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Cantinotti M, Jani V, Kutty S, Marchese P, Franchi E, Pizzuto A, Viacava C, Assanta N, Santoro G, Giordano R. Neonates and Infants with Left Heart Obstruction and Borderline Left Ventricle Undergoing Biventricular Repair: What Do We Know about Long-Term Outcomes? A Critical Review. Healthcare (Basel) 2024; 12:348. [PMID: 38338232 PMCID: PMC10855671 DOI: 10.3390/healthcare12030348] [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] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
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Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Vivek Jani
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Pietro Marchese
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Eliana Franchi
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Alessandra Pizzuto
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Cecilia Viacava
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Giuseppe Santoro
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Cantinotti M, Marchese P, Franchi E, Santoro G, Assanta N, Giordano R. Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still. Healthcare (Basel) 2024; 12:263. [PMID: 38275542 PMCID: PMC10815034 DOI: 10.3390/healthcare12020263] [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] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. The aim of the present investigation is to provide a review and update on potentialities and application of BSTE in children with congenital heart disease (CHD) and acquired heart disease. A literature search was performed within the National Library of Medicine using the keywords "echocardiography", "BST", and "children". The search was refined by adding the keywords "ultrafast imaging", "CHD", and "4D flow". Fifteen studies were finally included. Our analysis outlined how BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with CHD. BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD. Complex analysis (e.g., energy loss, vorticity, and vector complexity) are also highly feasible with BSTE, but software is currently available only for research. Furthermore, current technology allows for BSTE only in neonates and low-weight children (e.g., <40 kg). In summary, the feasibility and potentialities of BSTE as a complementary diagnostic tool in children have been proved; however, its systemic use is hampered by the lack of (i) accessible tools for complex quantification and for acquisition at all ages/weight, (ii) data on the diagnostic/prognostic significance of BSTE, and (iii) consensus/recommendation papers indicating when and how BSTE should be employed.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Fumanelli J, Garibaldi S, Castaldi B, Di Candia A, Pizzuto A, Sirico D, Cuman M, Mirizzi G, Marchese P, Cantinotti M, Piacenti M, Assanta N, Viacava C, Di Salvo G, Santoro G. Mid-Term Electrical Remodeling after Percutaneous Atrial Septal Defect Closure with GCO Device in a Pediatric Population. J Clin Med 2023; 12:6334. [PMID: 37834978 PMCID: PMC10573535 DOI: 10.3390/jcm12196334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/02/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIM The GORE® CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population. METHODS We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation. RESULTS Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m2 respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h (p < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved (p = 0.018 and p < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, p = 0.9 and 81.0 ± 12.7, p = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure. CONCLUSIONS Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.
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Affiliation(s)
- Jennifer Fumanelli
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Biagio Castaldi
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Alessandra Pizzuto
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Magdalena Cuman
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Giuseppe Santoro
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
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Cantinotti M, Marchese P, Assanta N, Franchi E, Pak V, Barberi E, Pizzuto A, Santoro G, Giordano R. Native Aortic Root Thrombosis in Hypoplastic Left Heart Syndrome: An Unusual Presentation (Soon after Atrial Septal Stenting) of a Relatively Unusual Complication-Experience and Literature Review with an Outlook to Diagnosis and Management. J Clin Med 2023; 12:5357. [PMID: 37629399 PMCID: PMC10455892 DOI: 10.3390/jcm12165357] [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] [Received: 07/09/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
We started with the experience of thrombus formation in the native aorta of a 3-year-old male child with hypoplastic left heart syndrome (HLHS) and severely hypoplastic but patent mitral and aortic valves after Glenn palliation, which occurred soon after left heart decompression by percutaneous stenting of the atrial septum. The diagnosis was incidental, with the child completely asymptomatic, and progressively subsided in a few days with heparin infusion and chronic warfarin therapy. We reviewed the incidence, diagnosis, and management of native aortic thrombosis in HLHS after different stages of Fontan palliation through a systematic literature search. In all 32 cases, native aortic thrombosis in HLHS was found. The HLHS anatomic subtypes included mitral stenosis/aortic stenosis (fourteen cases or 45.2%), mitral stenosis/aortic atresia (eleven cases or 35.5%), and mitral atresia/aortic atresia (four cases or 12.9%). The age at diagnosis ranged from 13 days to 18 years. Clinical presentation varied from incidental findings, chest pain and/or electrocardiographic abnormalities, cardiac arrest, and transient ischemic attack. Diagnosis was feasible in most of the cases with only transthoracic echocardiography. Mostly (59.4%), patients were treated with anticoagulation, while others underwent surgical (18.7%), direct (12.5%), or systemic (9.3%) thrombolysis. Transplant-free survival was 56.2%, and fatal events occurred in 25%. Major events occurred in 26.3% of those treated with anticoagulation, in 33.3% of patients treated with surgical/systemic thrombolysis, and in 100% of patients treated with direct thrombolysis. In summary, native aortic thrombosis in HLHS may occur at different ages, with a wide spectrum of presentation from incidental finding to a sudden major event. Diagnosis is feasible with transthoracic echocardiography, and management with anticoagulation is effective despite the incidence of major events remaining high.
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Affiliation(s)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | - Vitali Pak
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | - Elisa Barberi
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | | | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
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Favilli S, Assanta N, Carluccio M, Ricciardi G, Segreti L, Canale ML, Grippo G, Selvaggia Magnaghi GC, Misuraca L, Orso F, Sorini Dini C, Talini E, Mirizzi G, Spaziani G, Garibaldi S, Viacava C, Porcedda G, Casolo G. [Arrhythmias in adult congenital heart disease at the emergency department: ANMCO Tuscany clinical pathway]. G Ital Cardiol (Rome) 2023; 24:604-611. [PMID: 37492867 DOI: 10.1714/4068.40528] [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: 07/27/2023]
Abstract
Arrhythmias are a common complication in the adult population with congenital heart disease (ACHD). Arrhythmias often lead to hemodynamic instability and, on the other hand, may be a marker of hemodynamic impairment in ACHD patients, both in natural history and after cardiac surgery. Treatment requires knowledge of basic anatomy and any previous cardiac surgery; the availability of patient's health records, if possible, is therefore crucial for therapeutic choices. In the emergency setting, the first target is represented by the patient's hemodynamic stabilization; mainly in moderate or high complexity ACHD, the connection with the referral center is recommended, to which patients should be entrusted for follow-up. A regional epidemiological observatory, aiming to assess the number, type and outcomes of emergency admissions of ACHD patients could be a useful tool for analyzing the effectiveness of the collaboration network between the different structures involved and for implementing organizational pathways.
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Affiliation(s)
- Silvia Favilli
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Nadia Assanta
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Marisa Carluccio
- U.O. Cardiologia 2, SSN Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Giuseppe Ricciardi
- S.O.C. Elettrofisiologia, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Luca Segreti
- U.O. Cardiologia 2, SSN Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Maria Laura Canale
- Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | | | | | - Leonardo Misuraca
- U.O.S.D. Cardiologia Interventistica, Ospedale della Misericordia, Grosseto
| | - Francesco Orso
- S.O.D.c. Geriatria-UTIG, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Carlotta Sorini Dini
- Cardiologia Clinica-Chirurgia/UTIC, Azienda Ospedaliero-Universitaria Senese, Siena
| | | | - Gianluca Mirizzi
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Gaia Spaziani
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Silvia Garibaldi
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Cecilia Viacava
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Giulio Porcedda
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
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Cantinotti M, McMahon CJ, Marchese P, Köstenberger M, Scalese M, Franchi E, Santoro G, Assanta N, Jacquemyn X, Kutty S, Giordano R. Echocardiographic Parameters for Risk Prediction in Borderline Right Ventricle: Review with Special Emphasis on Pulmonary Atresia with Intact Ventricular Septum and Critical Pulmonary Stenosis. J Clin Med 2023; 12:4599. [PMID: 37510714 PMCID: PMC10380858 DOI: 10.3390/jcm12144599] [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] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex congenital heart diseases (CHDs) with borderline right ventricle (RV), with a focus on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS). A systematic search in the National Library of Medicine using Medical Subject Headings and free-text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords "PAIVS/CPS", Ebstein's anomaly, and unbalanced atrioventricular septal defect with left dominance. A total of 22 studies were selected for final analysis; 12 of them were focused on parameters to predict biventricular repair (BVR)/pulmonary blood flow augmentation in PAIVS/CPS. All of these studies presented numerical (the limited sample size) and methodological limitations (retrospective design, poor definition of inclusion/exclusion criteria, variability in the definition of outcomes, differences in adopted surgical and interventional strategies). There was heterogeneity in the echocardiographic parameters employed and cut-off values proposed, with difficultly in establishing which one should be recommended. Easy scores such as TV/MV (tricuspid/mitral valve) and RV/LV (right/left ventricle) ratios were proven to have a good prognostic accuracy; however, the data were very limited (only two studies with <40 subjects). In larger studies, RV end-diastolic area and a higher degree of tricuspid regurgitation were also proven as accurate predictors of successful BVR. These measures, however, may be either operator and/or load/pressure dependent. TV Z-scores have been proposed by several authors, but old and heterogenous nomograms sources have been employed, thus producing discordant results. In summary, we provide a review of the currently available echocardiographic parameters for risk prediction in CHDs with a diminutive RV that may serve as a guide for use in clinical practice.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Colin Joseph McMahon
- Department of Pediatric Cardiology, Childrens Health Ireland, D12 N512 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University Graz, 8036 Graz, Austria
| | - Marco Scalese
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | | | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Xander Jacquemyn
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
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Cantinotti M, Marchese P, Scalese M, Giordano R, Franchi E, Assanta N, Koestenberger M, Barnes BT, Celi S, Jani V, Voges I, Kutty S. Characterization of Aortic Flow Patterns by High-Frame-Rate Blood Speckle Tracking Echocardiography in Children. J Am Heart Assoc 2023; 12:e026335. [PMID: 37066781 PMCID: PMC10227241 DOI: 10.1161/jaha.122.026335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/05/2022] [Accepted: 12/26/2022] [Indexed: 04/18/2023]
Abstract
Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Adult Institute of Clinical PhysiologyPisaItaly
| | - Pietro Marchese
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Scuola Superiore Sant’AnnaPisaItaly
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical SciencesUniversity of Naples “Federico II”NapoliItaly
| | - Eliana Franchi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Nadia Assanta
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
| | - Benjamin T. Barnes
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Simona Celi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Vivek Jani
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric CardiologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Shelby Kutty
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
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Cantinotti M, Marchese P, Giordano R, Franchi E, Assanta N, Koestenberger M, Jani V, Duignan S, Kutty S, McMahon CJ. Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review. Heart Fail Rev 2023; 28:63-76. [PMID: 35332415 DOI: 10.1007/s10741-022-10230-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
The aim of this review is to highlight the strengths and limitations of major echocardiographic biventricular repair (BVR) prediction models for borderline left ventricle (LV) in complex congenital heart disease (CHD). A systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords for critical aortic stenosis (AS), borderline LV, complex left ventricular outflow tract (LVOT) obstruction, hypoplastic left heart syndrome/complex (HLHS/HLHC), and unbalanced atrio-ventricular septal defects (uAVSD). Fifteen studies were selected for the final analysis. We outlined what echocardiographic scores for different types of complex CHD with diminutive LV are available. Scores for CHD with LVOT obstruction including critical AS, HLHS/HLHC, and aortic arch hypoplasia have been validated and implemented by several studies. Scores for uAVSD with right ventricle (RV) dominance have also been established and implemented, the first being the atrioventricular valve index (AVVI). In addition to AVII, both LV/RV inflow angle and LV inflow index have all been validated for the prediction of BVR. We conclude with a discussion of limitations in the development and validation of each of these scores, including retrospective design during score development, heterogeneity in echocardiographic parameters evaluated, variability in the definition of outcomes, differences in adopted surgical and Interventional strategies, and institutional differences. Furthermore, scores developed in the past two decades may have little clinical relevance now. In summary, we provide a review of echocardiographic scores for BVR in complex CHD with a diminutive LV that may serve as a guide for use in modern clinical practice.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", 80131, Naples, Italy.
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Vivek Jani
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
| | - Sophie Duignan
- Children's Heart Centre, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shelby Kutty
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
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9
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Cantinotti M, Marchese P, Assanta N, Pizzuto A, Corana G, Santoro G, Franchi E, Viacava C, Van den Eynde J, Kutty S, Gargani L, Giordano R. Lung Ultrasound Findings in Healthy Children and in Those Who Had Recent, Not Severe COVID-19 Infection. J Clin Med 2022; 11:jcm11205999. [PMID: 36294320 PMCID: PMC9605002 DOI: 10.3390/jcm11205999] [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: 08/04/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Lung ultrasound (LUS) is gaining consensus as a non-invasive diagnostic imaging method for the evaluation of pulmonary disease in children. Aim: To clarify what type of artifacts (e.g., B-lines, pleural irregularity) can be defined normal LUS findings in children and to evaluate the differences in children who did not experience COVID-19 and in those with recent, not severe, previous COVID-19. Methods: LUS was performed according to standardized protocols. Different patterns of normality were defined: pattern 1: no plural irregularity and no B-lines; pattern 2: only mild basal posterior plural irregularity and no B-lines; pattern 3: mild posterior basal/para-spine/apical pleural irregularity and no B-lines; pattern 4: like pattern 3 plus rare B-lines; pattern 5: mild, diffuse short subpleural vertical artifacts and rare B-lines; pattern 6: mild, diffuse short subpleural vertical artifacts and limited B-lines; pattern 7: like pattern 6 plus minimal subpleural atelectasis. Coalescent B-lines, consolidations, or effusion were considered pathological. Results: Overall, 459 healthy children were prospectively recruited (mean age 10.564 ± 3.839 years). Children were divided into two groups: group 1 (n = 336), those who had not had COVID-19 infection, and group 2 (n = 123), those who experienced COVID-19 infection. Children with previous COVID-19 had higher values of LUS score than those who had not (p = 0.0002). Children with asymptomatic COVID-19 had similar LUS score as those who did not have infections (p > 0.05), while those who had symptoms showed higher LUS score than those who had not shown symptoms (p = 0.0228). Conclusions: We report the pattern of normality for LUS examination in children. We also showed that otherwise healthy children who recovered from COVID-19 and even those who were mildly symptomatic had more “physiological” artifacts at LUS examinations.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
- Institute of Clinical Physiology, 56127 Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | | | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, 3010 Leuven, Belgium
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Luna Gargani
- Cardiothoracic Department, University of Pisa, 56127 Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence: ; Tel./Fax: +39-08-1746-4702
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Orsini A, Foiadelli T, Sica A, Santangelo A, Carli N, Bonuccelli A, Consolini R, D’Elios S, Loddo N, Verrotti A, Di Cara G, Marra C, Califano M, Fetta A, Fabi M, Bergamoni S, Vignoli A, Battini R, Mosca M, Baldini C, Assanta N, Marchese P, Simonini G, Marrani E, Operto FF, Pastorino GMG, Savasta S, Santangelo G, Pedrinelli V, Massimetti G, Dell’Osso L, Peroni D, Cordelli DM, Corsi M, Carmassi C. Psychopathological Impact in Patients with History of Rheumatic Fever with or without Sydenham's Chorea: A Multicenter Prospective Study. Int J Environ Res Public Health 2022; 19:10586. [PMID: 36078300 PMCID: PMC9517806 DOI: 10.3390/ijerph191710586] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Sydenham's chorea (SC) is a post-streptococcal autoimmune disorder of the central nervous system, and it is a major criterium for the diagnosis of acute rheumatic fever (ARF). SC typically improves in 12-15 weeks, but patients can be affected for years by persistence and recurrencies of both neurological and neuropsychiatric symptoms. We enrolled 48 patients with a previous diagnosis of ARF, with or without SC, in a national multicenter prospective study, to evaluate the presence of neuropsychiatric symptoms several years after SC's onset. Our population was divided in a SC group (n = 21), consisting of patients who had SC, and a nSC group (n = 27), consisting of patients who had ARF without SC. Both groups were evaluated by the administration of 8 different neuropsychiatric tests. The Work and Social Adjustment Scale (WSAS) showed significantly (p = 0.021) higher alterations in the SC group than in the nSC group. Furthermore, 60.4% (n = 29) of the overall population experienced neuropsychiatric symptoms other than choreic movements at diagnosis and this finding was significantly more common (p = 0.00) in SC patients (95.2%) than in nSC patients (33.3%). The other neuropsychiatric tests also produced significant results, indicating that SC can exert a strong psychopathological impact on patients even years after its onset.
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Affiliation(s)
- Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Attilio Sica
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Andrea Santangelo
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Niccolò Carli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Rita Consolini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Sofia D’Elios
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | - Nicolò Loddo
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, 06123 Perugia, Italy
| | - Giuseppe Di Cara
- Department of Pediatrics, University of Perugia, 06123 Perugia, Italy
| | - Chiara Marra
- Child Neurology Unit, University of Bologna, 40126 Bologna, Italy
| | - Maria Califano
- Child Neurology Unit, University of Bologna, 40126 Bologna, Italy
| | - Anna Fetta
- Child Neurology Unit, University of Bologna, 40126 Bologna, Italy
| | - Marianna Fabi
- Child Neurology Unit, University of Bologna, 40126 Bologna, Italy
| | - Stefania Bergamoni
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, 20121 Milan, Italy
| | - Aglaia Vignoli
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, 20121 Milan, Italy
- Health Sciences Department, Università degli Studi di Milano, 20121 Milan, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
- Department of Developmental Neuroscience, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, 56121 Pisa, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Nadia Assanta
- Heart Hospital, G. Monasterio Tuscan Foundation, 54100 Massa, Italy
| | - Pietro Marchese
- Heart Hospital, G. Monasterio Tuscan Foundation, 54100 Massa, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology, Meyer Children Hospital, University of Florence, 50134 Florence, Italy
| | - Edoardo Marrani
- Pediatric Rheumatology, Meyer Children Hospital, University of Florence, 50134 Florence, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy
| | | | - Giuseppe Santangelo
- Child Neuropsychiatry Unit, ISMEP—P.O. Cristina—ARNAS Civico, Via dei Benedettini 1, 90100 Palermo, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Diego Peroni
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56121 Pisa, Italy
| | | | - Martina Corsi
- Occupational Health Department, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
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11
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Santoro G, Pizzuto A, Cuman M, Haxhiademi D, Marchese P, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. Transcatheter closure of "Surgical" ostium secundum atrial septal defects with GORE® Cardioform ASD Occluder. J Card Surg 2022; 37:3200-3206. [PMID: 35900295 DOI: 10.1111/jocs.16786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCA)(WL Gore & Associates) device for closure of ostium secundum atrial septal defects (ASDs) with predicted indication for surgical correction. BACKGROUND Closure of large ASD in small children by transcatheter approach is still challenging. This study evaluated the results of GCA in this subset of patients in a tertiary referral center. METHODS Between January 2020 and March 2022, 97 children underwent transcatheter ASD closure at our Institution. Of them, 38 had a large defect (diameter/weight > 1.2 or diameter/body surface area > 20 mm/m2 ), predicted suitable for surgery and underwent closure with GCA. Procedure results and midterm outcome are reported. RESULTS Patients' age and weight were 5.5 ± 1.5 years and 19.7 ± 4.7 kg, respectively. Absolute and relative ASD size was 21.5 ± 3.6 mm, 1.1 ± 0.2 mm/kg, and 27.7 ± 4.6 mm/m2 , respectively, resulting in QP/QS of 2.0 ± 0.8. Three patients were sent to surgery after balloon sizing. Four of the remaining 35 patients who underwent device deployment, needed rescue or elective surgery due to device embolization (n = 1), device instability (n = 2) or new-onset tricuspid valve regurgitation (n = 1). Procedure feasibility was 88.6%. Major complications were recorded in two patients (5.7%). Minor complications were recorded in five patients (14.3%). Complete closure at discharge was 90.3% (28/31 pts) rising to 100% at the last follow-up evaluation. Wireframe fracture rate at the 6 months examination was 52%, without clinical and instrumental consequences. CONCLUSIONS Percutaneous treatment with GCA device is effective and safe in a high percentage of ASD children with predicted indications for surgical correction.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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12
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Simeone S, Rea T, Platone N, Guillari A, Lanzuise A, Assanta N, Da Valle P, Baratta S, Pucciarelli G. Quality of Life of Families with Children Presenting Congenital Heart Disease:Longitudinal Study Protocol. Healthcare (Basel) 2022; 10:healthcare10071273. [PMID: 35885800 PMCID: PMC9317531 DOI: 10.3390/healthcare10071273] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Advances in medicine have caused a notable increase in the survival rates of children born with congenital heart disease, even in the most complicated cases, almost mitigating the disease’s pathology from lethal to chronic. The quality of life perceived by such children is influenced by the perceptions of their parents. However, the international literature has rarely considered the entire family nucleus. AIMS: This study aims to study the temporal trend of quality of life of families with children with congenital heart disease, particularly with respect to parents following a child’s hospitalization for an invasive procedure. DESIGN: A longitudinal study. METHOD: A sample of families (that is, those including a child with congenital heart disease and their parents) will be enrolled following the patient’s discharge from the hospital and examined every 3 months for 1 year. The study’s adopted hypothesis is that there is an interdependence between the subjects of the study that is capable of influencing individual perceptions of quality of life. RESULTS: This study will attempt to identify variables (and their temporal trend) that can be attributed to the family unit and—together with physical and clinical variables—that may influence the quality of life of children with congenital heart disease. CONCLUSION: Examining family quality of life with the longitudinal method will allow us to identify the predictors and interdependence of this factor with respect to children and their parents. This will help to correct and elaborate upon care guidelines, providing better assistance to patients and their caregivers.
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Affiliation(s)
- Silvio Simeone
- Clinical and Experimental Medicine Department, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy;
| | - Nicol Platone
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Assunta Guillari
- Department of Public Health, University Federico II of Naples, 80145 Napoli, Italy
- Correspondence:
| | | | - Nadia Assanta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Paola Da Valle
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Stefania Baratta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevenion, University of Rome Tor Vergata, 00133 Rome, Italy;
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13
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Fumanelli J, Garibaldi S, Castaldi B, Di Candia A, Cuman M, Pizzuto A, Sirico D, Mirizzi G, Piacenti M, Cantinotti M, Assanta N, Di Salvo G, Santoro G. Short-term electrocardiographic atrial remodelling after asd closure with the gco device in a pediatric population. Europace 2022. [DOI: 10.1093/europace/euac053.027] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Aim
The GORE® CARDIOFORM septal occluder (GCO) is an atrial septal defect/patent foramen ovale (ASD/PFO) closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance.
Our aim was to evaluate the short and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population.
Methods
We enrolled 39 patients with isolated ASD submitted to trans-catheter closure with GCO from January 2020 to June 2021. EKG was performed before (T0), at 24 hours (T1) and 6 months (T2) after ASD transcatheter closure. P wave dispersion was calculated as the difference between maximum and minimum P- wave duration, PR interval as the interval between beginning of the P wave and beginning of the QRS complex and QT dispersion as the difference between maximun and minimun of QTc intervals. At 6-months from device implantation, the patients were submitted to ambulatory EKG Holter recording.
Results
Patients’ age and BSA were 8.2±4.2 years (IQR 4.2-8.3, median 7.0) and 1.0±0.3 m2 (IQR 0.7-1.7, median 0.9), respectively. The strectched ASD diameter was 16.3±4.5 mm (median 16), resulting in QP/QS of 1.7±0.6 (median 1.5). At the baseline mean P wave dispersion was 40±15 msec and decreased to 30±13 msec (p<0.002) at 24h, without any further change at 6 months (30±13 msec, p<0.002). PR conduction significantly improved at 24 h from device implantation (from 175.0±20.8 to 144.0±22.7 msec, p=0.018) and did not significantly change at 6 months (164.0±19.5 msec, p=NS). QTc dispersion decreased at 24 hours (31.7±.20.3, p<0.02) and at 6 months (28.0±18.1, p<0.002) from device implantation. After device deployment, 2 pts (5%) developed transient, self-limited junctional rhythm and one of them needed a short course of anti-arrhythmic therapy for supra-ventricular tachycardia. No tachy/brady-arrhythmias were recorded at the 6-months follow-up EKG Holter monitoring.
Conclusions
Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium term follow-up. It might be due to a favourable volumetric remodelling that was not hindered by mechanical impact of the occluding prosthesis and could explain the low rate of arrhythmias found at the mid-term EKG evaluation.
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Affiliation(s)
- J Fumanelli
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - S Garibaldi
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - B Castaldi
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - A Di Candia
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - M Cuman
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - A Pizzuto
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - D Sirico
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - G Mirizzi
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - M Piacenti
- University of Pisa, Pediatric Department, Pisa, Italy
| | - M Cantinotti
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - N Assanta
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - G Di Salvo
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - G Santoro
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
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14
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Cantinotti M, Clerico A, Giordano R, Assanta N, Franchi E, Koestenberger M, Marchese P, Storti S, D'Ascenzi F. Cardiac Troponin-T Release After Sport and Differences by Age, Sex, Training Type, Volume, and Intensity: A Critical Review. Clin J Sport Med 2022; 32:e230-e242. [PMID: 34009785 DOI: 10.1097/jsm.0000000000000940] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postexercise release of cardiac troponin (cTn) is a well-known phenomenon, although the influence of various confounders remains unclear. The aim of this critical review was to analyze the postexercise release of cTn according to age, sex, different types of sport, exercise intensity and duration, and training level. DATA SOURCES A literature search was performed within the National Library of Medicine using the following keywords: cTn, peak, release, and exercise. The search was further refined by adding the keywords athletes, children/adolescents, and sport. MAIN RESULTS For final analysis, 52 studies were included: 43 adult studies, 4 pediatric studies, and 5 with a mixed population of adults and children. Several studies have investigated the kinetics of cTn response after exercise with different biomarkers. The current evidence suggests that sport intensity and duration have significant effects on postexercise cTn elevation, whereas the influence of the type of sport, age, and sex have been not completely defined yet. Most data were obtained during endurance races, whereas evidence is limited (or almost absent), particularly for mixed sports. Data on young adults and professional athletes are limited. Finally, studies on women are extremely limited, and those for non-White are absent. CONCLUSIONS Postexercise release of cTn can be observed both in young and master athletes and usually represents a physiological phenomenon; however, more rarely, it may unmask a subclinical cardiac disease. The influence of different confounders (age, sex, sport type/intensity/duration, and training level) should be better clarified to establish individualized ranges of normality for postexercise cTn elevation.
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Affiliation(s)
- Massimiliano Cantinotti
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
- Pediatric Cardiology Unit, Institute of Clinical Physiology (IFC) National Research Institute (CNR), Pisa, Italy
| | - Aldo Clerico
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Raffaele Giordano
- Department Advanced Biomedica Sciences, University of Naples Federico II, Naples, Italy
| | - Nadia Assanta
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Martin Koestenberger
- Department Advanced Biomedica Sciences, University of Naples Federico II, Naples, Italy
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria; and
| | - Pietro Marchese
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Simona Storti
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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Cantinotti M, Marchese P, Franchi E, Assanta N, Van Den Eynde J, Shelby K. Speckle tracking echocardiography strain analysis for the assessment and monitoring of myocardial mechanics after pediatric cardiac surgery. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.342] [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
Funding Acknowledgements
Type of funding sources: None.
Background. Speckle-tracking echocardiography (STE) is a relatively new ultrasound technique that exploits acoustic reflections and artifacts within the ultrasonic window, with the aim of analyzing global myocardial deformation and segmenting. STE has proved to be more sensitive in identifying a myocardial dysfunction so gained increasing value in the evaluation of congenital heart diseases (CHD) even though its use, in pediatric cardiac surgery, is still limited. The present study aims to evaluate the global and left ventricular (LV) systolic impairment after pediatric cardiac surgery by STE strain (ε) analysis.
Methods
We prospectively enrolled 120 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12-36 hours (Time-1), 3-5 days (Time-2), 6-8 days (Time-3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values.
Results. We collected data from 332 examinations in 120 children (mean age: 2.33 ±3.91, range: 0-16 years) at different post-operative times. 120 age-matched healthy children (3.1 ± 4.2 years) served as controls. All global, basal, and mid LVε values reduced after surgery; the lowest values were at Time-1 (p < 0.0001) but increased thereafter. At discharge, all global, basal, and mid LVε values persisted lower than pre-operatively and healthy children (p < 0.05). Instead, apical segments (lowest at baseline), increased after surgery (p < 0.0001), but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time-1 (p = 0.0003) but promptly recovered to Time-2, to standardize at Time-3.
Conclusions. Despite LVEF was normalized by the discharge, STE ε has shown a systolic impairment after cardiac surgery that disclosed a gradual improvement but still uncomplete normalization at discharge.
Regional STE differences revealed a discrepancy base-apex: apical segments, contrary to all the other regions, showed hypercontractility after surgery. The slower recovery of LVε values compared to LVEF, suggests that STE ε analysis may be more accurate in the follow-up of mild LV post-surgical impairment. Abstract Figure. LV ventricular ε values
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Affiliation(s)
| | - P Marchese
- Gabriele Monasterio Foundation, Massa, Italy
| | - E Franchi
- Gabriele Monasterio Foundation, Massa, Italy
| | - N Assanta
- Gabriele Monasterio Foundation, Massa, Italy
| | - J Van Den Eynde
- Johns Hopkins, Taussig Heart Center, Department of Pediatrics, J, Baltimore, United States of America
| | - K Shelby
- Johns Hopkins, Taussig Heart Center, Department of Pediatrics, J, Baltimore, United States of America
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16
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Cantinotti M, Marchese P, Assanta N, Van Den Eynde J, Franchi E, Shelby K. High frame rate blood speckle tracking echocardiography: left ventricle vortex analyisis in healthy children and in congenital heart disease. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.341] [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
Funding Acknowledgements
Type of funding sources: None.
Background
High-frame rate blood speckle tracking (BST) echocardiography is a new method, for the evaluation of intracardiac flow, independent of the insonation angle. Left ventricle, throughout cardiac cycle, creates a vortical flow still poorly analysed in children with congenital heart disease (CHD). Aim of this study is to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with CHD.
Methods
Characteristics of LV vortices were acquired on standard 4-chamber view and BST images from 230 healthy children (median age 5.96 years, range 2.9-10.1 years) and 72 children with CHD (median age 1.33 years, IQR 0.2-7.12 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics.
Results
Feasibility of vortex imaging was 97% for healthy children and 96.7% for CHD. After propensity matching, there were mild significant differences in vortex distance to apex, distance to interventricular septum, height, width, sphericity index. Indexed by BSA Vortex Area (VAi) was significantly higher on CHD patients than healthy subjects (p < 0.0001). However, multiple regression analysis exposed significant associations of LV morphology with vortex characteristics: a VAi >0.98 can predict an abnormal LV morphology (Sensibility 73%, Specificity 83%). Furthermore, CHD involving LV volume or pressure overload were both associated with vortices localized closer to the IVS.
Conclusions
LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. Since vortices are associated with LV morphology and are altered in some CHDs, vortices might yield diagnostic and prognostic value. Future studies are necessary to further establish applications of vortex imaging in the clinical setting. Abstract Figure. Vortex in healthy children and in CHD
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Affiliation(s)
| | - P Marchese
- Gabriele Monasterio Foundation, Massa, Italy
| | - N Assanta
- Gabriele Monasterio Foundation, Massa, Italy
| | - J Van Den Eynde
- Johns Hopkins, Taussig Heart Center, Department of Pediatrics, J, Baltimore, United States of America
| | - E Franchi
- Gabriele Monasterio Foundation, Massa, Italy
| | - K Shelby
- Johns Hopkins, Taussig Heart Center, Department of Pediatrics, J, Baltimore, United States of America
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17
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Santoro G, Pizzuto A, Cuman M, Cantinotti M, Franchi E, Corana G, Viacava C, Assanta N. Rescue atrial septal defect closure with the new GORE ® cardioform atrial septal defect occluder. Ann Pediatr Cardiol 2022; 15:192-194. [PMID: 36246756 PMCID: PMC9564420 DOI: 10.4103/apc.apc_240_20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
Atrioventricular block (AVB) is an infrequent but life-threatening complication of transcatheter closure of atrial septal defect (ASD), accounting for 0.1%–6.2% of cases in large series. It has been related to unfavorable defect anatomy as well as size and intrinsic stiffness of the occluding device. In this setting, the new GORE® cardioform ASD occluder (GCA) device could be an appealing technical advance in ASD treatment. We report a case of complete AVB after ASD closure with an Amplatzer septal occluding (Abbott, Plymouth MN, USA) device successfully treated by its percutaneous retrieval and “rescue” deployment of GCA device few months later.
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18
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Marchese P, Scalese M, Giordano R, Assanta N, Franchi E, Koestenberger M, Ravaglioli A, Kutty S, Cantinotti M. Pediatric ranges of normality for 2D speckle-tracking echocardiography atrial strain: differences between p- and r-gating and among new (Atrial Designed) and conventional (Ventricular Specific) software's. Echocardiography 2021; 38:2025-2031. [PMID: 34820892 DOI: 10.1111/echo.15244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/01/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND 2D speckle tracking echocardiography (STE) atrial strain (ε) analysis in children is gaining interest; however, pediatric nomograms remain limited. Comparison among conventional software's (designed for left ventricle and adapted to atria and using R-gating analysis) and new software's (designed for atria and allowing for both R- and P-gating) are lacking. The present study aims to establish pediatric nomograms for atrial ε using an atrial dedicated software and to compare values obtained by (a) R- and P-gating and, (b) R-gating with new and conventional software. METHODS Echocardiographic measurements included STE left (LA) and right (RA) atrial longitudinal reservoir, conduit and contractile ε. Age/weigh/height/heart rate, and body surface area (BSA) were used as independent variables in the statistical analysis. RESULTS In all, 580 healthy subjects (age range, 31 days-18 years; mean age 7.5 years; median age 7.1 years; inter-quartile range, 4.3-10.7 months; 45.5% female) were included. Feasibility of atrial ε measurements was high (98.9-96.8%). At lower age, atrial conduit ε was lower (p<0.001) while contractile ε was higher (p<0.001). All atrial ε values calculated with P-gating method were lower-than R-gating values (p<0.001). R-gated LA ε reservoir values generated with the new software were lower, and R-gated RA contractile ε higher than with the conventional software (p<0.011). CONCLUSION We report pediatric atrial ε values from a dedicated atrial software. Maturational changes in STE atrial ε values were demonstrated. Significant differences were observed among ε values obtained with P- and R-gating and with different software's.
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Affiliation(s)
- Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | | | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Adult Institute of Clinical Physiology, Pisa, Italy
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19
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Marchese P, Cantinotti M, Van den Eynde J, Assanta N, Franchi E, Pak V, Santoro G, Koestenberger M, Kutty S. Left ventricular vortex analysis by high-frame rate blood speckle tracking echocardiography in healthy children and in congenital heart disease. Int J Cardiol Heart Vasc 2021; 37:100897. [PMID: 34786451 PMCID: PMC8579140 DOI: 10.1016/j.ijcha.2021.100897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Background High-frame rate blood speckle tracking (BST) echocardiography is a new technique for the assessment of intracardiac flow. The purpose of this study was to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with congenital heart disease (CHD). Methods Characteristics of LV vortices were analyses based on 4-chamber BST images from 118 healthy children (median age 6.84 years, range 0.01-17 years) and 43 children with CHD (median age 0.99 years, range 0.01-14 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics. Results Feasibility of vortex imaging was 93.7% for healthy children and 95.6% for CHD. After propensity matching, there were no overall significant differences in vortex distance to apex, distance to interventricular septum (IVS), height, width, sphericity index, or area. However, multiple regression analysis revealed significant associations of LV morphology with vortex characteristics. Furthermore, CHD involving LV volume overload and CHD involving LV pressure overload were both associated with vortices localized closer to the IVS. Conclusions LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. As they are associated with LV morphology and are modified in some types of CHD, vortices might yield diagnostic and prognostic value. Future studies are warranted to establish applications of vortex imaging in the clinical setting.
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Key Words
- -i, indexed to BSA
- AV, atrioventricular
- BMI, body mass index
- BSA, body surface area
- BST, blood speckle tracking
- Blood speckle imaging
- Bpm, beats per minute
- CHD, congenital heart disease
- CI, correlation index
- Congenital
- ED, end-diastolic
- Echocardiography
- Fps, frame per second
- Heart defects
- ICC, intraclass correlation coefficient
- IQR, interquartile range
- IVS, interventricular septum
- LV, left ventricle/ventricular
- LVEDA, left ventricular end-diastolic area
- LVEDD, left ventricular end-diastolic dimension
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic dimension
- LVESV, left ventricular end-systolic volume
- LVOT, left ventricular outflow tract
- LVPO, CHD involving left ventricle pressure overload
- LVSV, left ventricular stroke volume
- LVVO, CHD involving left ventricular volume overload
- Left ventricle
- MV, mitral valve
- Pediatrics
- RVPO, CHD involving right ventricular pressure overload
- RVVO, CHD involving right ventricular volume overload
- TGA, transposition of the great arteries
- Vortex imaging
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Affiliation(s)
- Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Adult Institute of Clinical Physiology, Pisa, Italy
| | | | - Jef Van den Eynde
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Vitali Pak
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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20
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Santoro G, Cuman M, Pizzuto A, Haxhiademi D, Lunardini A, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. GORE® Cardioform ASD Occluder experience in transcatheter closure of "complex" atrial septal defects. Catheter Cardiovasc Interv 2021; 99:E22-E30. [PMID: 34652048 DOI: 10.1002/ccd.29977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/12/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for "complex" atrial septal defects (ASD) closure. BACKGROUND Transcatheter ASD closure is still challenging in "complex" clinical/anatomic settings. This study evaluated the results of GCO in closure of "complex" ASD in a tertiary referral center. METHODS Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as "complex" (n = 36, Group I) or "simple" (n = 36, Group II). We considered as "complex", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups. RESULTS Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of "surgical" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences. CONCLUSIONS Percutaneous treatment with GCO device is effective and safe in high percentage of "complex" ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessia Lunardini
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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21
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Cantinotti M, Marchese P, Koestenberger M, Giordano R, Santoro G, Assanta N, Kutty S. Intracardiac flow visualization using high-frame rate blood speckle tracking echocardiography: Illustrations from infants with congenital heart disease. Echocardiography 2021; 38:707-715. [PMID: 33729605 DOI: 10.1111/echo.15009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
We report applications of novel high-frame rate blood speckle tracking (BST) echocardiography in a series of infants with congenital heart disease (CHD). BST echocardiography was highly feasible, reproducible, and fast. High-frame rate BST provided complimentary information to conventional color-Doppler data enhancing the visualization and understanding of anomalous blood trajectories (eg, shunt direction, regurgitant volumes, and stenotic jets) and vortex formation. High-frame rate BST echocardiography is a new, promising imaging tool that may be helpful for deeper understanding of complex CHD physiology.
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Affiliation(s)
- Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA.,Institute of Clinical Physiology (IFC), National Research Institute (CNR), Pisa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA.,Department of Pediatrics, University of Pisa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics Medical University Graz, Graz, Austria
| | | | - Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA
| | - Shelby Kutty
- Johns Hopkins Medicine, Pediatrics, Baltimore, MD, USA
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22
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Alberio AMQ, Pieroni F, Di Gangi A, Cappelli S, Bini G, Abu-Rumeileh S, Orsini A, Bonuccelli A, Peroni D, Assanta N, Gaggiano C, Simonini G, Consolini R. Toward the Knowledge of the Epidemiological Impact of Acute Rheumatic Fever in Italy. Front Pediatr 2021; 9:746505. [PMID: 34976887 PMCID: PMC8714836 DOI: 10.3389/fped.2021.746505] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To estimate the incidence of Acute Rheumatic Fever (ARF) in Tuscany, a region of Central Italy, evaluating the epidemiological impact of the new diagnostic guidelines, and to analyse our outcomes in the context of the Italian overview. Methods: A multicenter and retrospective study was conducted involving children <18 years old living in Tuscany and diagnosed in the period between 2010 and 2019. Two groups were established based on the new diagnostic criteria: High-Risk (HR) group patients, n = 29 and Low-Risk group patients, n = 96. Results: ARF annual incidence ranged from 0.91 to 7.33 out of 100,000 children in the analyzed period, with peak of incidence registered in 2019. The application of HR criteria led to an increase of ARF diagnosis of 30%. Among the overall cohort joint involvement was the most represented criteria (68%), followed by carditis (58%). High prevalence of subclinical carditis was observed (59%). Conclusions: Tuscany should be considered an HR geographic area and HR criteria should be used for ARF diagnosis in this region.
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Affiliation(s)
| | - Filippo Pieroni
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Di Gangi
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Cappelli
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Bini
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Alessandro Orsini
- Pediatrics Unit, Section of Pediatric Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatrics Unit, Section of Pediatric Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Assanta
- Heart Hospital-G. Monasterio Tuscany Foundation, Massa, Italy
| | - Carla Gaggiano
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Rita Consolini
- Pediatrics Unit, Section of Clinical and Laboratory Immunology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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23
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Cantinotti M, Scalese M, Giordano R, Franchi E, Marchese P, Vicava C, Assanta N, Iervasi G, Kutty S, Koestenberger M. Pediatric nomograms for left ventricle biplane 2D volumes in healthy Caucasian children. Echocardiography 2020; 37:971-975. [PMID: 32426874 DOI: 10.1111/echo.14701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/25/2019] [Revised: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Left ventricular (LV) volumes are basic parameters used to estimate ventricular size and function; however, normal values are not available in children. The aim of our study is to provide normal values for LV volumes (measured with the biplane Simpson method) in healthy children. MATERIALS AND METHODS We prospectively studied 1320 healthy Caucasian Italian children (age 0 days-17 years, 49.4% female). Echocardiographic measurements on LV volumes were performed. Age, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. RESULTS Models with exponential (ln[y] = a + b*ln[x]) equations resulted in the best fit for LV volumes. The association with BSA was found to be stronger than the association of HR and age. Thus BSA was used for normalization of our data. Predicted values and Z-score boundaries by BSA are provided. CONCLUSIONS We report normal values for 2D biplane LV volumes in a population of healthy children. These data cover a gap in current pediatric echocardiographic nomograms and may serve as baseline for evaluation of children with cardiac defects characterized by LV dilatation or hypoplasia.
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Affiliation(s)
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Cecilia Vicava
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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Cantinotti M, Giordano R, Marchese P, Franchi E, Viacava C, Pak V, Murzi B, Arcieri L, Poli V, Federici D, Koestenberger M, Assanta N. Retrosternal Clots After Fontan Surgery by Systematic Evaluation With Transthoracic Ultrasound. J Cardiothorac Vasc Anesth 2020; 34:951-955. [DOI: 10.1053/j.jvca.2019.11.009] [Citation(s) in RCA: 1] [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] [Received: 08/16/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022]
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25
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Margaryan R, Assanta N, Menciassi A, Burchielli S, Matteucci M, Agostini S, Lionetti V, Luchi C, Cariati E, Pucci A, Coceani F, Murzi B. Selective perfusion of coronary vasculature in preterm sheep: a methodological innovation undermined by unfavourable operation of the foramen ovale. Can J Physiol Pharmacol 2020; 98:211-218. [PMID: 32202442 DOI: 10.1139/cjpp-2018-0648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/30/2023]
Abstract
Antenatal cardiac intervention affords new prospects for hypoplastic left heart syndrome. Its success, however, may come not only from absence of impediments to blood flow but also from a sufficiently developed cardiac wall. Here, we examined the feasibility to perfuse selectively the fetal coronary circulation for treatment with growth promoting agents. Pregnant sheep (94-114 days gestation, term 145 days) were used. An aortic stop-flow procedure was developed for intracoronary access in the nonexposed fetus and human mesenchymal stem cells and their exosomes served as test agents. We found that aortic stop-flow ensures preferential distribution of fluorescent microspheres to the heart. However, intracoronary administration of stem cells or exosomes was detrimental, with fetal demise occurring around surgery or at variable intervals afterwards. Coincidentally, stop-flow caused by itself a marked rise of intraluminal pressure within the occluded aorta along with histological signs of coronary obstruction. We conclude that it is feasible to perfuse selectively the coronary circulation of the preterm fetus, but treatments are not compatible with survival of the animals. The cause for failure is found in the absence of hemodynamic compensation to stop-flow via a left-to-right shunt. This unexpected event is attributed to a largely membranous foramen ovale, characteristic of sheep, that collapses under pressure.
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Affiliation(s)
- Rafik Margaryan
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Nadia Assanta
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Arianna Menciassi
- Institute of BioRobotics, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Silvia Burchielli
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Marco Matteucci
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Silvia Agostini
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Carlo Luchi
- Division of Prenatal Medicine, Pisa University Hospital, 56100 Pisa, Italy
| | - Ettore Cariati
- Department for Infant and Mother Care, Tuscany Center University Hospital, 50100 Florence, Italy
| | - Angela Pucci
- Department of Pathology, Pisa University Hospital, 56100 Pisa, Italy
| | - Flavio Coceani
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Bruno Murzi
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
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Simeone S, Platone N, Serra N, Assanta N, Guillari A, Rea T, Pucciarelli G, Da Valle P, Gargiulo G, Baratta S, McLellan M. Cardiac Children's Hospital Early Warning Score: Italian Validation. J Pediatr Nurs 2020; 51:e21-e26. [PMID: 31262605 DOI: 10.1016/j.pedn.2019.06.011] [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: 11/20/2018] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE The Cardiac Children's Hospital Early Warning Score (C-CHEWS) is an early warning scale used to identify paediatric patients experiencing clinical deterioration which may warrant a transfer to an ICU. However, no studies have tested the C-CHEWS in an Italian paediatric cardiac population. The aims of this study were to translate/back-translate and validate the Italian version of the C-CHEWS and its algorithm. DESIGN AND METHOD Retrospective study. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value were used to evaluate the performance of C-CHEWS. In additions the Cohen's kappa statistic was calculated to evaluate the agreement between patient's status described by C-CHEWS score (≥5) and actual ICU transfer. RESULTS High discrimination was observed for sensitivity (81.5%), specificity (99.6%), accuracy (99.7%), positive predictive value (86.7%), and negative predictive value (99.8%). The Cohen's kappa score was observed to be equal to 0.837 (p-value <0.001) indicating there was excellent significant agreement between a C-CHEWS score ≥ 5 and effective evaluation for patients transfer to an ICU. CONCLUSION The Italian version of the C-CHEWS proved to be a sensitive, specific and reliable tool in the early detection of a physical deterioration of hospitalized paediatric cardiac surgical patients. PRACTICE IMPLICATIONS This tool may help doctors, nurses and all healthcare professionals to promptly recognize and treat clinical deterioration and facilitate urgent transfers to the PICU.
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Affiliation(s)
- Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Serra
- Public Health Department, Federico II University Hospital, Naples, Italy
| | | | - Assunta Guillari
- Public Health Department, Federico II University Hospital, Naples, Italy
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, Naples, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | | | - Gianpaolo Gargiulo
- Haematology and HSCT Unit, Federico II University Hospital, Naples, Italy
| | | | - Mary McLellan
- Inpatient Cardiovascular Unit Heart Center Boston Children's Hospital, Boston, USA
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Cantinotti M, Giordano R, Marrone C, Franchi E, Koestenberger M, Assanta N. Double Orifice Mitral Valve in Tricuspid Atresia: A Rare Association. Pediatr Cardiol 2019; 40:1761-1762. [PMID: 31506732 DOI: 10.1007/s00246-019-02204-1] [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: 08/03/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
We here report a neonate with prenatal echocardiographic diagnosis of tricuspid atresia, with normally related great vessels, and large ventricular septal defect. This diagnosis could be confirmed with echocardiography at birth. An additional double mitral orifice was also seen. This is a very rare association.
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Affiliation(s)
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Chiara Marrone
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
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Cantinotti M, Giordano R, Gargani L, Marchese P, Franchi E, Koestenberger M, Kutty S, Ait-Ali L, Assanta N. Could judicious use of lung ultrasound reduce radiographic examinations in pediatric cardiac surgery patients? J Clin Anesth 2019; 61:109638. [PMID: 31668471 DOI: 10.1016/j.jclinane.2019.109638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/20/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Institute (CNR), Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Luna Gargani
- Institute of Clinical Physiology (IFC), National Research Institute (CNR), Pisa, Italy
| | - Pietro Marchese
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Eliana Franchi
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Shelby Kutty
- The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Lamia Ait-Ali
- Institute of Clinical Physiology (IFC), National Research Institute (CNR), Pisa, Italy
| | - Nadia Assanta
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
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Cantinotti M, Giordano R, Scalese M, Marchese P, Franchi E, Viacava C, Molinaro S, Assanta N, Koestenberger M, Kutty S, Gargani L, Ait-Ali L. Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery. Ann Thorac Surg 2019; 109:178-184. [PMID: 31400328 DOI: 10.1016/j.athoracsur.2019.06.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C. METHODS LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time. RESULTS The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007). CONCLUSIONS Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Pietro Marchese
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Eliana Franchi
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Cecilia Viacava
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Nadia Assanta
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
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Cantinotti M, Koestenberger M, Santoro G, Assanta N, Franchi E, Paterni M, Iervasi G, D'Andrea A, D'Ascenzi F, Giordano R, Galderisi M. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol 2019; 27:1294-1306. [PMID: 31266355 DOI: 10.1177/2047487319862060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/17/2022]
Abstract
In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values (Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Martin Koestenberger
- Division of Paediatric Cardiology, Department of Paediatrics, Medical University Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | | | - Antonello D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Maurizio Galderisi
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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31
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Cantinotti M, Giordano R, Scalese M, Franchi E, Assanta N, Molinaro S, Marchese P, Paterni M, Iervasi G, Kutty S, Koestenberger M. Nomograms of pulsed Doppler velocities, times, and velocity time integrals for semilunar valves and great arteries in healthy Caucasian children. Int J Cardiol 2019; 285:133-139. [PMID: 30857846 DOI: 10.1016/j.ijcard.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/03/2019] [Revised: 01/31/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, National Resarch Center, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", Italy.
| | - Marco Scalese
- Institute of Clinical Physiology, National Resarch Center, Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Resarch Center, Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Marco Paterni
- Institute of Clinical Physiology, National Resarch Center, Pisa, Italy
| | - Giorgio Iervasi
- Institute of Clinical Physiology, National Resarch Center, Pisa, Italy
| | - Shelby Kutty
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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32
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Cantinotti M, Scalese M, Giordano R, Franchi E, Marchese P, Assanta N, Molinaro S, Paterni M, Iervasi G, Koestenberger M, Kutty S. Three-Dimensional Echocardiography Derived Nomograms for Left Ventricular Volumes in Healthy Caucasian Italian Children. J Am Soc Echocardiogr 2019; 32:794-797.e1. [PMID: 30948143 DOI: 10.1016/j.echo.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/18/2019] [Indexed: 02/09/2023]
Affiliation(s)
| | | | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples "Federico II", Naples, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Sabrina Molinaro
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples "Federico II", Naples, Italy
| | | | | | - Martin Koestenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University Graz, Graz, Austria
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
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Cantinotti M, Scalese M, Giordano R, Franchi E, Assanta N, Marotta M, Viacava C, Molinaro S, Iervasi G, Santoro G, Koestenberger M. Normative Data for Left and Right Ventricular Systolic Strain in Healthy Caucasian Italian Children by Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2018. [PMID: 29526564 DOI: 10.1016/j.echo.2018.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is an increasing interest in echocardiographic strain (ε) measurements for the assessment of ventricular myocardial function in children; however, pediatric nomograms remain limited. Our aim was to establish pediatric nomograms for the left ventricular (LV) and the right ventricular (RV) ε measured by two-dimensional speckle-tracking echocardiography (2D-STE) in a large cohort of healthy children prospectively enrolled. METHODS Echocardiographic measurements included STE LV longitudinal and circumferential and RV longitudinal global end-systolic ε. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Echocardiograms were performed by Philips-iE33 systems (Philips, Bothell, WA) and offline measurements on Philips-Q-Lab-9. RESULTS In all, 721 subjects (age 31 days to 17 years; 48% female) were studied. Low coefficients of determination (R2) were noted among all of the ε parameters evaluated and adjusted for age, weight, height, BSA, and HR (i.e., R2 all ≤ 0.10; range, 0.01-0.088). This hampered the possibility of performing z-scores with a sufficient reliability. Thus, we are limited to presenting data as mean values (±SD) stratified for age groups and divided by gender. LV longitudinal ε values decreased with age (P < .001), while no significant age-related variations were noted for RV longitudinal ε. A significant base-to-apex (lowest to highest) gradient in circumferential LV ε values was noted at all ages (P < .001). CONCLUSIONS We report pediatric echocardiographic normative data for 2D-STE for the LV and RV ε by using vendor-specific software. Our results confirm previous observations, showing only little variations of strain parameters with age and gender.
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Affiliation(s)
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | | | | | | | | | | | | | | | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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Arcieri L, Pak V, Poli V, Baggi R, Serio P, Assanta N, Moschetti R, Noccioli B, De Masi S, Mirabile L, Murzi B. Tracheal surgery in children: outcome of a 12-year survey. Interact Cardiovasc Thorac Surg 2017; 26:660-666. [DOI: 10.1093/icvts/ivx390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/27/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Luigi Arcieri
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Vincenzo Poli
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Roberto Baggi
- Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Children Hospital, Florence, Italy
| | - Paola Serio
- Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Children Hospital, Florence, Italy
| | - Nadia Assanta
- Pediatric Cardiology Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Riccardo Moschetti
- Pediatric Cardiac Intensive Care Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Bruno Noccioli
- Pediatric Surgery Unit, Meyer Children Hospital, Florence, Italy
| | | | - Lorenzo Mirabile
- Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Children Hospital, Florence, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
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Cantinotti M, Giordano R, Paterni M, Saura D, Scalese M, Franchi E, Assanta N, Koestenberg M, Dulgheru R, Sugimoto T, Bernard A, Caballero L, Lancellotti P. Adult echocardiographic nomograms: overview, critical review and creation of a software for automatic, fast and easy calculation of normal values. J Thorac Dis 2017; 9:5404-5422. [PMID: 29312752 DOI: 10.21037/jtd.2017.11.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/15/2023]
Abstract
There is a crescent interest on normal adult echocardiographic values and the introduction of new deformation imaging and 3D parameters pose the issue of normative data. A multitude of nomograms has been recently published, however data are often fragmentary, difficult to find, and their strengths/limitations have been never evaluated. AIMS (I) to provide a review of current echocardiographic nomograms; (II) to generate a tool for easy and fast access to these data. A literature search was conducted accessing the National Library of Medicine using the keywords: 2D/3D echocardiography, strain, left/right ventricle, atrial, mitral/tricuspid valve, aorta, reference values/nomograms/normal values. Adding the following keywords, the results were further refined: range/intervals, myocardial velocity, strain rate and speckle tracking. Forty one published studies were included. Our study reveals that for several of 2D/3D parameters sufficient normative data exist, however, a few limitations still persist. For some basic parameters (i.e., mitral/tricuspid/pulmonary valves, great vessels) and for 3D valves data are scarce. There is a lack of studies evaluating ethnic differences. Data have been generally expressed as mean values normalised for gender and age instead of computing models incorporating different variables (age/gender/body sizes) to calculate z scores. To summarize results a software (Echocardio-Normal Values) who automatically calculate range of normality for a broad range of echocardiographic measurements according to age/gender/weight/height, has been generated. We provide an up-to-date and critical review of strengths/limitation of current adult echocardiographic nomograms. Furthermore we generated a software for automatic, easy and fast access to multiple echocardiographic normative data.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Daniel Saura
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Martin Koestenberg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Raluca Dulgheru
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
| | - Tadafumi Sugimoto
- Department of University Cardiology, University of Milano School of Medicine, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anne Bernard
- CHU Tours, France et Université de Tours, Tours, France
| | - Luis Caballero
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Patrizio Lancellotti
- Department of Cardiology, Cardio-Oncology Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Cantinotti M, Giordano R, Corsini I, Dani C, Scalese M, Murzi B, Assanta N, Spadoni I, Molinaro S, Kutty S, Iervasi G, Franchi E. Echocardiographic nomograms for upper abdominal aorta Doppler systolic wave values and systo-diastolic diameters variations in children. J Cardiol 2017; 71:394-400. [PMID: 29129395 DOI: 10.1016/j.jjcc.2017.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/28/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Abdominal aorta pulsatility and blood flow patterns are important diagnostic indicators in congenital heart disease. Reference values for these indexes are lacking. METHODS We prospectively studied abdominal aorta pulsed-wave Doppler systolic peak velocity, deceleration time, and wave duration, and two-dimensional vessel diameters in systole and diastole in healthy Caucasian children. Heteroscedasticity was accounted for by White or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z-scores were then computed. RESULTS In all, 853 subjects (age 0 days to 17 years; 45% females; BSA 0.12-2.12m2) were studied. The predicted values and Z-score boundaries are presented. Data are also presented as mean±2 SDs for a given BSA. CONCLUSIONS We report paediatric echocardiographic nomograms for multiple proximal abdominal aorta parameters including pulsed-wave Doppler systolic velocities, deceleration time, wave duration, and two-dimensional vessel diameter variations. Significant variations in these functional indexes with age were found that should be taken into account in clinical practice. At lower ages, steeper and shorter pulsed-wave Doppler peak velocity and limited pulsatility should be expected as physiologic findings.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Carlo Dani
- University of Florence, Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Italy
| | | | - Bruno Murzi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Isabella Spadoni
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
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Cantinotti M, Koestenberger M, Assanta N, Franchi E, Santoro G. Diagnostic Accuracy of Echocardiography in ALCAPA: Is It Always Correct to Rely Only on Echocardiography? The Issue of False Negatives. J Am Soc Echocardiogr 2017; 31:113-114. [PMID: 29056407 DOI: 10.1016/j.echo.2017.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Massimiliano Cantinotti
- Pediatric Cardiology and G.U.C.H. Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa and Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Nadia Assanta
- Pediatric Cardiology and G.U.C.H. Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa and Pisa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and G.U.C.H. Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa and Pisa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and G.U.C.H. Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa and Pisa, Italy
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Cantinotti M, Giordano R, Scalese M, Franchi E, Corana G, Assanta N, Maura C, Marco M, Molinaro S, Koestenberger M, Iervasi G. Nomograms for echocardiographic right ventricular sub-costal view dimensions in healthy Caucasian children: A new approach to measure the right ventricle. J Cardiol 2017; 71:181-186. [PMID: 28893427 DOI: 10.1016/j.jjcc.2017.07.015] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/03/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The sub-costal examination of the heart is part of routine examination in pediatric echocardiography, and has the advantage to visualize also the infundibulum part of the right ventricle (RV). Despite this fact, currently nomograms for sub-costal RV dimensions are lacking. METHODS We prospectively studied healthy Caucasian Italian children by two-dimensional echocardiography. Measurements included: sub-costal end diastolic basal-apical and latero-lateral diameters, end diastolic and end systolic area, 4 chamber end diastolic and end systolic area and length, end diastolic basal (RV1) and mid-cavity (RV2) diameters. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z scores were then computed. Agreement of RV diameters and areas in subcostal view and 4-chamber view were investigated. RESULTS 732 subjects (age 0 days-17 years; 48% female; BSA 0.12-2.12 m2) were studied. The Haycock formula was used when presenting data as predicted values (mean ± 2 SDs) for a given BSA and within equations relating echocardiographic measurements to BSA. The predicted values and Z-score boundaries for all measurements are presented. Excellent correlations were found among two-dimensional diameters and area calculated in sub-costal view with those evaluated in 4-chamber view. CONCLUSIONS We report echocardiographic nomograms for RV diameters and areas measured in the sub-costal view. Our data may implement normative data for 2D echocardiography evaluation of the RV in children.
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Affiliation(s)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Crocetti Maura
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Marotta Marco
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
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Cantinotti M, Giordano R, Emdin M, Assanta N, Crocetti M, Marotta M, Iervasi G, Lopez L, Kutty S. Echocardiographic assessment of pediatric semilunar valve disease. Echocardiography 2017; 34:1360-1370. [DOI: 10.1111/echo.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
| | | | - Michele Emdin
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Maura Crocetti
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Marco Marotta
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Giorgio Iervasi
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
| | - Leo Lopez
- Miami Children's Hospital; Miami FL USA
| | - Shelby Kutty
- University of Nebraska Medical Center; Children's Hospital and Medical Center; Omaha NE USA
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Arcieri L, Serio P, Nenna R, Di Maurizio M, Baggi R, Assanta N, Moschetti R, Noccioli B, Mirabile L, Murzi B. The role of posterior aortopexy in the treatment of left mainstem bronchus compression. Interact Cardiovasc Thorac Surg 2016; 23:699-704. [DOI: 10.1093/icvts/ivw209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 11/14/2022] Open
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Cantinotti M, Giordano R, Clemente A, Murzi B, Assanta N, Lunardini A, Spadoni I. Major Aortopulmonary Collaterals in Transposition of the Great Arteries: A Cause for Preoperative and Postoperative Hemodynamic Imbalance. Ann Thorac Surg 2016; 102:e33-5. [DOI: 10.1016/j.athoracsur.2015.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/02/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022]
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Cantinotti M, Assanta N, Crocetti M, Spadoni I, Iervasi G. Challenges in Interpreting Pediatric Normative Left Ventricular Strain Data and the Quest for Comprehensive Deformation Nomograms. J Am Soc Echocardiogr 2016; 29:567-8. [DOI: 10.1016/j.echo.2016.03.005] [Citation(s) in RCA: 2] [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] [Received: 01/18/2016] [Indexed: 01/23/2023]
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Cantinotti M, Kutty S, Giordano R, Assanta N, Murzi B, Crocetti M, Marotta M, Iervasi G. Review and status report of pediatric left ventricular systolic strain and strain rate nomograms. Heart Fail Rev 2016; 20:601-12. [PMID: 26003444 DOI: 10.1007/s10741-015-9492-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Indexed: 11/26/2022]
Abstract
Interest in strain (ε) and strain rate (SR) for the assessment of pediatric left ventricular (LV) myocardial function has increased. However, the strengths and limitations of published pediatric nomograms have not been critically evaluated. A literature search was conducted accessing the National Library of Medicine using the keywords myocardial velocity, strain, strain rate, pediatric, reference values, and nomograms. Adding the following keywords, the results were further refined: neonates, infants, adolescents, range/intervals, and speckle tracking. Ten published studies evaluating myocardial velocities, ε, or SR nomograms were analyzed. Sample sizes were limited in most of these studies, particularly in terms of neonates. Heterogeneous methods-tissue Doppler imaging, two- and three-dimensional speckle tracking-were used to perform and normalize measurements. Although most studies adjusted measurements for age, classification by specific age subgroups varied. Few studies addressed the relationships of ε and SR measurements to body size and heart rate. Data have been generally expressed by mean values and standard deviations; Z scores and percentiles that are commonly employed for pediatric echocardiographic quantification have been never used. Reference values for ε and SR were found to be reproducible in older children; however, they varied significantly in neonates and infants. Pediatric nomograms for LV ε and SR are limited by (a) small sample sizes, (b) inconsistent methodology used for derivation and normalization, and (c) scarcity of neonatal data. Some of the studies demonstrate reproducible patterns for systolic deformation in older children. There is need for comprehensive nomograms of myocardial ε and SR involving a large population of normal children obtained using standardized methodology.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Ospedale del Cuore, via Aurelia Sud, 54100, Massa, Pisa, Italy
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Cantinotti M, Giordano R, Clemente A, Assanta N, Murzi M, Murzi B, Crocetti M, Marotta M, Scalese M, Kutty S, Iervasi G. Strengths and Limitations of Current Adult Nomograms for the Aorta Obtained by Noninvasive Cardiovascular Imaging. Echocardiography 2016; 33:1046-68. [PMID: 27060285 DOI: 10.1111/echo.13232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Normalized measurements for the evaluation of aortic disease severity are preferred to the adoption of generic cutoff values. The purpose of this review is to evaluate the strengths and limitations of currently available aortic nomograms by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI). A literature search was conducted accessing the National Library of Medicine using the keywords normal values, aorta, echocardiography, CT, and MRI. Addition of these keywords further refined the results: reference values, nomograms, aortic arch, and adults. Thirty studies were included in the final analysis. Despite the strengths noted in the recent investigations, multiple methodological and numerical limitations emerged. The numerical limitations included sample size limitation in most of the studies (only few investigations consisted of >800 subjects and many had 70-300), lack of aortic arch measurements, and paucity of data for non-Caucasian subjects. Methodological limitations consisted of lack of standardization in measurements (systole vs. diastole, internal vs. external border, axial vs. orthogonal planes), heterogeneity and data normalization issues (various age intervals used, body size often not evaluated, data expressed as observed values rather than estimated values by z-score), and study design issues. The designs were mostly retrospective with poorly defined inclusion and exclusion criteria. The nomograms presented range of normality with significant differences, but also with some reproducible pattern. Despite recent advances, multiple methodological or numerical limitations exist in adult nomograms for the aorta. Comprehensive nomograms of aortic dimensions at multiple levels including the aortic arch for different imaging techniques, involving a wide sample size, and using standardized methodology for measurements and data normalization are warranted. The availability of robust nomograms may encourage the use of personalized rather than generic cutoff values.
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Affiliation(s)
| | | | - Alberto Clemente
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Michele Murzi
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Bruno Murzi
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Maura Crocetti
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Marco Marotta
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- University of Nebraska Medical Center and Children's Hospital, Omaha, Nebraska
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Giordano R, Arcieri L, Cantinotti M, Pak V, Poli V, Maizza A, Melo M, Assanta N, Moschetti R, Murzi B. Custodiol Solution and Cold Blood Cardioplegia in Arterial Switch Operation: Retrospective Analysis in a Single Center. Thorac Cardiovasc Surg 2015; 64:53-8. [PMID: 26600405 DOI: 10.1055/s-0035-1566235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The cardioplegia is one of the most significant tools used to increase myocardial protection. The aim of our study is to compare the use of Custodiol solution versus intermitted blood cardioplegia in a retrospective analysis of data for patients who underwent arterial switch operation in our institution. MATERIAL AND METHODS From January 2008 to March 2011, myocardial protection was performed in 44 neonates (blood group) with intermittent blood cardioplegia. From March 2011 to November 2014, myocardial protection was performed in 50 neonates (Custodiol group) with one-shot anterograde Custodiol cardioplegia. RESULTS Cardiopulmonary bypass and aortic cross-clamp were more favorable in Custodiol group (p-value 0.005 and ≤ 0.00001). The rate of delayed sternal closure was 63.6% in the blood group and 52% in the Custodiol group (p = 0.25). In the postoperative outcomes we did not find differences between the two groups. The 30-day mortality was one patient in the blood group (p = 0.46). We observed a transient ischemic electrocardiogram in 10 patients of the blood group and in 14 of the Custodiol group (p = 0.72), all cases with full resolution during hospitalization without coronary reoperation. A trend of higher peak of troponin-I and brain natriuretic peptide in Custodiol group has been reported. CONCLUSION No prefect cardioplegia exists, the Custodiol solution does not cause extra/additional myocardial damage in arterial switch operation. In our experience this strategy seems warranted to simplify the procedure and to be more comfortable for the surgeon.
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Affiliation(s)
- Raffaele Giordano
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Luigi Arcieri
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Massimiliano Cantinotti
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Vitali Pak
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Vincenzo Poli
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Anna Maizza
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Manuel Melo
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Nadia Assanta
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Riccardo Moschetti
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
| | - Bruno Murzi
- Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy
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Cantinotti M, Giordano R, Volpicelli G, Kutty S, Murzi B, Assanta N, Gargani L. Lung ultrasound in adult and paediatric cardiac surgery: is it time for routine use? Interact Cardiovasc Thorac Surg 2015; 22:208-15. [DOI: 10.1093/icvts/ivv315] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
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Cantinotti M, Giordano R, Scalese M, Murzi B, Assanta N, Spadoni I, Crocetti M, Marotta M, Molinaro S, Kutty S, Iervasi G. Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children. J Cardiol 2015; 68:288-99. [PMID: 26564714 DOI: 10.1016/j.jjcc.2015.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 07/24/2015] [Revised: 08/23/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pediatric echocardiographic nomograms for systolic/diastolic functional indices are limited by small sample size and inconsistent methodologies. Our aim was to establish pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities. METHODS We performed PWD/TDI measurements of MV velocities and generated models testing for linear/logarithmic/exponential/square root relationships. Heteroscedasticity was accounted for by White test or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. RESULTS In all, 904 Caucasian Italian healthy children (age 0 days-17 years; 45.5% females; BSA 0.12-2.12m(2)) were prospectively studied. No individual variable provided equations with an acceptable coefficient of determination (R(2)) and even the inclusion of multiple variables in the model resulted in only a partial amelioration of the R(2). Higher R(2) were obtained for PWD-E deceleration time (0.53), septal (Se') and lateral (Le') MV-TDI e' velocity (Se': 0.54; Le': 0.55). Variability was higher at lower age and BSA. In older children patterns were more reproducible; however, the exclusion of neonates did not substantially improve the final models. The low R(2) hampered building of z-scores and calculation of estimated percentiles. Thus normative data have been presented as observed percentile according to age for all measurements. CONCLUSIONS We report normal ranges for PWD and TDI mitral velocities derived from a large population of Caucasian children. Variability of diastolic patterns especially at lower ages needs to be taken into account.
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Affiliation(s)
| | | | | | - Bruno Murzi
- Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy
| | - Nadia Assanta
- Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy
| | | | - Maura Crocetti
- Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy
| | - Marco Marotta
- Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy
| | | | - Shelby Kutty
- University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA
| | - Giorgio Iervasi
- Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
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Cantinotti M, Giordano R, Assanta N, Murzi B, Gargani L. Chest Ultrasound: A New, Easy, and Radiation-Free Tool to Detect Retrosternal Clot After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:e59-60. [DOI: 10.1053/j.jvca.2015.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/11/2022]
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Cantinotti M, Spadoni I, Assanta N, Crocetti M, Marotta M, Arcieri L, Murzi B, Imazio M. Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age. J Cardiovasc Med (Hagerstown) 2015; 15:847-54. [PMID: 23846676 DOI: 10.2459/jcm.0b013e328362c5b5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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
Postsurgical pericardial syndromes are common complications after cardiac surgery; however, their treatment is not well established yet. We reviewed the accuracy and limits of clinical trials of prophylaxis and treatment of these diseases to identify an evidence-based therapeutic approach. We performed a literature search in the National Library of Medicine using the keywords pericardial effusion, cardiac surgery and paediatric/congenital. The research was then redefined adding separately the keywords postpericardiotomy syndrome, NSAIDs, steroids and colchicine. We found 12 clinical trials (eight for the prophylaxis and four regarding treatment), testing three major agent classes: NSAIDs, corticosteroids and colchicine. Therapy is generally based on NSAID with or without steroids with the adjunct of colchicine for recurrences. Only a few randomized controlled trials (RCTs) in adults support NSAID therapy. Efficacy of steroids has been proved only in small paediatric works, whereas no studies are available for colchicine. Studies furthermore presented some limitations: not univocal endpoints (not allowing for a meta-analysis), a limited sample size, scarce attention to confounders (such as the underlying cardiac disease and diuretic/analgesic regimen). Moreover, different agents were not assessed, nor when to start therapy. More evidence (two wide RCT plus a meta-analysis) supports the role of colchicine for prophylaxis in adults. Prophylaxis with NSAID/corticosteroids instead failed to have significant advantage in children, whereas a few data are available for adults. Evidence for the treatment of postsurgical pericardial syndromes is incomplete, making it difficult to understand when to treat and which agent to employ, especially in children.
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Affiliation(s)
- Massimiliano Cantinotti
- aFondazione Toscana G. Monasterio, Massa bCardiology Department, Maria Vittoria Hospital, Torino, Italy
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Cantinotti M, Giordano R, Scalese M, Molinaro S, Murzi B, Assanta N, Crocetti M, Marotta M, Ghione S, Iervasi G. Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants. Hypertens Res 2015; 38:577-87. [PMID: 25876830 DOI: 10.1038/hr.2015.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/13/2015] [Accepted: 02/09/2015] [Indexed: 01/25/2023]
Abstract
The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Marco Scalese
- Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Sabrina Molinaro
- Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Bruno Murzi
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Nadia Assanta
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Maura Crocetti
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Marco Marotta
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Sergio Ghione
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Giorgio Iervasi
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
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