bluuebunny/crossref_metadata_2025 huggingface dataset:
C81 CORRECTION OF MASSIVE TRICUSPIDAL INSUFFICIENCY WITH PERCUTANEOUS TRICLIP SYSTEM IN WOMAN WITH MARFAN‘S SYNDROME
Authors: De Remigis F , Benvenuto M , Tomassoni G , Lavorgna A , De Rosa M , Fabiani D , Napoletano C
Published: May 2022

The interventional–percutaneous therapy of valve pathologies has undergone, in recent years, an enormous technological development in traditional surgery. In particular, the recent introduction for the percutaneous treatment of tricusp insufficiency allows you to correct forms otherwise not surgically treatable. We report a case of a 58–year–old woman suffering from Marfan‘s Sd with massive tricuspidal insufficiency in relation to valve leaf prolapse, complicated by retrograde heart failure and recurrent episodes of atriale flutter, Anamnestic cardiovascular hystory began at the age of 38 (2000) when patient underwent to the first cardiac surgery in emergency contest, with replacement of the ascending aorta and aorto–coronary bypass for acute dissection (type A); after one year (2002) perform surgery to replace the aortic arch with reimplantation of the neck vessels; at the age of 45 (2009) she underwent aortic valve replacement surgery with mechanical prosthesis, for severe aortic valve insufficiency; finally, at the age of 48 (2012) she underwent surgery to replace the thoraco–abdominal aorta and reimplantation of the abdominal vessels for chronic dissecting aneurysm. Given the high risk of re–surgery for tricuspid valve repair/replacement, the Heart–Team has indicated the percutaneous correction of tricuspid insufficiency using the valve clip. The procedure was performed under general anesthesia, ultrasound–guided with transesophageal; three clips were placed at the level of the commissure between the anterior flap and septal flap with the final result of an 80% reduction in the degree of tricuspid insufficiency, absence of peri and post procedural complications; discharge of the patient on day 3. The follow–up was completed at six months: asymptomatic patient, significant reduction of arrhythmic episodes, absence of peripheral venous stasis, reduction of hepatomegaly; echocardiographic control showed persistence of optimal alignment of the clips in the closing rim of the anterior and septal tricuspid flap; normal volume and function of the right ventricle, absence of indirect signs of hypertension in the small circulation, to report a significant reduction in arrhythmic events (two episodes of atrial flutter treated effectively with drug therapy).
C82 PROCEDURES AND DEVICES FOR CALCIUM TREATMENT IN AN INCREASINGLY COMMON SCENARIO: YOUNG ONCOLOGIC PATIENTS
Authors: Demola P , Bosi D , Musto D‘Amore S , Tarantini L , De Francesco V , Romagnoli F , Colaioiri I , Pignatelli G , Navazio A , Guiducci V
Published: May 2022

Background

Cardiovascular disease and cancer have a high prevalence in Western countries, sharing many risk factors: obesity, diabetes, cigarette smoking, advanced age, diet and sedentary lifestyle. There is growing evidence that patients with ischemic heart disease (CAD) have a higher risk of developing cancer and, conversely, patients with a history of cancer are exposed to a higher incidence of CAD. In particular, cancer and its related therapies may promote the process of atherosclerosis, often with high calcific burden.

Case Report

This is a case of a 58 years old gentleman with a past smoking habit. Unfortunately from 2019 he was diagnosed by a stage IV lung adenocarcinoma, actually in 3rd line therapy: Carboplatin–Alimta, Atezolizumab and Paclitaxel weekly; no metastatic localizations was found at follow up CT scan. Last July, the patient complained of breath fatigue during exertion. At a complete cardiologic examination EKG was normal, and severe aortic stenosis was detected with concentric left ventricular hypertrophy, preserved ejection fraction. At CT scan, the aortic valve was confirmed as bicuspid Sievers type 0 (Figure 1, panel A). Vmax was 5.49 cm/s, max gradient was up to 120 mmHg, and medium gradient was 67 mmHg, as shown in Figure 1, panel B. Coronary angiography showed a very severe, focal, concentric calcific lesion of the left anterior descendant branch (Figure 2, Panel A). The patient was then referred to our local Heart Team and due to his oncological condition with prognosis >12 months, we decided to treat him percoutaneously. Aortic stenosis was treated Transcatheter Aortic Valve Implantation (TAVI) a few days later: predilatation, implant of a with a balloon–expandable valve Edwards Sapien 3 n°23 and post–dilatation, by femoral access (Figure 2, four steps of TAVI). Coronary lesion was uncrossable with the lowest profile balloons, so rotatripsy was perfomed: rotational atherectomy followed by 40 pulses of lithotripsy with Shockwave (Figure 2, Panel B and C). Everolimus eluting stent 3.00 x 23 mm was implanted and optimized (Figure 2, Panel D). Conclusion Recent devices and techniques in Invasive Cardiology allow percutaneous therapies for patients with time–dependent diseases, such as patients with advanced lung adenocarcinoma. Lately, oncological therapies for this type of lung cancer are very promising, allowing the combination of interventional procedures capable of further increasing the prognosis of these patients.
C85 IMPACT OF QUARANTINE ON CARDIOVASCULAR RISK FACTORS
Authors: Castello L , Di Fusco S , Leggio M , Alonzo A , Aiello A , Imperoli G , Colivicchi F
Published: May 2022

Background

Pandemic–related quarantine has led to critical lifestyle changes with possible detrimental consequences on health. The effects of lockdown on cardiovascular (CV) risk factors have been investigated to define patient–tailored strategies aimed at reducing the negative impact on CV health.

Methods

We administered a closed response survey to consecutive patients coming to our cardiac outpatient centre over a period of 10 days. Questions focused on quarantine–related lifestyle changes during March and April 2020.

Results

We enrolled 150 patients (62% male, mean age 65 years). The vast majority of subjects (73%) did not work due to retirement/unemployment, 14% worked in office and 13% worked from home. 50% had hypertension and/or diabetes and/or dyslipidemia, 33% had atrial fibrillation, 17% coronary artery disease, 6% had heart failure and 4% had a pacemaker/ICD implanted. Physical activity did not change for 44%, increased in 2%, decreased in 33% and was stopped in 21%. Dietary pattern remained the same in 73% while 22% consumed more junk food and 5% more healthy food. Body weight was not monitored in 35%, remained unchanged in 32%, increased in 28% and decreased in 5%. Among active smokers (22%), 86% reported higher cigarette consumption while 14% reduced/unchanged number of cigarettes per day. Sleep disorders were present in 73%. Regarding health needs, 16% had to reschedule medical check–ups due to personal choice or hospital unavailability.

Conclusions

Quarantine appeared to have different effects on CV risk factors. During lockdown, on–site work was limited, which may partially account for the observed lifestyle changes. Physical activity was reduced/interrupted in more than half of the population, whereas dietary pattern did not change in the vast majority of subjects, with only a small proportion reporting worse dietary habits. Body weight increased in only a minority of subjects, though this may be underestimated because most participants did not monitor their weight. Cigarette consumption was higher for the majority of active smokers. Similarly, sleep disorders were present in the vast majority of subjects. To conclude, consistent with current literature, our real–world data confirm that quarantine seems to have affected lifestyle habits defining CV risk profile differently. A patient–tailored approach should be implemented to minimise possible detrimental effects of quarantine on CV health.
C86 TAKO–TSUBO SYNDROME IN PATIENTS WITH COVID–19: A SINGLE CENTRE RETROSPECTIVE CASE SERIES
Authors: Alonzo A , Di Fusco S , Castello L , Spinelli A , Altamura V , Mocini D , Imperoli G , Colivicchi F
Published: May 2022

Background

COVID–19 presents with a wide range of symptoms, from mild flu–like complaints to severe acute respiratory distress and cardiovascular complications. Recent literature provides some case reports of Tako–Tsubo syndrome (TTS) in COVID–19 patients. However, its prevalence, pathophysiological mechanisms and prognostic impact in this setting is unknown.

Methods

We collected data of patients hospitalized for COVID–19 in our multidisciplinary COVID–19 department who had a diagnosis of TTS during hospitalization. The criteria for hospital admission were: 1) naso–pharyngeal polymerase chain reaction diagnosis of SARS–CoV–2 infection and 2) symptoms and signs of mild–moderate COVID–19 with a paO2/FIO2 ratio > 200. The period of the study covered the second and third wave of the pandemic in Italy.

Results

Of 635 patients admitted to our centre, we had four cases, two males and two females, with TTS associated with COVID–19. No patient had any classical trigger for TTS except for COVID–19. Mean age was 72 years (67–81) and all patients had a diagnosis of SARS–CoV–2–related interstitial pneumonia confirmed by computed tomography. One patient was admitted to our centre after stabilization of a critical respiratory distress syndrome that required intubation. All patients showed typical apical ballooning with a transitory reduction of left ventricle (LV) systolic function. The mean LV ejection fraction (LVEF) at TTS onset was 42% (40–48%). ECG showed ST–segment elevation in two cases, while an evolution with negative T waves and long QTc was observed in all patients. All patients were treated in the intensive care unit (ICU), with a median ICU stay of 9 days. The long ICU stay duration was due to intercurrent superinfections. All patients recovered a normal LVEF before discharge. The mean value of the high–sensitivity troponin T peak was 1092 ng/L. Three patients underwent coronary angiography. One patient needed vasopressors in the acute phase. Two patients had a previous diagnosis of cognitive impairment. The time interval from hospital admission to TTS onset was 4 (2–6) days, and the time interval from COVID–19 symptom onset to TTS diagnosis was 10 (8–12) days. The mean hospital stay was 32 days (26–37).

Conclusion

COVID–19 may be a trigger for TTS. Possible mechanisms to explain the contribution of COVID–19 to TTS development include the activation of the inflammatory cascade, direct myocardial injury, and stress–related conditions due to COVID–19.
P7 HEMODYNAMIC DEVICE BASED SENSOR TO CRT OPTIMIZATION
Authors: Covino G , Ciardiello C , Covino S , Sibilio G
Published: May 2022

Cardiac resynchronization therapy (CRT) is an effective and established therapy for patients with medically refractory heart failure (HF), left ventricular (LV) ejection fraction ≤ 35%, and a wide QRS complex; CRT obtained notable results but there is a not negligible rate of patients considered clinical and/or instrumental non responder. Amongst several factors that could adversely affect response, suboptimal optimization of the atrioventricular (AV) timing is the most common and most supposed correctable variable to achieve optimal outcome from CRT. All companies have a specific algorithm to obtain an automatic optimization of AV timing, among these Microport has developed a different approach to perform this automatic optimization based on a hemodynamic sensor. The SonR sensor, embedded in the tip of an atrial pacing lead, is able to perform automatic optimization recording mechanical vibration generated by cardiac contraction. The aim of the present study has been to correlate the variability of AV interval, automatically programmed by SonR sensor, with echocardiographic response. 57 patients eligible for CRT–D implantation were included in the study, for all patients programmed follow–up were performed at 6 and 12 months. We have defined three different CRT response classes: Responder A with LVESV reduction > 15%, Responder B with LVEF > 40% and Responder S (Super Responder) if the patient was at the same time Responder A and B. At 12–month follow–up we recorded the following results: Responder A = 69%, Responder B = 59% and Responder S = 55%. In all patients we decided to analyse the variability of the A–V timing controlled by SonR algorithm, we used the coefficient of variation (CV) that appears to be among the most widespread and validated in the literature. The highest values of the CV index are significantly correlated to RESP S and RESP A patients compared to the relative groups of non–responders. In conclusion, the SonR is able to improve the performance of the CRT in the majority of patients by ensuring a high variability of the programmed AV interval. Furthermore, it has been shown that as the CV index increases, the probability of response to CRT increases.
P24 WEAREBLE CARDIOVERTER – DEFIBRILLATOR : UTILITY AND USER FRIENDLINESS
Authors: Bolognesi M , Rossi L , Biagi A , Coccia M , Sticozzi C , Comastri G , Aschieri D
Published: May 2022

Background

Worldwide, cardiovascular disease are still a major mode of death, being sudden arrhythmic death (SCD)25 % of total death. Implantable cardioverter defibrillator (ICD) is an effective weapon for SCD prevention in high risk patients with reasonable expectation of survival with good functional status for >1 year. However sometimes the risk of SCD can be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered.

Methods

We considered consecutively 40 patients discharged from our cardiology department of Piacenza and Castel san Giovanni that, for potentially transient high risk of SCD, weared a WCD from August 2017 to September 2021, after a systematic education session lasting 30 – 45 minutes. They are followed through remote monitoring.

Results

Out of 40 patients, with average age 66 years old and average left ventricular ejection fraction (LVEF) 29%, 88% were males, 70 % suffered from arterial hypertension, 32% diabetes mellitus, 17,5 % peripheral vascular disease, 35 % chronic renal failure, 55% heart failure, 7,5% previous stroke. 56% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 7% after removal of an infected ICD, 9 % whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 34% after newly diagnosed cardiomyopathy.The patients were discharged in high risk mode of SCD with WCD protection.The average wearing time of WCD was 51 days and 22,98 hours daily. We received 953 trasmissions, with 21 events: 7 ventricular tachicardia, 4 Sopraventricular tachicardia and 5 T wave oversensing .Neither inappropriate shock and neither death were detected .After wearing time and after clinical evaluation, only 52% of patients were subjected to ICD implantation.

Conclusions

In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients, considering wearing time. The WCD allows saving resources with less hospitalization time.
P28 AN OMINOUS FINDING OF BRUGADA PATTERN: FROM PAROXYSMAL ATRIAL FIBRILLATION TO SEVERE TRICUSPID VALVE REGURGITATION
Authors: Di Nicola F , Barile L , Bertelli M , Bertolini D
Published: May 2022

49 years old male, without family history of sudden cardiac death, subjected in 2010 to effective electrical cardioversion for a first episode of paroxysmal atrial fibrillation. In 2013, a new episode of atrial fibrillation subjected to effective pharmacological cardioversion with flecainide and contextual finding of intermittent Brugada type I pattern, confirmed by ajmaline provocation test. Considering the asymptomaticity of the patient and the negative family history of sudden cardiac death, no indication was given to defibrillator implantation. In 2015 the patient performed an Electrophysiological Study, positive for induction of ventricular fibrillation, in the light of which an ICD was implanted. In the following years regular checks of the device were performed, in absence of activations. In 2021, at the annual checkup, rupture of the leads was documented, resulting in a complete extraction and reimplantation of the device. A few days later the patient was admitted to the Emergency Room for chest pain and worsening dyspnea, signs of initial right heart failure and increased inflammatory markers. In consideration of the anamnestic history, the presence of infective endocarditis was suspected, for which the patient was admitted to the Cardiology ward. The echocardiogram showed severe tricuspid valve regurgitation due to complete flail of the septal flap and rupture of first order tendon cord, probably iatrogenic and consequent to the extraction of the leads. FDG–PET was performed, which ruled out the presence of infective endocarditis, and surgical correction of the valvulopathy and definitive ICD explant was indicated. The surgery consisted of plastic repair of the tricuspid valve, implantation of definitive epicardial bipolar electrodes, isolation of the pulmonary veins for atrial fibrillation ablation and removal of the ICD. Brugada syndrome, starting from the 2013 consensus, can be diagnosed in patients who only feature the type 1 pattern, spontaneous or pharmacologically induced, even in the absence of malignant arrhythmias or family history of sudden death. This leads as a consequence to an increase in the number of patients undergoing invasive procedures and interventions even with low arrhythmic risk, being instead susceptible to the complications that such procedures can fatally provoke.
P29 AICD IMPLANTATION IN A PATIENT RESURRECTED FROM CARDIAC ARREST, WITH THE R / T PHENOMENON AT THE HOLTER
Authors: Incampo G , De Luca V , Rizzo D , Bux F , Moramarco M , Pirozzi M , Valecce R , Cassano F , Bonfantino M
Published: May 2022

A 72–year–old woman with hypertension for thirty years, resuscitated from cardiac arrest during prosthetic surgery of the right knee in January 2020, with external heart massage and orotracheal intubation. On examination Holter performed in February 2021, presence of couples and R / T phenomenon with Lown 1B–3–4A–5 class. The patient is subjected to coronary angiography which showed only mild atheroma without stenosis hemodynamically significant of the arterial districts explored. On the Echocardiogram, FE estimated at 60%. Based on the anamnestic data and the feedback from the fifth class of Lown at the Holter, it was decided to implant a dual chamber defibrillator for secondary prevention. The vulnerable point of refractory ventricular notoriously falls below 300 msec and in the clinical case in question there is a comparison to the holter of fifth class of lown with phenomenon R on T and coupling interval of 276 msec. The precocity of the ventricular ectopias is already in itself a risk factor for MI, reinforced in the case of clincio in question from a history of resuscitated cardiac arrest in a hospital setting. Not indicated to ours opinion of the electrophysiological inducibility study, given the positive clinical history and dynamic ECG according to Holter who examines the arrhythmic phenomenon in its spontaneous and natural way of presenting itself in circadian rhythm. The reproducibility in the laboratory with the SEI, of the electrical vulnerability was in fact in the recent years downsized, due to high specificity but low sensitivity, as there is in the clinical reality of patient neurovegetative and biohumoral fluxuonary factors, which favor the induction of malignant arrhythmias and that escape the predictive laboratory analysis. Making the patient safe with the implant of the bicameral AICD resulted from a clinical – diagnostic – instrumental analysis and after extensive discussion by the heart team in our Operating Unit.
P33 SUPRAVENTRICULAR TACHYARRHYTHMIAS AND RECURRENT SYNCOPES AFTER PERCUTANEOUS CLOSURE OF PFO IN A YOUNG PATIENT WITH NO HISTORY OF THROMBOEMBOLISM. IMPORTANCE OF CURRENT GUIDELINES
Authors: Scapinelli M , Campisano M , Bagni E
Published: May 2022

The presence of a PFO (patent foramen ovale) has been associated with cryptogenic stroke in particular in the young adult, sustained by paradoxical embolism. Its percutaneous closure represents a prophylactic treatment. The procedure can involve various post–procedural complications including supraventricular tachyarrhythmias related to the mechanical action exerted by the device. The clinical case presented concerns a 49–year–old woman with a negative cardiovascular history, suffering from headache, who came to the emergency room due to the onset of relapsing episodes of symptomatic cardiopalmus due to dizziness and syncope. The ECG documented the presence of a high–frequency supraventricular tachyarrhythmia treated by external electrical cardioversion as the patient was pale and hypotensive. The laboratory tests were normal as well as the echocardiogram. The patient had undergone, three weeks earlier, percutaneous closure of PFO diagnosed following the finding of brain ischemic areas on magnetic resonance imaging (MRI) performed only to complete the diagnosis of the headache. The patient was then admitted to Cardiology where further arrhythmic relapses occurred, including a 2:1 atrial flutter treated effectively with amiodarone, a drug then introduced orally. Given the recent interventional procedure, pharmacological prophylaxis of arrhythmias was opted for, with benefit as the episodes have progressively reduced in terms of frequency and intensity. At two–months FU the patient reported only two episodes per week until complete regression, after a further 4 months. This allowed the suspension of amiodarone. Several studies and the latest guidelines indicate PFO closure in the case of stroke in patients under the age of 60 clearly correlated with paradoxical embolism; in our case, the procedure was performed after the occasional finding of ischemic micro–areas on MRI considered secondary to PFO in the absence of multidisciplinary cardiological–neurological evaluation and in a symptomatic patient only for headache. The patient had significant arrhythmic complications that had an important impact on her quality of life, also from a psychological point of view, for at least 6 months. Compared to the past, current guidelines have filled a gap that often led to “lightly” performing procedures whose complications can be really important.
P34 ASYMPTOMATIC VENTRICULAR PRE–EXCITATION WITH DISAPPEARANCE DURING EXERTION: ALWAYS AN INDEX OF BENIGNITY?
Authors: Barengo A , Parise A , Notaristefano F , Sforna S , Padoan L , Bernardini G , Notarianni G , D‘ammando M , Zingarini G , Cavallini C
Published: May 2022

Introduction

The disappearance of pre–excitation at high heart rates points to a low arrhythmic risk: why resort to electrophysiological studies anyway?

Clinical Case

L.S., a 12–year–old patient, performed an ECG for sports examination with evidence of ventricular pre–excitation from an asymptomatic left lateral accessory route (Fig. A). A 24 h ECG–Holter during training showed the disappearance of the pre–excitation at high frequencies (Fig. B) which is considered a low risk index. The patient underwent a transesophageal electrophysiological study (SETE) during which an effective refractory antegrade period of 228 ms of the pathway was objectified through atrial extrastimuli (*) (Fig. C: drive of atrial stimuli (*) followed by extrastimulus with conduction on an accessory route (E)). In addition, a 1: 1 conduction was observed on the atrial pathway up to at least 270 bpm (222 ms). The antegrade refractory period of the resting path was <250 ms and therefore identified a high–risk condition to be treated with ablation.

Discussion

The disappearance of pre–excitation at high heart rates is usually considered indicative of an accessory pathway with a long refractory period and therefore at low risk, however it must be sudden. According to European guidelines, the execution of invasive studies in asymptomatic patients who are employed in high–risk jobs or competitive sports has a class I B indication, but in the remaining asymptomatic cases the indication is IIa B. The Holter ECG alone or the stress test, with a careless evaluation of the disappearance of the pre–excitation (sudden vs progressive with minimal residual pre–excitation) would have erroneously led to labeling this accessory pathway at low risk. In the left lateral accessory pathways, with the increase of the HR, there can be a disappearance or pseudo–disappearance of the pre–excitation for anatomical reasons (being further away from the SA node) and for an increase in the AV conduction speed, not therefore for a long refractory period of the pathway. SETE is closer to the atrial side of the left accessory pathway and allows to correctly classify the risk.

Conclusion

SETE is a low–cost and minimally invasive method that should be considered as an integral part of the study of patients with asymptomatic ventricular pre–excitation even if non–invasive stratification indicates low risk.
P43 CARDIAC SURGERY IN PATIENTS WITH MARFAN SYNDROME: 20–YEAR SINGLE–CENTER EXPERIENCE
Authors: Leone A , Cavalli G , Di Marco L , Botta L , Mariani C , Gliozzi G , Votano D , Snaidero S , Nania R , Savini C , Martin–suarez S , Pacini D
Published: May 2022

Marfan syndrome is a connective tissue disease whose most fearsome complications are proximal thoracic aorta enlargement and dissection. Nonetheless, cardiac surgery has proven to be able to considerably extend average life expectancy up to approximately 70 years1. The aim of our study was to analyze which procedures had been performed on these patients. From 2000 to 2020 we retrospectively enrolled 89 consecutive patients undergoing a first–time surgical operation at our department. Overall, aortic root surgery represented the most frequent procedure (82 patients, 92.2%), with valve–sparing operation being the preferred one (53 patients, 59.6%). On the other hand, 29 patients (32.6%) underwent Bentall–De Bono procedure. Consequently, we compared these 2 groups of patients. In emergent operation, typically type A aortic dissection, Bentall–De Bono procedure was preferred in almost all cases (p–value 0.031). Few patients required the replacement of part or all of the arch, respectively 3 and 6, with no statistical difference between the two groups. However, while 2 valve–sparing patients required a mitral valve repair, 8 patients who underwent aortic root replacement had also their mitral valve replaced. Considering mean age (average 34.68 years), predictably almost all Bentall–De Bono patients had both their aortic and mitral valve replaced with a mechanical prosthesis (respectively 27 and 7 out of 29 and 8). Although there was no significant difference, replacement of the aortic root with a composite graft required less cross–clamp time, being also different the complexity of the technique. ICU stay was significantly different, since patients who had their aortic valve spared needed intensive assistance for an average of just 1.57 days, while the other group for 6.03 days (p–value 0.037). Similarly, but non significantly, hospital stay differed (13.91 and 18.17 days). Only 2 patients died during hospital recovery, both part of the Bentall–De Bono group (p–value 0.055). During the follow–up period (average 89.39 months), 6 patients died, 2 of them for noncardiac related causes, and 9 (11.3%) required another operation. In conclusion, Marfan syndrome is characterized by a dangerous proximal aorta involvement, which in some cases may be life–threatening if left untreated. Fortunately, surgery has significantly improved life quality and expectancy of these patients, who must be adequately diagnosed and then monitored by their referral centers.
P46 THREE–DIMENSIONAL ECHOCARDIOGRAPHY EVALUATION OF MITRAL VALVE ANATOMY AFTER PERCUTANEOUS EDGE TO EDGE REPAIR
Authors: Polizzi V , Chianta V , Russo M , Ranocchi F , Cammardella A , Pergolini A , Manzara C , Musumeci F
Published: May 2022

Background

Transcatheter edge–to–edge repair (TEER) is a safe strategy for high–risk patients with significant mitral regurgitation (MR). We aimed to characterize by three–dimensional echocardiography (3D–E) acute reshaping of mitral valve apparatus, with specific reference to the underlying MR mechanism (functional (FMR)and degenerative (DMR))

Methods

We prospectively enrolled 15 patients(November 2020 to September 2021),(median age 81 y.o, range 79–84, 50% male, 1 urgent procedure) with severe mitral valve regurgitation who underwent intra–procedural 3D–E before and after device deployment. Using a dedicated semiautomatic software, we obtain parametric quantification of mitral valve anatomy to describe acute changes in FMR and DMR.

Results

Eight patients (53%) were affected by FMR of whom one case was performed as bridge to heart transplantation candidacy. In the remaining 7 DMR cases, P2 prolapse was present in 5 (71%), commissural flail and A2 flail in 2 cases. Procedural success (MR < 2) was achieved in 14 cases (93%). 30–day survival was 100% in elective cases. A second clip was necessary in 8 patients (53%). After TEER, the FMR group experienced an immediate annular reshaping, with reduction of antero–posterior diameter (p 0.05), next to a recovery of physiological saddle–shape, defined by lower non–planar angle (p = 0.001) and higher annulus height (p ≤ 0.001). The DMR group showed a trend of decrease of maximum annular velocity, addressing a stabilizing effect of the device.The deployment of a second clip has no significant effect of the annular reshaping in both groups.

Conclusions

TEER causes multiple effects on mitral valve geometry which variesaccording to MR mechanism. Three–D parametric quantification of MV anatomy identifiedspecific parameters of acute annular remodeling. FMR exhibited pronounced modification. This “annuloplasty–like” effect may play a role in the late freedom from MR.
P48 RETROSPECTIVE POSTOPERATIVE NEAR INFRARED SPECTROSCOPY MONITORING ANALYSIS TO DETECT POTENTIAL CRITERIA TO IMPROVE POSTOPERATIVE PREDICTION OF UNFAVOURABLE OUTCOME FOLLOWING AORTIC SURGERY
Authors: Totaro P , Milanesi E , Belliato M , Pelenghi S
Published: May 2022

Objective

Near Infrared Spectroscopy (NIRS) monitoring has become a frequent practice during aortic surgery. The real impact of NIRS in predicting postoperative outcomes, however is still debated, as many cases of “false negative” with severe cerebral damage despite apparently normal NIRS monitoring during surgical procedure. We applied extended retrospective postoperative NIRS monitoring analysis in order to investigate potential criteria to enhance postoperative unfavorable outcome prediction. Materials and

Methods

Data of NIRS monitoring of 41 patients undergoing aortic surgery (19 acute dissection) were retrospectively analyzed. Partial circulatory arrest with selective bilateral (21 pts) or unilateral (20 pts) cerebral perfusion (CP) was used in all patients. Double channel (R and L) NIRS value was continuously recorded (every 30 sec) from anaesthetic induction to patient’s transfer to ICU. Postoperatively all data were downloaded in excel format and retrospectively analyzed. Baseline, maximum, and minimum value with percentage drop and R/L channel gap were all analyzed considering 5 different phases of surgery: before extracorporeal circulation (EC); in EC before circulatory arrest and selective cerebral perfusion (CA–SCP); in EC following CA–SCP, following EC. Overall time <25% (in each channel) or with a > 20% gap were also evaluated.

Results

Overall 661±125 values were recorded for each patient. Baseline value on the Left (61±7) was significantly lower then Right (66±12). Maximum drop did not differed in two channels (Fig 1a) but varied according surgical phases (Fig 1). R/L asymmetry also varied according surgical phases with a peak value during rewarming and not during CA–SCP despite unilateral SCP and complexity of procedure (Figure 2 and 3).

Conclusion

Extended postoperative analysis of NIRS recorded value shows different trend and behavior according surgical phase and cerebral perfusion strategy. Accurate extended NIRS analysis is therefore mandatory in order to improve knowledge of physiological cerebral perfusion during SCP and early identification of patients at high risk of postoperative cerebral complications.
P51 HYBRYD TREATMENT FOR CORONARY ARTERY DISEASE CONCOMITANT WITH MINIMALLY INVASIVE CARDIAC VALVE SURGERY
Authors: Ramoni E , Del Giglio M , Ceresa R , Savarese G , Lamarra M , Di Chicco E , Grattoni C
Published: May 2022

Cardiac valvular surgery concomitant with coronary artery bypass grafting has a higher mortality than isolated valve surgery. Therefore, a hybrid approach that combines the benefits of the low risk of percutaneous coronary angioplasty (PCI) with those of minimally invasive valve surgery, should be considered. At present, data on hybrid valve/PCI procedures are limited to clinical cases and small cases, in which the PCI procedure is usually followed by surgery after about 3 weeks. We report our experience in which valve surgery was first performed with a minimally invasive approach (minithoracotomy or ministernotomy), then followed by coronary revascularization with PCI, to reduce the risks of post–surgical bleeding due to anti–aggregating therapy, in a non–randomized but consecutive case. Between July 2019 and June 2021, 22 patients were treated. Median of the days between surgery and PCI was 8, median of total hospitalization was 13 days. In 6 patients the surgical approach was a ministernotomy, in 16 was performed a right minithoracotomy. In 14 (64%) patients PCI was performed on single coronary vessel, in 5 (22.5%) on 2 coronary vessels and in 3 (13.5%) on 3 coronary vessels. There were no reinterventions for postoperative bleeding. One patient presented gastro–intestinal bleeding from a colon polyp. No patients died during hospitalization, nor at the follow–up performed by telephone every 6 months. No patients required valve reintervention or coronary artery bypass during hospitalization or follow–up. One patient underwent a new PCI procedure at 7 months. In conclusion, the hybrid approach consisting of minimally invasive valve surgery followed by PCI may offer an alternative to the standard but more complex operation of coronary artery bypass grafting plus valve surgery through complete sternotomy.
P54 MORTALITY AFTER CORONARY ARTERY BYPASS GRAFT IN PATIENTS WITH PRIOR PERCUTANEOUS CORONARY INTERVENTION
Authors: Mallia G , Jiritano F , Battaglia D , Mastroroberto P , Serraino G
Published: May 2022

Background

The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring surgical revascularization (CABG) is not well investigated. We explore whether prior PCI is associated with adverse outcome after CABG.

Methods and Results

Operations conducted between October 2014 and July 2021 at Magna Graecia University were analyzed using propensity weighted methodology to adjust for confounding. Of a total of 1410 adult patients included in the study, (24%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.77; 95%; P = 0.41 and odds ratio, 0.93; 95% confidence interval; P = 0.84, respectively). Subgroup analyses confirmed that prior PCI had no impact on hospital mortality and morbidity, including reexploration for bleeding, blood transfusion, hospital resource use, and neurological, renal, and cardiac complications.

Conclusions

Our study showed that prior PCI was not associated with an increased risk of mortality or other adverse outcomes in patients undergoing CABG. Further studies are needed to ascertain the prognostic impact of prior PCI in the outcome after CABG.
P55 A CHALLENGING RIGHT ATRIAL MASS
Authors: Cinelli F , Sciatti E , Rondi M , Sanvito R , Capoferri A , Innocente F , Fino C , Terzi A
Published: May 2022

A 64–year–old woman presented at the Emergency Department with worsening dyspnoea and fever. Blood tests revealed normal white blood count, elevated C–reactive protein (244 mg/L) and D–dimer (2618 ng/mL). At arterial blood gases test hypoxaemia and hypocapnia was found (pH 7.48, pO2 83 mmHg, pCO2 30 mmHg, base excess –1.2 mmol/L, lactates 1.0 mmol/L). She underwent thoracic computed tomography (CT), which showed right inferior pulmonary embolism with infarction. A transthoracic echocardiography (TTE) revealed the presence of a mobile heterogeneous iso–hyperechoic neoformation completely occupying the right atrial cavity and moving partially across the tricuspid valve (Figure 1). A right atrial thrombotic formation was hypothesized and, due to its dimension, despite a valid hemodynamic, the patient underwent thrombolysis with rtPA 100 mg iv infusion over 2 hours. However, the next day at CT and TTE the mass was still there and unmodified. The screening for thrombophilia and for cancer markers were negative. Cardiac magnetic resonance imaging was waived because the clinical conditions were rapidly deteriorating. Indeed, the patient was transferred for urgent cardiac surgery. The excised mass was 5 cm x 3.5 cm large and adherent to the right atrial roof, 1 cm close to the atrioventricular node. It was completely removed by the cardiac surgeon (Figure 2). The subsequent journey was regular, without complications. The histologic exam revealed that the mass was a giant myxoma (Figure 3). At follow–up the patient persisted asymptomatic. Figure 1. Transthoracic echocardiography. Figure 2. The excised right atrial mass. Figure 3. Histologic examination of the right atrial mass.
P57 SPONTANEOUS DISSECTION OF THE DISTAL MARGINAL BRANCH IN A YOUNG WOMAN IN THE PERIPARTUM WITH NO FLOW LIMITATION AT THE PRESENTATION EVOLVED INTO SEVERE DISSECTION OF THE ANTERIOR CIRCUMFLEX AND DESCENDING ARTERY COMPLICATED BY CARDIOGENIC SHOCK
Authors: Pezzi L , Magnano R , D‘Alleva A , Forlani D , Fulgenzi F , Corazzini A , Vitulli P , Verrengia E , Di Marco M , Paloscia L
Published: May 2022

We describe the case of a 39–year–old woman with a history of recent natural birth, who came to our observation for an episode of oppressive chest pain while breastfeeding her baby at night. At the entrance, the electrocardiographic and echocardiographic findings and myocardiocitonecrosis enzymes were normal; after three hours the second enzymatic determination was clearly increased, so the patient was admitted to our ICU with a diagnosis of SCA / NSTEMI. She was therefore subjected to coronary angiography with a small hematoma in the distal tract of the marginal branch without flow limitation; it was therefore decided, in accordance with the AHA and ESC guidelines, for a conservative medical therapy. On the third day of hospitalization, the patient presented recurrence of chest pain with electrocardiographic evidence of ST segment elevation in the anterolateral site. A new angiographic evaluation was therefore performed urgently, showing a complete retrograde dissection from the marginal branch to the circumflex branch and to the anterior descending branch with TIMI 0–1 flow. During the procedure the patient underwent a prolonged hypotensive episode associated with frequent polymorphic ventricular ectopic beats, with rapid evolution towards a picture of overt cardiogenic shock. Therefore we proceeded quickly to perform PTCA with placement of medicated stents on all branches involved in the dissection, with rapid improvement of the haemodynamic picture. Spontaneous coronary dissections represent for a hemodynamist a condition of great technical difficulty where the margins of error are very high. Thanks to the technological evolution of materials, an experienced hemodynamist is able, more and more easily, to be successful in the revascularization procedure and to resolve extremely serious clinical pictures. This case report describes a spontaneous coronary dissection that most often occurs in young women in good health and without risk factors for coronary heart disease, particularly in the peripartum period. The presentation was similar to an acute coronary syndrome. According to AHA and ESC guidelines, therapy was conservative if dissection / hematoma is not a flow restriction with coronary angiography after a few days to demonstrate vessel restoration.
P58 IMMEDIATE CORONARY ANGIOGRAPHY AND SYSTEMATIC TARGETED TEMPERATURE MANAGEMENT ARE ASSOCIATED WITH IMPROVED OUTCOME IN COMATOSE SURVIVORS OF CARDIAC ARREST
Authors: Dall’Ara G , Compagnone M , Spartà D , Carletti R , Grotti S , Guerrieri G , Gaetani S , Cortigiani M , Maitan S , Fabbri A , Ottani F , Caravita L , Tarantino F , Galvani M
Published: May 2022

Background

Rapid and systematic access to coronary angiography (CAG) and target temperature management (TTM) might improve outcome in comatose patients who survive cardiac arrest (CA). However, there is controversy around indicating immediate CAG in the absence of transmural ischemia on the electrocardiogram after return of spontaneous circulation (ROSC). We evaluated the short– and long–term outcome of our retrospective cohort of patients undergoing systematic CAG and TTM, based on whether culprit lesion percutaneous coronary intervention (PCI) was performed.

Methods

All consecutive comatose CA survivors with no obvious extracardiac causes undergoing TTM were included. Analysis involved the entire population and subgroups, namely patients with initial unshockable rhythm, no ST–elevation on electrocardiogram, and good neurological recovery.

Results

We enrolled 107 patients with a median age of 64.9 (57.7–73.6) years. The initial rhythm was shockable in 83 (77.6%). Sixty–six (61.7%) patients underwent PCI. In–hospital survival was 71%. It was 78.8% and 58.5% in those undergoing or not PCI (p = 0.022), respectively. Age, time from CA to ROSC and culprit lesion PCI were independent predictors of in–hospital survival. Long–term survival was significantly higher in patients who underwent PCI (respectively 61.5% vs 34.1%; Log–rank: p = 0.002). Revascularization was associated with better outcomes regardless of initial rhythm (shockable vs non–shockable) and ST–deviation (elevation vs no–elevation), and improved the long–term survival of patients discharged with good neurological recovery.

Conclusion

Systematic CAG and revascularization, when indicated, were associated with higher survival in comatose patients undergoing TTM, regardless of initial rhythm and ST–deviation in the post–ROSC electrocardiogram. The benefit was sustained at long–term particularly in those with neurological recovery.
P59 A COMPLEX PCI IN A CARDIOGENIC SHOCK NSTEMI PATIENT NEEDING PTA AND LEFT VENTRICLE ASSISTANCE
Authors: Buccheri D , Lombardo R , Abrignani M , Priolo L , Augugliaro S , Caiolo A , Casciolo M , Lombardo A , Rizzo C , Zabbia D , Vinci D , La Manna A , Martino S
Published: May 2022

A 72–years–old man, smoker, type 2 DM and hypertension in history, was admitted for NSTEMI complicated by cardiogenic shock; Echocardiogram revealed LV dilatation with severe disfunction (EF 20%), moderate mitral regurgitation; he started inotropic support and high dose diuretics, then he needed dialysis and positioning of a temporary PM. Coronary angiography revealed chronic total occlusion (CTO) of the left anterior descending artery (LADA) and CTO of the right coronary artery (RCA). A first CTO PCI procedure was attempted for the LADA occlusion, with the support of IABP, using an antegrade approach, polimeric wire (ASAHI Fielder) and more penetrating ones (ASAHI Gaia I and II), unable to gain the true lumen beyond the occlusion. A second attempt was planned, with the support of Impella CP device for left ventricle assistance; due to critical stenosis in the right common iliac artery, a PTA with stenting (8/38 mm) was preparatory for that. For the second attempt a dual coronary approach was prepared (6 F Amplatz left 1,0 for RCA and 7 F XB 3,5 for left coronary artery); at first a novel antegrade attempt was pursued with a step–up technique (ASAHI wires: Gladius, Gaia I, II and III, Conquest pro), ineffective to reach the true lumen distally the occlusion. The retrograde approach was then pursued, through a collateral originating from the acute marginal branch of the RCA to the distal segment of LADA, using the Caravel microcatheter with ASAHI wires Sion blue, Sion black, Suoh 03, effective to reach the distal cap of the occlusion, this one passed by the Gladius wire. The ASAHI RG3 externalization wire (330 mm) was then used, entering from the radial access and the amplatz catheter for the RCA, reaching the XB catheter in the left coronary artery through a Guideliner extension catheter, and externalized in the femoral access. IVUS analysis was then used to confirm good wire position and the vessel calibers, so pre–dilatation was done and 3 drug–eluting stents were implanted (2,25/23 + 3,25/38 + 3,5/18 mm) distal–to–proximal overlap, with final post–dilatation, obtaining a good final result on angiography and IVUS. During the 4–hours procedure clinical condition was stable and Impella was removed with a rapid weaning; the double pre–mounted Proglide device was used for femoral hemostasis. 5 days after the patient was discharged, II–III NYHA class, 25% EF. At the 3 months f–up he was asymptomatic in good clinical condition, 30% EF, he refused ICD implant.
P69 LONG–TERM OUTCOMES WITH DRUG–ELUTING BALLOONS FOR THE TREATMENT OF IN–STENT RESTENOSIS AND DE NOVO LESIONS
Authors: Zilio F , Verdoia M , Viola O , Fanti D , Brancati M , Soldà P , Bonmassari R , De Luca G
Published: May 2022

Introduction

Drug coated balloons (DCB) have emerged for percutaneous coronary interventions (PCI) and mainly for in–stent restenosis or particular anatomies. However, the indications and the predictors of long–term failure of DCB have been poorly evaluated besides small–sized randomized clinical trials. Therefore, the aim of the present study was to provide a real–world analysis of the prognostic determinants and long–term outcomes among patients treated with DCB for any type of lesion and included in a comprehensive multicenter registry.

Methods

We included patients undergoing coronary angiography and PCI with DCB for in–stent restenosis or de novo lesions in 3 centers. Quantitative parameters for coronary lesions were calculated by an automatic edge–detection system. The primary study endpoint was the occurrence of major cardiovascular events (a composite of death, MI and target vessel revascularization) at the longest available follow–up. Secondary endpoints were the individual components of the primary endpoint, target lesion failure (TLF) or any acute coronary syndrome.

Results

Out of 281 patients treated with DCB, the 267 displaying a follow–up > 12 months were included, of whom 196 treated for in–stent restenosis and 71 with de novo lesions. At a median follow–up of 616 [368–1025] days, MACE occurred in 70 (26.2%) of the patients. No difference in clinical, demographic of angiographic features was observed between patients with or without an event, with the exception of a higher rate of in–stent restenosis (p = 0.04), longer and more type C lesions (p = 0.05 and p = 0.04) related with MACE. At multivariate Cox–regression, type C lesions emerged as the only independent predictor of MACE (adjusted OR[95%CI]= 1.83[1.13–2.97], p = 0.014), mainly driven by target vessel revascularization (adjusted OR[95%CI]= 1.78[1.05–2.95], p = 0.03) although not conditioning survival. However, in–stent restenosis emerged as a major determinant of TLF (adjusted OR[95%CI]= 2.59[1.17–5.75], p = 0.02).

Conclusion

The present registry shows that drug–coated balloons represent a potential treatment strategy even for de–novo lesions, especially in less complex cases. In fact, we observed an increased risk of MACE and target lesion failure in case of type C and restenotic lesions.