bluuebunny/crossref_metadata_2025_split huggingface dataset:
P73 ANGIOGRAPHY–DERIVED INDEX OF MICROVASCULAR RESISTANCE (IMR–ANGIO) IN TAKOTSUBO SYNDROME
Authors: Castaldi G , Fezzi S , Widmann M , Mammone C , Rizzetto F , Lia M , Prati D , Pighi M , Pesarini G , Tavella D , Scarsini R , Ribichini F 
Published: May 2022

Abstract

Introduction
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through non–invasive angio–derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation.

Methods
41 consecutive TTS patients were retrospectively analyzed. Three different formulas for compute Non–Hyperemic IMRangio (NH–IMRangio) derived by 3D–Quantitative Coronary Angiography (3D–QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was deﬁned as an IMRangio ≥ 25. The correlation between NH–IMRangio and clinical presentation and the comparation between the three formulas were provided.

Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. NH–IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either NH–IMRangio 1 (52.7 vs 35.3 vs 41.4), NH–IMRangio 2 (47.2 vs 31.8 vs 37.3) or NH–IMRangio 3 (52.7 vs 36.1 vs 41.8). All patients presented CMD with NH–IMR angio ≥ 25 in at least one territory with each formula. NH–IMRangio in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH–IMRangio LAD 1: 59.3 vs 46.3, p. value=0.030; NH–IMRangio LAD 2: 52.9 vs 41.4, p–value=0.037; NH–IMRangio LAD 3: 59.2 vs 46.3, p–value=0–035). Association between NH–IMRangio computed in LAD and LVEF showed a moderate correlation (NH–IMRangio 1: r = –0,3485, Rho = 0,1214, p = 0,0256; NH–IMRangio 2: r = –0,3513; Rho = 0,1234, p = 0,0256; NH–IMRangio 3: r = –0,3326, Rho = 0,1106, p = 0,0336). Finally, Bland–Altman plot analysis showed good agreement between NH–IMRangio 1 and 3, while NH–IMRangio 2 showed a consistent bias of –5 units against both NH–IMRangio 1 and NH–IMRangio 2 with increasing difference at higher absolute values.

Conclusion
CMD, assessed with NH–IMRangio, is a common finding in TTS and it is inversely correlate with LVEF dysfunction. The available formulas for NH–IMRangio computation have a substantial superimposable diagnostic performance in assessing CMD.
P76 A ‘PARACHUTE EFFECT’ MOCKINGLY SEALING A SPONTANEOUS CORONARY ARTERY DISSECTION
Authors: Buccheri D , Priolo L , Vinci D , Lombardo R 
Published: May 2022

Abstract
We present a case of a 38–year–old female admitted for Non ST–Elevation Myocardial Infarction. 15 days before the patient experienced an inferior ST–Elevation Myocardial Infarction and underwent primary Percutaneous Coronary Intervention with 2 drug–eluting stent (DES) in the mid–Right Coronary Artery (RCA). At presentation ECG and echocardiogram was negative for myocardial ischemia. For the typical chest pain, an urgent coronary angiography (CA) was performed. The previously stented RCA did not show any significant stenosis but a posterolateral branch appeared occluded at the ostium, with a retrograde flow from the left anterior descending artery. However, suspecting a dissection distally to the stents previously implanted, an Optical Coherence Tomography (OCT) was performed after 2 guidewires placement. The presence of two guidewires and the contrast medium pushing from inside–out caused a ‘sealing effect’ of the intima to the media, hence hiding the presence of dissection. The day after, a new chest pain episode associated with transient ST–segment elevation in the inferior leads warranted a new CA. Another OCT of the RCA was performed, this time using a single guidewire: a clear imaging confirmed the spontaneous coronary artery dissection (SCAD) presence. To have a better understanding of the vessel morphology an Intravascular Ultrasound (IVUS) analysis was carried out and even this imaging modality confirmed the presence of a true and false lumen. The interventional cardiologist decided to treat the dissection with two overlapping drug–eluting stents and a TIMI–3 flow was restored, with the complete resolution of the symptoms The patient was discharged after 5 days with dual antiplatelet therapy and statin. At the 24 month follow–up she was still asymptomatic. SCAD expertise is of utmost importance in recognizing this entity and, perhaps, this is the reason why it is still underdiagnosed, also in view of the frequent absence of hallmarks at CA. This is a case in which a complete imaging evaluation (CA + OCT + IVUS) has discovered and documented a SCAD after a recent stent implantation and in which the exclusive acquisition of angiograms by inexperienced operators could have missed the dissection.
P81 SIMULTANEOUS TRANS–APICAL AORTIC AND MITRAL VALVE IMPLANTATION IN A PATIENT WITH A DEGENERATED MITRAL BIOPROSTHESIS AND SEVERE AORTIC STENOSIS
Authors: D‘Ascoli R , Manzan E , Prestipino F , Innelli P , Cristiano A , Costantino M , Stabile E , Luzi G 
Published: May 2022

Abstract
Transcatheter Valve–in–Valve implantation has shown promising results in high–risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. This is a case of a 82–year–old man, with history of multiple previous mitral valve replacement, admitted to the hospital for heart failure. During diagnostic work out he was diagnosed with a severe aortic stenosis and structural degeneration of a mitral valve bioprostheses Epic 29mm, St Jude Medical, (Inc, St Paul, Minn, USA). The heart team defined the patient at high surgical risk profile and was therefore scheduled for a simultaneous mitral and aortic transcatheter valve implantation. Through a double trans–apical approach (Figure A and B), the patient underwent two balloon expandable valves (Sapien 3, Edwards Lifesciences, Irvine, CA, USA) deployment in native aortic (Figure C) and mitral bioprosthesis (Figure D), respectively. Final angiography showed lack of aortic (Figure E) and left atrial (Figure E) regurgitation. The procedure was uneventful as well as the following hospital stay. Post–procedural transesophageal echocardiography confirmed the absence of paravalvular leakage nor aortic or mitral regurgitation. The patient was discharged at home on day 7. Simultaneous transapical transcatheter aortic and mitral valve replacement is technically feasible with the current available technology and can be a possible alternative in patients with high surgical risk.
P86 IN–HOSPITAL OUTCOMES OF PORTICO TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE FLEXNAV AS COMPARED TO THE FIRST–GENERATION DELIVERY SYSTEM
Authors: Marino G , Rigattieri S , Giovannelli F , Tommasino A , Berni A , Volpe M 
Published: May 2022

Abstract

Introduction
technological advancements in transcatheter heart valve platforms, along with increasing operator experience and careful patient selection, are essential to reach high standards of efficacy and safety in transcatheter aortic valve replacement (TAVR). Aim of this study was to evaluate the performance of the new version of the Portico valve delivery system (FlexNav) as compared to the first–generation device.

Materials and Methods
we report the results of a single–center, observational study on patients with severe aortic valve stenosis undergoing TAVR with the Portico valve at our Institution. Consecutive patients treated with the new FlexNav delivery system (DS), available since May, 2020, were compared with patients treated with the first–generation delivery system (1st Gen–DS). In–hospital outcomes were self–adjudicated according to the Valve Academic Research Consortium–3 definition.

Results
50 patients were included in this study; 22 were treated with the FlexNav–DS and the remaining with the 1st Gen–DS. Clinical characteristics were similar between group, expect for older age (82.6 ± 3.6 vs 80.7 ± 3.8; p = 0.07) and higher prevalence of female gender (68.2% vs 39.3%; p = 0.04) in FlexNav–DS group as compared to 1st Gen–DS group, respectively. We observed similar rates of procedural success but higher rate of moderate–to–severe paravalvular leak in 1st Gen–DS as compared to FlexNav–DS group (28.6% vs 4.6%; p = 0.03); major vascular complications were reduced, although not significantly, in the FlexNav–DS as compared to 1st Gen–DS group (4.5% vs 10.7%; p = 0.64).

Conclusion
Our data suggest that the FlexNav DS, thanks to lower profile and enhanced stability during valve deployment, has the potential to allow for to better procedural and clinical results of TAVR with the Portico valve as compared to the 1st Gen–DS.
P90 LEFT ATRIAL APPENDAGE OCCLUSION AND RIGHT CARDIAC CATHETERIZATION IN PATIENT WITH PORTO–PULMONARY HYPERTENSION AND PERSISTENT ATRIAL FIBRILLATION WITH GASTRO–INTESTINAL BLEEDING IN ORAL ANTICOAGULANT TREATMENT
Authors: Cacciola G , Serra W , Vignali L , Niccoli G , Lina D , Cattabiani M 
Published: May 2022

Abstract
62–year–old male with multiple cardiovascular risk factors.Known pre–capillary porto–pulmonary hypertension treated with Macitentan 10 mg per day, in the context of serum–negative liver disease complicated by portal hypertension and congestive gastropathy.Persistent atrial fibrillation in AVK due to high thromboembolic risk (CHA2DS2VAsc 3).At the last echocardium–TT evidence of worsening of right ventricular systolic function (TAPSE from 20 to 16 mm) and estimated pulmonary hypertension (PAPS from 45 to 65 mmHg). Subsequent hospitalization for severe anemia (Hb 6.5 g/dl), with diagnosis of bleeding angiodysplasias.In consideration of high bleeding risk (HAS–BLED 3), left atrial appendage occlusion has been indicated.The patient underwent right cardiac catheterization, via right femoral vein, with confirmation of severe pulmonary pre–capillary hypertension (mean PAP 45 mmHg, PCWP 14 mmHg); during the same session, left atrial appendage was occluded percutaneously using a Watchman device. At discharge, combination therapy with Riociguat plus Macitentan and single antiplatelet therapy with Clopidogrel 75 mg per day were undertaken. Shortly thereafter, recurrence of gastro–enteric bleeding occurred; after cardiac evaluation, Clopidogrel was discontinued and anticoagulant therapy with Edoxaban 30 mg od was started.The choice of shifting from Clopidogrel to low dose NOAC was guided by the unclear evidence of efficacy and safety of single or dual antiplatelet therapy in a population of patients with both high thrombotic and bleeding risk, such as in this case.Given that NOACs can be considered as an alternative to Warfarin after Watchman implantation (class IIB), after the second recurrence of bleeding, we opted for long–term antithrombotic strategy using a direct oral anticoagulant at reduced dose, making bleeding risk more acceptable instead of the administration of full dosage of NOAC, matter of major importance in candidates for left appendage closure, in whom long–term anticoagulant therapy itself is contraindicated; on the other hand, aiming for a better protection against thromboembolic events compared to standard antiplatelet therapy.
P100 HYNOTIC COMMUNICATION IN INTERVENTIONAL CARDIOLOGY: OUR REALITY…………
Authors: Benigni M , Civalleri M , Sartelli S 
Published: May 2022

Abstract
In the past two years we have progressively introduced the practice of hypnotic communication in our hemodynamics and electrofisiology laboratory in S. Paolo Hospital, Savona. The objective of hypnotic communication is to support patients during procedures electrophysiology in particular but also in hemodynamics, and help them in managing, if possible eliminate, fear, anxiety and pain while reducing the use of drugs to achieve this result. Hypnotic communication applies to relaxation phase and, if require, analgesia which can affect one or more areas of the body. We use this practice in a team of four: two doctors and two nurses. We all have successfully attended a one–year training course in clinical hypnosis and hypnotic communication at the CIIS (Italian Center for Experimental Clinical Hypnosis) Franco Granone Institute in Turin. The area in which we generally use hypnotic communication is electrophysiology: atrial fibrillation ablations, atrial flutter ablations, supraventricular tachycardia (TPSV), during pacemakers implants (ICD). In Hemodynamics we use it with patients affect by Acute myocardial infarction (AMI), and during patent foramen ovale (PFO). It is essential to always make contact with the patient and even more important to use all representational channels ( when possible): verbal, visual and tactile to stimulate suggestions of change in the patient. To achieve this, every member of the team uses his/her own schedule that changes according to the type of intervention. Almost all patienrs approched the procedure expressing concern, fear and anguish; on the contrary, patients treated with a hypnotic approach are calm, relaxed and do not feel pain. Upon their return to the “ here” their feedback backup is summed up in one “ I was fine and I did not notice the time passed”.
P102 NEW THREE–DIMENSIONAL ECHOCARDIOGRAPHIC PREDICTING PARAMETERS IN TRANS–VENTRICULAR HEART–BEATING MITRAL VALVE REPAIR WITH NEOCHORDAE: A MONOCENTRIC RETROSPECTIVE STUDY
Authors: Gaiero L , Vairo A , Fioravanti F , Piroli F , Gallone G , D‘Ascenzo F , Desalvo P , Marro M , Sebastiano V , Alunni G , De Ferrari G , Rinaldi M , Salizzoni S 
Published: May 2022

Abstract

Background
Trans–ventricular off pump mitral valve (MV) repair with neochordae implantation (Neochord procedure) is a minimally invasive surgical technique for correction of degenerative mitral regurgitation (MR) due to prolapse or flail. The aim of this study was to evaluate mid–term results of patients undergoing this procedure and find new three–dimensional pre–operative echocardiographic parameters to predict MR recurrence at follow–up.

Methods
We performed a retrospective analysis of 72 consecutive patients with severe MR due to prolapse or flail who underwent Neochord procedure at our hospital from March 2015 to February 2021. MV pre–operative anatomical parameters were assessed using 2D TEE, 3D TEE and dedicated three–dimensional (3D) post–processing analysis with dedicated software (QLAB, Philips). TTE follow–up and clinical evaluation were performed at 3 months, 6 months, 1 year and then annually.

Results
Twenty–seven patients were female (37.5%), mean age was 77±9 years. The average preoperative EuroSCORE II was 2.2%±1.5%. Twenty–three patients (32%) had an history of paroxysmal or persistent atrial fibrillation. Procedural success at discharge was achieved in sixty–eight patients (94.5%). Mean follow–up was 30±16 months. Three years follow–up was completed by fifty patients. At three years thirteen patients (26%) presented with recurrence of severe MR or underwent new surgical operation. Prevalence of mild or trace MR at three years follow–up visit was 70%. End–systolic annulus area (12.5±2.5 cm2 vs 14.1±2.6 cm2; p = 0.038), end–systolic annulus diameter (13.2±1.2 cm vs 14±1.3 cm; p = 0.042) and indexed left atrial volume (59±17 ml/m2 vs 76±37 ml/m2; p = 0.041) were lower in patients with residual MR less than moderate (MR &lt; 3+/4+). Three–dimensional indexes specifically focused on coaptation reserve and annular disfunction were the best predictors of MR &lt; 3+/4+ at follow–up, in particular diastolic sum of the leaflets/end–systolic annulus area ([AUC] 0.74; p = 0.029) and systo–diastolic annulus area fractional change ([AUC] 0.743; p = 0.035). Furthermore, each of these annular parameters, calculated using dedicated 3D software, were predictive of residual MR, whereas annular 2D dimensions were not (p = 0.347).

Conclusion
In patients with degenerative MR treated with Neochord procedure, 3D analysis focused on annular measures and coaptation indexes, that included 3D annular dimensions, predicts better MR relapse than conventional 2D parameters.
P104 FEASIBILITY AND ROLE OF ECHOCONTRAST EVALUATION IN PATIENTS WITH LVAD
Authors: Baroni G , Pergola V , Dellino C , Aruta P , Cecchetto A , Baritussio A , Fiorencis A , Di Michele S , Mastro F , Tarzia V , Gerosa G , Iliceto S , Mele D 
Published: May 2022

Abstract

Background
Advanced heart failure is a clinical syndrome characterized by persistent or progressive symptoms of heart failure despite optimal medical therapy. Left ventricular assist device (LVAD) brings survival benefits and improvement in quality of life, compared with conventional medical treatments. Development of Right ventricle failure in patients with LVAD has a direct effect on mortality and hospitalization.

Purpose
evaluation of clinical safety and feasibility of echocontrast in patients implanted with 3 different types of LVAD; improvement in the visualization of heart structures; intra and inter–operator agreement of RV assesement with and without contrast. Methods 43 patients were implanted with LVAD, 7 patients (16%) with Jarvik 2000, 31 (72%) with HeartMAte 3, 5 (12%) with (HeartWAre HVAD). Nine patients (21%) had contraindication or refused contrast. In 3 (7%) patients was technically challenging to obtain apical images at all levels. Two (5%) patients lost their follow–up. Our final population was of 29 (67%) patients (mean age 65±7 y; 100% Male). We assessed the reproducibility of these measurements between two different expert blind operators

Results
Total 329 (64%) of 516 RV wall segments were available for qualitative analysis without contrast vs 451 (87%) with contrast (p &lt; 0.001) with a significant improvement of the evaluability of regional contractility (especially due to the better evaluation of medial and apical segments of lateral and anterior walls) and FAC (41% vs 90%, p &lt; 0.001). Evaluation of TAPSE, TR and sPAP was similar with and without contrast (p=NS). All the RV parameters showed little inter–operator variability when measured with contrast. TAPSE, FAC, and RWMA showed an excellent reproducibility (ICC &gt;0.86) while it was good for 2D–baseline derived parameters (ICC = 0.74) showing improvement of inter operator reproducibility in the evaluation of regional contractility in the contrast echocardiography modality.

Conclusion
EC is safe with all the types of LVAD examined. Accurate and reproducible visualization of RV is imperative for reliability of information, a routine use of EC could play a pivotal role in interpreting RV features. EC improves RV morphologic and functional judgment allowing greater accuracy and precision in the assessment of both global and regional RV functions. This finding may have important clinical improvement, especially in the future for analysis focused in RV prognostic role in LVAD patients.
P106 A LEFT GIANT MYXOMA WITH A NOTABLE NEOVASCULARIZATION
Authors: Cortese F , Costantino M , Prestipino F , Manzan E , D‘Ascoli R , D‘Addeo G , Cristiano A , Lopizzo A , Bochicchio A , Luzi G 
Published: May 2022

Abstract
A 73–year–old asymptomatic woman came to our observation to perform a routine echocardiographic examination. The patient suffered from arterial hypertension, dyslipidemia, hypothyroidism, paroxysmal atrial fibrillation. She underwent a bilateral mastectomy for breast cancer about 5 years ago, and she was undergoing chemotherapy and radiation therapy for a stage IV lung adenocarcinoma. The clinical evaluation was normal, as was the electrocardiogram. Transthoracic echocardiographic evaluation showed the presence of a rounded formation with variable echogenicity, with an irregular surface (4 x 3 cm), adherent to the interatrial septum at the level of the fossa ovalis, which did not hinder the excursion of the mitral valve. No other significant cardiac abnormalities were detected. Tansesophageal echocardiography confirmed the presence of atrial mass adhered to the oval fossa (panels A, B). of coarsely rounded shape, and variable echogenicity, in the absence of interference with the movement of the valve leaflets and of anomalies of the interatrial septum (panel C). Coronary angiography showed a right–dominant coronary circulation (panel D) and a mild stenosis of the mid left anterior descending artery. An abundant arterial perfusion of the atrial mass, with several vessels originating from the circumflex artery was also evident at the coronary angiography (panels E, F). The patient underwent cardiac surgery; the surgical exeresis of the left atrial mass was performed through right mini thoracotomy. Because the neo–formation was adherent not only to the atrial septum but also to the left atrial roof, to obtain a radical excision, a large portion of the atrial wall and the septum were removed and totally reconstructed with the pericardium. The main artery supplied the mass related vascular network was ligated. The post–operative course was uneventful, and the patient was discharged at home on day six. The pre–discharge echocardiography showed absence of any residual mass in left atrium that appear anatomically reshaped, no shunt at level of interatrial septum, preserved ventricular function of both ventricles. Histological analysis confirmed the diagnosis of atrial myxoma. At six–month follow–up the patient was asymptomatic and the echocardiography was superimposable to discharge.
P108 PLEURAL EFFUSION AND THE POSTERIOR THORACIC WINDOW: ONE MORE CHANCE TO IMAGE THE AORTIC VALVE
Authors: Mantovani F , Monari D , Guiducci V , Manca F , Navazio A 
Published: May 2022

Abstract

A 85–year–old woman was admitted to our institution with acute respiratory distress. Clinical examination revealed a 5/6 systo–diastolic murmur radiating to both carotid arteries and bilateral lung crackles. Laboratory workup was notable for a N–terminal pro–brain natriuretic peptide (NT–proBNP) of 15.000 ng/L (normal range: &lt; 300 ng/L) and a moderate high–sensitive troponin T elevation of 245 ng/L (normal range: &lt; 14 ng/L) with no increase on serial testing. The hemoglobin and renal function was normal. Evaluation by chest X–ray showed bilateral diffuse pulmonary infiltrates consistent with pulmonary edema and bilateral pleural effusion. The patient was admitted in CCU. A transthoracic echocardiogram was performed bedside, but it was extremely difficult to obtain good quality images from standard view given the ortopnoic decubitus of the patient. However, the aortic valve was heavily calcified and severe aortic stenosis was documented with a mean gradient of 42 mmHg from apical 5 chambers view; 35 mmHg from right parasternal view, with an functional aortic valve area ≈0.6 cm2 (figure, upper panel). Left ventricle shows eccentric hypertrophy and a moderate diffuse reduction of ejection fraction (EF 35–40%). Then, the patient was positioned sitting upright, because the left pleural effusion offered an additional acoustic window—the posterior thoracic window (PTW)—that allowed better alignment of the ultrasound beam with the aortic jet. Mean gradient was recorded definitely higher than from standard view at 50 mm Hg. Moreover, aortic regurgitation that appeared mild from standard view was documented as significant from PTW. In fact, a proper alignment of the aortic regurgitation jet was feasible from this view with a quantification of severity with multiparameter criteria as suggested from the guidelines (PHT 166 ms, Vena contracta 8 mm; Rvol 60 ml). (Figure, lower panel)

Conclusion
Obtaining adequate echocardiographic images in critically ill patients is important for better diagnosis and treatment. For several reasons, this group of patients remains among the most challenging with regard to quality of echocardiographic images. In presence of pleural effusion and technically difficult echo exams, the PTW should be considered in the assessment of cardiac structures including aortic valve as a potentially useful option to provide further diagnostic information.