bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRANSIENT VENTRICULAR ARRHYTHMIAS DURING EXERCISE TEST TRIGGERED BY IRON DEFICIENCY ANAEMIA
Authors: Di Virgilio E , Basile P , Forastefano B , Totaro M , Falagario A , Carella M , Falco G , Ciccone M , Cicolini G , Guaricci A 
Published: May 2024

Abstract

Introduction
The onset of ventricular arrhythmias (VAs) during an exercise test (ET) is a common finding in asymptomatic middle–aged individuals. However, their clinical significance is uncertain, especially in absence of myocardial ischaemia or structural heart disease (SHD). VAs from the right ventricular outflow tract (RVOT) are the most common in a structurally normal heart and they can be exacerbated by several triggers.

Case Report
An asymptomatic 53–year–old woman without cardiovascular risk factors and good functional status was referred for a cardiologic evaluation before uterine polypectomy. Laboratory exams showed moderate iron deficiency anaemia (IDA), due to uterine chronic blood loss, treated with iron sulfate and folic acid. The ECG pointed out a QS aspect in leads V1–V3. A preserved regional and global systolic function and a mild concentric hypertrophy of the left ventricle (LV) were observed at the transthoracic echocardiogram. The ET with echocardiography, according to the Bruce protocol, was interrupted due to physical exhaustion, reaching the theoretical maximum heart rate, in absence of ischaemic repolarization alterations and a normal segmental wall kinetic with a preserved contractile reserve of the LV. However, after the first minute of recovery, multiple monomorphic non–sustained ventricular tachycardias (NSVT) originating from the RVOT were observed. In the following minutes their frequency reduced with the onset of isolated premature ventricular contractions (PVCs), terminating with a single polymorphic NSVT of 3 beats. During both exercise and recovery, were observed occasional runs of atrial tachycardia. A significant coronary artery disease was ruled out by coronary angiography (CA). Subsequently, a contrast–enhanced Cardiac Magnetic Resonance revealed a mid–wall late gadolinium enhancement in the basal segment of the inferior wall. The patient underwent uterine polypectomy without complications, restoring haemoglobin (Hb) values during the following months. Subsequently, Holter ECG and ET did not revealed VAs. Thus, the patient resumed moderate aerobic physical activity without any adverse arrhythmic events.

Discussion
The RVOT VAs are commonly idiopathic and triggered by several factors. CA and CMR may provide additional information during the diagnostic algorithm. IDA may promote VAs after exercise in predisposed patients without SHD, requiring a prompt restoration of Hb and iron levels.
VENTRICULAR ARRHYTHMIA EVENTS IN PATIENTS WITH IMPLANTABLE CARDIOVERTER–DEFIBRILLATOR BEFORE AND AFTER THE TREATMENT WITH SODIUM–GLUCOSE CO–TRANSPORTER 2 INHIBITORS
Authors: Vecchi A , Giannotti Santoro M , Pasanisi E , Talini E , Lapira F , Puccioni E , Menegato A 
Published: May 2024

Abstract

Background
Role of sodium–glucose co–transporter 2 inhibitors (SGLT2i) in the treatment of chronic heart failure is increasing. However, some case series described appropriate shocks from ICD in patients following the initiations of SGLT2i and a larger analysis is not present in the literature.

Methods
The aim of this study is to investigate the rate of ventricular arrhythmic burden and appropriate anti–tachycardia therapy from ICD before and after the initiation of SGLT2i therapy. A retrospective single–center analysis was performed, comparing ventricular events from home monitoring reports 3 months before and 3 months after SGLT2i therapy treatment.

Results
Seventeen patients were enrolled in the study. The baseline clinical e therapy characteristics of patients are shown in the table. Ten patients (59%) had mono cameral or dual cameral ICD and 7 had implantable cardiac resynchronization therapy (CRT) defibrillators.During the 3 months before SGLT2i treatment, 4/17 patients had nun–sustained ventricular tachycardia (NSVT) vs 8/17 (23% vs 47%, P value 0.23) patients with NSTV after the treatment. Seven patients (41%) had an increase in the rate of NSVT events (with a patient with 28 NSVT after treatment vs 0 before treatment). No patients had anti–tachycardia therapy in the 3 months before treatment, while during the 3 months after the SGLT2i treatment, 1 patient had a ventricular tachycardia treated with anti–tachycardia pacing (110 days after the beginning of the treatment) and 2 patients had a ventricular tachycardia treated with appropriate shock (2 and 25 days after the beginning of SGLT2i treatment).

Conclusion
This small retrospective analysis showed an increase in ventricular arrhythmic events in the 3 months after the initiation of SGLT2i. These data prospect the need for a larger analysis for a stronger statistical correlation.
SYNCOPE OF UNCERTAIN NATURE
Authors: Perfetti S , Greco G , Mandunzio D , Citarelli G , Zaccaro S , Pedio E , Caldarola P 
Published: May 2024

Abstract
A 59 year–old male without relevant past medical history presented to our hospital because of an episode of chest pain followed by a syncope during driving, completely resolved once arrived at the ED. He complained of other chest pain episodes in the last past weeks. During hospitalization he has been asympthomatic and physical examination was unremarkable. ECG showed q waves in inferior leads and a Brugada pattern type 2. Cardiac enzymes were normal. Echocardiography showed akinesis of medio–basal inferior wall with slight reduction of EF (50%). Coronary angiography demonstrated a total occlusion of RCA and a 50% stenosis of LCA, treated with PCI and DES implantation. A following ECG revealed a spontaneous Brugada pattern type 1. This element let us reevaluate his past syncope nature. Electrophysiologists were consulted and the patient was deemed to be at low risk for sudden cardiac death. No ICD was indicated and a loop recorder was implanted. He underwent genetic test for Brugada syndrome, still pending at the moment. Brugada syndrome is a congenital electrical disorder associated with a high risk of ventricular arrhythmias and sudden cardiac death. Cardiac sodium channel gene SCN5A mutations represent the most frequent genetic variant, also associated with other cardiac disorders, but other potentially pathogenic variants have been reported. Brugada syndrome is diagnosed in patients with a spontaneous type 1 ECG pattern, characterized by J point elevation of &gt; 2 mV with coved ST elevation and T wave inversion in at least one right precordial ECG lead, V1 or V2, positioned in the second, third or fourth intercostal spaces. This is an unusual case of incidental evidence of Brugada pattern type 1 after coronary revascularization. According to latest guidelines, our patient, due to his unexplained syncope nature, was deemed to loop recorder implantation (IIA Class). Actually his syncope could be due to the total occlusion of RCA or an arrythmia correlated to Brugada syndrome. Only loop recorder monitoring and genetic test results will help us in our patient’s management and to consider the possibility of ICD implantation.
CARDIONEUROABLATION IN A YOUNG PATIENT WITH A THIRD–DEGREE ATRIO–VENTRICULAR BLOCK
Authors: Valenti N , Di Monaco A , Romanazzi I , Vitulano N , Quadrini F , Troisi F , Grimaldi M 
Published: May 2024

Abstract

Clinical Case
The clinical case focuses on a 19–year–old women with a non–congenital third degree atrio–ventricular block (AVB), symptomatic for dyspnoea for mild efforts, with structurally normal heart, no other comorbidities and no medications taken. Both the exercise stress test and the atropine test documented a sinus tachycardia at 190 bpm with a 2:1 AVB and a narrow QRS, and 1:1 AV conduction until a sinus rate of 90 bpm. She underwent CNA procedure, targeted the inferior paraseptal ganglionated plexus (IPSGP), both the right and left atrial sides, with gradual improvement of impulse conduction. After the procedure, we observed a persistence of only first degree AVB (PQ interval 260 msec) and a complete regression of symptoms, persistent at 6–month follow–up.

Conclusions
A strategy of modulation of ganglionated plexi by endocardial ablation is conceivable for the treatment of pathological conditions due to parasympathetic hyperactivity. Patients with functional atrioventricular block (FAVB), even without organic damage to the conduction system, often present disabling symptoms with a significant reduction in quality of life. Treatment with drugs and/or pacemakers has given poor results; pacemaker implantation is not well accepted and is accompanied by significant psychological discomfort, as well as carrying a risk of infection and long–term ventricular desynchronization. The absence of an organic disease as well as a presumed benign course of the disease make the decision more difficult. Current guidelines recommend the implantation of a definitive pacemaker in patients with paroxysmal or permanent third degree AVB, regardless of symptoms. Although not yet included in current guidelines, the CNA procedure could be used in the future to treat AV node dysfunctions in young subjects with a dominant functional component.
DIFFERENT INTRAOPERATIVE TRANSIT TIME FLOW MEASUREMENT DOES NOT AFFECT EARLY OUTCOME IN FEMALE AND MALE GENDER AFTER CABG
Authors: Nardi P , Labriola V , Calogera P , Altieri C , Buioni D , Scognamiglio M , Salvati A , Ruvolo G 
Published: May 2024

Abstract

Background
Intraoperative transit time flow measurement (TTFM) of left internal thoracic (L–ITA) and saphenous vein (SV) grafts (SVG) can improve graft patency and, consequently, clinical outcome in patients undergoing coronary artery bypass grafting (CABG). We have investigate if there were differences in female and male gender on TTFM –flow (mL/min) and pulsatility index (PI)– measured at the weaning form cardio–pulmonary bypass after CABG and early results. We started to use TTFM on September 2022.

Methods
Between September 2022 and September 2023, TTFM was performed in 101 patients (21 females, 80 males) undergoing CABG, isolated (n=75) or in association with other procedures (n=26).

Results
No significant differences were observed in age (66.2±11 vs 66.9±9 years; P=0.81), Euroscore–2 (4.2±3 vs 3.8±3; P=0.24), left ventricular ejection fraction (54±8 vs 52±9; P=0.08). Associated procedures were more frequently performed in females (47.6% vs 20%; P&lt;0.05). Left anterior descending artery (1.4±0.2 vs 1.6±0.2 mm; P=0.001), first obtuse marginal branch (1.3±0.2 vs 1.5±0.3 mm; P&lt;0.05), right posterior artery (1.2±0.2 vs 1.4±0.3 mm; P&lt;0.05) diameters were smaller in females. TTFM flow of L–ITA or SV grafts on the left anterior descending artery (28±9 vs 38±18 mL/min; P&lt;0.05), first obtuse marginal branch (27±15 vs 42±28 mL/min; P&lt;0.05), right posterior descending artery (29±11 vs 36±19 mL/min; P&gt;0.5) was lower in females. No PI values differences were observed in the coronary arteries territories (3.9±0.8 vs 3.7±0.9; 3.8±0.5 vs 3.9±1; 3.5±0.9 vs 3.3±1) (P&gt;0.5). There were no operative mortality and major cardio–vascular complications; postoperative respiratory failure occurred in three males.

Conclusions
As compared with their male counterpart, the lower values of L–ITA and SV grafts flow observed in females can be related to the smaller diameter of coronary arteries rather than to their vascular resistance. However, the reduced graft flow observed in female gender does not affect early outcomes.
RIGHT AXILLARY MINI–THORACOTOMY FOR MINIMALLY INVASIVE MITRAL SURGERY: A 5–YEAR SINGLE–CENTER EXPERIENCE
Authors: Greco C , Mangia F , Zaccaria S , Casali G , Paraninfi A , Nicolardi S 
Published: May 2024

Abstract

Objectives
To report early– and long–term outcomes of patients undergoing minimally invasive mitral surgery (MIMS) through right axillary mini–thoracotomy (RAMT) over a 5–year period.

Methods
From July 2016 to December 2021, a total of 172 patients underwent MIMS through RAMT at “Vito Fazzi” Hospital.

Results
Mitral valve diseases were degenerative (62.8%), rheumatic (13.9%), functional (13.4%), Barlow (5.2%), and endocarditis (4.7%) mitral disease. Mitral valve repair was performed in 142 patients (82.5%) and 30 (17.5%) had mitral replacement. Repair techniques included neochordae implantation (53.5%), isolated annuloplasty (28.9%), leaflet resection (11.3%), sliding plasty (4.9%) and Alfieri procedure (0.7%). Furthermore, in 29 patients (16,8%) concomitant procedures were associated. All cardiac procedures were performed under direct vision and without using thoracoscopes. Mean length of skin incision under the armpit (fig 1) was 5.7 ± 1.3 cm. Of note, conversion to median sternotomy occurred only in 2 (1.2%) cases. Stroke incidence was 0.9% and in–hospital mortality 0.5%. Overall survival and freedom from reoperation at 5 years were 91.5% and 99.1%, respectively (fig 2).

Conclusions
RAMT access for MIMS is a safe and reproducible approach associated with low mortality and morbidity, the possibility to perform complex mitral surgery under direct vision, high rate of mitral valve repair, and excellent late results. Importantly, limited skin incision under the armpit provided excellent aesthetic results.
MECHANICAL HEART VALVES AND ORAL ANTICOAGULATION: A SURVEY OF THE ITALIAN SOCIETY OF CARDIAC SURGERY
Authors: Santarpino G , Di Mauro M , De Feo M , Menicanti L , Paparella D , Mastroroberto P , Speziale G , Pollari F , Mauro M , Torella M , Coscioni E , Barili F , Cardetta F , Parolari A 
Published: May 2024

Abstract
In the latest European guidelines for the management of valvular heart disease, mechanical valve prostheses maintain a strategic role, particularly for certain patient subsets and age groups. Despite the high number of devices implanted in clinical practice, particularly in non–European and North American regions, current scientific literature and debate seem to suggest a limited use of mechanical heart valves. The cardiac surgery community seems to be highly interested in biological and transcatheter valve prostheses but less interested in mechanical heart valves, including possible strategies for self–management of anticoagulation therapy. In this respect, the Italian Society of Cardiac Surgery (SICCH), in particular the Italian Group of Research for Outcome in Cardiac Surgery (GIROC), has promoted a survey among its members to stimulate the interest in this topic and express their opinion on this issue that, due to the prevalence of the affected population and the new treatment options for improving patient’s quality of life, should be more appraised and debated in the cardiac surgery community. The recorded results, obtained on the answers to 111 questionnaires, seem to divide the specialists into "pros" and "contras" on a useful tool for the entire cardiac surgery community. For this reason, SICCH proposes in conclusion to declare its unified and institutional opinion on this topic.
HAEMODYNAMIC FORCES ANALYSIS IN PATIENTS WITH PARAVALVULAR REGURGITATION AFTER TAVR: A PROPENSITY–SCORE MATCHED RETROSPECTIVE STUDY
Authors: Scudeler L , Alessandro V , Miccoli D , Mascaretti D , Airale L , De Ferrari G , Alunni G 
Published: May 2024

Abstract

Background
Paravalvular regurgitation (PVR) after TAVR is a frequent complication, but its direct quantification and grading with conventional echocardiography is still limited by several factors. LV remodeling has still a role in the evaluation of PVR and its pathophysiology. Hemodynamic forces (HDF) analysis has emerged as a new tool to evaluate LV cardiac function in addiction to ejection fraction (EF) and global longitudinal strain (GLS). Aim of the study: To evaluate the difference in pre– and post–TAVR HDF in patients with preserved EF, using a propensity–matched analysis comparing patients with more than mild PVR to patients with mild or no PVR. Medis Ultrasound Suite software has been used for the estimation of HDF in order to differentiate earlier LV function modification between the two groups and its relationship with clinical outcomes.

Material and Methods
25 patients from two European high–volume centers with more than mild PVR and coupled pre– and post–TAVR echocardiographic evaluation available for HDF analysis were retrospectively included, paired 1:2 with 50 patients, matched for characteristics that may influence HDF analysis and with mild or none PVR. Clinical outcome was a composite of heart failure (HF) valve–related hospitalization and worsening HF at 1 year.

Results
No significative differences were found at baseline clinical and echocardiography evaluation between the two groups: median age was 83 years, mean LVEF was 61%. Post–procedural echocardiographic evaluation was performed at 34 days after TAVR (IQR 5 – 50). Patients with significant PVR had higher LV end–diastolic volume (p = 0.044), lower endocardial GLS (p = 0.07) and lower LV diastolic apex–base longitudinal forces (LVD Apex–Base) (p = 0.045). The difference between LVD Apex–base pre– and post–TAVR was significantly lower in the significant PVR group (–0.8 vs 0.3%, p = 0.021). At Cox regression analysis, LV longitudinal force (LVLF) Ratio turned out to be predictive of clinical outcome (HR 1.11, 95CI 1.02 – 1.20, p = 0.017) in the overall population.

Conclusion
HDF analysis seems to be superior to conventional echocardiographic values of left ventricular cardiac function to detect the early effects of LV volume overload in patients with significant PVR after TAVR. Furthermore, in the overall population, LVLF Ratio predicts clinical outcomes and could be a promising new index to better evaluate the development of heart failure in patients with AS undergoing TAVR.
SAFETY AND EFFICACY OF PFO CLOSURE DEVICES IMPLANTATION AND CLINICAL OUTCOMES: A SINGLE–CENTER LONG–TERM REVIEW
Authors: Varotto L , Sgreva S , Dotto A , Cardillo G , Piccolo S , De Boni A , Bonanno C 
Published: May 2024

Abstract

Introduction
Patent foramen ovale (PFO) is present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. The current standard of care for selected patients with PFO and cryptogenic stroke is transcatheter closure, but the risk of post–closure–new–onset atrial fibrillation (AF) has been described. Published trials report a 3.6%–5.8% prevalence of recurrent ischemic stroke and 2%–6.6% incidence of postimplant AF, and some authors assume that to protect from one embolic stroke aetiology, there is the risk of creating another one. We aimed to investigate the efficacy and safety of device implantation in a single–center study, but as well as the long–term clinical outcomes up to over 16 years of follow–up.

Methods
This is a prospective, non–randomised study in Vicenza, from February 2007 to July 2021, enrolling 200 consecutive patients addressed to PFO closure, with implantation of various devices. A research was performed via telephone interviews and clinical follow–up reports on outcomes of percutaneous PFO closure. The main endpoint was recurrence of stroke/transient ischemic attack (TIA). Other outcomes included new–onset AF, major bleeding, serious adverse events, and device–related complications. All–cause mortality was examined too.

Results
Two–hundred patients were enrolled over 14 years; 106 (53%) were men. Mean age was 49±10 years, ROPE score was 5.9±1.5. All patients had a device implanted and technical success was 99.5% (number of devices per case 1.0±0.07). Post–procedural trivial residual shunt was observed in 2 patients. Procedural success, defined as no serious adverse device–related event or large shunt, was 198/200, resulting in 99% success rate. The incidence of recurrent stroke/TIA and AF was the same (2.5%), so the rate of both recurrences was 2.7 events per 1000 patient–years. Adverse events occurred in 8 patients: 1 access site hematoma, 1 supraventricular tachycardia, 4 deep vein thromboses and 2 pulmonary embolisms. Four patients died from malignancies, 1 from sudden death and 1 from stroke.

Conclusions
Our review represents one of the largest cohort of PFO patients treated with devices, and shows that their use is associated with high procedural success and low adverse events on a long–term follow–up (mean follow–up of 9.4 years). The efficacy and safety results are lower than those reported by randomized studies, probably due to good patient selection and effective cardio–neurological teamwork.
PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AFTER A FAILED DEVICE–CLOSURE ATTEMPT: A HIGH–VOLUME SINGLE CENTRE EXPERIENCE
Authors: Giordano M , Gaio G , Marzullo R , Scognamiglio G , Altobelli I , Gaudieri G , Palladino M , Cappelli Bigazzi M , Della Cioppa N , Golino P , Sarubbi B , Russo M 
Published: May 2024

Abstract

Introduction
Persistence of patent foramen ovale (PFO) has been associated with cryptogenic stroke due to a paradoxical systemic embolism. In these cases, a percutaneous closure allows to decrease the risk of redo cerebral ischemic events. However, the presence of a complex anatomy might prevent a correct device–deployment with a high–risk o residual shunt and/or device embolization. We describe our experience about alternative technique after a failed device closure attempt.

Methods
We reviewed six cases wherein the device was not able to close effectively the PFO. In these cases, alternative techniques and skills were adopted to close the PFO.

Results
From 2021 to 2023, 194 PFO were closed in the congenital catheterization laboratory of Monaldi Hospital (Naples). In the most of cases (188/194 pts, 96.9%) an effective device closure was obtained. However, in 6 cases (3.1%) the device failed to have a PFO closure. In these 6 patients, the PFO anatomy was characterized by: a severe hypertrophy of the septum secundum (2 cases, 33%), an aneurysmatic interatrial septum (3 cases, 50%), a long stiff tunnel (6 cases, 100%). In three cases a deviceless suture–mediated system (NoblestichTM) was effective to achieve a complete PFO closure; whereas, in two cases a combined approach (suture–mediated system followed by a device deployment) allowed to achieve a complete PFO closure. In a patient with Ebstein anomaly and significant cyanosis due to right–to–left PFO shunt, a partial PFO closure (with mild residual right–to–left shunt) was obtained after NoblestichTM deployment. In this setting, the partial PFO closure was effective to achieve a significant improvement of the patient’s arterial saturation and the procedure stopped without to complete the PFO closure with a device.

Conclusion
Trans–catheter device closure is often effective to achieve a complete PFO closure. However, in some circumstances, the device was unable to have an appropriate PFO closure. A suture–mediated system or a combined approach (suture–mediated system with concomitant device deployment) are effective to achieve the PFO closure in these complex scenarios.