bluuebunny/crossref_metadata_2025_split huggingface dataset:
P173 THERAPEUTIC MANAGEMENT OF FLUOROPYRIMIDINE CARDIOTOXICITY: AN ANECDOTAL CASE
Authors: Paccone A , Bisceglia I , Lestuzzi C , Fiscella D , Canale M , Turazza F , Russo G , Gallucci G , Camilli M , Quagliariello V , Maurea C , Maurea N 
Published: May 2023

Abstract

Background
Fluoropirimidine represents one of the staple treatment of metastatic colorectal cancer; chemoterapy–based cardiotoxicity is unfortunately habitual in clinical practice. Raltitrexed could represent a valid alterantive to 5–FU in patients with cardiovascular comorbidities or in which 5–FU Has not been tolerated.

Case Report
Our patient is a 73 years–old woman, who underwent left colon surgical resection due to subocclusion; a whola body staging was not performed. After surgery, patient underwent CT scan,i n which multiple liver, lung and peritoneal metastases were identified. Biomolecular profiling assessment was perfomed (RAS, BRAF Wild type, DPYD*6 heterozigosis mutation). On January 2020, patient began FOLFIRI + PANITUMUMAB scheme as first line treatment (total cycles perfomed: 15). On January 2021, PD was detected though restaging imaging, and patient was subsequently treated with FOLFOX + BEvacizumab as second line. After 5 cycles, patient developed dyspnoea and palpitation; EKG was performed depicting Atrial fibrillation with heart rate: 73bpm, preserved biventricular systolic function and increased BNP and NT–pro–BNP serum concentration. According to patient’s high thromboembolic risk, oral anticoagulation (NOAC) was administered and multidisciplinary discussion was scheduled. NAO were preferred to Vitamin K antagonists due to drug–drug interactions; the treatment–of–choice was Apixaban 2.5 mg bis in die. Given the fact that aforementioned condition could have been attributed to 5–FU cardiologic toxicity, Raltitrexed was administered in lieu thereof 5–FU once synusal rythm was restored (TOMOX scheme). Bevacizumab administration was restored after a longer waiting (ca 2 months); the patient uderwent systematic and serial cardiologic assessment through clinical and EKG consults.

Conclusion
Our case report depicts the undelayable necessity of a Multidisciplinar collaboration in which oncologists and cardiologists could propose personalized treatment strategies which ensure correct antitumoral activities without significant and life–threatening toxicities.
P178 OCCASIONAL ECHOCARDIOGRAPHIC DIAGNOSIS OF BRONCHOGENIC CYST
Authors: Rossini D , Giordano P 
Published: May 2023

Abstract
Bronchogenic cysts (BCs) are abnormal rounded formations associated with the tracheobronchial tree, that can cause recurrent infections or obstructive respiratory symptoms. They are often asymptomatic and can be discovered on occasional cardiac imaging. The treatment of bronchogenic cyst is controversial; some clinicians recommend surgical resection or transbronchial needle aspiration, others prefer a conservative attitude, reserving treatment for the possible appearance of symptoms or complications. We describe the case of a 54–year–old male patient which came to our observation in 2005, for the onset of intermittent angina pectoris. The first tests showed: no ECG alterations, mild hypokinesia of the inferolateral wall of the left ventricle with preserved systolic function on the echocardiogram, a modest increase in myocardial enzymes: total CK 731 U/L, CK–MB 40 U/L, CK–MB/CK ratio 5,4. The next day, the patient underwent coronary angiography and ramus intermedius PCI. However, the echocardiogram showed a rounded, anecogenic formation, 52 x 49 mm, behind the left atrium (Fig.1–2), which CT and MRI of the chest (Fig.3) diagnosed as BC in mediastinal location. Excluding the presence of neoplastic cells in the bronchoalveolar lavage fluid, a conservative strategy was agreed with the pulmonologists, choosing echocardiogram for follow–up. In the 17–year observation period, BC remained clinically silent, with no increase in size. Bronchogenic cysts are caused by an abnormal branching of the respiratory airways, that leads to the formation of segments separated from the tracheobronchial tree. About 80% of BCs are localized in the mediastinum, the remainder in the lung parenchyma. Unlike lung BCs, mediastinal BCs rarely communicate with the tracheobronchial tree and therefore usually do not undergo infectious processes. Mediastinal BCs localized near the carina of the trachea can cause compression symptoms (cough, dysphagia, dyspnoea). The other mediastinal BCs usually do not cause disorders. Knowledge of this rare congenital pulmonary disease is useful for echocardiographic differential diagnosis. Sometimes the cardiologist can play a role in the follow–up of this pathology.
P180 EXTREMELY WIDE QRS TACHYCARDIA IN SEVERE HYPERKALEMIA: THE IMPORTANCE OF MONITORING MRA THERAPY
Authors: Ciampi C , Baroni M , Maloberti A , Ghidini S , Mazzone P , Giannattasio C 
Published: May 2023

Abstract
Although uncommon in the general population, hyperkalemia can affect up to 50% of patients with heart failure who are receiving MRA and/or are affected by CKD . Since potassium is the most abundant intracellular cation, hyperkaliemia causes a profound change in action potential, which manifests as expected electrocardiographic changes (lower voltage P wave, AV block, wide QRS, high voltage T wave) and arrhythmias. Clinic case. A 77–year–old woman was admitted to ED for dyspnea. She had a medical history of stage 3 CKD and a HFrEF with a recent admission in medical department for worsening congestion, from which was dimitted with a supratherapeutic dose of MRA (canrenone 300 mg/die). Physical examination at the admission excluded signs of central or peripheral congestion . An EKG was performed and revealed an heart rate of 95 beats per minute and extremely wide QRS (280 ms). Contextually, a blood gas analysis showed high potassium level (K 9 mmol/l) and metabolic acidosis. Due to the inability to demonstrate the presence of P wave and a regular A–V conduction, a differential diagnosis between a VT and a SVT with a wide QRS was required. The presence of a fusion beat, a negative concordance of QRS in the precordials derivation, and an extreme right axis deviation led to a diagnosis of slow VT. Cuncurrently with the onset of hyperkalemia therapy, an ECV with sinus rhythm restoration was done. The following EKGs showed expected electrical changes based on the measured potassium level. After ECV with K 8 mmol/l: QRS remained wide (180ms) with an heart rate of 65 beats per minute in the presence of possible junctional rhythm or sino–ventricular rhythm, which is sometimes described in hyperkalemia as an expression of atrial inectability with the exception of the conduction fibers. After 1 hour with K 6.3 mmol/l: QRS of normal duration with an HR of 60 bpm and a sinus rhythm but with low voltage P wave and concomitant AV block of I grade that was gradually restored with the normalization of potassium levels after canrenone suspension. Because the numerous side effects of hyperkaliemia careful monitoring of MRA therapy and potassium level plays a critical role in the prevention and diagnosis of arrhythmias and EKG changes in patients with HFrEF.
P182 A STRANGE ELECTROCARDIOGRAM RECORDED AFTER A FALL TO THE GROUND
Authors: Clò S , Bertini M , Sirugo P , Orazio G , Capanni A , Guardigli G , Malagù M 
Published: May 2023

Abstract
An 84–year–old man was found unconscious on the ground by his daughter. The patient had a medical history of arterial hypertension, dyslipidemia and type II diabetes mellitus complicated by peripheral neuropathy and has been experiencing frequent falls. The emergency services were alerted, and the man was taken to the emergency room. In the ER, an abnormal electrocardiogram was recorded, and an urgent cardiological consultation was requested. Upon reading the ECG, the cardiologist ordered the patient‘s body temperature to be measured, which was found to be 29.7°C. The recorded ECG showed signs of severe hypothermia, including an advanced atrioventricular block (in this case, III–degree AV block), a widening of the QRS complex with the appearance of the Osborn wave, and a prolonged QT interval. The Osborn wave is a positive deflection visible at the J point and it is an uncommon electrocardiographic finding that immediately suggests hypothermia, although it is not pathognomonic (it can also be found in acute myocardial ischemia, hypercalcemia, sepsis, and other non–hypothermic conditions). The electrophysiological basis of the Osborn wave lies in the Ito current, a transient current caused by the release of potassium ions from the ventricular myocardiocyte, which is responsible for a brief partial repolarization during phase 1 of the action potential. Hypothermia increases the amplitude and width of the action potential notch due to the Ito current in the epicardium much more than in the endocardium, creating a transmural voltage gradient that manifests on the surface ECG as the Osborn wave. The Osborn wave is initially more evident in the inferolateral leads; as the body temperature decreases, the wave gradually becomes visible in all 12 leads and, when the body temperature returns to normal, the wave progressively disappears. This potential difference also correlates with possible proarrhythmic effects and, when linked to acute myocardial ischemia, the Osborn wave is an adverse prognostic factor as it is associated with a higher risk of ventricular fibrillation. In this case, the patient had fallen during the night and remained on the ground for hours. He was hospitalized for short intensive observation, warmed up, and hydrated, with a rapid and complete resolution of the clinical and electrocardiographic abnormalities
P185 FOLLOW–UP OF PATIENTS UNDERGOING POST–EXTRACTION LEADLESS PACEMAKER IMPLANTATION
Authors: Ferrieri A , Dentico A , Altieri T , Carretta F , D‘Agostino C , Carretta D 
Published: May 2023

Abstract

Introduction
The implantation of traditional stimulation devices involves numerous complications, in the short and long term, among which one of the most important is represented by infections. Most patients who experience this complication undergo a lead extraction procedure. In pacemaker–dependent patients, there is often the problem of having to perform an early reimplantation after extraction. This study aims to evaluate the outcome of Micra implantation in patients previously undergoing TLE, comparing them with patients who have a Micra as their first implant. Study materials and methods. From January 2017 to November 2022, 190 leadless pacemaker implant procedures were performed in our center. Of these patients 24 underwent an extraction procedure. To evaluate the technical performance of leadless pacemakers in post–extracted patients, a comparison was made between these and the "de novo" implanted leadless, so as to evaluate the effectiveness of the technical specifications. In particular, all the basic characteristics of the various patients, the data of the extraction and the implantation procedure were considered. Subsequently, the values ​​of the sensing, threshold, impedance and percentage of stimulation parameters collected in the follow–ups performed by the two groups of patients at 1 month after implantation, 6 months and every year were compared. Study results. An initial analysis of the follow–up of the aforementioned classes of patients from 2017 to today already provides us with some important data: in the patients who have implanted a leadless pacemaker following extraction, in no case has there been a recurrence of infection; the success of the Micra implant was 100%. Furthermore, the analysis of the electrical parameters statistics demonstrated the absolute effectiveness of the leadless device in both classes of patients compared, without highlighting major differences.

Conclusions
Leadless pacemaker implantation in post–extracted patients has proven to be an effective choice as an alternative to the implantation of a traditional pacemaker, to allow the reduction of the risk of infectious complications, while still guaranteeing optimal performance
P186 LEADLESS PACEMAKER VERSUS TRANSVENOUS PACEMAKER: THE BEST ALTERNATIVE FOR THE POST–EXTRACTION PATIENT
Authors: Dentico A , Ferrieri A , Altieri T , Carretta F , D‘Agostino C , Carretta D 
Published: May 2023

Abstract

Introduction
As complications associated with pacemakers or defibrillators implant increase, the number of patients undergoing transvenous lead extraction following infection has increased. This study aims to compare follow–up and to evaluate the incidence of reinfection between post–extracted patients re–implanted with leadless pacemakers and post–extracted patients re–implanted with transvenous device. Materials and

Methods
From December 2016 to October 2022, 163 patients underwent transvenous lead extraction in our center. Of these patients, 24 were subsequently reimplanted with a leadless pacemaker, while 52 with a traditional device. Instead, 11 were reimplanted with S–ICD, 3 with a loop recorder; 73 are patients who, after cardiological re–evaluation, either didn’t reimplant a new device or were redirected to the first implant center. For each patient has been evaluated the efficacy of the reimplanted device, the appearance of any minor or major complications, the recurrence of infection.

Results
About the 24 post–extracted patients who were reimplanted with a leadless pacemaker, in no case there was a recurrence of infection and/or complications associated with the device. In the 52 post–extracted patients reimplanted with a traditional device, only 1 case experienced a recurrence of infection (0.02% rate). If we analyze this last class better, we see how in the past some of these had already undergone a pocket overhaul or an extraction of first implant device. Many are also patients with leads abandoned by another center and with new device’s infection.

Conclusions
Leadless PM implantation in post–extracted patients, when we have patients eligible for this device, proved to be an effective choice in reducing re–infection recurrences compared to the population of patients reimplanted with a transvenous device. However, if we consider the low rate of reinfection in patients re–implanted with transvenous device, we can say that when the patient is well prepared and the implant prophylaxis is correct, the recurrence of infection is low even if one decides to re–implant a traditional device.
P190 TWIDDLER’S SYNDROME IN A 96–YEAR–OLD PATIENT TREATED BY REPOSITIONING THE VENTRICULAR LEAD
Authors: Massacesi C , Core A , Di Eusanio M , Di Francesco G , Di Saverio M , Marini L , Rolando M , Gregori G 
Published: May 2023

Abstract
A 96–years–old woman was admitted to our cardiological intensive care unit in December 2022 with atrioventricular dissociation, with a junctional ventricular escape rhythm at a rate of 38 beats per minute, and an atrial rhythm dissociated from the ventricular rhythm, at a rate of 80 beats per minute (Figure 1). The patient had a history of third–degree atrioventricular block, effectively treated with single–chamber pacemaker implantation (Assurity MRI SR, Abbott), operation performed approximately 10 months before access, in February 2022. The patient underwent a chest X–ray, which showed "coiling" of the ventricular catheter in the pacemaker pocket area (left subclavicular), with macroscopic dislocation of the ventricular electrode, which had its distal tip in the right atrium (Figure 2). Therefore, the clinical case was typical of Twiddler‘s syndrome. The patient would therefore have undergone revision surgery. An attempt was made to reposition the original lead, with passive fixation (Isoflex 1948/58, Abbott), by inserting a "straight" stylet, a procedure which was done effectively. The ventricular lead was repositioned in the right ventricular apex. The detected parameters were optimal (sensing 7 mV, ventricular barrier threshold 0.5 mV/0.4 ms, impedance 797 Ohm). The result was considered acceptable. The remainder of the hospital stay was without complications. The patient was discharged on the fifth day in good general condition. Twiddler syndrome is defined as a dislocation of one or more catheters, resulting in the catheters "coiling" in the pocket of the device. It is usually related to the manipulation of the generator by the patient itself. It usually occurs within a year of implantation and is usually more common in females, the elderly, the obese, pediatric patients, or patients with psychiatric disorders. The identification of patients at risk for this pathology, the adequate education of the patient and family regarding the management of the device, the use of catheters with active fixation, as well as the fixation of the generator device to the pectoral muscle, through non–absorbable sutures. In the case described, the patient denied manipulation of the device, which however could not be excluded, given the age of the patient.
P191 MITRAL VALVE REPAIR FOR INFECTIVE ENDOCARDITIS LONG TERM RESULTS
Authors: Malvindi P , Bifulco O , Zingale A , Berretta P , Alfonsi J , Pierri M , Suvitesh L , Ohri S , Di Eusanio M 
Published: May 2023

Abstract

Background and aim
The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis remain not clearly established. We aim to review the clinical experience in mitral valve surgery for infective endocarditis looking at mid–term survival.

Methods
Prospectively collected data of patients who underwent cardiac surgery for infective endocarditis between 2001 and 2021 at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest–neighbour propensity score matching, including twelve preoperative variables, was performed to account for differences in patients’ profile between the repair and replacement subgroups.

Results
Propensity matching provided 87 well–matched pairs. Mean age was 60±15 years, 76% of the patients were male. Twenty–two patients (12%) had a recent cerebral event. CABG and aortic valve replacement were associated in 10% and in 38% of the cases, respectively. Patients who underwent mitral valve replacement had a higher rate of annular, commissures and bileaflet lesions. Overall in–hospital mortality was 7% with no difference between the repair and the replacement cohorts (p=0.77). Survival probabilities at 1, 5– and 10–years were 89%, 70% and 67%, respectively after mitral repair, and 88%, 76% and 62%, respectively after mitral replacement; log–rank p=0.94. Freedom from mitral intervention by any cause at 10–years was 3.3% and 8.7%, respectively after mitral repair and mitral replacement; Gray’s p=0.37.

Conclusions
Mitral valve repair was associated with acceptable in–hospital mortality and survival in a high–risk and comorbid cohort of patients with mitral valve infection. We found no difference in early, mid–term survival and mitral reoperation risk between patients who underwent repair or replacement of the mitral valve in the setting of infective endocarditis.
P195 INFECTIVE ENDOCARDITIS OF COMPOSITE AORTIC VALVE GRAFTS
Authors: Olevano C , Fiorani B 
Published: May 2023

Abstract

Background
The Infection of aortic valve graft conduit is a relatively rare complication still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extends into adjacent cardiac structures, systemic spread and identify microbes.

Methods
In this retrospective and observational study, we report two centre experience in the management of thirty patients consecutively admitted to our centre with composite aortic valve graft infection during the period 2008–2020. Our end–points were: infection control, early mortality and long–term survivor.

Results
Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7–year follow–up. Ten patients were treated medically and experienced an early mortality of 30% and a mid–term survival of 33%. Patients with stable haemodynamic in the absence of local and systemic complications had an acceptable survival after lone antibiotic therapy.
P196 ENDOCARDITIS MASQUERADING AS STILL‘S DISEASE: WHEN AN ECHOCARDIOGRAM SAVES YOUR LIFE
Authors: Giovannico L , D‘Errico Ramirez A , Fischetti G , Parigino D , Santeramo V , Savino L , Silva A , Vitale N , Bavaro D , Di Bari N , Bottio T , Milano A 
Published: May 2023

Abstract
A 44–year–old man in apparent good health thus far presented with weight loss and fever preceded by shivers, profuse sweating, and arthralgias. Blood tests documented normal white blood count with slightly altered CRP and ESR. Chest X–rays did not find pleuro– parenchymal lesions with normal cardiac silhouette. Abdomen ultrasounds was regular. Due to the persistence of the symptoms, he was referred to a rheumatologist who diagnosed Adult Still’s disease (AOSD) and recommended therapy with prednisone and sulfasalazine, interleukin–1 inhibitor, with the resolution of the fever. After three months, because of the recrudescence of the fever, he was admitted to the emergency room a total–body CT–scan documented inflammatory–abscess lesions in the brain and hypodense areas in the spleen. ECG showed type 1 second–degree atrioventricular (AV) block. The patient was therefore transferred to the Cardiology Department; echocardiograms documented an endocardic mass on the aortic valve and suspected periannular abscess also infiltrating the interventricular septum. The patient underwent urgent surgery with excision of the aortic valve, opening and draining of the abscessual cavities, reconstruction of the aortic annulus with bovine pericardium patch and aortic valve replacement with bioprosthesis. The patient did not present further febrile episodes after surgery but a pacemaker implantation was necessary due to persistent AV block. Biological material sent for culture was positive for S. gallolyticus. AOSD is one of the most common conditions responsible for fevers of unknown origin. It is characterized by fever, arthritis, evanescent rash, leukocytosis, and multiorgan involvement. Yamaguchi criteria required for the diagnosis of AOSD are as follows: main criteria: Fever &gt;39°C, lasting 1 week or more, Arthralgia or arthritis, lasting 2 weeks or more, Typical rash, Leukocytosis &gt;10,000/mm3; Minor criteria: Sore throat, Recent development of significant lymphadenopathy, Hepatomegaly or splenomegaly, Negative tests for antinuclear antibodies and rheumatoid factor; Exclusion criteria: Infections, Malignancies, Other rheumatic diseases.