bluuebunny/crossref_metadata_2025_split huggingface dataset:
P113 TRANSCATHETER CORRECTION OF RESIDUAL INFERIOR SINUS VENOSUS DEFECT AFTER SURGICAL CLOSURE
Authors: Granata G , Corciu A , Oliveri F , Bollati M , Bedogni F , Mazzarotto P 
Published: May 2023

Abstract
A 21–year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV–ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event. The contrast transcranial Doppler (CTD) was positive for right–to–left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left–to–right shunt and severe RLS after Valsalva’s Manovre (&gt;20 bubbles) (fig.A–B). No clear intra–cardiac source of embolization was detected on workup. After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior–posterior rim towards the IVC (&lt;5 mm). A Figulla Flex II ASD Occluder with the smallest waist of 4 mm was implanted with no evidence of residual intraprocedural shunt; no intraprocedural complications were observed (fig.C). The 1 month follow–up CTD was negative for RLS.

Conclusions
Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior–inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case–by–case basis. Reference 1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure. Cardiovascular Intervention and Therapeutics (2021) 36:256–259 2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002
P114 NO CONTRAST APPROACH FOR TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH SEVERE RENAL DISFUNCTION
Authors: Pignatelli G , Travaglio N , Cavalla F , Elicio A , Carrozzo A , Pantaleo P 
Published: May 2023

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) is nowadays the preferred procedure for patients with symptomatic aortic stenosis (AS) older than 75 years or not suitable for surgery. On the other hand, acute kidney injury (AKI) is one of the strongest predictors of mortality after TAVI The purpose of our study has been to evaluate the impact of a no–contrast approach for TAVI in patients with severe renal disfunction.

Methods
41 consecutive patients were enrolled from April 2021 to June 2022 in our Center. Mean age was 83 ± 5 yo, 43% were women. Mean glomerular filtration rate 29 ± 4.2 ml/min; The Society of Thoracic Surgeons mortality score (STS Score) was 16.1 ± 4.5. All procedures were performed without use of contrast dye. All patients underwent angio computed tomography (CT) and Coronary angiography with a minimal use of contrast dye at least two months before the procedure. Echo scan was perfomed to evaluate the femoral and carotid arteries anatomy Outcomes and events were evaluated according to the Valvular Academic Research Consortium 2 criteria (VARC–2). Baseline and postopertative creatinine were collected for each patient and glomerular filtration rate was calculated using CKD–EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Acute kidney injury was defined using KDIGO definitions as an increase in serum creatinine (Scr) by ≥ 0.3 mg/dl (26.5 mol/l) within 48 hours; or increase in SCr to ≥ 1.5 times base–line or urine volume &lt; 0.5 ml/kg/h for 6 hours. TAVI procedure was performed under general anesthesia. Intraprocedural transesophageal echocardiogram was used for annulus valve sizing and to monitor proper positioning of self–expanding bioprosthesis.

Results
No patients died during hospital stay. A permanent pacemaker before discharge was required in 2 cases. No patients developed acute kidney injury at 48 h or at discharge. At 3 and 6 months of follow up, two patients died, one for cerebral event and one for sudden death; mean glomerular filtration rate and creatinine values were similar to pre–discharge values.

Conclusions
Our data show that a zero–contrast TAVI approach in patients with advanced chronic kidney disease is feasible and should always be considered for these subset of patients
P121 MITRAL VALVE STENOSIS ASSOCIATED WITH LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION: A TERRIBLE COMBINATION WITH A DIFFICULT TREATMENT
Authors: Deola P , Carasi M , Zadro M , Iavernaro A , Lentini P , Onorato E , Chirillo F 
Published: May 2023

Abstract
Case n. 1 A 77 year–old woman with obstructive hypertrophic cardiomyopathy who had undergone alcohol septal ablation with a reduction in dynamic left ventricular outflow tract (LVOT) gradient from 95 to 65 mmHg was hospitalized for pulmonary oedema. Echocardiography and cardiac catheterization confirmed the presence of obstructive hypertrophic cardiomyopathy with a dynamic gradient of 65 mmHg, and identified a severe calcific mitral stenosis (3D planimetric area= 0,9 cm2). There was severe postcapillary pulmonary hypertension (pulmonary artery mean pressure of 60 mmHg and pulmonary capillary wedge pressure of 26 mmHg). The patient underwent a combined surgical intervention of mitral valve replacement (Epic 27 mm bioprosthesis) and surgical septal myectomy via a mini–thoracotomic approach. After the intervention there were dehiscence and infection of the thoracotomy and right inguinal surgical wounds, septic shock, hyporexia (with marked cachexia), emotional instability and delirium. After 21 days of hospitalization in the ICU, the patient was transferred to a medical department and died seven days later. Case n. 2 A 82 year–old woman with severe mitral stenosis associated with marked left ventricular hypertrophy and LVOT obstruction was admitted for heart failure and worsening renal function. Her comorbidities included diabetic neuropathy and stage 4 chronic kidney disease. Cardiac catheterization excluded significant coronary artery disease; mitral valve area was 1 cm2, and LVOT gradient was 75 mmHg. Pulmonary artery mean pressure was 32 mmHg, pulmonary capillary wedge pressure was 25 mmHg, and right atrial mean pressure was 8 mmHg. She was deemed a high–risk surgical candidate. The patient therefore was treated initially with peritoneal dialysis. However she demonstrated persisting pulmonary congestion. An atrial septostomy inserting a 8–mm Atrial Flow Regulator was subsequently performed, with an immediate reduction of capillary wedge pressure to 18 mmHg. In the following 18 months the patient had no more hospitalizations for heart failure.

Conclusion
The association between mitral stenosis and LVOT obstruction is associated with elevated capillary wedge pressure and frequent episodes of heart failure. Surgical intervention remains the first therapeutical option. Nevertheless, in older patients, the association between atrial septostomy and peritoneal dialysis may represent a valuable solution, with a lower operative risk.
P125 LEFT ATRIAL AND VENTRICULAR STRAIN, AND 3D–ECHOCARDIOGRAPHY FOR SUBCLINICAL CHEMOTHERAPY–RELATED CARDIAC DYSFUNCTION IDENTIFICATION IN PATIENTS WITH BREAST CANCER
Authors: Magnesa M , Casavecchia G , Pesolo M , Mautone F , Barone R , Masella A , Brunetti N 
Published: May 2023

Abstract
Cardio–oncology is a recent rapid–developing multidisciplinary approach created by oncologists in accordance with cardiologists with the objective to minimize the adverse cardiovascular effects of contemporary cancer therapy and to maximize the benefits that can be obtained from it. Pre–treatment cancer therapy–related cardiovascular toxicity (CTR–CVT) risk assessment can be performed using HFA–ICOS risk assessment tools, in addition to a careful clinical history analysis, physical examination, ECG, biomarkers, and echocardiography. In our study, the analysis of standard and advanced echocardiographic parameters (left atrial strain or LAS, left ventricular global longitudinal strain or GLS, and 3D echocardiography) were performed at baseline, at three, six, and 12 months timepoints. A number of 53 female patients with breast cancer, scheduled to receive chemotherapy, was enrolled. All patients had basal 3D LVEF values ≥ 50% and a basal GLS &gt; –18,5%. Statistically significant reductions (p&lt;0,001) in 3D LVEF at three, six, and 12 months compared to baseline were found, and in all cases 3D LVEF levels were within the reference values (3D LVEF ≥ 50%). GLS and atrial strain parameters (LASr and LASct) were significantly reduced compared to the baseline at 3 months (GLS p&lt;0.01; LASr p&lt;0,001; LASct p&lt;0,001), 6 months (GLS p&lt;0.05; LASr p&lt;0,001; LASct p&lt;0,001) and 12 months (GLS p&lt;0.01; LASr p&lt;0,05; LASct p&lt;0,01). Moreover, 10 patients out of 53 (18,87%) had asymptomatic cardiotoxicity (expressed by &gt;15% of GLS reduction compared to baseline) after 12 months, and 17 out of 53 patients (32,08%) had atrial dysfunction (expressed by &gt;15% of LASr reduction compared to baseline) after three months. Although atrial dysfunction was not statistically significant in predicting asymptomatic cardiotoxicity (p=0.12), patients with atrial dysfunction at three months have a 3,7 times greater risk of developing asymptomatic cardiotoxicity at 12 months. With our analysis, we found that HFA–ICOS risk score could be considered a predictor of cardiotoxicity at 12 months (p&lt;001). Further studies will be conducted, in order to expand the population and to confirm our results.
P127 ASSESSMENT OF LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN A POPULATION AFFECTED BY CANCER AND IN THERAPY WITH POTENTIALLY CARDIOTOXIC CHEMOTHERAPY
Authors: Spinelli A , Cianfrocca C , Di Fusco S , Di Michele S , Aquilani S , Colivicchi F 
Published: May 2023

Abstract
Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. The aim of this observational study is to analyse some echocardiographic (echo) features of patients affected by cancer evaluated in our laboratory.

Methods
We studied patients who came to our laboratory for echo assessment of potential chemotherapeutic cardiotoxicity in October and November 2022. We performed complete echocardiograms (Philips Epiq 7) with a focus on systolic (left ventricular ejection fraction, LVEF and GLS) and diastolic function.

Results
Over the study period, 112 cancer patients underwent echo. Twenty–six patients waiting to start radio/chemotherapy were excluded from analysis. Twenty patients were excluded due to poor quality of echo images. The majority of patients were female (92%, mean age 61.9 years). The predominant type of cancer was breast cancer (78%), followed by prostate cancer (4%), ovarian cancer (2%), and lymphoma (2%). No patients had signs or symptoms of heart failure. Twenty–three patients had a history of hypertension, 3 had diabetes mellitus, and 1 had coronary artery disease (Table 1). We separately evaluated patients according to cancer treatment. Twenty–four patients (28%) had been treated with anthracycline (AT), 3 patients (3%) had been treated with AT in combination with trastuzumab, 9 patients (10%) had been treated with trastuzumab monotherapy, 25 patients (29%) had been treated with left chest radiotherapy (RT) and were currently undergoing hormone therapy (HT), and 25 patients (29%) had been treated with other chemotherapy (CT), specifically tyrosine kinase inhibitors, anti VEGF–drugs, taxanes, and antimetabolites. No moderate or severe dysfunction was found in the study population, however 52 patients (60%) had mild diastolic dysfunction. The mean EF value was 63% and the mean GLS value was 17.4% (Table 2). Ten patients had reduced GLS values (&lt; 16%) with normal EF. Of these patients, 2 had been treated with AT, 3 with trastuzumab, 2 with HT, and 3 with other CT (Table 3).

Conclusions
According to the literature, GLS assessment during/after cardiotoxic CT could help identify subclinical left ventricular dysfunction. Our data, derived from a short observation period, show mild reduction in GLS in asymptomatic patients treated with different CT, thus suggesting a potential benefit of closer follow–up of these pts.
P131 ACUTE RIGHT HEART FAILURE: MASSIVE PULMONARY EMBOLISM OR RIGHT INFARCTION?
Authors: Ottaviani A , De Donno F , Pierfelice F 
Published: May 2023

Abstract
Right ventricular infarction is often unrecognized. Rarely isolated, it complicates up to 50% of inferior infarction, conditioning morbidity and mortality. Clinical presentation, characterized by hypotension, and echocardiografic features, with right ventricular involvement, can often mimic high risk pulmonary embolism. This case report focuses on an 85–years–old woman who called 118 for chest pain and asthenia. The patient is in shock, when accepted into the emergency room. ECG reveals a third–degree AV block with escape rhythm at rate of 35bpm and ST segment elevation in inferior leads, requiring temporary transvenous pacemaker placement. Bedside echo shows a borderline LV systolic function (EF 50%) with inferior wall akinesis and a dilated and hypokinetic right ventricle (TAPSE 15mm). In emergency we perform a coronary angiogram, that reveals a total occlusion of the ostial right coronary artery, treated by PCI 2 DES. During clinical course, no complications occur. At hospital discharge, the patient is hemodynamically compensated, without neurological sequelae and with cardiac enzymes in decrease (Trp I HS peak 94 000pg/ml). The aim of this case report is to focus cardiologist’s attention on right ventricular infarction, knowing its clinical presentation and its laboratory, electrocardiographic and echocardiographic features.
P133 ZEBRA HOOFBEATS: A RARE CASE OF STEMI IN GRANULOMATOUS NECROTIZING AORTITIS
Authors: Facci G , Alberti G , Dotto A , Briani F , Benfari G , Pighi M , Ribichini F 
Published: May 2023

Abstract
We present the unusual case of an AMI STEMI, complicated by ventricular fibrillation, in a 26 years old caucasic male patient, affected by necrotizing and granulomatous aortitis, in the context of a primary immunodeficiency. Initially the patient was referred to the Cardiology Unit for worsening dyspnea and fatigue. In his medical history he has primary immunodeficiency complicated by multiple opportunistic infections. We performed an echocardiography that revealed an aneurismatic ascending aorta (58 mm) with associated significant aortic valvular regurgitation. He was later referred to heart surgery OR where Bentall–De Bono operation was performed. Two years later he developed a lateral STEMI, complicated by ventricular fibrillation. The coronary angiography, performed in foreign country, showed total occlusion of the circumflex coronary artery with diffuse aneurismatic coronary disease, granulomatosis and ulcerative lesions. A percutaneous revascularization approach was tried, but ineffective. Actually the patient, during follow up, presents dilatative post–ischemic cardiopathy with moderate ejection fraction reduction, initial aortic bioprosthesis failure. We noted at follow up echocardiograms early dilatation of the native aortic arch (35 mm), suggesting a progressive disease. In conclusion, AMI‘s etiology includes many non atherosclerotic mechanisms that should be considered alongside common causes. This case shows a rare cause of STEMI in a very young male patient, and teaches us that aortitis is a progressive and complex pathology, often involving multiple arteriosus districts, that needs close follow–up and integrated management.
P140 THE “SMOKER’S PARADOX”: A QUESTION OF SHORTER ISCHEMIC TIME AND YOUNGER AGE. RESULTS FROM A LARGE COHORT OF CONSECUTIVE STEMI PATIENTS TREATED WITH PRIMARY PCI
Authors: Paradossi U , De Caterina A , Dossi F , Raccis M , Benedetti G , Marchi F , Palmieri C , Berti S 
Published: May 2023

Abstract

Background
Smoker’s paradox usually refers to the common observation of a favourable outcome of smoker patients in acute myocardial infarction. The interpretation of this phenomenon is still controversial and not fully explained. We aimed at assessing whether smoking could be associated with mortality in a large cohort of prospectively enrolled patients with ST segment elevation myocardial infarction (STEMI) referred to primary percutaneous coronary intervention (PCI).

Methods
From April 2006 to December 2018 a population of 2456 STEMI patients treated with primary PCI were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data and 1–year follow–up were collected.

Results
Among 2546 patients admitted with STEMI 1007 (41%) were current smokers. Smokers were 10 years younger and had lower crude in–hospital and 1–year mortality (1.5% vs 6%, p&lt;0.0001 and 5% vs 11%, p&lt;0.0001), shorter ischemic time (203 [147–299] vs 220 [154–334] minutes, p=0.002) and shorter decision time (60 [30–135] vs 70 [36–170] minutes, p=0.0063). After adjustment for different risk factors using Cox regression model, age [adjHR: 1.11 (95%CI: 1.03 – 1.18) – p&lt;0.01] and ischemic time [adjHR: 1.01 (95%CI: 1.01 – 1.02) – p&lt;0.05] appeared to be the confounder factor of the relationship between smoking and in hospital mortality.

Conclusions
In our large prospectively–enrolled population the so–called “smoker’s paradox” is explained by the shorter ischemic time and younger age of the smoking population. Our data shows that smokers were admitted to the hospital for STEMI about 10 years before non–smokers, with a premature coronary atherothrombosis that could be the price to pay for smoking. Smokers had non–significant different risk of in–hospital mortality compared to non–smoking.
P149 INTEGRATED CARDIO–RADIOLOGICAL TEAM
Authors: Pancaldo D , Armando E , Cavallero E , Groppo Marchisio F , Amoroso G , Barbero U , Bassignana A , Battisti A , Bricco G , Coppolino A , Correndo L , Dogliani S , Iacovino C , Moncalvo C , Scollo A , Valeri L , Salmè G , De Benedictis M 
Published: May 2023

Abstract

Introduction
Cardiovascular diseases are the main cause of mortality: a multidisciplinary approach is essential to fight them successfully. CT coronary angiography and cardiac magnetic resonance are diagnostic tests increasingly used to complement traditional methods. At the "SS Annunziata" hospital in Savigliano (CN) there has already been collaboration between dedicated cardiologists and radiologists for many years: first for CT and then also for MRI. In 2020 the collaboration was formalized, through the drafting of an operating procedure, and the "Integrated multidisciplinary cardio–radiological Team" was officially established. Who is part of the team: Dedicated and identified figures, never occasional, of the Cardiology Department and Radiology Department, whose essential requirements are: a) for cardiologists: advanced competence in echocardiography, general technical knowledge, targeted training b) for radiologists: advanced competence in CT and MRI, mastery of specific sequences and processing techniques, cardiological knowledge. Additional requirements for both figures: certifications and publications. Team activities: 1) Scheduling of exams 2) Discuss the case based on the request and documentation and plan the most suitable technical execution. 3) Monitor for the onset of adverse effects if beta–blocker drugs or stimulant drugs are administered 4) Supervise the execution of the exam: 5) Perform image processing and interpretation: for coronary CT, reconstruction of coronary images in the different modalities, search and quantification of stenoses; for MRI, calculation of volumes and ejection fraction for both ventricles, diameters of the cavities and thicknesses of the walls, search for edema, search and quantification of fibrosis, search for basal perfusion defects and after possible pharmacological stimulation, search for any findings extracardiac. 6) Write and sign the report (radiologist and cardiologist). 7) Contact the patient or the referring doctor by the cardiologist if the findings of the tests performed impose decisive implications of a therapeutic nature. 8) Detect the indicators of set goals Perspectives: The technological advance of cardiac imaging diagnostics, with CT and resonance magnetic, suggests that in the near future these techniques can further improve and open up to new applications that will be the task of the group to evaluate, learn and put into practice.
P150 STRESS–REST DYNAMIC–CT MYOCARDIAL PERFUSION IMAGING IN THE MANAGEMENT OF MYOCARDIAL BRIDGING: A “ONE–STOP SHOP” EXAM
Authors: Perna G , Schicchi N , Fogante M , Pirani P , Paolini E 
Published: May 2023

Abstract
Myocardial bridging (MB) is a congenital anomaly characterized by intramyocardial coronary course that can cause coronary compression during systole and can lead to myocardial ischemia. The improvement in computed tomography (CT) scanner technology has increased the detection of MB during coronary–CT (cCT) exam but the assessment of their functional significance is often challenging. Tha stress–rest myocardial perfusion imaging (MPI) single–photon emission CT (SPECT) is often required to decide patient’s management after anatomical evaluation with cCT or Invasine Coronary Angiography (ICA). However, SPECT has long acquisition protocols, poor spatial resolution, and the anatomical/Functional protocols expose patients to significant radiation doses. Thus, dynamic–CT MPI after cCGT can represent a valid alternative. We report the cases of seven patients in which we detected MBs during cCT exam and we evaluated their functional significance using a stress–rest dynamic–CT MPI to decide the correct patient’s management. Three patients showed reversible perfusion defect in the left anterior descending (LAD) territory segments involved with MB and they were referred for treatment. The remnants four patients with MB in the LAD revealed normal MPI and they were conservatively managed. In all patients the results of the stress perfusion were completely overlapping, but the study with SPECT after anatomical evaluation required a longer process. The cCT and stress–rest dynamic–CT MPI allowed to detect and to evaluate the functional significance and to decide the management of MB in a “one–stop shop” exam.