bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1 NEW TREATMENT STRATEGIES IN PATIENTS WITH SENILE CARDIAC AMYLOIDOSIS
Authors: Chiorazzo L , Valerii F , Bencivenga S , Acitelli A , Antonini L , Romano S , Sciarra L 
Published: May 2023

Abstract
We present the case of a 75 year–old man, diabetic, dyslipidemic, hypertensive, previous ischemic heart disease, AF, previous hospitalizations for heart failure, who underwent cardiology evaluation for worsening dyspnea (NYHA class II–III), swallen ankles and elevated BNP levels (900 pg/ml). The patient suffered from sensory–motor polyneuropathy diagnosed with EMG and ENG. Echocardiographic evaluation: severe concentric hypertrophy of the left ventricle (SIV 18 mm, PP 17 mm), granular sparkling and EF 50%, left atrium dilatation, light–moderate mitral regurgitation, moderate tricuspid regurgitation with PAPS 40–45 mmHg. Circumferential pericardial effusion (12 mm). Moreover, we noticed a decreased longitudinal contractive function of the left ventricle (TDI e‘, a’, e s’ &lt;5 cm/s e absolute GLS &lt; 15%), speckle–tracking ‘cherry on the top‘ and restrictive diastolic pattern. •ECG: low QRS voltage and increased wall thickness (&gt;12 mm). •Laboratory: (SPIE and UPIE) no monoclonal protein present. •Bone scintigraphy: grade 3 cardiac uptake. •Cardiac MRI: asymmetric hypertrophy of the left ventricle with moderate biventricular systolic dysfunction. Subendocardial late gadolinium enhancement. •Genetic testing: no sarcomeric or TTS gene mutations. All findings were suggestive for senile cardiac amyloidosis (ATTR wt), the patient was discharged from the hospital with optimized medical therapy for heart failure and follow up was prescribed. After 3 months from the first diagnosis we added Tafamidis to the therapy (ESC indications class IB). ATTR–ACT, published on ‘New England Journal of Medicine’ showed that Tafamis is superior to placebo in reducing the combination of all–cause mortality and cardiovascular–related hospitalizations. Tafamidis was also associated with a significant reduction in the decline in functional capacity (as measured by the 6–minute walk test) and the decline in quality of life (as measured by the KCCQ–OS) at month 30, with differences first observed at 6 months. Tafamidis was well–tolerated, with a safety profile comparable to placebo. Follow–up: 6 months later the introduction of Tafamidis, the patient has not needed other hospitalizations for heart failure, well tolerates the drug with a subjective symptom reduction and remarkable improvement in quality of life.
P2 A RARE CASE OF MUTANT TRANSTHYRETIN CARDIAC AMYLOIDOSIS
Authors: Del Torto A , Agostoni P , Assanelli E 
Published: May 2023

Abstract
A 65–year–old man with a history of multiple hospitalizations in the past 12 months for heart failure with preserved left ventricular ejection fraction (HFpEF) attended the emergency department for exertional dyspnea, peripheral edema, abdominal bloating, and weight gain. An ECG showed sinus bradycardia with first degree AV block, RBBB, and inferior pseudo–q. Blood tests showed NT–proBNP 8985 pg/ml, troponin hs–cTnI 106 ng/L. An echocardiogram demonstrated severe left ventricular hypertrophy, EF 50%, GLS –11% with apical sparing, and restrictive transmitral pattern, raising suspicion of infiltrative disease (Figure 1). A cardiac MRI corroborated the suspicion, showing altered gadolinium kinetics, diffuse subendocardial LGE, and increased native T1 and extracellular volume (Figure 2). A search for monoclonal components on serum and urine was negative. A bone tracer scintigraphy showed cardiac uptake (Perugini grade 2). A genetic test showed the presence of p.Ile88Leu (Ile68Leu) mutation in heterozygosity, so a non–biopsy diagnosis of mutant transthyretin cardiac amyloidosis (ATTRv) was posed. A thorough neurological evaluation did not document signs of amyloid neuropathy. The patient was then started on tafamidis therapy. Transthyretin cardiac amyloidosis (ATTR) is still an underdiagnosed but increasingly recognized condition, causing up to 13% of HFpEF cases. ATTR is caused by extracellular accumulation of amyloid substance resulting from transthyretin misfolding. In Italy ATTRv is rare and Ile68Leu is among the most frequent mutations, especially in the Tuscan–Emilian Apennines. Ile68Leu is usually associated with an almost exclusively cardiac phenotype, clinically indistinguishable from ATTR wild type, except for an earlier age of onset. Because effective treatments are available for ATTRv with cardiac and/or neurological involvement, it is important to suspect the diagnosis of ATTR in patients with HFpEF and to proceed with genetic testing to identify individuals with ATTRv.
P13 THE PHANTOM OF TRICUSPID PROSTHESIS: CASE REPORT OF A PECULIAR TRANSCATHETER TRICUSPID VALVE–IN–VALVE IMPLANTATION
Authors: Colucci E , Mattei C , Scavelli F , Sclafani R , Notaristefano S , Santucci A , Aimi A , Bordoni E , Cavallini C 
Published: May 2023

Abstract

Background
Transcatheter tricuspid valve–in–valve replacement for patients with degenerative tricuspid surgical bioprosthesis disease has emerged in recent years as a new treatment possibility in patients that required tricuspid valve replacement at young age and in circumstances where redo tricuspid valve replacement is not feasible because of the remarkable morbidity and mortality. Case presentation. A 76 year–old Caucasian male was referred to our center for worsening dyspnoea and fatigue. He had a pacemaker implanted for third degree atrio–ventricular block in 1996. After massive endocarditis affecting the tricuspid valve and the pacemaker right ventricular lead, the patient underwent surgical tricuspid valve replacement with a 32 mm Liotta BioImplant L.P.B., right ventricular lead extraction and concomitant epicardial pacemaker reimplantation. Transthoracic echocardiogram at hospital admission denoted a degenerative stenosis of the tricuspid prosthesis with a trans–valvular mean gradient of 8 mmHg associated with right atrial and inferior vena cava dilatation. Given the high surgical risk due to comorbidities (systemic arterial hypertension, paroxysmal atrial fibrillation in DOAC, grade II obesity, smoking history and chronic lymphoproliferative leukemia) the patient was deemed not suitable for a re–do surgical tricuspid valve replacement and was offered a percutaneous replacement. Preprocedural planning with computed tomography allowed accurate reconstruction of the tricuspidal prosthetic annulus and correct sizing of Edwards SAPIEN valve, the most used in valve–in–valve procedures. The degenerated prosthesis was not visible at fluoroscopy meaning no fluoroscopic landmarks available to provide an anatomic view for valve deployment. Therefore, a combination of balloon valvuloplasty and right atrium angiographies before the valve–in–valve deployment were critical to provide the correct valve position and yield the procedure effective and safe. Hemodynamic gradient post–TVIV was absent and no paravalvular leaks were observed. Clinical and echocardiographic improvement were confirmed after the procedure and at 1 year–follow up.

Conclusion
Tricuspid valve–in–valve replacement can be technically feasible and a safer alternative to re–do surgical valve replacement, also in radiolucent bioprosthesis. In our case the successful procedural outcome not only relied on meticulous planning before the procedure, but also on specific intra–procedural adjustments.
P15 EFFICACY AND SAFETY OF LEFT ATRIAL APPENDAGE CLOSURE COMPARED WITH ORAL ANTICOAGULATION IN ATRIAL FIBRILLATION: A META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND PROPENSITY–MATCHED STUDIES
Authors: Piroli F , Franchin L , Demola P , Navazio A 
Published: May 2023

Abstract

Backgrounds
In the recent years, two randomized controlled trials (RCTs), the PROTECT–AF trial and the PREVAIL trial demonstrated that in atrial fibrillation (AF) patients, left atrial appendage closure (LAAC) compared with oral anticoagulants (OAC), showed a non–inferiority in the prevention of stroke and even a reduction in mortality. Nevertheless, this net clinical benefit was not confirmed in the most recent RCT comparing LAAC vs OAC, the PRAGUE–17 trial. The aim of the present meta–analysis was to evaluate the efficacy and safety of LAAC compared to OAC among available high–quality studies.

Methods
A systematic search of electronic databases (Medline, Scopus, Embase and the Cochrane Library) was performed to identify eligible RCTs and observational studies with propensity score matching (PSM) analysis. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Outcomes of interest were the occurrence of cardiovascular death (CVD), all cause death, all–type stroke, and major bleedings.

Results
A total of 3 RCTs and 6 PMS studies involving 6924 patients were identified. After a median follow–up of 2.7 years (IQR 2–4.5), patients who received LAAC had a lower risk of CVD (OR=0.58; 95%CI 0.48–0.71, I2=0%), all cause death (0.59; 95% CI 0.45–0.76, I2 67%) and major bleedings (OR=0.58; 95%CI 0.43–78 I2=52%) compared with patients on OAC. No difference was found between the two groups regarding strokes incidence (OR=0.94; 95% CI 0.76–1.16, I2=0%).

Conclusions
According to this meta–analysis, LAAC presents a comparable efficacy in the prevention of stroke compared to OAC with a reduced risk of major bleedings, all cause death and CVD that may stand out with longer follow–up.
P16 ELIGIBILITY COAPT TRIAL IN DAILY PRACTICE: A REAL WORLD EXPERIENCE
Authors: Zancanaro E , Buzzatti N , Denti P , Maisano F 
Published: May 2023

Abstract

Background
The COAPT Trial was the first ever to demonstrate a survival benefit in treating functional mitral regurgitation (FMR). That was achieved through transcatheter mitral repair in selected patient. The exact proportion of patients fulfilling COAPT selection criteria in the real–world is unknown.

Objectives
To assess the of COAPT in real–world .

Methods
We assessed the clinical data and follow–up results of all consecutive patients admitted for FMR at our Department between January 2016 and May 2021 according to COAPT eligibility and received. COAPT eligibility was retrospectively assessed by a cardiac surgeon and a cardiologist

Results
Among 394 patients, 56 (14%) were COAPT eligible. The most frequent reasons for exclusion were MR&lt;=2 (22%), LVEF &lt;20% or &gt;50% (19%) and non–optimized GDMT (21,3%). The 4–year survival between non–COAPT (MC–NC) patients vs Medical Therapy (MC–NC) group was 91,5% (CI: [0.864, 0.96] vs 71,8 % (CI = [0.509, 0.926]) respectively, p=0.027,Figure 1. Concerning the 4–year recurrent MR&gt;=3+ in MitraClip patients was 17,2% (CI: [0.101, 0.238]), while in Medical therapy group was 40% (CI = [0.248, 0.522]), p 0.0019, Figure 2.

Conclusions
Only a minority (14%) of real–world patients with FMR referred to a tertiary hospital fulfilled the COAPT selection criteria. Patients treated with MitraClip beyond the restrictive COAPT.
P24 AN UNSUAL ENDOCARDITIS
Authors: Arrigoni P , Ammendolea C , De Leo A , Coscarelli Mezzano S , Sartor R 
Published: May 2023

Abstract
In February 2021 a 28 years old woman presented with effort dyspnea. She refers a history of post caesarean section sepsis treated with antibiotic therapy. At TTE and following TEE: thickening of the interatrial septum, protruding neoformation in the left atrium as well as mitral valve steno–insufficency related to infiltration of the neoformation. The patient was then referred for cardiac surgery in Vicenza. The resection of the neoformation infiltrating the left atrium, interatrial septum, leaflet, annulus and papillary muscles of the mitral valve was performed (minithoracotomy). Finally valve replacement with Hanckock bioprosthesis no. 27 was performed. Extemporaneous histological examination showed a possible intimal sarcoma, which was subsequently confirmed (G3, IV stadium, MDM2+). At CT angiography evidence of vascular involvement (VCI and pulmonary vein) and possible secondary sites. The patient was referred to the regional reference centre (C.R.O. Aviano) where she was treated with six cycles of chemotherapy with EpiADM and Ifofosfamide, resulting in excellent remission of the tumour. At control PET/CT with FDG (01/22) substantial absence of disease. Intimal sarcoma (ISA) is an exceedingly rare undifferentiated sarcoma that arises in the pulmonary artery and less frequently in the aorta or its branches. ISAs behave highly aggressive with a mean patients’ survival ranging from 5 to 18 months. Patients with ISA are mostly of middle age at diagnosis and typically present with non–specific symptoms, which sometimes masquerades as thromboembolic disease. Thus, patients are often diagnosed in an advanced disease stage. Furthermore, ISAs are often reported to be resistant to conventional chemotherapy.
P30 A STONE ON THE HEART
Authors: Viele A , Lombardi M , Trivisonno A , Pierro A , Paolone P , Colavita A 
Published: May 2023

Abstract
We report a case of a 71–year–old female patient presented to our observation with worsening episodes of chest pain associated with cold sweat and spontaneous regression. Seven months earlier, the patient had undergone mitral valve replacement surgery with bioprosthesis for severe insufficiency. Pre–operative coronary angiography had documented the absence of significant lesions of the coronary arteries. Four months after the operation, hospitalisation was necessary due to an infective endocarditis on the prosthetic valve, effectively treated with specific antibiotic therapy. The patient came to the Emergency Department reporting episodes of stress related angina, lasting for a few days. The ECG documented sinus rhythm and non–specific anomalies of the ventricular repolarization phase. The haematochemical tests showed a minimal increase in the HS troponine values. Ultrasound documented normal left ventricular dimensions, no regional kinetic abnormalities with normal global systolic function and good functioning of the mitral bioprosthesis. The patient was admitted in our department of cardiology for further investigations. The next day the patient complained of severe oppressive chest pain with ECG evidence of diffuse ST–T segment depression and elevation in aVR and V1. Blood pressure was 170/90 mmHg and ultrasound showed apex hypokinesia with severely reduced systolic function. Nitrate s.l was administered with gradual improvement of symptoms and normalisation of the ECG. The patient underwent coronary angiography but during the first injection of contrast test, an anomalous stagnation of the contrast was highlighted in the aorta. It was urgently decided to perform aortic CT scan. The examination showed the presence of a voluminous pseudoaneurysm starting from the aortic bulb, partially thrombosed, which compressed the left main and the origin of the circumflex artery. The patient was therefore subjected to cardiac surgery the following day, with a good follow–up result one month after discharge.
P33 VENTRICULAR EXTRASYSTOLES IN YOUNG ATHLETIC PATIENT
Authors: Pesolo M , Casavecchia G , Mautone F , Gravina M , Brunetti N 
Published: May 2023

Abstract
We present a clinical case of a 19–year–old young athletic patient with reported episodes of heart palpitation. The baseline electrocardiogram was negative. Holter ECG documented: "16 single supraventricular extrasystoles normally conducted to the ventricles; 3877 polymorphic, single and repetitive, ventricular extrasystoles; 45 pairs and 4 triplets." In light of the Holter report, he underwent Exercise Testing that documented : "isolated and repetitive polymorphic BEVs, a few pairs and two 4 beats run nsVT " Since the patient had contracted SARS–COVID 19 infection about two months earlier, the first diagnostic hypothesis was to be referred to secondary myocarditis and therefore an indication for cardiac MRI was placed. Cardio–RM documented the presence of mesocardial and subepicardial fibrosis with Late Gadolinium Enhancement distribution pattern of non–ischemic type, in the mid–apical segments of the lateral wall of the left ventricle and in the lateral wall of the right ventricle at the outflow tract, findings compatible in first hypothesis with Arrhythmogenic Cardiomyopathy of the Right Ventricle.
P43 MUSIC THERAPY IN HAEMODYNAMICS: PRELIMINARY STUDY OF THE CHANGE IN VITAL PARAMETERS IN PATIENTS UNDERGOING INTERVENTIONAL PROCEDURES
Authors: D'Antonio L , Liporace P , Bartucca M , Bernardini F , Doganiero C , Rossi M , Vender V , Marelli S , Rossana A , Grigioni F , Ussia G 
Published: May 2023

Abstract

Introduction
Patients undergoing invasive procedures may have abnormal emotional reactivity that can lead to impaired vital signs. Music has been shown to modify physiological responses, but there is insufficient data in the literature to demonstrate the relationship between the improvement in vital signs and listening to music during interventional procedures. The aim of this study is to investigate how listening to music modifies vital signs in patients undergoing coronary angiography.

Methods
Patients admitted to the Campus Bio–Medico University Hospital of Rome for diagnostic coronary angiography were included in the study. During the procedures, patients listened to music selected by an experienced music therapist. The songs belonged to 6 musical genres and were also evaluated for agogic, tempo, and tonality. 7 phases were defined for the collection of vital signs (from the arrival in the waiting room to the stay in the "recovery room"). The results were compared with a homogeneous group of patients undergoing the same procedures.

Results
During phase 3 (insertion of the introducer), the mean systolic blood pressure was lower in the music therapy group than in the control group (139.9+–23.9 vs 145+–25.5 mmHg; p=0.529). During phase 2 (entering the room), mean oxygen saturation was higher in the music therapy group than in the control group (96 1.5% vs 95.4 1.8%; p=0.212). In all phases, the mean heart rate was lower in the music therapy group than in the control group (70.7+–10.8 vs 75+–18.1 bpm; p=0.33). The lowest mean systolic blood pressure and heart rate were recorded while listening to the Adagio and with 2/4 tempo tracks (mean systolic blood pressure 143,3+–26,9 mmHg; mean heart rate 69,7+–9,3 bpm).

Conclusions
This study was the first one to focus on changes in vital signs during music therapy in patients undergoing interventional cardiology procedures. Patients receiving music therapy showed a reduction in heart rate in all phases, a reduction in systolic blood pressure in phase 3, and an improvement in oxygen saturation in phase 2 compared with the control group. This approach may reduce the need for drug sedation and its side effects. The results are preliminary and require further analysis with a larger sample size.
P45 MINITHORACOTOMY APPROACH FOR MITRAL VALVE REDO SURGERY
Authors: Fiorentino M , Mikus E , Tripodi A , Zucchetta F , Calvi S , Sangiorgi D , Tenti E , Savini C 
Published: May 2023

Abstract

Objective
Redo cardiac surgery through median sternotomy still represents a challenging procedure due to the high risk of graft injuries, the presence of dense adhesions and complex valve exposure. The use of a minithoracotomy approach may reduce the surgical complexity. We report our experience performing redo mitral valve surgery through a right–sided mini–thoracotomy.

Methods
From march 2010 to May 2022, 58 patients (Median age 68 years (IQR 56–76) and 41.4% females) underwent redo mitral valve surgery through right anterior thoracotomy at our institution. Median EuroSCORE II was 3.83 (IQR 2.54–7.28).

Results
The median time from the original operation to redo surgery was 6.1 (1.0–10.3) years. First surgery was mitral repair in 60% of patients, mitral valve replacement in 15%, Coronary Artery Bypass Grafting in 12% and Aortic valve Replacement in nearly 9% of our population. Four patients (6.9%) were affected by active endocarditis at the time of surgery. Median cardiopulmonary bypass and cross–clamp times were 120 (IQR 80–148) minutes and 81 (IQR 59.5–114) minutes, respectively. No conversion to full sternotomy was necessary. Twenty–eight patients (48.3%) required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 6 patients (10.3%) and 7 patient (12.1%) required Pace–maker implantation due to third degree AV block. Moreover, we observed 1 rethoracotomy for bleeding (1.7%). One patient (1.7%) required re–intubation, dialysis and Extracorporeal Life Support, for a septic shock that finally caused exitus. Median ventilation time was 7 hours (IQR 4–13). Median ICU and in–hospital length of stay were 2 (IQR 2–3) days and 10 (IQR 8–15) days respectively. In–hospital and 30–days mortality was 1.7%.

Conclusions
In our experience, a minimally invasive approach through right thoracotomy for redo mitral valve procedures is safe and feasible, with acceptable CPB and Cross–clamp times and good in–hospital outcomes. Therefore, it can be an attractive option for patients with previous cardiac surgery, above all for patients with patent grafts. Further studies are needed with a bigger population and a comparison to full sternotomy results.
P47 MITRAL VALVE RE–REPAIR THROUGH A RIGHT MINITHORACOTOMY
Authors: Mikus E , Calvi S , Fiorentino M , Sangiorgi D , Pin M , Tripodi A , Brega C , Tenti E , Savini C 
Published: May 2023

Abstract

Objective
Recurrent mitral valve regurgitation after prior repair is usually treated with re–repair or replacement through a median sternotomy. We report our small initial experience with mitral valve re–repair through a repeated minimally invasive approach.

Methods
From July 2018 to November 2021, 10 patients (median age 52 years IQR 49–68; male 90%) underwent isolated mitral valve re–repair with a right mini–thoracotomy approach with peripheral arterial and venous cannulation. Median Euroscore II was 2.05 (IQR 2.03–2.54).

Results
The median time from the original operation to redo surgery was 4.7 (3.5–8.1) years. Median cardiopulmonary bypass and cross–clamp times were 128 (IQR 109–134) and 99.5 (IQR 81–112) minutes, respectively. Failure of previous mitral valve repair was mainly due to Gore–Tex chordal rupture (3 patients), annular detachment (3 patients), native chordal rupture (2 patients), and posterior leaflet prolapse (2 patients). Concerning the surgical terchnique, a complete mitral valve ring Corcym Memo 3D or 4D was used in 8 patients while additional repair techniques were needed 5 patients (PTFE neochords implantation, cleft or commissure closure). No conversion to full sternotomy and no reoperation for bleeding was necessary. Median ICU and hospital stay were 2.0 (IQR 2.0–2.0) and 7.5 (7.0–9.0) days respectively. Median follow up time was 3.5 (2.8–3.9) years. Neither deaths nor major postoperative complications occurred in the follow–up period.

Conclusions
In our experience, mitral valve re–repair can be an attractive option for patients with failure of previous mitral valve surgery and can be safely performed through a minimally invasive approach with good outcomes. Main advantages seem to be the avoidance of extensive surgical dissection, optimal valve exposure, and low risk of surgical complications.