bluuebunny/crossref_metadata_2025_split huggingface dataset:
P17 MITRAL ANNULUS CALCIFICATION IN TRANSCATHETER AORTIC VALVE IMPLANTS
Authors: Nardi B , Cammelli T , Zoppi F , Grippo G , Maioli M , Di Mario C , Toso A 
Published: May 2023

Abstract

Background
Mitral annular calcium (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, assessment of MAC in the pre–TAVI diagnostic pathway is not among the procedures routinely performed.

Aim of the study
In this retrospective study conducted in patients undergoing TAVI, we evaluated (1) the presence and extent of MAC using a multimodal imaging approach; (2) the clinical and structural factors associated with it; and (3) the possible prognostic role of MAC.

Methods
Between 2016 and 2022, 62 patients with severe aortic stenosis underwent TAVI at the Cardiovascular Department of A.O.U. Careggi (Florence, Italy). Baseline and post–TAVI clinical and echocardiographic data were collected at Santo Stefano Hospital (Prato, Italy). MAC assessment was performed by quantitative analysis on echocardiographic and computed tomography (CT) images, obtaining a MAC severity score. A clinical follow–up was conducted at 30–day intervals in all patients.

Results
MAC was detected in 48 patients (77%), a severe MAC in 16 patients (26%). CT analysis was more accurate in defining the presence and extent of MAC. Patients with MAC were more female, older in age, with greater cardiovascular risk profile and comorbidities; they presented more frequently mitral valvulopathy and arrhythmias. These differences were amplified by stratifying the population according to MAC severity score. Patients with severe MAC had a pattern of ventricular remodeling with predominantly concentric hypertrophy. Post–TAVI, patients with severe MAC had less hemodynamic benefit and a greater need for pacemaker implantation. A trend of increasing all–cause mortality as MAC score increased was noted.

Conclusions
Assessment of mitral annular calcium and its extension should become an integral part of the patient‘s pre–TAVI risk stratification process. A phenotypic pattern of concentric left ventricular hypertrophy, mainly associated with patients with severe MAC, identifies a category with lower post procedural recovery.
P20 LOOK BEYOND APPEARANCES:NOT ONLY A SIMPLE AORTIC ENDOCARDITIS
Authors: Verrengia E , Pezzi L , Addari M , Caprio M , Genovesi E , D’Alleva A , Magnano R , Forlani D , Fulgenzi F , Vitulli P , Di Marco M , Paloscia L 
Published: May 2023

Abstract
Infective endocarditis (IE) refers to the colonization of cardiac valve endocardium by virulent microorganisms. It is the fourth leading cause of life–threatening infectious disease syndrome, if not efficiently diagnosed and treated. The three most common causes of IE on native valves (from the most to the least frequent) are Staphylococci, Streptococci and Enterococci. Enterococcus related IE are often associated to endoscopic procedures involving the digestive tract. The most remarkable structural complications associated with IE are: cusp or leaflet rupture, perforation, aneurysm/pseudoaneurysm, fistula, abscess, embolization. The usual final consequences of these lesions are severe valve regurgitation and heart failure.A 74 years old male patient with no history of heart disease, presented to the hospital with orthopnoea and periferal edema, consistent with acute heart failure.Few months before he underwent a routine colonscopy. Transthoracic echocardiography revealed a mildly reduced ejection fraction and the presence of a little, mobile mass on the aortic valve, suggestive of vegetation, associated with a severe aortic regurgitation. The diagnosis was confirmed thanks to a transesophageal echocardiogram that represents the technique of choice for the diagnosis of endocarditis and for detecting eventual perivalvular extention; it documented the presence of an endocarditic vegetation protruting in the LVOT, complicated by a pseudoaneurysm, identified as a pulsatile perivalvular echo free–space with colour doppler flow inside. Successively, a specific antibiotic therapy was started because of the positivity of blood cultures for Enterococcus Faecalis. After performing a thoracic computed tomography that showed the presence of “plus image" at the level of aortic valvular plane, particularly between the right coronary and non–coronary cusp, consistent firstly with a pseudoaneurysm, the patient underwent urgent cardiac surgery with the removal of the vegetations and the implantion of an aortic valve bioprosthesis after the apposition of bovine pericardial patches for repairing aortic wall’s lacerations. A post–operative transesophageal echocardiogram revealed a good result with a mild paravalvular leak. Pseudoaneurysm and severe valvular regurgitation are among the major causes of acute heart failure in the setting of infective endocarditis. In such cases, surgery should be considered to decrease mortality.
P22 AN UNEXPECTED DIAGNOSIS; GEMELLA MORBILLORUM, A POORLY KNOWN KILLER
Authors: Cozza E , Bellin A , Videsott L , Cutolo A , Temistoclakis S 
Published: May 2023

Abstract
58–year–old woman, previous smoking habit. In medical history holosystolic murmur since childhood. At echocardiogram performed in 2019: "VS with preserved FE, mild–to–moderate IA, likely perimembranous DIV." No major comorbidities. In June 2021, she was admitted to the Mestre NICU for paroxysmal complete atrioventricular block. On echocardiogram, mild worsening of IA was described, with a sub–valvular shunt and doubtful aortic bicuspidia. At 24 hours after admission, the patient underwent definitive bicameral PM implantation. In light of the clinical and echocardiographic suspicious, we began to think of a possible organic genesis of the event; a hypothesis supported by the finding of serotin fever and a dental examination with dental hygiene that the patient reported having performed a month earlier. So, on suspicion of an infectious genesis, cold blood cultures were requested and found to be positive for Gemella Morbillorum. The endocarditis hypothesis was confirmed by performing a TE echo and PET/CT scan. Antibiotic therapy was then set up, and an infectious source was subsequently searched for, through a CT scan of the dental arches, which was positive for foci of periodontopathy, and through a rectosigmoidocolonoscopy finding an adenoma with high–grade dysplasia. HOT TOPIC: infective endocarditis is a disease with a high risk of mortality and complications. Among the complications, conduction disturbances are relatively rare. A–V block is often paroxysmal, driven by inflammation, and therefore potentially reversible. Hence, the paramount importance of performing a thorough echocardiogram and resolving any suspicions before referring the patient for definitive device implantation. The case also turns out to be particularly interesting not only for the onset of symptomatology but also for the etiology of the latter. In fact, the microorganism responsible is not among the most frequent germs but represents a rare cause of which there are few cases described in the literature. The main infectious source in humans is the dental system, but several studies have shown a correlation between Gemella morbillorum and rectal colon cancer. Ultimately, the above case represents a typical example of how a "easy" hospitalization for a conduction disorder can actually reveal a much more complex pathology.
P27 DOPPLER ULTRASOUND SELECTION AND FOLLOW–UP OF THE INTERNAL MAMMARY ARTERY AS CORONARY GRAFT
Authors: Scicchitano P , De Palo M , Gesualdo M , Trotta F , Sanasi M , Piscopo A , Pignatelli A , Pinto M , Caldarola P , Ciccone M 
Published: May 2023

Abstract
The impact of coronary artery disease (CAD) on all–cause mortality and overall disabilities is well–established. Percutaneous and/or surgical coronary revascularization procedures dramatically reduced the occurrence of adverse cardiovascular events in patients suffering with atherosclerosis. Specifically, guidelines from the European Society of Cardiology on the management of myocardial revascularization promoted coronary artery by–pass graft (CABG) intervention in patients with specific alterations in coronary tree due to higher beneficial effects of this procedure as compared to percutaneous one. Left internal mammary artery (LIMA) is one of the best–performing vessels in CABG procedures due to its location and its own structural characteristics. Nevertheless, non–invasive assessment of its patency is challenging. Doppler Ultrasonography (DU) might perform as a reliable technique for non–invasive evaluation of the patency of LIMA. Data from literature revealed that DU may detect severe (&gt;70%) stenosis of the LIMA graft. In this case, pulsed–wave Doppler might show peak diastolic velocity/peak systolic velocity &lt; 0.5 and diastolic fraction &lt; 50%). Stress test might also be adopted for the evaluation of patency of LIMA through DU. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow–up after CABG intervention. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow–up after CABG intervention.
P28 CONVERSION TO OPEN SURGERY FOR COMPLICATED TAVI: STILL FUTILE?
Authors: Petrini F , Paduvakis I , Cerillo A , Stefano P 
Published: May 2023

Abstract

Background and aim
Mechanical complications of TAVI may be catastrophic, and conversion to open surgery in this context has been associated with an extremely poor prognosis, with a mortality close to 50%. We report our recent experience on 9 patients requiring cardiac surgery during TAVI. Patients and methods: 9 patients undergoing various transcatheter procedures at a high volume centre required cardiac surgery for valve misplacement (2), valve embolization (2), annular rupture (3), acute coronary occlusion (1) and aortic dissection (1). Four patients were initially treated by a hybrid team including a cardiac surgeon performing transcatheter procedures (3 TAVI in NAVR and one transseptal Mitral VIV), while five were performed by an interventional cardiology team (all TAVI).

Results
The complications and the surgical procedures performed are reported in the table. Four patients underwent immediate conversion in the hybrid room, 3 underwent delayed conversion and two were managed conservatively. Eight patients survived and were discharged from the hospital. The only patient dying was a TAVI patient having aortic valve embolization. A second transcatheter valve was deployed too ventricular. The patient had cardiac arrest needing CRP and the surgical team was called to start ECMO assistance several minutes after the initial complication. Comment: Our small series suggests that prompt conversion to open surgery, especially if performed immediately by surgeons that were initially involved in the transcatheter procedure, might offer excellent results. We believe that hybrid teams may offer a significant benefit, especially in low–risk patients and during complex or off–label procedures.
P29 LVOTO IN HCM: HYBRID TREATMENT MAY STILL NOT SOLVE CHALLENGING CASES
Authors: Federico F , Marcolin C , Stella S , Biondi F , Ancona F , Ingallina G , Tavernese A , Margonato D , Belli M , Agricola E , Slavich M , Buzzatti N , Belluschi I , Maisano F 
Published: May 2023

Abstract
MA, a 28 years old male with a diagnosis of OHCM since 2008, came to our attention for effort dyspnea (NYHA II) and fatigue limiting his greengrocer activity. Decompensated T1DM (HbA1C 12%), HTN, obesity (BMI 37). In 2017 he implanted a bicameral ICD in primary prevention, later extracted for sepsis and replaced with S–ICD. In the last 2 years he had 3–4 episodes of FAP, the latter causing an AHF requiring hospitalization in ICU. CV therapy: metoprolol 100 mg bid; disopyramide 100 mg x 3; rivaroxaban 20 mg die, insulin. Resting ECG: sinus bradycardia, HR 50 bpm, LVH with secondary repolarization abnormalities, long QTc (&gt;500 ms). At basal and stress echocardiography (Fig. 1) he had a maximum wall thickness at medium IVS of 21 mm and severe dynamic obstruction due to complete SAM (Gmax 50 –&gt; 135 mmHg); moderate mitral regurgitation, secondary to SAM, with eccentric jet; worsening of obstruction and MR at peak of stress (Gmax 145 mmHg; MR 3+); absence of pulmonary hypertension; severe left atrial dilatation (53ml/mq). He was considered not eligible for Morrow myectomy due to unfavorable anatomy (basal IVS of 11–14 mm, maximum thickness at medium IVS). Mitral valve area was &gt; 4cmq. After Heart Team evaluation the patient was proposed for a reparative approach of mitral valve, and TEER was preferred to open surgery for favorable anatomy and to avoid an increased peri–operative risk in a patient with different comorbidities. The procedure was successfully conducted with the implantation of 1 MitraClip (MITRACLIP® Evalve – Abbott) in central position, with echocardiographic evidence (Fig. 2) of complete SAM resolution, reduction of MR to 1+ and gradient abolition (13 mmHg post–Valsalva maneuver). MVA at intraoperative TEE: &gt;2 cmq. At six–months follow–up the patient reported a satisfactory reduction of symptoms without limitations in non–agonist physical activity and work, yet he still was not asymptomatic. Although on best medical treatment and after TEER, transthoracic echocardiographic control showed a recurrence of SAM and LVOTO (40 mmHg at basal, 70 mm Hg post – Valsalva maneuver). He is still candidate to myosin inhibition treatment. This case highlights the multiple challenges of LVOTO in HCM patients. Although a hybrid approach may be a promising treatment of OHCM, especially in youngers, an increase of expertise in this field and further research is needed, focusing on predictors of procedural failure and success.
P31 A RARE CASE OF PERSISTENT ECG CHANGES AT STRESS TEST
Authors: Guerri E , Navazio A , Quinto S , Conti M 
Published: May 2023

Abstract

Background
Cardiac lipomas are rare benign tumors. They carry usually a good prognosis and are often an incidental finding of cardiovascular imaging exams for cardiac evaluations.

Methods
We present a case of left ventricular intramyocardial lipoma detected during the work–up for a positive stress test.

Results
This case report involves a 55–year–old male, light smoker, with a history of glucose intolerance. Height 190 cm; weight 90 kg; BMI 24.93 kg/m2 He has always played sports and since the age of 16 he performed serial cardiological assessments and stress test for competitive fitness. Already from the first evaluation the ergometric test was markedly pathological (ST segment depression greater than 1 mm in leads V3 to V6), in absence of symptoms. The subsequent diagnostic exams performed (including an exercise myocardial scintigraphy) excluded ischemic aetiology. Competitive fitness has always been reconfirmed for many years. He also performed repeated holter–ECG in absence of any arrhythmias. He was admitted because of a routine check–up. A new stress test (ECG stress test) resulted positive for ECG changes and clinically negative (fig 1) Cardiac MRI demonstrated a small intramyocardial "round like" mass of about 7 mm, located on the middle–distal segment of the left ventricle lateral wall; MRI signals were consistent with a lipom: no evidenced of delayed enanchement (fig 2) and T1 weighted scans assessed perfusion lack of the mass (fig 3). Computed tomography confirmed this diagnosis; the coronary angiography excluded significant coronary artery stenosis.

Conclusion
We hypnotize that cardiac lipoma in our patient caused persistent ST changes at stress ECG since young age
P32 PERSISTENT ISOLATED LEFT SUPERIOR VENA CAVA ASSOCIATED WITH BICUSPID AORTIC VALVE
Authors: Faleburle A , Cosmi D , Pagnotta F , Buccolieri M , Capponi E , Cardona A , Cardile M , Di Pasquale T , Martinelli S , Ray L , Piccioni N , Murrone A , Cappannelli S 
Published: May 2023

Abstract
Persistent left superior vena cava (VCSSP) is the most frequent systemic venous return anomaly. It often occurs during right heart catheterization (0.1%) and is associated with right superior vena cava aplasia in 10 to 33%. It can lead to the development of a left superior venous system mirroring the normal right return. It runs between the pulmonary veins and the left auricle, to join the coronary sinus. Sometimes the coronary sinus does not communicate directly with the right atrium but drains into the VCSS. An increased incidence of arrhythmias has also been reported in the presence of venous drainage abnormalities. Its discovery has implications as it can create difficulties in the insertion of central venous catheters, cardiac surgery, thoracic and PMK implantation.VCSSP in the absence of the right superior vena cava (VCSD) is a rare congenital anomaly.

Clinical case
An 18–year–old soccer player came to our observation for an episode of presyncope and palpitations during a soccer match. The ECG showed sinus rhythm and incomplete right bundle branch block. The echocardiogram showed a bicuspid aortic valve and significant dilatation of the coronary sinus, with suspicion of persistence of the left superior vena cava. Cardiac MRI showed an isolated persistent left superior vena cava along the left mediastinum and extending it connected with the coronary sinus, which in turn drained into the right atrium. There was no evidence of LGE in the late sequences.

Discussion
VCSSP does not constitute a hemodynamic problem if isolated. The presence of VCSSP in the absence of right superior vena cava (VCSD) is in itself an occurrence rarely described in the literature. The anomalies most frequently associated with the presence of a VCSSP are the Atrial septal defect of the sinus venosus type and tetralogy of Fallot. Rare cases of association with aortic valve bicuspid have also been reported.In patients with VCSSP and absence of VCSD, the coexistence of impulse formation and impulse conduction disorders associated with histological alterations such as fragmentation and stretching of the specific conduction tissue and of the atrioventricular node has been described. The abnormal development can also induce sinus node alterations resulting in sinus dysfunction. In our case, no conduction anomalies or arrhythmias were described
P34 TAKOTSUBO SYNDROME OR UNKNOWN MYOCARDIAL ISCHEMIA? THE ROLE OF CARDIAC MAGNETIC RESONANCE IN DIFFERENTIAL DIAGNOSIS
Authors: Citarelli G , De Feo D , D’ Alessandro M , De Laura D , De Gennaro L , Rutigliano D , Basso P , Locuratolo N , Ficco M , Grimaldi V , D’ Aprile P , Caldarola P 
Published: May 2023

Abstract
There are numerous clinical conditions in which symptoms and signs may overlap, among these myocardial Ischemia in the absence of obstructive coronaropathy (INOCA/MINOCA), gets into differential diagnosis with a plethora of clinical pictures such as Takotsubo syndrome, myocarditis and cardiomyopathies. In this setting, cardiac magnetic resonance has a critical discriminating role. Herein we report the clinical case of a 52–year old patient suffering from hypertension and dyslipidaemia, with a history of chest pain episodes and recent intense psychophysical stress. After symptoms exacerbation, ambulance was called, loss of conscience was witnessed, observing ventricular fibrillation, subjected to prompt DC shock. Once in Emergency room, ECG showed ST–elevation in V1, V2 and AVR for which urgent coronary angiography was performed. It surprisingly resulted negative for epicardial coronary artery disease. Moderate left ventricular dysfunction (LVEF 45%) was found on 2D ultrasound along with apex akinesia, while mild elevation myocardial necrosis enzymes was seen at blood tests. The clinical picture characterized by female sex, history of psychophysical stress, by association of chest pain, ischemic type alterations of repolarization at ECG, akinesia of the apex and the concomitant slight elevation of myocardial necrosis enzymes in the absence of epicardial coronary lesions, highly suggested Tako–Tsubo Syndrome. In order to confirm the diagnosis, cardiac MRI was performed which, unexpectedly, showed the presence of oedema on T2–weighted STIR sequences at the level of the left ventricular apex, associated to same site transmural fibrosis at post–contrast imaging sequences, thus eliciting the hypothesis of a MINOCA. After a new retrosternal pain with transient ST–elevation in V1, a IVUS – guided new coronary angiography examination was performed, resulting intoIVA diffuse coronary spasm, reduced after intravenous nitrate administration. Final diagnosis was “MINOCA complicated by primary VF‘‘ and a subcutaneous AICD implant CMR imaging by virtue of its ability to provide information about cardiac structure and function and simultaneously, to define the characterization of tissues, together with the data of dynamic coronary spasm, proved to be essential in this case to establish the diagnosis, often misunderstood, of MINOCA, hence allowing to define the best therapeutic strategy. ​
P44 IMPROVEMENT OF THE LEFT VENTRICULAR CONTRACTILE RESERVE IN PATIENTS UNDERGOING MITRAL VALVE PLASTIC CARDIAC SURGERY
Authors: Tassone E , Carullo G , Morabito G , Valiante G , Leonetti S , Maselli D 
Published: May 2023

Abstract
Mitral Regurgitation (MR) is a clinical condition characterized by a high morbidity and mortality in severe or moderate forms complicated by hemodynamic instability, that often finds a solution only in the reparative surgical treatment. MR is often caused the presence of myxomatous degeneration that affects one or more structures of the valve apparatus, causing the prolapse of one or both leaflets. Surgical treatment can improve the hemodynamic parameters and consequently the prognosis of the patients, even though there is not still data concerning the myocardial contractile reserve. The aim of the study was to evaluate the effect of MR reparative surgery on the left ventricular contractile reserve during physical stress echocardiography. We enrolled 12 patients, 8 females and 4 males, affected by MR candidate to cardiac surgery. We performed a physical stress–echo test by using the ABCDE protocol suggested by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), before and after approximately 12 weeks from cardiac surgery. After each test, the prognostic score deriving from the sum of the ABCDE criteria was calculated; in addition, we measured the left ventricular contractile reserve (C parameter of the score) that represents a parameter of the force deriving from the hemodynamic changes during the test. In all patients we observed a significant improvement in the ABCDE prognostic score after cardiac surgery (3.89 + 0.43 vs 3.18 + 0.37; p = 0.002). There were no significant changes in ejection fraction, indexed left atrial volume, wall motion score index–WMSI (A parameter), coronary reserve (D parameter), and heart rate reserve (E parameter). The most relevant data concerns the increase in the left ventricular contractile reserve at 3 months after cardiac surgery (1.77 mmHg/ml vs 2.44 mmHg/ml, p&lt;0.0001). Furthermore, a significant reduction in pulmonary congestion during stress was observed (B parameter). These data demonstrate for the first time that mitral valve plastic surgery is able to improve the left ventricular contractile reserve in patients with severe MR. Furthermore, the surgical procedure determined both a reduction in the degree of pulmonary congestion and an improvement in the ABCDE prognostic score during physical stress echocardiography.