., Tetralogy of Fallot) frequently report long-term dysfunctions (i.e., pulmonary stenosis and/or incompetence) of the native right ventricle outflow tract (RVOT). The efficacy of percutaneous pulmonary valve implantation (PPVI) is recognized worldwide; however, the procedure is only feasible in RVOTs with appropriate size and functional substrate. Accordingly, a three-dimensional (3D) and dynamic assessment of the native RVOT function can be crucial to identify patients who can effectively benefit from PPVI, thus avoiding the risk of device embolization or fracture.
Purpose
We herein exploited an optical flow-based approach to develop a novel 3D framework for the quantitative in vivo assessment of dimension and dynamic changes of the native RVOT throughout the cardiac cycle. PPVI candidates (n=15) with previous surgery of the native RVOT were enrolled to demonstrate the additional contribution of our 3D patient-tailored analysis to the decision-making process.
Methods
Contrast-enhanced computed tomography (CT) was performed on a 64-slice dual-source multidetector CT system with retrospective ECG-gating. Multi-phase images of the RVOT were acquired at each 10% increment of the cardiac cycle (slice thickness = 1.5mm, increment = 1mm, pixel spacing = 0.35mm). We implemented a dedicated in-house framework, based on the optical flow tracking algorithm, to dynamically follow three anatomical cross-sections (i.e., proximal, mid and distal) of the native RVOT. The time course of area, perimeter and other relevant parameters (e.g., equivalent radius, elliptical ratio) were extracted and both areal (εA) and longitudinal strain (εlong) were computed on each the RVOT tracked cross-section. Maximum regional strain were calculated between the maximum and minimum value over the cardiac cycle. Dynamic changes in CT-derived variables were assessed using analysis of variance (p<0.05, statistically significant).
Results
All the enrolled anatomies were successfully analysed, locally pinpointing the in vivo pattern of deformation within each 3D RVOT anatomy (a). Anatomical regional RVOT dimensions (p<0.0001) and changes proved to be significantly different (p≤0.0002) throughout the cardiac cycle. In addition, the dysfunctional RVOT anatomy exhibited an irregular pattern of contraction and dilation: maximum regional strains markedly differed between RVOT regions, e.g., comparing the εA between RVOT mid (22.6%) and distal (46.0%) regions.
In vivo tracking of RVOT dynamic changes
Conclusions
The combination of patient-specific in vivo imaging and bioengineering strategies can improve our understanding of RVOT dysfunctions in congenital patients referred to PPVI. Our optical flow-based and clinically-oriented framework can support the patient selection process and the planning of the percutaneous procedure in order to enhance its efficacy and shorten the operating time while improving the patient safety.
Acknowledgement/Funding
IRCCS Policlinico San Donato is a clinical research hospital partially funded by the Italian Ministry of Health
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Affiliation(s)
- F Sturla
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - A Caimi
- Politecnico di Milano, Milano, Italy
| | | | - L Giugno
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Secchi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - E Votta
- Politecnico di Milano, Milano, Italy
| | - M Carminati
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
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12
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Kenny D, Morgan GJ, Murphy M, AlAlwi K, Giugno L, Zablah J, Carminati M, Walsh K. Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts. Catheter Cardiovasc Interv 2019; 94:409-413. [PMID: 31408262 DOI: 10.1002/ccd.28409] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Edwards SAPIEN valve and its delivery system may complicate transit through the right heart during transcatheter pulmonary valve replacement (tPVR). We report our early experience using a large diameter, 65 cm delivery sheath to facilitate delivery of the SAPIEN valve to the right ventricular outflow tract (RVOT). METHODS Retrospective analysis of all patients from three large congenital heart centers undergoing tPVR with the Edwards SAPIEN valve delivered with the 65 cm Gore Dryseal Sheath. RESULTS Over a 12 month period, 30 patients (17 female) with median age 17.5 years (range 8-72) underwent attempted tPVR with the SAPIEN valve delivered using the 65 cm Dryseal sheath (20-26Fr). All procedures resulted in successful valve delivery to the target area. Twenty patients had a native RVOT. The most commonly used valve diameter was 29 mm (n = 15) with the majority of cases requiring a 26Fr Dryseal sheath (n = 20). One patient with severe RVOT stenosis underwent prestenting. Median procedure time was 100 min (59-225). No patient had increase in tricuspid valve regurgitation as a consequence of valve delivery. One patient required a synchronous cardioversion for intraprocedural VT and another required ECMO postprocedure due to severe pre-existing left ventricular dysfunction. On median follow-up of 5 months, all patients had mild or less pulmonary regurgitation. Median peak Doppler velocity across the pulmonary valve was 2.2 m/s (1.7-4). There were no clinically relevant complications relating to vascular access. CONCLUSIONS Using 65 cm Dryseal sheaths facilitates delivery of SAPIEN valves in patients with dysfunctional RVOTs.
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Affiliation(s)
- Damien Kenny
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gareth J Morgan
- The Heart Institute, Children's Hospital of Colorado, Denver, CO
- Department of Adult Congenital Cardiology, University of Colorado Hospital, Denver, CO
| | - Matthew Murphy
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Khalid AlAlwi
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
| | - Luca Giugno
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Jenny Zablah
- The Heart Institute, Children's Hospital of Colorado, Denver, CO
| | - Mario Carminati
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Kevin Walsh
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
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13
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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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14
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Caimi A, Sturla F, Pluchinotta FR, Giugno L, Secchi F, Votta E, Carminati M, Redaelli A. Prediction of stenting related adverse events through patient-specific finite element modelling. J Biomech 2018; 79:135-146. [PMID: 30139536 DOI: 10.1016/j.jbiomech.2018.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/03/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
Right ventricular outflow tract (RVOT) calcific obstruction is frequent after homograft conduit implantation to treat congenital heart disease. Stenting and percutaneous pulmonary valve implantation (PPVI) can relieve the obstruction and prolong the conduit lifespan, but require accurate pre-procedural evaluation to minimize the risk of coronary artery (CA) compression, stent fracture, conduit injury or arterial distortion. Herein, we test patient-specific finite element (FE) modeling as a tool to assess stenting feasibility and investigate clinically relevant risks associated to the percutaneous intervention. Three patients undergoing attempted PPVI due to calcific RVOT conduit failure were enrolled; the calcific RVOT, the aortic root and the proximal CA were segmented on CT scans for each patient. We numerically reproduced RVOT balloon angioplasty to test procedure feasibility and the subsequent RVOT pre-stenting expanding the stent through a balloon-in-balloon delivery system. Our FE framework predicted the occurrence of CA compression in the patient excluded from the real procedure. In the two patients undergoing RVOT stenting, numerical results were consistent with intraprocedural in-vivo fluoroscopic evidences. Furthermore, it quantified the stresses on the stent and on the relevant native structures, highlighting their marked dependence on the extent, shape and location of the calcific deposits. Stent deployment induced displacement and mechanical loading of the calcific deposits, also impacting on the adjacent anatomical structures. This novel workflow has the potential to tackle the analysis of complex RVOT clinical scenarios, pinpointing the procedure impact on the dysfunctional anatomy and elucidating potential periprocedural complications.
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Affiliation(s)
- Alessandro Caimi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca Romana Pluchinotta
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Giugno
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Mario Carminati
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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15
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Faccini A, Giugno L, Carminati M, Butera G. Percutaneous Pulmonary Valve Implantation Contraindicated by Severe Aortic Regurgitation Due to Left Coronary Sinus Deformation. Circ J 2018; 82:2212. [PMID: 29459497 DOI: 10.1253/circj.cj-17-1207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alessia Faccini
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato
| | - Luca Giugno
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato
| | - Mario Carminati
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato
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16
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Faccini A, Micheletti A, Negura DG, Giugno L, Butera G, Carminati M, Giamberti A, Chessa M. Heart failure in grown-up congenital heart disease. Minerva Cardioangiol 2018; 66:329-336. [PMID: 29327893 DOI: 10.23736/s0026-4725.18.04591-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The increasing survival to adulthood of patients with congenital heart disease (CHD) has changed the epidemiology of adult CHD (ACHD) patients and has led to an increment in hospitalization rates due to heart failure (HF). ACHD patients hospitalized for HF have a five-fold higher risk of death than those compensated. HF occurs predominantly in patients with tetralogy of Fallot, single ventricles, and after the Mustard operation for transposition of the great arteries. Diagnostic strategies applied in acquired HF patients are usually used to evaluate ACHD patients, but sometimes this can postpone the identification of HF that can become manifest with unusual and peculiar signs or symptoms. In the same way, therapeutic management resembles the acquired HF one, even if no large randomized clinical trials have been conducted in ACHD patients. Therefore, a close monitoring in dedicated units is mandatory in order to identify in time HF manifestations and manage them adequately.
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Affiliation(s)
- Alessia Faccini
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Angelo Micheletti
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Diana G Negura
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Giugno
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianfranco Butera
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alessandro Giamberti
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy -
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17
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Abstract
Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size and the best position for deployment to achieve complete occlusion of the fistula without compromising the flow in coronary side branches.
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Affiliation(s)
- Mario Carminati
- Pediatric and Adult Congenital Cardiology - Policlinico San Donato IRCCS, Milan, Italy
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18
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Affiliation(s)
- Francesca Romana Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, Italy
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19
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Santoro G, Scognamiglio G, Gaio G, Iacono C, Giugno L, Russo MG. Transcatheter treatment of Starr-Edwards paravalvular leaks. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 2:e218-e220. [DOI: 10.2459/jcm.0000000000000105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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20
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Tarzia P, Conforti E, Giamberti A, Varrica A, Giugno L, Micheletti A, Negura D, Piazza L, Saracino A, Carminati M, Chessa M. Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects. J Cardiovasc Med (Hagerstown) 2016; 18:430-435. [PMID: 27828833 DOI: 10.2459/jcm.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction. METHODS Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve. RESULTS No procedural-related complications occurred. After valve implantation, right ventricular systolic pressure (RVSP, 80.5 ± 25.3-41.2 ± 8.35 mmHg, P < 0.05), right ventricular outflow tract (RVOT) gradient (55.3 ± 23.4-10.6 ± 3.8 mmHg, P < 0.05), and RVSP-to-aortic pressure (0.75 ± 0.21-0.38 ± 0.21, P = 0.01) fell significantly. Echocardiograms at follow-up revealed a significant reduction in estimated RVSP (88.7 ± 22-21.7 ± 4.7 mmHg, P < 0.05), in RVOT (76.2 ± 17.9-25.7 ± 6.1 mmHg, P = 0.005), and in mean RVOT (40.7 ± 9.9-15.5 ± 4.8 mmHg, P < 0.05) gradients. Cardiac magnetic resonance showed no significant change in biventricular dimensions and function. Symptomatic patients reported improvement of symptoms, although cardiopulmonary exercise did not show any significant differences. CONCLUSION TPViV is an effective and well tolerated treatment for BPV dysfunction, improving freedom from surgical reintervention. Long-term studies will redefine the management of dysfunctional RVOT, either native or surrogate.
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Affiliation(s)
- Pierpaolo Tarzia
- aPediatric and Adult Congenital Heart Centre, IRCCS, Policlinico San Donato, University Hospital, Via Morandi, 30, San Donato M.se, Milan 20097, Italy bInstitute of Cardiology, Catholic University of the Sacred Heart, IRCCS Policlinico Universitario 'Agostino Gemelli', Rome, Italy
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Pluchinotta FR, Bussadori C, Butera G, Piazza L, Chessa M, Saracino A, Fernandez Sarabia J, Giugno L, Arcidiacono C, Micheletti A, Negura DG, Fesslova V, Carminati M. Treatment of right ventricular outflow tract dysfunction: a multimodality approach. Eur Heart J Suppl 2016; 18:E22-E26. [PMID: 28533712 DOI: 10.1093/eurheartj/suw019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/14/2022]
Abstract
The right timing to replace the pulmonary valve in a patient with dysfunction of the right ventricular outflow tract is unknown. Both percutaneous pulmonary valve and surgical prosthesis are suitable options. In every patient, the right ventricle (RV) remodels and recovers differently after pulmonary replacement. Therefore, it is difficult to identify the best treatment option and to predict the long-term results. In the last few years, we focused our research on optimizing the characterization of these patients through advanced cardiovascular imaging in order to find possible variables, parameters, and reproducible measurements that can help us in the decision-making process. The aim of the present article is to present our ongoing research lines that focus on the characterization and optimal treatment approach to the dysfunction of the RVOT.
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Affiliation(s)
- Francesca Romana Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Claudio Bussadori
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Gianfranco Butera
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Luciane Piazza
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Massimo Chessa
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Antonio Saracino
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Javier Fernandez Sarabia
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Luca Giugno
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Carmelo Arcidiacono
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Angelo Micheletti
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Diana Gabriela Negura
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Vlasta Fesslova
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease - IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
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Chessa M, Carminati M, Cinteză EE, Butera G, Giugno L, Arcidiacono C, Piazza L, Bulescu NC, Pome G, Frigiola A, Giamberti A. Partial abnormal drainage of superior and inferior caval veins into the left atrium: two case reports. Rom J Morphol Embryol 2016; 57:559-562. [PMID: 27516034] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic vein drainage anomaly, with only a few cases reported among congenital heart disease (CHD), around 20 cases published in the medical literature. The inferior vena cava connection with the left atrium, also very rare, can appear directly or in heterotaxy. Clinical suspicion arises due to the presence of cyanosis in the absence of other specific clinical signs (without other associated CHD). We present the cases of two children with abnormal superior and inferior systemic venous return. The first case is an abnormal connection of right superior vena cava to the left atrium associated with persistent left superior vena cava draining into the right atrium through the coronary sinus. The second case is an interruption of the inferior vena cava with hemiazygos continuation, drained into the left superior vena cava, which drained into the left atrium. The diagnosis was imagistic - echocardiography and angiography. Surgical treatment solutions vary from one case to another, usually following anatomic correction. Hypoxia accompanied by cyanosis must bring into question the pathology of systemic venous drainage anomaly, after other common causes have been excluded. Surgery is indicated in all cases due to the risk associated with the presence of right-to-left shunt.
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Affiliation(s)
- Massimo Chessa
- Department of Pediatric Cardiology, "Maria Sklodowska Curie" Emergency Children's Hospital, Bucharest, Romania;
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Chessa M, Butera G, Giugno L, Micheletti A, Negura DG, Carminati M. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience. World J Cardiol 2015; 7:695-699. [PMID: 26516424 PMCID: PMC4620081 DOI: 10.4330/wjc.v7.i10.695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/29/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien™ valve (Patient 1), and a Medtronic Melody™ valve (Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances.
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Santoro G, Gaio G, Capozzi G, Giugno L, Palladino MT, Capogrosso C, D'Aiello AF, Caianiello G, Russo MG. Fate of Hypoplastic Pulmonary Arteries After Arterial Duct Stenting in Congenital Heart Disease With Duct-Dependent Pulmonary Circulation. JACC Cardiovasc Interv 2015; 8:1626-32. [PMID: 26386761 DOI: 10.1016/j.jcin.2015.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 02/18/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study sought to evaluate the impact of arterial duct (AD) stenting in promoting catch-up growth of hypoplastic pulmonary artery (PA) tree in congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). BACKGROUND Significant and balanced PA growth following AD stenting has already been consistently reported in the literature. However, no data are so far available about the role of this approach in severe PA hypoplasia, which significantly impacts the risk of surgical repair. METHODS Pre-surgical angiographic PA evaluation was performed in 45 patients with confluent PAs submitted to neonatal AD stenting as palliation of CHD-DPC. PA growth was evaluated as Nakata Index and McGoon ratio as well as individual PA z-score changes, both in the whole population and according to the original vessel size (Nakata Index <100 mm(2)/m(2), Group I [n = 15] vs. Nakata Index >100 mm(2)/m(2), Group II [n = 30]). RESULTS Control angiography was performed 7.5 ± 6.5 months (median 6 months) after duct stenting, showing significant and balanced PA growth. The Nakata Index increased from 143 ± 73 mm(2)/m(2) to 270 ± 88 mm(2)/m(2) (124 ± 118%, p < 0.0001); left PA z-score from -0.7 ± 1.7 to 1.0 ± 1.4; right PA z-score from -0.6 ± 1.3 to 1.2 ± 1.3 (p < 0.0001 for both comparisons). Group I showed a greater increase of global PA growth (Nakata Index increase 227 ± 141% vs. 72 ± 57%, p < 0.001) as compared with Group II. Final PA size did not significantly differ between the groups (246 ± 105 mm(2)/m(2) vs. 282 ± 78 mm(2)/m(2), p = NS). CONCLUSIONS Percutaneous AD stenting is highly effective in promoting a significant and balanced catch-up growth of diminutive PAs, being therefore advisable in this subset of patients as a reliable alternative to surgical palliation.
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Affiliation(s)
- Giuseppe Santoro
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy.
| | - Gianpiero Gaio
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Giovanbattista Capozzi
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Luca Giugno
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Cristina Capogrosso
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Angelo Fabio D'Aiello
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Giuseppe Caianiello
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
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Affiliation(s)
- Massimo Chessa
- Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS-Policlinico San Donato, Via Morandi, 30, San Donato Milanese, Milano 20097, Italy
| | - Luca Giugno
- Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS-Policlinico San Donato, Via Morandi, 30, San Donato Milanese, Milano 20097, Italy
| | - Gianfranco Butera
- Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS-Policlinico San Donato, Via Morandi, 30, San Donato Milanese, Milano 20097, Italy
| | - Mario Carminati
- Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS-Policlinico San Donato, Via Morandi, 30, San Donato Milanese, Milano 20097, Italy
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26
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Santoro G, Gaio G, Giugno L, Capogrosso C, Palladino MT, Iacono C, Caianiello G, Russo MG. Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: Early results, learning-curve changes, and mid-term outcome. Catheter Cardiovasc Interv 2015; 86:249-57. [DOI: 10.1002/ccd.25949] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 05/07/2014] [Accepted: 03/15/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Giuseppe Santoro
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Gianpiero Gaio
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Luca Giugno
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Cristina Capogrosso
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Carola Iacono
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Giuseppe Caianiello
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
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27
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Butera G, Giugno L, Basile D, Piazza L, Chessa M, Carminati M. The Edwards Valeo lifestents in the treatment and palliation of congenital heart disease in infants and small children. Catheter Cardiovasc Interv 2015; 86:432-7. [DOI: 10.1002/ccd.25872] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/17/2014] [Revised: 01/03/2015] [Accepted: 01/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Gianfranco Butera
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
| | - Luca Giugno
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
| | - Domenica Basile
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
| | - Luciane Piazza
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
| | - Massimo Chessa
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
| | - Mario Carminati
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect; Policlinico San Donato IRCCS; San Donato Milanese Milan Italy
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Timoteo AT, Moura Branco L, Ramos R, Aguiar Rosa S, Agapito A, Sousa L, Oliveira J, Leal A, Cruz Ferreira R, Kutty S, Li L, Danford D, Houle H, Xiao Y, Pedrizzetti G, Porter T, Leren IS, Hasselberg N, Saberniak J, Haland T, Kongsgard E, Smiseth O, Edvardsen T, Haugaa K, Ben Moussa N, Cinteza E, Giugno L, Butera G, Piazza L, Micheletti A, Saracino A, Negura DG, Carminati M, Chessa M, Kubik M, Dabrowska-Kugacka A, Lewicka E, Danilowicz-Szymanowicz L, Szalewska D, Kutniewska-Kubik M, Raczak G, Enache R, Mateescu A, Nastase O, Popescu B, Ginghina C, Karsenty C, Hadeed K, Hascoet S, Amadieu R, Dulac Y, Acar P, Ammirati A, Palmieri R, Silvetti M, Drago F. Oral Abstract session: Advanced echo techniques - New eyes on congenital heart disease: Thursday 4 December 2014, 08:30-10:00 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Santoro G, Giugno L, Gaio G, Capogrosso C, Iacono C, Russo MG. Trans-catheter treatment of residual leak after PFO device closure. Int J Cardiol 2014; 174:e13-5. [PMID: 24767132 DOI: 10.1016/j.ijcard.2014.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Giuseppe Santoro
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy.
| | - Luca Giugno
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy
| | - Gianpiero Gaio
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy
| | - Cristina Capogrosso
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy
| | - Carola Iacono
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology, A.O.R.N. "Ospedali dei Colli", 2nd University of Naples, Naples, Italy
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30
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Santoro G, Giugno L, Gaio G, Iacono C, Palladino MT, Sarubbi B, D'Alto M, Russo MG. Transcatheter treatment of fenestrated aneurismal atrial septum: safety, feasibility and mid-term follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2195] [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: 11/13/2022] Open
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31
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Santoro G, Castaldi B, Iacono C, Giugno L, Gaio G, Russo MG. Alarm!!! A UFO inside the heart. J Cardiovasc Med (Hagerstown) 2012; 13:645-7. [PMID: 22955207 DOI: 10.2459/jcm.0b013e328356a529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 8-year-old asymptomatic child was referred for surgical repair of coronary sinus atrial septal defect resulting in significant left-to-right shunt and right chamber volume overload. The septal fenestration was located near to its drainage site into the right atrium. Due to this seemingly favourable anatomy, transcatheter closure of the septal defect was performed using an Amplatzer Septal Occluder device. The echocardiographic postprocedural evaluation imaged the occluding device almost perpendicular to the atrial septum, seemingly floating above the mitral valve orifice, like an alien spaceship inside the heart.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology, A.O.R.N. Ospedale dei Colli, II University of Naples, Naples, Italy.
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Rezzani R, Giugno L, Buffoli B, Bonomini F, Bianchi R. The protective effect of caffeic acid phenethyl ester against cyclosporine A-induced cardiotoxicity in rats. Toxicology 2005; 212:155-64. [PMID: 15967562 DOI: 10.1016/j.tox.2005.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 04/13/2005] [Accepted: 04/21/2005] [Indexed: 11/27/2022]
Abstract
Cyclosporine A (CsA) is the immunosuppressor, which is most frequently used in transplant surgery and in the treatment of autoimmune diseases. Oxidative stress has been considered as one of the possible mechanisms of CsA-induced cardiotoxicity. The present investigation examines the ability of caffeic acid phenethyl ester (CAPE), which is an active component of propolis extracts, as a natural antioxidant to protect against CsA-induced oxidative stress and cardiotoxicity. CsA cardiotoxicity was induced by subcutaneous injection of CsA at a dose of 15 mg/kg/body weight daily for 21 days in rats. Cardiotoxicity was evaluated by morphological and biochemical studies. CsA treated rats showed degenerative changes with cardiac fibrosis localized around the fibers. These latters were disorganised and the network was disappeared. The ROS production was increased whereas cytochrome-c-oxidase decreased. The expression and levels of matrix metalloproteinase 2 (MMP2) were increased whereas those of its inhibitor were downregulated. CAPE subcutaneous administration (15 micromol/kg/day) improved cardiac cytoarchitecture, decreased the levels and the expression of MMP2, and increased those of TIMP2 proteins. Moreover, it increased cytochrome-c-oxidase activity and decreased ROS production. These results suggest that CAPE could have protective effect against CsA-induced cardiotoxicity.
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Affiliation(s)
- R Rezzani
- Division of Human Anatomy, Department of Biomedical Sciences and Biotechnology, University of Brescia, 25123 Brescia, Italy.
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Abstract
Lesions, which destroy the area postrema and damage the adjacent nucleus of the solitary tract, attenuate or abolish conditioned taste aversions (CTA) induced by a variety of pharmacological agents. In the present experiment 2 groups of male rats received lesions of the area postrema and 2 groups were given sham lesions. One lesioned group and one sham-lesioned group were twice conditioned with 30-min access to a novel 0.15% saccharin solution followed by injection of nicotine (1 mg/kg, IP). The other 2 groups were similarly conditioned with saccharin followed by saline injections. In subsequent two-bottle choice tests (saccharin vs. water), the saline-injected rats exhibited strong preferences for saccharin, the sham-lesioned rats injected with nicotine showed a weak but significant (p less than 0.05) aversion to saccharin, and the area postrema-lesioned rats injected with nicotine displayed a significantly (p less than 0.05) stronger CTA than the drug-injected sham-lesioned animals. In Phase 2 all rats were given novel chocolate metrecal (30 min) followed by injection of scopolamine HCl (1 mg/kg, IP). The area postrema-lesioned rats showed significant (p less than 0.01) preference for the chocolate taste relative to the aversions shown by the sham-lesioned animals. Thus, area postrema lesions attenuated a scopolamine-induced CTA, but enhanced a nicotine-induced aversion. These results suggest that nicotine and scopolamine act at different neural sites in producing CTAs.
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Affiliation(s)
- K P Ossenkopp
- Department of Psychology, University of Western Ontario, London, Canada
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Ossenkopp KP, Giugno L. Gamma radiation-induced conditioned taste aversions in rats: a comparison of the protective effects of area postrema lesions with differing doses of radiation. Physiol Behav 1989; 46:747-50. [PMID: 2690155 DOI: 10.1016/0031-9384(89)90361-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/02/2023]
Abstract
Lesions which destroy the area postrema (AP) and damage the adjacent nucleus of the solitary tract (NTS) attenuate or abolish conditioned taste aversions (CTA) induced by a variety of pharmacological agents as well as exposure to radiation. In the present experiment, 4 groups of male rats received lesions of AP and 4 groups were given sham lesions. One sham-lesioned and one AP-lesioned group were given a single pairing of 1-hr access to a novel 0.10% sodium saccharin solution followed immediately with exposure to 0, 100, 200, or 400 rad of gamma radiation, respectively. Four days later all groups were given daily two-bottle preference tests (saccharin vs. water) on 4 consecutive days. The sham-lesioned groups exposed to the radiation (100, 200, or 400 rad) developed profound aversions to the saccharin on all test days (p less than 0.001). In contrast, all of the AP-lesioned groups as well as the sham-irradiated (0 rad) sham-lesioned group exhibited strong, comparable (p greater than 0.30) preferences for saccharin. Thus, lesion of AP abolished the radiation-induced CTA at all dose levels of radiation. These results raise the possibility of pharmacological intervention at the level of AP to prevent radiation-induced CTA in cancer patients undergoing radiation therapy.
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Affiliation(s)
- K P Ossenkopp
- Department of Psychology, University of Western Ontario, London, Canada
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Abstract
The role of the alpha 2 adrenergic receptor in the development and propagation of amygdala kindled seizures was determined. Male Wistar rats, depleted of norepinephrine with the neurotoxin 6-hydroxydopamine and vehicle controls, received an injection of the alpha 2 agonist, clonidine (0.001, 0.01, or 0.1 mg/kg, i.p.), or saline, 30 min prior to each amygdala stimulation (every 3 to 4 days). The largest dose of clonidine had a significant retarding effect on the development of kindling in both the vehicle- and 6-hydroxydopamine-treated groups. The majority of this effect was observed as a protracted number of trials with unilateral afterdischarge. When the discharge became bilateral, generalized seizures were soon apparent. There was no effect of clonidine on the amygdala afterdischarge threshold in both groups, or on the subsequent generalized motor seizure and associated afterdischarge durations in the vehicle groups. The largest dose of clonidine, however, reduced the severity of the convulsive response in the 6-hydroxydopamine-treated rats from violent stage 7 or 8 seizures to more moderate stage 5 responses. The significance of these data, and the involvement of the postsynaptic alpha 2 receptors in the genesis of amygdala kindled seizures, are discussed.
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Affiliation(s)
- D C McIntyre
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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36
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Abstract
Lesions which destroy the area postrema (AP) and damage the adjacent nucleus of the solitary tract (NTS) attenuate conditioned taste aversions (CTA) induced by a variety of pharmacological agents as well as exposure to radiation. In this experiment the possibility that AP lesions might not attenuate a radiation-induced CTA, when multiple pairings of the novel taste stimulus and exposure to gamma radiation occurred, was examined. Three groups of male rats received lesions of AP and another 3 groups received sham lesion. Following a recovery period all rats were adapted to a 23.5 h/day water deprivation schedule. A sodium saccharin solution (0.1%) was offered to all rats during the regular drinking period (0.5 h) on two days per week, with water available on the other days. Access to saccharin was followed by exposure to 0, 20 or 40 rad of gamma radiation with one lesioned and one sham-lesioned group assigned to each dose level. After 4 pairings of saccharin with radiation the sham-lesioned groups exposed to 20 and 40 rad of radiation exhibited a dose-dependent aversion to the saccharin solution (P less than 0.0001), whereas the AP-lesioned groups did not differ significantly from the 0 rad sham-lesioned group. Subsequent two-bottle choice tests, which are a more sensitive measure of CTA, confirmed that the AP-lesioned rats exposed to 20 and 40 rad radiation did not develop a significant CTA relative to the two 0 rad radiation groups. Thus, AP lesions abolished the CTA normally induced by multiple pairings of saccharin with exposure to 20 or 40 rad gamma radiation.
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Ossenkopp KP, Giugno L, Sutherland C. Conditioned taste aversions induced by 1-5-hydroxytryptophan are mediated by the area postrema. Prog Neuropsychopharmacol Biol Psychiatry 1985; 9:745-8. [PMID: 3878977 DOI: 10.1016/0278-5846(85)90053-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Previous studies have shown that injections of 5-HTP can induce conditioned taste aversions when paired with a novel taste. Adult male albino rats received either lesions of the area postrema or were subjected to a sham lesion procedure. All rats were adjusted to a 23 1/2 hr/day water deprivation schedule and on the conditioning day were given a 0.15% saccharin solution for 1/2 hr. After drinking the saccharin fluid 9 area postrema lesioned and 10 sham lesioned rats were injected i.p. with 25 mg/kg 1-5-hydroxytryptophan. Similarly 10 area postrema lesioned and 6 sham lesioned rats were injected with the vehicle solution. A two-bottle choice test between the saccharin solution and water was given to all animals on the third and fourth days after the conditioning day. The sham lesioned rats injected with the 1-5-hydroxytryptophan exhibited a strong aversion to the saccharin taste whereas the vehicle injected sham lesioned rats showed an equal preference for the two fluids. The difference in group mean saccharin preference ratio was significant (p less than .01). Both area postrema lesioned groups exhibited saccharin preference ratios that were comparable to and not significantly different from the sham lesioned animals injected with the vehicle solution. These results show that an intact area postrema is necessary for induction of conditioned taste aversions with 1-5-hydroxytryptophan.
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