bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG–TERM EFFECT OF RADIOTHERAPY: A CASE OF PREMATURE ONSET OF INFRA–HISIAN CONDUCTION DISEASE
Authors: Rosso J , Vio R , Quinto L , Vitale R , Marras E , China P , Themistoclakis S 
Published: May 2024

Abstract
New chemotherapy agents and radiotherapy have improved mortality and survival of patients with neoplastic diseases; however, such therapies can cause significant side effects. One of the main concerns about mediastinal radiotherapy is the occurrence of cardiovascular side effects a long time after the treatment. This is an important issue – especially for thoracic neoplasms with long term survival, such as Hodgkin‘s lymphoma– because of the increase in cardiovascular morbidity and mortality. We report the case of a 40 years old male with infra–Hisian atrioventricular block developed progressively about twenty years after receiving radiotherapy for Hodgkin lymphoma. The patient experienced episodes during effort of abrupt and sudden reduction of the cardiac frequency and a syncope due to effort with finding of remarkable bradycardia. He was subsequently admitted for asthenia, dyspnea due to mild–moderate effort and bradycardia found at the self monitoring. The electrocardiogram showed atrioventricular block 2:1 with right branch block and left anterior fascicular block. Heart rate monitoring after the admission showed almost persistent 2:1 AV block. We performed a transthoracic echocardiography showing valvular thickening attributed to former radiotherapy in the absence of any clinical history of interest. A RMC was performed and it excluded the presence of edema or pathologic late gadolinium enhancement. We performed an electrophysiologic study that showed impairment of the infra–Hisian conduction system. With continuous atrial stimulation with RR cycle 620 me we documented infrahisian Wenckebach point. Therefore, a dual chamber pacemaker was implanted. This case rase the need for new studies evaluating the incidente of radiation induced heart disease. Clinicians must pay attention to bradyarrhythmia–related symptoms in patients whit previous exposure to chest radiation because of possibile premature onset of conduction disturbances.
STERNAL WOUND INFECTION AFTER CARDIAC SURGERY: LOOKING FOR INTERACTIONS BETWEEN PERIOPERATIVE VARIABLES AND PATHOGEN AGENTS
Authors: Gatti G , Radesich C , Savonitto G , Rizzi J , Munaretto L , Maurel C , Costantino V , Gripshi F , Franzese I , Barbati G , Rodriguez Garcia A , Busetti M , Luzzati R , Sinagra G , Mazzaro E 
Published: May 2024

Abstract

Background
Sternal wound infection (SWI) can be a major complication of cardiac surgery. Both the risk factors and the pathogens agents are well known today. Yet, possible interactions between perioperative variables and pathogens have not been explored.

Methods
Between Jan 1st, 2006 and Nov 30, 2023 (∼18 years), perioperative data of all patients undergoing cardiac operations through median sternotomy at the Cardio–Thoraco–Vascular Department of the University Hospital of Trieste, Italy, were recorded prospectically in a computed database. Every patient developing a sternal complication was followed in a dedicated outpatient clinic and, in the presence of infection, the causative pathogen was always searched for by cultural examination of tissue speciments. Different strategies of unsupervised clustering were applied to find groups of patients with similar clinical, surgical and microbiological profiles.

Results
Of 9,680 consecutive cardiac surgery patients, 516 (5.3%) experienced a SWI that involved superficial soft tissue in 25.6% of cases, deep soft tissue in 51%, sternal bone in 16.7%, or mediastinum in 6.8% of cases. Staphylococcus aureus, coagulase–negative Staphylococci, Enterobacteriaceae, and Pseudomonas aeruginosa were pathogens in 100 (19.4%), 158 (30.6%), 89 (17.2%) and 36 (7%) patients, respectively; other pathogens, polymicrobial and negative cultures were found in 27 (5.2%), 26 (5%) and 80 (15.5%) patients, respectively. Following statistical analyses, significant associations were found between the Pseudomonas aeruginosa etiology of SWI and some variables such as female gender (p&lt;0.0001) and preoperative renal failure (p=0.008); significant associations between the Pseudomonas aeruginosa etiology were found also with more serious forms of sepsis (p=0.025), as well as with early postoperative death (p=0.02) and complications such as acute kidney injury (p=0.006), multiple transfusion (p=0.003), and prolonged mechanical ventilation (p=0.005).

Conclusion
For women having renal impairment and undergoing cardiac surgery through median sternotomy, in the case of SWI, the Pseudomonas aeruginosa etiology may be more frequent and a really life–threating complication.
MINIMALLY INVASIVE SURGERY FOR ISOLATED MITRAL VALVE DISEASE: A SINGLE CENTER 5–YEAR EXPERIENCE
Authors: Borrelli E , Faragasso E , Caprili L , Fahim N , Fedeli C , Adornini G , Fiorani V 
Published: May 2024

Abstract

Introduction
Minimally invasive surgery (MIS) has become the standard of care in our department to address mitral valve diseases (MVD). We nowadays use the mini–thoracotomy approach independently of the MVD etiology and for both complex and simple lesions (posterior leaflet prolapse).
The aim of this study was to analyze the efficacy of the approach by observing also post–operative results.

Methods
We retrospectively analyzed 484 patients who consecutively underwent mitral valve surgery with a minimal invasive approach from January 1st 2018 to December 31st 2022. The patients included in the study were addressed to surgery for a mainly mitral valve pathology (regurgitation, stenosis, prosthesis disfunction). All of the interventions were executed by the same surgeon. We performed a minithoracotomy at the III or IV intercostal space, depending on the anatomy of the patient, always assisted by an endoscopic camera. When necessary, we used periareolar thoracotomy or axillary approach. In the latter without assistance of the camera. The patients had a 3–month follow up visit at least and the longest follow–up monitoring was at five years.

Results
Overall repair rate was 90% (±3%) which increased to 96% (±1%) when we analyzed the repair rate for degenerative mitral valve pathology as unique etiology. 48% of the mitral valve insufficiency was related to posterior leaflet prolapse and among them 63% had an isolated lesion of of P2 scallop. Hospital stay was 10 days that turned to 6 days when we excluded patients with transitory complications.

Conclusions
MIS for isolated mitral valve disease provided a good repair rate even in complex anatomy. We also observed good results for mitral valve replacement, deemed necessary in non–degenerative etiologies. A good exposure of the valve, then, permits to address the great majority of the MVD avoiding the longer hospital stay needed after median sternotomy and guarantees a faster return to work without rib fracture implying excellent pain control.
A PARTICULAR CASE OF CARDIAC ARREST
Authors: Sanna S , Lampus M 
Published: May 2024

Abstract
88–year–old man with arterial hypertension, cognitive impairment, carrier of dual–chamber PM due to sinus node disease. Diagnosis of congenital long QT syndrome (LQT1) approximately 20 years ago during family screening (syncopal episodes in his son positive for LQT1), no history of syncope or major arrhythmias. In home therapy with mirtazapine and norvasc. He arrived in our cardiac intensive care unit for ACC on torsade de pointes trated with two cycles of CPR and 1 DC shock at 200 Joules with ROSC. On arrival ECG evidence of electrically induced ventricular rhythm, QTc 850 msec. On echocardiogram akinesia of the mid–basal segments of all the LV walls (takotsubo–like) with EF 25–30%. On coronary angiography non critical multivessel coronary disease. At laboratory tests increase of WBC, PCR and PCT, slight plateau movement of troponin, normal electrolytes. The patient underwent a chest CT scan with evidence of an inflammatory focus for which antibiotic therapy was started. Congenital long QT syndrome (LQTS) is an inherited condition characterized by prolongation of the QT interval (more than 450 ms in men and 460 ms in women), associated with repolarization abnormalities. There are three main forms transmitted via AD: LQT1, LQT2 and LQT3. The most common variant is LQT1 caused by a loss of function mutation in the KCNQ1 gene which causes a reduction in the outgoing potassium current during phase 3 of the action potential. In these patients, episodes of syncope caused by torsade de pointes, major arrhythmias and sudden cardiac death are frequent. Patients with LQTS should avoid taking drugs that can prolong the QT interval such as some antipsychotics, antidepressants (like mirtazapina that can cause QT prolongation, torsade de pointes, ventricular tachycardia and sudden cardiac death if administered at high doses or in patients with predisposing factors), antibiotics. Furthermore, there are various factors that can influence the QT prolongation: electrolyte alterations, physical stress, cerebrovascular events. The use of mirtazapine for a long period in association with takotsubo syndrome (probably triggered by underlying pneumonia) in a patient with LQTS, may have resulted in massive lengthening of the QT interval causing torsade de pointes and therefore ACC. During the hospitalization, mirtazapine was suspended and nadolol was introduced with a progressive reduction of the QT segment. No new arrhythmic events were recorded.
ADVANCED CARDIAC IMAGING IN LIVER TRANSPLANTATION ECHOCARDIOGRAPHIC VENTRICULAR STRAIN AS PROGNOSTIC TOOLS
Authors: Cartoni D , Giannelli V , Sperduti N , Scirpa R , Buffa V , Guglielmo N , Pellicelli A , Petrolati S 
Published: May 2024

Abstract
While cardiac involvement in the end–stage liver disease (ESLD) is a known condition, the characteristics of cardiac function in cirrhotic cardiomyopathy and their effects on candidates to liver transplant (LT) are still vague. The evaluation of right ventricular failure (RVF) in liver transplant candidates has been revolutionized by advanced cardiac imaging techniques, particularly echocardiography with global longitudinal strain (GLS) analysis. Aim of the present study is to evaluate RV function indexes in ESLD patients candidate to LT and the potential relationship with the liver disease status and cardiovascular major events on early post–LT phase Forty ESDL adult patients (age 46.8 ± 10 yrs, M/F 33/7) candidate to LT (19 for hepatic failure, 18 for hepatocarcinoma and 3 for other causes) were evaluate. All were submitted to transthoracic echocardiography and coronary CT angiography or coronary angiography. The Model for End–stage Liver Disease (MELD) score in the study population was 19±6.8. The higher values of the MELD score (i.e. the worst liver function condition) were directly correlated with the lower RV–GLS (p&lt;0.02). Cardiac function indexes were LV–EF 62.8±4.5%, RV–GLS –22.9±4.5%, LV–GLS –19.5±4.6% and PAPs 31.8±6.6 mmHg. On 21 day follow–up, 4 patients died (2 with acute RV failure, 1 with Tako–Tsubo syndrome). On CT–angiography the value of calcium score was significantly different between the group of fatal events and the rest (0 vs 567±900), revealing that none of the died patient suffered from coronary atheromatic disease. Our findings identified that specific RV–GLS patterns on echocardiography, indicative of subclinical myocardial dysfunction, were strongly correlated with worst clinical hepatic conditions and reduced survival rates post–transplant. The study highlights the importance of advanced cardiac imaging in identifying liver transplant candidates at higher risk of post–transplant mortality due to RHF.
AN ACUTE EVENT AS SIGN OF A CHRONIC PROCESS
Authors: Carluccio R , Ippolito D , Rumolo M , Parlati A , Giallauria F , Santoro C , De Luca N 
Published: May 2024

Abstract
A 66–year–old woman was admitted to the Emergency Department with dyspnea at rest. 11 days earlier she had undergone surgery because of femoral fracture. The Computed Tomographic Pulmonary Angiogram (CT Angiogram) confirmed the diagnosis of Pulmonary Embolism (PE). Patient was transferred to Cardiac Intensive Care Unit were Echocardiogram showed signs of right ventricle overload and Echo–Vascular showed trombotic occlusion of the right popliteal vein. Infusional heparin sodium and NIV were started. After 6 days of treatment, patient was asymptomatic, heparin was switched to DOAC and she was transferred to Rehabilitative Cardiology for thrombofilia and oncological screening: oncological markers resulted negative but for the evaluation of hypercalcemia, high value of PTH and low value of Vitamin D, she was transferred to Endocrinology Department with suspicious of primary hyperparathyroidism, possible cause of bone fracture in a young woman.
A CASE OF PARADOXICAL PULMONARY EMBOLISM AS CAUSE OF RENAL INFARCTION: IT’S TIME FOR USAT
Authors: Falagario A , Camassa N , Pansini M , Ostuni V , Mannarini A , D‘Agostino C 
Published: May 2024

Abstract

Case Report
A 67 years old Angolan woman was referred to our hospital for worsen dyspnea, palpitation and left flank pain while walking. She had no relevant medical history and her only cardiovascular (CV) risk factor was hypertension. For high suspicion of pulmonary embolism (PE), an abdominal–thoracic CT was performed, demonstrating the presence of bilateral PE with greater thrombotic burden of the right branch, right ventricle (RV) enlargement and left renal infarction. She was stratified in an intermediate–high risk class. The patient was hemodynamically stable (BP: 120/65 mmHg, HR: 115 bpm) with a calculated PESI class of III and elevated Hs–cTnI. Transthoracic echocardiography (TTE) showed RV dilation, McConnell sign, flattened intra–ventricle septum, mild pulmonary and severe tricuspid valve regurgitations. Therefore, we decided to start anticoagulation and to perform ultrasound–assisted thrombolysis (USAT) without procedural complications. A venous echo–doppler demonstrated the presence of thrombosis of the left popliteus veins. Moreover, screening for thrombophilia syndromes and neoplastic markers were negative. The day after, a partially–restored flow was noticed on renal artery US. The bubble test during transesophageal echocardiography revealed a patent foramen ovale (PFO) with a moderate right–to–left shunt. From these findings, a paradoxical embolism (PDE) through amoderate PFO was confirmed as the cause of her renal infarction. After 7 days of hospitalization, the patient was discharged on anticoagulant (apixaban) in good health status and with reduced serum creatinine levels.

Discussion
PE is the 3rd leading cause of CV mortality. A rare scenario in PE is PDE, manifesting in this case with acute kidney injury, with no other organ involvement. PDE occurs when a thrombus crosses an intracardiac defect into systemic circulation and it usually follows PE because elevated right–side pressure enhances right–to–left shunting. For patients with intermediate–risk PE, there is no clear consensus on 1st–line therapy. In our case, USAT has been effective in reversing RV dysfunction with early decrease of right–side pressures by TTE assessments. Compared with anticoagulation alone, USAT may quicker protect from PDE recurrence and potentially reduce the incidence of chronic thromboembolic pulmonary hypertension, a rare but serious long–term complication. Moreover, as we observed, thrombolytic local release can dissolve systemic clots when PDE occurs.
A REAL–WORLD PROTOCOL OF EARLY USE OF TRIPLE LIPID LOWERING THERAPY WITH I–PCSK9
Authors: Demichelis B , Giammaria M , Annibali G , De Rosa C , Muccioli S , Fasano R , Sillano D , Civera S , Bongioanni S , Coda L , Zappia L , Radano I , Musumeci G , Delnevo F 
Published: May 2024

Abstract

Aim
We evaluated the feasibility of an early triple lipid lowering therapy (LLT) with PCSK9 inhibitors in patients with acute coronary syndromes (ACS).

Methods
In this multicenter experience, we consecutively enrolled ACS patients from July to November 2023. The prescribed LLT was evaluated at discharge. Triple therapy with a high–intensity statin plus ezetimibe and PCSK9i was recommended in the following cases: patients already on statin or statin/ezetimibe therapy with LDL–C values &gt; 70 mg/dl; patients not on LLT at admission with LDL–C values &gt; 70 mg/dl and at least one of diabetes mellitus (DM), multivessel coronary artery disease (MV) or peripheral arterial disease (PAD); patients not on LLT at the time of admission and LDL–C values &gt; 140 mg/dl even in the absence of DM, MV or PAD. A six–month follow–up was planned to determine LDL–C target attainment, compliance, side e!ects, and cardiovascular events.

Results
We consecutively enrolled 264 patients, 95% of whom were discharged with high–intensity statin plus ezetimibe and 29% discharged with in–hospital addition of PCSK9i (triple therapy). Of the 77 patients discharged in triple LLT, the median age was 71.4 years, 71% were male, 42% were current smokers, DM was present in 19%, and 48% had history of hypertension. The diagnosis at admission was ST–Elevation Myocardial Infarction in 66.2%, Non–ST–Elevation Myocardial Infarction in 29.5%, and unstable angina in 4.3% of cases; 63% of patients had history of coronary artery disease and 6.8% had history of peripheral artery disease (PAD); 19.6% were already on at least one statin therapy and the median LDL–C value at admission was 128 mg/dl.

Conclusions
In conclusion, the use of an early and strong lipid lowering approach in very high risk patients with in–hospital or at discharge PCSK9i administration is feasible and safe. The complete results of six–months follow–up and LDL–C values will be available for the congress.
NON–RESPONSE TO INCLISIRAN THERAPY IN THREE PATIENTS WITH STATIN INTOLERANCE: A CASE SERIES
Authors: Pozzi A , Bonfanti P , Bartesaghi G , Refugjati T , Marini A , Corrado G 
Published: May 2024

Abstract

Background
Inclisiran is the first silencing–RNA therapy used to reduce LDL–C. It is also recommended in patients with statin intolerance. We describe a case series of three no–responder patients to inclisiran.

Case Series
64–year–old man with medical history of type II diabetes mellitus, obesity, hypertension, chronic kidney disease (eGFR 38 ml/min/1.73 m^2), dyslipidemia and statin intolerance. In 2022 the coronary angiography showed diffuse atherosclerosis without significant stenosis. His LDL–c was 115 mg/dl. Rosuvatatin 10 mg was prescribed however it was withdrawn due myalgia. Inclisiran and ezetimibe were prescribed, however one, three and four months later his LDL–C was 96 mg/dl, 114 mg/dl, and 115 mg/dl respectively (Fig 1). Due to the lack of effect, lovastatin 20 mg was added after the third dose of inclisiran, reaching LDL–C levels of 100 mg/dl one month after the initiation of lovastatin. Inclisiran was withdraw (as well as statin due to myalgia) and evolocumab 140 mg was administrated three months later the last dose of inclisiran. Ten days after evolocumab, LDL value was 66 mg/dl. 60–year–old man with hypertension, obesity, and dyslipidemia (LDL 152 mg/dl) with a moderate cardiovascular risk (target LDL–C &lt;70 mg/dl). Patient refused statin therapy because he was scared about myalgia. In October 2021 (first Italian patient out of clinical trial) inclisiran was administrated. However, LDL–C did not change one month after the first and the second dose (147 mg/dl and 134 mg/dl respectively, Fig1). Due to the inefficacy, inclisiran was withdraw and the combination rosuvastatin and ezetimibe 10/10 mg was started with a reduction in LDL–cholesterol levels (51 mg/dl) four months later. However, this treatment was withdrawn due to myalgia in favor of bempedoic acid. One month later LDL–C level was 79 mg/dl. 79–year–old woman with history of coronary revascularization. She was statin and ezetimibe–intolerant, so she was treated with alirocumab 150 mg (LDL–C 89 mg/dl). Since the treatment was ineffective to reach the LDL target values, alirocumab was stopped in favor to inclisiran. However, LDL values increased over the time reaching 103 mg/dl one month after the first dose and 120 mg/dl two months later the second dose (Fig1).

Conclusion
some patients may be no–responder to inclisiran. A polymorphism of the asialoglycoprotein receptors might be a possible reason. Statin intolerance may also affect inclisiran efficacy.
ANTIBIOTIC THERAPY IN POST-EXTRACT PATIENTS
Authors: Ferrieri A , Pastore I , Carretta D , D‘Agostino C , Benedetto L 
Published: May 2024

Abstract

Introduction
With the increase in complications associated with the implantation of pacemakers and defibrillators, the number of patients who undergo transvenous extraction of leads following infection has increased. Often, in pacemaker-dependent patients there is the problem of having to carry out an early reimplantation after extraction. This study aims to evaluate the incidence of reinfection in post-extracted patients treated with antibiotic therapy and reimplanted with a second device.

Methodology
To demonstrate the reduction in infection recurrences, a follow-up was carried out on all patients extracted in our center, differentiating between patients reimplanted with a second device who underwent targeted antibiotic therapy before and after surgery and patients reimplanted without targeted pre-extraction antibiotic coverage due to the failure to identify a specific germ.

Results
184 device extraction procedures performed due to infection in our center were considered. In 100 patients the need arose to reimplant a second device at the same time as the extraction procedure. Among these patients, 33, in whom the germ of the infection was known, were treated with pre- and post-procedure antibiotic therapy, while in 24 patients no pre-extraction antibiotic therapy was carried out as they did not have a targeted antibiotic and in waiting for a positive blood culture. 4 patients, however, were treated with empirical therapy, which was then updated post-extraction following the results of the analysis of the extracted material. Subsequently, a follow-up was carried out to evaluate any recurrence of infections and it emerged that: a recurrence of infection occurred in 6% of patients treated with targeted antibiotics pre- and post-extraction and in 4% of patients treated with antibiotics only post-extraction -extraction. Among the 4 patients treated with empiric antibiotic therapy, 1 had a recurrent infection.

Conclusions
From this study it was possible to demonstrate that targeted antibiotic therapy also made it possible to limit infections in the short and long term even in patients who, not having positive blood cultures before the extraction procedure, underwent the therapy only following the results obtained by the extracted material, without the use of empirical antibiotic therapy.