bluuebunny/crossref_metadata_2025_split huggingface dataset:
P70 ESPERIENZA CLINICA DELLE PRIME 41 PROCEDURE DI LITOTRISSIA INTRACORONARICA IN UN CATH–LAB ITALIANO
Authors: Barbero U , Pavani M , Moncalvo C , Ajassa M , De Benedictis M 
Published: May 2022

Abstract

Introduction
Stent under expansion is one of the main predictors of percutaneous coronary intervention (PCI) failure, being a trigger for both in–stent restenosis and stent thrombosis, with their obvious clinical impact. Among the main causes of stent failure, the presence of a severely calcified lesion is the most frequent and dangerous. Correct recognition and preparation of target lesion are therefore mandatory before stenting.

Methods
We enrolled all the patients treated with angioplasty and IVL (Shockwave Medical Inc, Santa Clara, USA) from October 2020 to October 2021 in our cath lab. Each patient signed informed consent.

Results
We enrolled 35 patients (with 41 lesions treated with IVL). Mean age was 73 years old, 29 were males (82%). Clinical characteristics are shown in the table. Twenty–one lesions (50%) were treated up–stream before stenting, 6 (16%) were bail–out IVL for inadequate stent expansion after post–dilation and 14 (37%) were in–stent restenosis with evidence of stent under–expansion because of the high burden of calcium. Fifty–four per cent of patients were treated in the context of Acute Coronary Syndrome (ACS). Seventy–three per cent of patient had three–vessel disease. The majority of procedure were done through radial access (74%) and 79% of the stenosis was prepared with NC balloons (at least 2.5 mm diameter) before deployment of the IVL balloon; in 2 case IVL was done after rotational atherectomy. Intravascular ultrasound (IVUS) guidance was used in in 15 pts. Two balloon were broken during lithotripsy. In 26 of 41 stenosis (63%) IVL delivery was obtained on a single wire, while 11 required buddy–wire (of whom 8 required child–in–mother technique to obtain adequate support for delivery). We had two major complications: 1 case of ventricular fibrillation (in a patients with recent myocardial infarction and severe reduction of ejection fraction, and 1 case of perforation at the time of inflation of the NC balloon after IVL easily treated with positioning of a covered stent which was easily delivered thanks to the previous IVL treatment).

Conclusion
IVL is a safe and all–around technique for treatment of severely calcified lesion in different clinical contexts from stable coronary artery disease to ACS, useful for upstream calcium treatment as well as bail–out stent optimization and correction of under expansion in calcified in–stent restenosis.
P87 MEDIASTINAL SYNDROME REVEALED HEART LOCALIZATION OF A PRIMARY MEDIASTINAL B–CELL LYMPHOMA
Authors: Branca E , Cicco S , Susca N , Longo L , Albanese F , Pappagallo F , Giliberti T , Morelli C , Dell‘Atti C , Ingravallo G , Prete M , Solimando A , Lauletta G , Vacca A , Ria R 
Published: May 2022

Abstract

Background
Primary mediastinal B–cell lymphoma (PMBCL) is an aggressive B–cell lymphoma that represents 2–3% of non –Hodgkin lymphoma cases and typically affects young adult Caucasian women. Diagnosis can be difficult and often need a multidisciplinary approach.

Case
a 75 year old female, with history of hypertension, came to ER for severe dyspnea. She complains also neck and left arm oedema. Blue swelling of face and trunk were described. Heart PoCUS was inconclusive, describing only a hypoechoic dilation of right atrium while the other three heart chambers were reduced in dimensions. Chest TC revealed a huge mediastinal mass next to a thrombosis of superior cava vein and right atrium (7 cm diameter) and a diffuse subsegmental pulmonary embolism. Arm and neck Lymphnodes were also enlarged . Low molecular weight heparin was given twice a day. Due the respiratory failure a high–flow nasal cannula oxygen treatment was performed. PET revealed FDG uptake in antero–superior mediastinum, but there was the same uptake in heart right atrium without a connection with the previous described. Therefore, this was no more considered as thrombus but as mass. The micro–bubble test revealed right to left shunt. She refused heart MRI. The patient was not suitable for an open–surgery biopsy, thus she was scheduled for a TC guided one, in order to obtain a pathological diagnosis for a suspected right atrium sarcoma. Due to the high risk we choose to perform the less invasive as possible way to have a histological sample. Thus, and intravascular biopsy of atrial mass by femoral vein was performed. The patient did not present any sequelae after procedure and she continued anticoagulation. The subsequent histological analysis revealed a PMBCL with a primary localization in Right atrium. Unfortunately, a sepsis by multiple resistant pseudomonas Aeruginosa and Aspergillus spp. arose and the patient died three weeks after biopsy.

Conclusion
A PMBCL is a rare and aggressive disease. Like in our patient, mediastinal syndrome is often associated to the disease. However, intracardiac localization are even rarer events. In large case series, less than 1% of intracardiac masses were lymphomas. In our patient, open–surgery was not suitable for multiple comorbidities. However, intravascular approach was less aggressive but effective to obtain enough tissue for diagnosis. Unfortunately, the immune suppression related to PMBCL and opportunistic infections drive a mortal sepsis.
P105 A MARBLE IN THE HEART: A MYSTERIOUS MITRAL MASS
Authors: Cosmi D , Buccolieri M , Capponi E , Di Pasquale T , Da Col U , Murrone A 
Published: May 2022

Abstract
A 70–year–old woman came to our observation for acute heart failure during atrial fibrillation with high ventricular response. In the medical history she presented a previous radiofrequency ablation of paroxysmal supraventricular tachycardia, a previous episode of atrial fibrillation treated with electrical cardioversion, two hospitalizations for transient ischemic attack (TIA), the last two months before hospitalization . The patient had always refused the introduction of oral anticoagulant therapy. The transthoracic echocardiogram showed a rounded formation, with regular margins, of 20x19 mm, isoechoic and poorly mobile, adhered to the atrial side of the annulus and the posterior mitral flap, confirmed by the transesophageal echocardiogram (Fig 1,2,3). The formation did not result in mitral obstruction or significant mitral regurgitation. The left atrium appeared markedly dilated, with moderate spontaneous echo inside. In the left appendage there was no thrombus, and there were no other relevant findings. Markers of inflammation and serial blood cultures taken during hospitalization were negative, so bacterial endocarditis appeared unlikely. Mixoma or fibroelastoma appeared to be the most likely diagnosis. In consideration of the high risk of embolization and to clarify the diagnosis, the patient underwent cardiac surgery with exeresis of the formation (Fig 4–5), subsequent quadrangular resection of the posterior mitral flap, sliding and mitral annuloplasty. Macroscopically, the mass appeared brownish–red, with a smooth surface, solid and compact consistency. The histological analysis showed red blood cells and platelets mixed with vessels and granulation tissue; the wall of the mass was made up of connective tissue. Based on the findings, the differential diagnosis was between a blood cyst or a native mitral valve thrombosis. Blood cysts are generally congenital and disappear spontaneously in childhood, rarely occurring in adults. They are fluid or semi–fluid formations, and ultrasonographically they appear as masses with anechoic or hypoechoic content, surrounded by a thin wall. Thrombosis on native mitral valve is also an infrequent event, but described in literature, particularly in the presence of hypercoagulative states, mitral stenosis, atrial fibrillation. Based on the characteristics of the mass, we believe that the most likely hypothesis is that of a rare case of thrombosis on a native mitral valve.
P118 THE ROLE OF PULMONARY ACT IN THE PATIENT WITH SARS–COV–2 INFECTION
Authors: Bava A , Zema D , Zito C , Benedetto F 
Published: May 2022

Abstract
Already from the first data in China it emerged that patients with cardiovascular comorbidities had an increased risk of contracting SARS–CoV–2 infection and a more unfavourable clinical course. From March to May 2020, 85 patients affected by COVID–19 were enrolled, hospitalized at the Hospital of Reggio Calabria. All patients underwent anamnesis, clinical evaluation, chest CT, ECG and measurement of markers of cardiovascular damage (Troponin I, CK–MB, LDH, D–dimer, BNP) and of inflammation (PCR, IL–6, and PCT). Thirty–one patients underwent echocardiography. In particular, we evaluated parietal dimensions and thicknesses, biventricular function and transvalvular tricuspid and pulmonary flows and correlated the data obtained with ECG, radiological, clinical, and biohumoral parameters. The aim of our study was to evaluate the prognostic impact of cardiovascular involvement in COVID– 19, investigating the effect of cardiovascular risk factors, levels of cardiovascular damage markers and newly emerging ECG and echocardiographic changes on a composite primary endpoint, consisting of the combination of death and the need for intensive care (ICU). The enrolled patients were divided into two subpopulations: those with better prognosis and those with poorer prognosis (ICU/exitus). We analysed the reciprocal correlation of each of the parameters and searched for the presence of echocardiographic signs of repercussion on the right sections of the pulmonary pathology. All markers of cardiovascular damage had significantly higher values in the most critically ill patients and similar behaviour had indices of inflammation. Patients with poorer prognosis had significantly lower lung AcT values, which correlated with higher D–dimer levels and more complicated hospital stays. There were no statistically significant differences between PAPs, right ventricular size, TAPSE and pulmonary trunk diameter in the two subpopulations. Larger right ventricular diameters were associated with more dilated lung trunks and higher IL–6 levels. The most interesting data of our study is the behaviour of pulmonary AcT: lower values of AcT were associated with higher levels of D–dimer, expression of a greater pulmonary microthrombotic burden, and a poorer prognosis, in the presence of PAPs normal. The dynamic analysis of this parameter, which is easy to calculate in the patient’s bed, can play a crucial role in the instrumental follow–up of patients hospitalized for SARS–CoV–2 infection.
P124 ECOCARDIOGRAPHIC DIAGNOSIS OF TYPE A AORTIC DISSECTION
Authors: D‘Agostino S , Gizzi G , Parato V 
Published: May 2022

Abstract

Clinical case
In August 2021, an 89–year–old woman with no previous cardiovascular history, suffering from systemic arterial hypertension under pharmacological treatment, dyslipidemia and M. di Parkinson came to our observation for syncopal episode. The clinical presentation was characterized by a syncopal episode in the absence of prodromes and reported chest pain upon awakening. At the time of arrival in PS the patient was alert, attentive, and oriented, asymptomatic, hemodynamically stable with PAS 90 mmHg, with normo–iso–sphygmic peripheral pulses. A cardiological evaluation was requested and the transthoracic echocardiography revealed dissection of the proximal ascending aorta with evidence of intimal flap starting from the aortic root and extending to the proximal tract of the aortic arch, moderate aortic valve insufficiency and moderate circumferential pericardial effusion (2 cm), with the presence of blood clots, in the absence of signs of hemodynamic compromise. CT angiography confirmed Stanford type A aortic dissection with intimal flap originating in the supravalvular site (maximum diameter 6 cm), longitudinally extended for about 6 cm at the level of the ascending aorta until the emergence of the epiaortic vessels which were not involved. Consequently, cardiac surgery teleconsultation was required which, based on the patient‘s advanced age, did not allow surgical treatment due to a prohibitive operative risk, considered comparable to the natural course of the disease. The patient was then admitted to intensive care where remained asymptomatic and in cardio–circulatory compensation until death occurred on the third day due to cardio–circulatory arrest from PEA.

Conclusions
Aortic dissection is a high–mortality condition that requires an immediate diagnostic–therapeutic approach. In the diagnostic process, transthoracic echocardiography represents the most promptly performed examination and not infrequently allows the diagnosis before radiological confirmation by angioTC.
P160 RIGHT SISTEMIC VENTRICLE AND PREGNANCY
Authors: Urru M , Orrù L , Stara R , Congia M , Marini E , Scano F , Campagnolo A , Marini A , Montis S , Tumbarello R 
Published: May 2022

Abstract
Patient with complex congenital heart disease: situs inversus with dextrocardia and transposition of the great vessels (D–TGA), right aortic arch and inferior cava agenesis with azygos continuation; at 4 months Mustard atrial switch (intratrial baffle for redirection of the systemic venous circulation in the left subpulmonary left ventricle and of the pulmonary venous circulation in the right subaortic systemic ventricle). At 22 years, 1st pregnancy without complications, caesarean section, birth weight 2.2 kg. Two pregnancies spontaneously terminated in the firts trimester. At 29 years echocardiography: right systemic ventricle hypertrophic, dilated and slightly hypokinetic with tricuspid (systemic) valve with mild to moderate insufficiency; Mustard circuit normally functioning on the systemic side, mild stenosis of the pulmonary buffle (Gmax 6mmHg). At 33 years monochorionic biamniotic twins pregnancy; the risk linked to pregnancy for the patient on the basis of her heart disease was included in a WHO class III worsened by twinning. Because of the high probability of maternal and fetal complications related to the continuation of pregnancy, it was necessary to recommend a selective interruption of the pregnancy of the fetus affected by severe selective underdevelopment with signs of twin to twin transfusion at the 20th week of gestation. Maternal clinical and haemodynamic conditions have been stable during pregnancy. At the 24th week of gestation echocardiography: worsening of the systemic right function ventricle, moderate tricuspid insufficiency and increased gradients in the Mustard circuit (systemic Gmax 13mmHg and pulmonary venous Gmed 8mmHg). After the pregnancy team‘s discussion, a delivery plan was proposed to transfer the patient to a third level cardiac surgery center with experience in congenital heart disease adult between the 35th and 36th week. This was not possible because the patient at 32th week presented preterm labor with caesarean section without maternal and newborn complications (birth weight 1,650 kg). In the puerperium ehocardiography: hypertrophic, dilated and moderately hypokinetic systemic right ventricle with moderate tricuspid insufficiency; Mustard circuit: systemic baffle max gradient 16mmHg and pulmonary venous medium gradient 9mmHg. 7 years after this pregnancy at the last visit: stable clinical and echocardiographic situation with persistence of moderate dysfunction of the systemic right ventricle.
P175 ELECTROCARDIOGRAPHIC ELEMENTS ASSOCIATED WITH ARRHYTHMIC RISK IN BRUGADA SYNDROME
Authors: Berloni M , Di Domenico A , De Carolis B , Canovi L , Vitali F , Bertini M , Guardigli G , Balla C 
Published: May 2022

Abstract

Introduction
Brugada syndrome is an inherited disease characterized by an increased arrhythmic risk and sudden death. The type 1 ECG pattern is the only standard required to make a diagnosis but the stratification of arrhythmic risk remains a controversial element. Some electrocardiographic signs have been described as associated with an increased arrhythmic risk. We present a case of Brugada Syndrome in which different electrocardiographic elements of incremental risk could have predicted the later evolution of the clinical case.

Clinical Case
A 68–year–old male patient with family history of sudden cardiac death (brother 51aa) and occasional finding of Brugada type 1 ECG pattern (2009), implanted with Medtronic bicameral ICD device in primary prevention. The electrocardiogram shows type 1 Brugada pattern in the right precordials with characteristic ST–elevation, followed by a concave ST segment, one of the signs of association with an increased arrhythmic risk; first–degree AV block with a long PR (323 msec) associated with the presence of the SCN5A mutation and an increased risk of arrhythmic events and sudden cardiac death; in the end a fragmented QRS in V2 with extended duration (153 ms). At the next follow–up the patient had some episodes of arrhythmic storm, effectively treated by the device; in consideration of the arrhythmic burden, he was subjected to epicardial ablation and was also subjected to genetic analysis that was positive for pathological mutation on the SCN5A gene (SCN5A ex 22: c.3929C&gt;T;p.Pro1310Leu).

Conclusions
Brugada Syndrome can be diagnosed from the type 1 ECG pattern, but the current risk stratification score remains a controversial element. Electrocardiographic signs of malignancy can contribute to create a multiparametric evaluation of the patient in order to predict future arrhythmic events. Fig 1. ECG: RS 74 bpm, first–degree AV block (PR 323 msec), BFA, Brugada type 1 pattern (QRS 153 ms), fragmented QRS in V2. Fig. 2 Family tree.
P186 PROLONGED ASYSTOLIA REQUIRING CRP ON THERAPY WITH TICAGRELOR AND CYCLOSPORINE
Authors: Stucchi M , Lazzarotti M , Sacchi R , Cirò A 
Published: May 2022

Abstract
64–year–old man, from SriLanka, affected by arterial hypertension, complicated diabetes mellitus (retinopathy, vasculopathy, peripheral neuropathy) and chronic kidney injury in hemodialysis. Liver transplantation for hepatocarcinoma due to alcholic cirrhosis required cyclosporine as immunosuppressive agent. He also suffered from chronic multifactorial anemia and mild thrombocytopenia. Home therapy included atenolol 50mg, clonidine, lercanidipine, insulin, kayexalate, cyclosporine. He was admitted in ED for a chest pain during hemodialysis, associated with high blood pressure values and lateral ST–depression on ECG. Iv nitroglycerin relieved symtoms and normalized the repolarization. Echocardiogram showed a concentric ventricular hypertrophy, without wall motion changes or significant valvulopathy. Laboratory tests detected the known anemia, thrombocytopenia (Hb 9.6g/dl, PLT 100x109/L) and renal injury (creat 10mg/dl, K + 5.1mmol/L) with a stable rise of troponin T hs 80pg/ml (n.v.&lt;14). Aspirin and ticagrelor 180mg were administered and Patient admitted for unstable angina. Coronary angiography (femoral approach) was performed and revealed a critical stenosis of proximal IVA with subocclusion of diagonal branch; no other significant lesion was detected. Coronary artery disease was effectively treated by PCI with 2 DES. During the 2nd day of hospitalization an asystolia up to 10” occurred and atenolol was stopped. The next day, he had a new diurnal sinus arrest, lasting about 40”; external pacing had no efficacy. After CPR, he had a ROSC with recovery of sinus rhythm. No electrolyte alteration or ischemic recurrences. Aminophylline was started and ticagrelor was suspended for possible side effect enhanced by interaction with cyclosporine; shift to clopidogrel was made. No recurrence of rhythm alteration occurred neither after aminophylline interruption at 72 hours nor after reintroduction of beta–blocker on the 8th day for sinus tachycardia. Cyclosporinemia was mildly elevated. It’s known that ticagrelor is associated with a higher incidence of bradyarrhythmias mediated by increase in adenosine concentration, but these are mainly asymptomatic and nocturnal. Cyclosporine– ticagrelor interaction, through inhibition of cytochrome P450 (CYP3A4) and P–gp, increased the concentration of ticagrelor and promoted its side effect: in our case prolonged episodes of asystolia requiring CPR, solved by drug withdrawal and aminophylline with target on adenosine receptors.
P224 PRIMITIVE DILATED CARDIOMYOPATHY IN YOUNG MAN NOT ELIGIBLE FOR CARDIAC TRANSPLANTATION: COMBINED USE OF DEFIBRILLATOR, CARDIAC CONTRACTILITY MODULATION (CCM) AND CARILLON
Authors: Verrengia E , Magnano R , D‘Alleva A , Forlani D , Pezzi L , Fulgenzi F , Vitulli P , Paloscia L , Di Marco M 
Published: May 2022

Abstract
Acute heart failure refers to rapid or gradual onset of symptoms and/or signs of chronic heart failure due to precipitating factors. Many patients with heart failure progress into a phase of advanced heart failure, characterized by persistent symptoms despite maximal therapy. Prognosis remains poor, with high 1–year mortality. Prognostic stratification is important to identify the ideal time for referral to an appropriate center capable of providing advanced therapies. We present the case of a 36–year–old black homeless man was admitted to Cardiological intensive care unit for acute heart failure complicated by intermediate–high risk bilateral subsegmentary pulmonary embolism, left endoventricular thrombosis, severe biventricular systolic dysfunction and secondary severe mitral insufficiency. After infusional diuretic and anticoagulant therapy, coronary angiography was performed documenting non–obstructive epicardial coronary arteries. Thereafter the therapy with sacubitril/Valsartan was falled, due to marked hypotension. Due to the high risk of sudden cardiac death, a single–chamber ICD was implanted in primary prevention. He was not eligible for long–term mechanical assistance (VAD) implantation and/or heart transplantation from referral centers, because of the patient‘s precarious psychosocial background. Furthermore, in the fullness of his faculties, the patient refused this possibility for religious reasons. Discharged in fair compensation, after resolution of pulmonary embolism and intracavitary thrombosis, he was again hospitalized for an exacerbation of chronic heart failure. Once labile hemodynamic compensation was reached, a cardiac contractility modulation device (CCM) was positioned, with the aim of improving symptoms. After optimization of therapy, with persistence of severe symptoms despite optimal medical and device therapy, options for intervention on the mitral valve were evaluated before further deterioration of the clinical conditions. Since this is a highly symptomatic patient at high risk for surgery, we opted for a coronary sinus mitral annuloplasty repair with Carillon, performed in the absence of complications. At the follow–up there was a mitral regurgitant volume reduction, improvement symptoms, in the absence of further hospitalizations.