1
|
Giordano M, Gaio G, Marzullo R, Scognamiglio G, Altobelli I, Russo MG, Sarubbi B. Patent foramen ovale closure with NobleStitch EL system in a case of Ebstein's anomaly after a failed device closure attempt. J Cardiovasc Med (Hagerstown) 2024:01244665-990000000-00205. [PMID: 38625819 DOI: 10.2459/jcm.0000000000001615] [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: 04/18/2024]
Abstract
In the setting of an Ebstein's anomaly, a right-to-left shunt via a patent foramen ovale (PFO) may be the cause of a significant cyanosis. In these patients, the PFO closure is able to improve the arterial saturation. Furthermore, a partial closure is often recommended to obtain a reduction in the PFO right-left shunt without a significant impact on the right chamber hemodynamics. However, in some cases, a complex PFO anatomy may prevent an effective device closure. We describe the case of a patient with Ebstein's anomaly and a significant cyanosis due to a right-to-left shunt via the PFO wherein an effective partial PFO closure with a suture-mediated NobleStitch EL system was achieved in a setting of a complex PFO anatomy (large aneurismatic septum, long stiff tunnel, and hypertrophic septum secundum) after a failed device-closure attempt.
Collapse
Affiliation(s)
- Mario Giordano
- Pediatric Cardiology Unit, University of Campania 'Luigi Vanvitelli'
| | - Gianpiero Gaio
- Pediatric Cardiology Unit, University of Campania 'Luigi Vanvitelli'
| | | | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| | - Ippolita Altobelli
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| |
Collapse
|
2
|
Giordano M, Marzullo R, Gaio G, Bigazzi MC, Palladino MT, Della Cioppa N, Gaudieri G, Fabiani D, Sarubbi B, Russo MG. Assessing the feasibility of using the antecubital vein to perform right heart catheterization in children and adults with congenital heart disease: a retrospective, observational single-center study. J Invasive Cardiol 2023; 35. [PMID: 37984324 DOI: 10.25270/jic/23.00219] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Right heart catheterization (RHC) usually is performed via the femoral vein or the internal jugular vein. However, the antecubital fossa vein is a valid venous access, and it has become increasingly popular to perform right heart catheterization utilizing this access. METHODS A retrospective, observational study was conducted to describe use of the antecubital fossa vein for right heart catheterization in adults and children with congenital heart disease (CHD). Patients who had undergone RHC via antecubital fossa vein at the authors' hospital between September 2019 and December 2022 were included. The outcomes studied were procedural failure and procedure-related adverse events. RESULTS Fifty-two patients with CHD underwent right cardiac catheterization via an upper arm vein. The upper arm vein was unable to perform the RHC in only 2 patients (3.8%). Only 1 patient developed a minor adverse event. No irreversible and/or life-threating adverse events were detected. CONCLUSIONS The upper arm veins are safe and effective to perform a RHC in children and adults with CHD. This approach demonstrates a high percentage of technical success, and few mild complications.
Collapse
Affiliation(s)
- Mario Giordano
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy.
| | - Raffaella Marzullo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gianpiero Gaio
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Invasive Cardiology Unit, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Teresa Palladino
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Nadia Della Cioppa
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gabriella Gaudieri
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Dario Fabiani
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| |
Collapse
|
3
|
Marzullo R, Capestro A, Muçaj A, Piva T. Percutaneous rheolytic thrombectomy and cerebral embolic protection in a massive thrombosis of a fenestrated Fontan conduit: a case report. Eur Heart J Case Rep 2023; 7:ytad238. [PMID: 37215519 PMCID: PMC10199720 DOI: 10.1093/ehjcr/ytad238] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
Background Clinical thromboembolism in Fontan patients is often a catastrophic event resulting in death and adverse long-term outcomes. The treatment of acute thromboembolic complications in these patients is very controversial. Case summary We describe the use of rheolytic thrombectomy in a Fontan patient with life-threatening pulmonary embolism, employing a cerebral protection system to reduce the risk of stroke through the fenestration. Discussion Rheolytic thrombectomy may be a successful alternative to systemic thrombolytic therapy and open surgical resection for the treatment of acute high-risk pulmonary embolism in the Fontan population. Embolic protection device to capture and remove thrombus/debris may be an innovative tool to reduce the risk of stroke through the fenestration while performing a percutaneous procedure in fenestrated Fontan patient.
Collapse
Affiliation(s)
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
| | - Andi Muçaj
- Department of Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
| | | |
Collapse
|
4
|
Francese GM, Aspromonte N, Valente S, Geraci G, Pavan D, Bisceglia I, Caforio ALP, Colavita AR, Cutolo A, De Angelis MC, Di Fusco SA, Enea I, Fiscella D, Frongillo D, Gil Ad V, Giubilato S, Giuffrida C, Ingianni N, Lucà F, Marcantoni L, Martinis F, Marzullo R, Masciocco G, Parrini I, Rakar S, Resta M, Riva L, Rossini R, Russo D, Russo G, Russo MG, Scardovi AB, De Luca L, Gabrielli D, Gulizia MM, Oliva F, Colivicchi F. [ANMCO Position paper: Cardiovascular disease in women - prevention, diagnosis, treatment and organization of care]. G Ital Cardiol (Rome) 2022; 23:775-792. [PMID: 36169129 DOI: 10.1714/3881.38644] [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: 06/16/2023]
Abstract
Cardiovascular diseases are still the main cause of death among women despite the improvements in treatment and prognosis achieved in the last 30 years of research. The determinant factors and causes have not been completely identified but the role of "gender" is now recognized. It is well known that women tend to develop cardiovascular disease at an older age than men, and have a high probability of manifesting atypical symptoms not often recognized. Other factors may also co-exist in women, which may favor the onset of specific cardiac diseases such as those with a sex-specific etiology (differential effects of estrogens, pregnancy pathologies, etc.) and those with a different gender expression of specific and prevalent risk factors, inflammatory and autoimmune diseases and cancer. Whether the gender differences observed in cardiovascular outcomes are influenced by real biological differences remains a matter of debate.This ANMCO position paper aims at providing the state of the research on this topic, with particular attention to the diagnostic aspects and to care organization.
Collapse
Affiliation(s)
- Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Nadia Aspromonte
- U.O.S. Scompenso Cardiaco, Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Serafina Valente
- Cardiologia Clinico-Chirurgica (UTIC), Ospedale Santa Maria alle Scotte, A.O.U. Senese, Siena
| | - Giovanna Geraci
- U.O.C. Cardiologia-UTIC ed Emodinamica, P.O. "V. Cervello", Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo
| | - Daniela Pavan
- S.O.C. Cardiologia, Ospedale di San Vito al Tagliamento, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento (PN)
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | | | - Ada Cutolo
- U.O. Cardiologia, Ospedale dell'Angelo, Venezia-Mestre, Azienda ULSS 3 Serenissima
| | - Maria Carmen De Angelis
- U.O.C. Cardiologia-UTIC-Emodinamica-Elettrofisiologia-Elettrostimolazione, Ospedale del Mare, Napoli
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, Roma, ASL Roma 1
| | - Iolanda Enea
- U.O.C. Medicina e Chirurgia d'Urgenza, A.O.R.N. Sant'Anna e San Sebastiano, Caserta
| | - Damiana Fiscella
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Doriana Frongillo
- U.O.C. Cardiologia, Ospedale San Sebastiano Martire, Frascati (RM), ASL Roma 6
| | - Vered Gil Ad
- U.O. Cardiologia, Ospedale Policlinico San Martino, Genova
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Clea Giuffrida
- Psicologa e Psicoterapeuta Cognitivo Comportamentale, Catania
| | - Nadia Ingianni
- U.O.C. di Cardiologia e UTIC, P.O. Sant'Antonio Abate, Erice (TP), ASP Trapani
| | - Fabiana Lucà
- Cardiologia-UTIC, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Lina Marcantoni
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo, ULSS 5 Polesana
| | - Flavia Martinis
- S.O.C. Cardiologia, Ospedale di San Vito al Tagliamento, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento (PN)
| | - Raffaella Marzullo
- U.O.C. Cardiologia Pediatrica, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | - Gabriella Masciocco
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Iris Parrini
- Dipartimento di Cardiologia, Ospedale Mauriziano, Torino
| | - Serena Rakar
- S.C. Cardiologia, Dipartimento CardioToracoVascolare, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste
| | | | - Letizia Riva
- U.O.C. Cardiologia, Ospedale Maggiore, Azienda USL di Bologna, Bologna
| | | | | | - Giulia Russo
- S.C. Cardiovascolare e Medicina dello Sport, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste
| | - Maria Giovanna Russo
- U.O.C. Cardiologia Pediatrica, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | | | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, Roma, ASL Roma 1
| |
Collapse
|
5
|
Capestro A, Soura E, Compagnucci P, Casella M, Marzullo R, Dello Russo A. Atrial Flutters in Adults with Congenital Heart Disease. Card Electrophysiol Clin 2022; 14:501-515. [PMID: 36153130 DOI: 10.1016/j.ccep.2022.05.008] [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: 11/29/2022]
Abstract
The macroreentrant atrial tachycardia is very frequent in the adults with congenital heart disease. The impact of the arrhythmias on this type of patients is related to several factors: the anatomy and physiopathology of the specific congenital heart disease (CHD), the sequelae of the corrective surgery or surgical palliation, the presence of residual lesions (shunt, regurgitation), and the age and the clinical status of the patient and the comorbidities. In turn, the mechanism of the MAT depends on the peculiar features of the conduction's system in the CHD and native and acquired (post-surgery) substrates.
Collapse
Affiliation(s)
- Alessandro Capestro
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy.
| | - Elli Soura
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy
| | - Paolo Compagnucci
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
| | - Michela Casella
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
| | - Raffaella Marzullo
- Department of Pediatric Cardiology, University of Campania "Luigi Vanvitelli", Former Second University of Naples, "Monaldi Hospital-AORN Ospedale dei Colli", piazzale E Ruggieri, Naples 80131, Italy
| | - Antonio Dello Russo
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
| |
Collapse
|
6
|
Marzullo R, Ladouceur M, Gaio G, Giordano M, Russo MG, Sarubbi B. Impact of pregnancy on natural history of systemic right ventricle in women with transposition of the great arteries. Int J Cardiol 2022; 366:20-24. [PMID: 35842002 DOI: 10.1016/j.ijcard.2022.07.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
In the recent years, the pregnancy trend among women with Congenital Heart Disease (CHD) has increased; this has leaded to a growing demand for specialized care both in mother and in children. Although pregnancy is often well tolerated, maternal CHD may affect in some cases a maladaptive hemodynamic response carrying additional risks of cardiovascular events like arrhythmias, heart failure and, in rare cases, death. The impaired utero-placental perfusion due to maternal cardiac status may result in placental dysfunction, which may be associated with fetal growth restriction, preeclampsia, premature birth and perinatal morbidity. Systemic Right Ventricle (SRV) is one of the main conditions under which pregnancy is challenging. The sub-aortic position of morphological Right Ventricle (RV) is "physiologically" predisposed to fail at the adult age and may be potentially inadequate to support the hemodynamic stress of the pregnancy. Current literature about pregnancy in women with SRV consists of small retrospective series not providing conclusive evidence about the feasibility of a successful pregnancy outcomes. In addition, the long-term effects of pregnancy on SVR are not still adequately investigated and it remains unclear if maternal complications reported are due to pregnancy or to natural history of SVR. The aim of this paper is to offer a critical review of the knowledges at regard and to provide a practice update on the risk assessment and the pregnancy management in women with SRV in order to support the decision making and to optimize outcomes in these patients.
Collapse
Affiliation(s)
- Raffaella Marzullo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
| | - Magalie Ladouceur
- Unité de cardiologie congénitale adulte, Hôpital Européen Georges-Pompidou, Centre de référence des malformations cardiaques congénitales complexes, M3C, Paris, France
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Diseases Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| |
Collapse
|
7
|
Marzullo R, Gaio G, Giordano M, Palladino M, Ancona R, Scognamiglio G, D‘Alto M, Russo M, Sarubbi B. P156 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT IN OVER 60 YEARS OLD PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.149] [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: 11/13/2022]
Abstract
Abstract
Background
Ostium secundum ASD (ASDII) is the most common type of congenital heart disease in adults. Percutaneous closure has emerged as the first–line treatment for the majority of ASDII. However, the occurrence of Pulmonary Hypertension (PH) with combined pre– and post–capillary component may render ASD management challenging in elderly patients.
Methods
We report the hemodynamic data and clinical findings of elderly patients (> 60 years old) undergoing transcatheter closure of an ASDII at our department.
Results
From 2000 to 2021, 82 elderly patients were scheduled (mean age 65,4+ 4,4) of which 60 (73%) were female. Systemic arterial hypertension and supraventricular arrhythmias were the most common comorbidities accounting respectively 51% and 38% of cases. The right ventricular overload supported the ASD closure in 76 cases (93%) and paradoxical embolism in the remaining 6 (7%). 17 patients (21%) were in NYHA class III– IV. At right heart catheterization, 33 patients had normal pulmonary arterial pressure and 49 patients showed a mean pulmonary artery pressure > 20 mmhg. In the latter cohort, 33 showed a pulmonary artery wedge pressure (PAWP) < 15 mmHg (Group I) and 16 > 15 mmHg (Group II). The device implantation was completed in all patients except one with elevated pulmonary vascular resistance (PVR) of the Group I. For 14 patients of Group II, balloon occlusion test was required during the catheterization. ASD closure was achieved promptly in 10 patients. However, to reduce the risk of acute pulmonary oedema, in one case we created a small fenestration in the occluder device and in other case we retained the patency of additional defect (both patients exhibiting slightly PAWP increase during balloon occlusion test). In one patient showing significantly PAWP increase during balloon test, delayed ASD closure was performed ensuring the improvement of hemodynamic parameters at 3 months initiation of medical therapy with angiotensin–converting enzyme inhibitor and loop diuretic diuretics. For the remaining 4 patients, the percutaneous closure was not been done because of prohibitive hemodynamic parameters. Overall, ASD closure was performed successfully in 94% of cases.
Conclusions
Age and comorbidities are not absolute contraindications to ASDII percutaneous closure. In the complex cases, both medical therapies and balloon occlusion test may be use to support the decision–making process.
Collapse
Affiliation(s)
- R Marzullo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - G Gaio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Giordano
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Palladino
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - R Ancona
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - G Scognamiglio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M D‘Alto
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Russo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - B Sarubbi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| |
Collapse
|
8
|
Ancona R, Gaio G, Giordano M, Marzullo R, Cappelli Bigazzi M, Palladino M, Scognamiglio G, Sarubbi B, Russo M. C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.082] [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: 11/14/2022]
Abstract
Abstract
Background
Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure.
Materials and Methods
We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA>5 mm); Group II (one defect >5 mm and more than one further fenestrations); Group III (multiple fenestrations).
Results
Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P < 0.01) and need of implantations of more than one devices (P < 0.01).
Conclusions
Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.
Collapse
Affiliation(s)
- R Ancona
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - G Gaio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Giordano
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - R Marzullo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Cappelli Bigazzi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Palladino
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - G Scognamiglio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - B Sarubbi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Russo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| |
Collapse
|
9
|
Giordano M, Santoro G, Gaio G, Cappelli Bigazzi M, Esposito R, Marzullo R, Di Masi A, Palladino MT, Russo MG. Novel echocardiographic score to predict duct-dependency after percutaneous relief of critical pulmonary valve stenosis/atresia. Echocardiography 2022; 39:724-731. [PMID: 35466466 PMCID: PMC9322398 DOI: 10.1111/echo.15358] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/07/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed to identify clinical, hemodynamic, or echocardiographic predictive features of persistent duct‐dependency of pulmonary circulation (PDDPC) after effective percutaneous relief of pulmonary atresia with the intact ventricular septum (PA‐IVS) or critical pulmonary stenosis (CPS). Methods From 2010 to 2021, 55 neonates with PA‐IVS or CPS underwent percutaneous right ventricle (RV) decompression at our Institution. After successfully relief of critical obstruction, 27 patients (group I) showed PDDPC, whereas RV was able to support the pulmonary circulation in the remaining 28 patients (group II). Clinical, hemodynamic, and echocardiographic features of these two groups were compared. Results No significant difference in clinical and hemodynamic data was found between the groups, although the group I had a lower oxygen saturation at hospital admission. However, tricuspid valve (TV) diameter <8.8 mm, TV z‐score ←2.12, tricuspid/mitral valve annular ratio <.78, pulmonary valve diameter <6.7 mm, pulmonary valve z‐score ←1.17, end‐diastolic RV area <1.35 cm2, end‐systolic right atrium area >2.45 cm2, percentage amount of interatrial right‐to‐left shunt >69.5%, moderate/severe tricuspid regurgitation, RV systolic pressure >42.5 mmHg, tricuspid E/E′ ratio >6.6 showed each significant predictive value of PDDPC. These parameters were used to build a composite echocardiographic score (PDDPC‐score), assigning one point each above the respective cut‐off value. A score ≥4.00 showed high sensitivity (100%) and specificity (86%) in predicting PDDPC. Conclusion Clinical and hemodynamic features fail to predict the short‐term fate of the pulmonary circulation after successful treatment of PA‐IVS/CPS. However, a simple, composite echocardiographic score is useful to predict PDDPC and could be crucial in the management of this frail subset of patients.
Collapse
Affiliation(s)
- Mario Giordano
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Giuseppe Santoro
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Gianpiero Gaio
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Invasive Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Esposito
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Marzullo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Antonio Di Masi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| |
Collapse
|
10
|
Marzullo R, Balducci A, Cafiero G, Cifra B, Trocchio G, Varnier M, Colonna P. [Physical activity in patients with repaired and unrepaired congenital heart diseases. Task Force for exercise prescription in patients with congenital heart disease of the Italian Society of Pediatric Cardiology and Congenital Heart Disease]. G Ital Cardiol (Rome) 2021; 22:756-766. [PMID: 34463685 DOI: 10.1714/3660.36453] [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: 06/13/2023]
Abstract
Regular physical activity is essential for physical health and mental wellbeing in children and teenagers. However, patients with congenital heart disease are often restricted from being physically active due to parental overprotection and lack of physical activity promotion or exercise prescription from their physicians. A comprehensive medical evaluation is crucial for the development of personalized exercise programs for these patients. The aim of this review is to provide physicians with a practical guide on how to promote physical activity and prescribe exercise for patients with congenital heart disease with or without surgical correction.
Collapse
Affiliation(s)
- Raffaella Marzullo
- Cardiochirurgia e Cardiologia Pediatrica e Congenita A.O.U. Ospedali Riuniti di Ancona, Ancona
| | - Anna Balducci
- Cardiologia Pediatrica e dell'Età Evolutiva, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna
| | - Giulia Cafiero
- U.O.S.D. Medicina dello Sport, Dipartimento di Cardiochirurgia e Cardiologia, IRCCS Bambino Gesù, Roma
| | - Barbara Cifra
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | | | - Maurizio Varnier
- U.O.C. Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliera Università di Padova, Padova
| | | |
Collapse
|
11
|
Viganò G, Colaneri M, Capestro A, Marzullo R, Iezzi F, Pozzi M. RF13 CONGENITAL CORONARY ARTERY ANOMALIES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550028.80355.ef] [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]
|
12
|
Viganò G, Colaneri M, Capestro A, Marzullo R, Iezzi F, Pozzi M. RF17 EARLY DIAGNOSIS AND SURGICAL TREATMENT OF MIOCARDIAL BRIDGES IN CHILDREN. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550048.73625.7e] [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]
|
13
|
Cerrato E, Macaya Ten F, Conrotto F, Tamburino C, Van Lavieren M, Dascenso F, Latib A, Barbanti M, Piek J, Marzullo R, Applegate R, Macaya C, Gaita F, Varbella F, Escaned J. P4657Clinical implications of concomitant atherosclerosis in patients with spontaneous coronary artery dissection. Insights from an international multicentric registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4657] [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: 11/14/2022] Open
|
14
|
Conrotto F, D'Ascenzo F, Cerrato E, Fernández-Ortiz A, Gonzalo N, Macaya F, Tamburino C, Barbanti M, van Lavieren M, Piek JJ, Applegate RJ, Latib A, Spinnler MT, Marzullo R, Iannaccone M, Pavani M, Crimi G, Fattori R, Chinaglia A, Presbitero P, Varbella F, Gaita F, Escaned J. Safety and efficacy of drug eluting stents in patients with spontaneous coronary artery dissection. Int J Cardiol 2017; 238:105-109. [PMID: 28318654 DOI: 10.1016/j.ijcard.2017.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 07/22/2016] [Revised: 01/19/2017] [Accepted: 03/08/2017] [Indexed: 01/29/2023]
Abstract
AIMS Given the different pathogenesis, use of drug eluting stent (DES) in patients with Spontaneous Coronary Artery Dissection SCAD may delay the healing of the dissected vessel. Aim of our study was to compare the safety and the efficacy of DES vs. bare metal stent (BMS) in a cohort of patients who underwent stenting for SCAD. METHODS AND RESULTS Consecutive patients with SCAD between January 1995 and August 2014 were retrospectively identified in 12 centers and included. Major Adverse Cardiac Events (MACE) was the primary end point. A total of 238 SCAD patients were identified: of them 108 patients underwent PCI with DES or BMS. Overall 24 patients (22.2%) suffered an intra-procedural complication without any differences between the 2 groups. At median follow-up of 1201days (Inter Quartile Range 541-2760), incidence of the primary endpoint showed a trend towards less events in the DES-treated patients (38.7% vs. 25.9% p=0.14) mainly driven by the benefit of DES in terms of TVR (17.6% vs. 4%, p=0.08), mortality (16.8% vs. 9.3%, p=0.4), and MI rate (16% vs. 8.4%, p=0.33). STEMI at presentation (HR 6.4, CI 95% 1.29-31.9, p=0.02) but not kind of stent (HR 0.97, CI 95% 0.2-4.7, p=0.9) emerged as independently related to prognosis at multivariable analysis. CONCLUSIONS In SCAD patients use of DES seems to be as safe as BMS with trend of better efficacy in the long term.
Collapse
Affiliation(s)
- Federico Conrotto
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | - Nieves Gonzalo
- Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
| | - Fernando Macaya
- Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Marco Barbanti
- Cardiology Department, Ferrarotto Hospital, Catania, Italy
| | | | - Jan J Piek
- Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Robert J Applegate
- Cardiology Department, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Azeem Latib
- San Raffaele Scientific Institute, Milan, Italy
| | | | - Raffaella Marzullo
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mario Iannaccone
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pavani
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | | | | | | | - Fiorenzo Gaita
- Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Javier Escaned
- Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
15
|
Marzullo R, Bordese R, Bassignana A, Ferraro G, Dall'Orto G, Ferrarotti L, Libertucci D, Rissone L, Amoroso G, Actis Dato G, Albera C, Bergamasco L, Agnoletti G. [Preliminary results and future perspectives of the Piedmont Adult Congenital Heart Disease Registry]. G Ital Cardiol (Rome) 2016; 17:225-33. [PMID: 27029881 DOI: 10.1714/2190.23668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adults with congenital heart disease are a relatively new population that progressively increases in size and complexity. In Italy, there are no accurate data concerning the distribution of congenital defects and the long-term outcome relating to both congenital heart disease per se and comorbidities, due to the aging process. METHODS The Piedmont Adult Congenital Heart Disease Registry has been designed to investigate these aspects and to support a high quality healthcare development for grown-up congenital heart patients. Within 2 years, 459 consecutive patients routinely followed in 10 divisions of cardiology in Piedmont were included in the project. Electronic dedicated software has supported data collection. RESULTS Mean age of patients is 35 ± 16 years. Septal defects are the most common type of congenital heart disease (35.3%). At baseline evaluation, 71.7% of patients reported a previous surgical and/or percutaneous treatment and 6.3% an electrophysiological procedure. Freedom from intervention is 44%, 81% and 56% at the age of 18, 30 and 45 years, respectively. Patients who had a treatment during infancy show a better intervention-free survival (p=0.038) compared with patients treated during adulthood. Despite the majority of the population had an almost preserved functional status, 27.5% had ≥1 long-term sequelae (arrhythmias 27.5%; pulmonary hypertension 5.2%; neurological problems 4.1%; cyanosis 4.8%; liver dysfunction 2.4%; enteropathy 2.4%; lung disease 2.2%). During 2 years of follow-up, the estimated mortality rate is 0.88%. CONCLUSIONS Adults with congenital heart disease are a heterogeneous population of relatively young patients with relevant clinical and social problems. The late sequelae related to both the underlying heart disease and the advancing age require continuous monitoring and lifelong specialized care.
Collapse
Affiliation(s)
- Raffaella Marzullo
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | - Roberto Bordese
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | | | - Gaetana Ferraro
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | - Daniela Libertucci
- Dipartimento Cardiovascolare e Toracico, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | - Carlo Albera
- S.C. Pneumologia, A.O.U. San Luigi Gonzaga, Orbassano (TO)
| | - Laura Bergamasco
- Dipartimento di Scienze Mediche e Chirurgiche, A.O.U. Città della Salute e della Scienza, Torino
| | - Gabriella Agnoletti
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| |
Collapse
|
16
|
Marzullo R, Aprile A, Sangiorgi G. Capture and repositioning of third-generation migrated abdominal endovascular graft by bilateral femoral wire externalization and pulling by "horse-riding" technique followed by balloon EVG stabilization. J Invasive Cardiol 2012; 24:685-688. [PMID: 23220987] [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: 06/01/2023]
Abstract
Endovascular aneurysm repair is becoming the treatment of choice for elderly patients bearing abdominal aortic aneurysms with particular anatomical characteristics. Endovascular grafts are usually oversized to achieve sealing and minimize graft migration, the likelihood of which is also reduced by fixation hooks and barbs in the newer generation grafts. Yet, upward migration of the prosthesis, potentially compromising flow to renal and splanchnic vessels, may still occur acutely and requires timely management. We describe a patient with abdominal aortic aneurysm in whom proximal migration of an endovascular graft occurred, leading to renal and mesenteric artery obstruction, which was successfully managed by means of capturing and repositioning the device with a "horse-riding" technique followed by balloon stabilization of the graft to reduce the risk of re-dislodgment during controlateral leg insertion.
Collapse
Affiliation(s)
- Raffaella Marzullo
- Department of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | |
Collapse
|
17
|
Leuzzi C, Marzullo R, Modena MG. [Is menopause a risk factor for ischemic heart disease in women?]. G Ital Cardiol (Rome) 2012; 13:401-6. [PMID: 22622118 DOI: 10.1714/1073.11757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in men and women worldwide. The apparent cardioprotective effects of endogenous estrogens seem to prevent CVD in premenopausal women. Following menopause and loss of hormonal effects, gender-based differences in CVD are reduced, with the CVD risk being higher in women who develop the metabolic syndrome. In postmenopausal women, many features of the metabolic syndrome emerge with estrogen deficiency. Estrogen deficiency occurring in the menopausal period is associated with 1) dyslipidemia (hypertriglyceridemia, reduced HDL, and increased small dense LDL particles); 2) insulin resistance; 3) hypertension; 4) increased central fat and reduction in lean body mass; and 5) increased hypercoagulability and pro-inflammatory state. In addition to traditional cardiovascular risk factors, also early menopause has a negative impact on females. Over the past years, different approaches were found to improve quality of life and cardiovascular health in menopausal women. Since the concept of hormone replacement therapy (HRT), large observational studies and randomized clinical trials have amassed a wealth of data about the effects of menopause and the safety and efficacy of using estrogen replacement therapies to treat menopause symptoms and menopause-related diseases. While there is no question that HRT effectively mitigates troublesome menopause symptoms, conflicting evidence about other effects of HRT has fueled controversy concerning its relative benefits and risks. Moreover, it seems that CVD protection mediated by replacement therapy is maximum when treatment is initiated in the absence of signs of atherosclerosis (typically in the premenopausal period), whereas it vanishes as atherosclerosis progresses (postmenopausal period). However, many questions remain unsolved regarding the effectiveness of hormonal compounds, doses, regimens, and route of administration. On the basis of these considerations, it is necessary in the near future to expand scientific knowledge and develop appropriate lifestyle modifications and therapeutic strategies for the treatment of either traditional cardiovascular risk factors or menopause-related metabolic changes.
Collapse
Affiliation(s)
- Chiara Leuzzi
- Cattedra di Cardiologia, Universita degli Studi di Modena e Reggio Emilia, Modena
| | | | | |
Collapse
|
18
|
Marzullo R, Aprile A, Clementi F, Stella P, Modena MG, Sangiorgi GM. Paclitaxel eluting balloon: from bench to bedside. Minerva Cardioangiol 2009; 57:597-609. [PMID: 19838150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Despite the impressive progress of percutaneous treatment modalities, restenosis remains the major Achilles heel of interventional cardiology. Approximately 25% of the general population treated for coronary diseases with a bare-metal stent and about 10% of patients treated with a drug-eluting stent develop an overgrowth of vascular tissue and renarrowing inside the stent, or in-stent restenosis. These rates are even greater in diabetics and patients at higher risk of restenosis both for clinical presentation (patients in dialysis, low ejection fraction) or anatomical characteristics (ostial, bifurcation, long lesions). Non-stent based local drug delivery and particularly the use of paclitaxel eluting balloon (PEB) could be one promising strategy to reduce restenosis. This review will briefly explore the different characteristics of PEB devices currently present in the market and summarize the results obtained both in animal models and clinical practice, giving an indication of the potential field of application of this new technology.
Collapse
Affiliation(s)
- R Marzullo
- Department of Cardiology, Policlinic of Modena, Modena, Italy
| | | | | | | | | | | |
Collapse
|