bluuebunny/crossref_metadata_2025_split huggingface dataset:
P134 A RARE CASE OF CARDIAC DIFFUSE LARGE CELL B LYMPHOMA: ECHOCARDIOGRAPHIC RESPONSE TO CHEMOTHERAPY
Authors: Morgagni R , Parato A , Zizzari G , Martuscelli E , Cantonetti M 
Published: May 2022

Abstract

Introduction
Diffuse large B–cell lymphoma (DLBCL) is the most common subtype of non–Hodgkin‘s lymphoma in adults. Rituximab and Anthracycline–based chemotherapy are the standard treatment, complete remission (CR) is achived in approximately 67% of patients. About one third of patients have refractory disease or relapse after standard therapy, mostly within 5 years of achieving CR.

Clinical Case
A 62–year–old patient, current smoker, without previous cardiovascular diseases presented to our ER for dyspnea and asthenia. Medical history showed GBC–DLBCL at third stage that achieved CR with R–CHOP therapy and intrathecal prophylaxis. The ECG documented sinus tachycardia with normal ventricular repolarization. Arterial blood gas analysis showed a condition of respiratory distress (pO2 71 mmHg, pCO2 27 mmHg). For suspicion of pulmonary embolism, chest CT with contrast was done showing a bulky mass extending from the right atrium to the right ventricle, also involving the pericardial sac (image 1). Transthoracic echocardiography showed a bulky mass (area 31 cm2) occupying almost the entire right atrium (5.9 x 4.4 cm) and extended, through the tricuspid valve, into the right ventricle, displacing the interventricular septum (image 2). Endomyocardial biopsy confirmed the diagnosis of GBC–DLBCL cardiac recurrence. Assumed the good systolic function of the left ventricle and the age of the patient, chemotherapy debulking was performed with Gemcitabine, followed by R–CHOP and MTX. One month after therapy post–treatment Total Body CT shows a good response with no evidence on echocardiogram of pathological tissue in the right ventricle (image 3).

Conclusions
Cardiac DLBCL is a rare tumor with few cases reported in the literature. There is currently no standard therapy, particularly for those who are unsuitable for high–dose chemotherapy a/o autologous stem cell transplantation. The multidisciplinary cardiological and hematological approach has proved to be fundamental these patient‘s therapeutic management.
P135 NEOPLASTIC DISEASE LONG AFTER ACUTE CORONARY SYNDROME. THE ABC–4* STUDY ON HEARTDISEASE
Authors: Berton G , Mahmoud H , Cavuto F , Bagato F , Palmieri R , Stocchero L , Selvestrel E , Allocca G , Lorenzon E , Merotto D 
Published: May 2022

Abstract

Background
Non cardiac outcomes after ACS are seldom reported specially on the long term. In the literature, aspects of parallelism between the atherosclerotic, inflammatory, and neoplastic process have been observed. However, there is a lack of prospective studies looking for potential association between ACS and future neoplasia.

Aim
To describe the presence, incidence of malignant neoplasia long after ACS. Comparison with the general population registries incidence rate worldwide and in Italy was also considered. Methods This prospective study included 541 patients who were discharged alive after index hospitalization with ACS in three hospitals and followed for 22 years.

Results
All but 3 patients completed the follow–up or were followed until death. Pre–existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow–up period, which represented 6232 person–years. The most common sites were the lungs (22%), colorectal (19%), and prostate (15%), as well as the pancreas (5%), breast (5%), and leukaemia (5%). A total of 99 (18%) patients died due to malignancy (Figure 1). The risk of malignancy after ACS in the present study, appears higher than that of general population; as we observed a cancer incidence rate approximating 17.8 case per 1000 person–year, while in general population estimates carried out globally, in Europe, Italy and in Veneto Region, the age standardized cancer incidence rate was reported to be 3.27, 4.64, 4.73 and 4.70 cases per 1000 person–years, respectively [according to GLOBOCAN 2020].

Conclusions
In this prospective, long–term study, we observed an increase in the risk of malignant neoplasia in patients who survived ACS, notably higher than the risk observed in the general population globally, in Europe, in Italy and in Veneto region. Further understanding of the delicate interaction between CV disease and cancer may lead to better prevention, earlier detection, and safer treatment strategies.
P138 CARDIAC LIPOMA IN PATIENT WITH SYSTEMIC LIPOMATOSIS
Authors: Parato A , Morgagni R , Martuscelli E 
Published: May 2022

Abstract

Introduction
Primary adipose cardiac tumors are divided into two different entities: lipomatous hypertrophy of the interatrial septum (LHIS) and lipomas. Lipomas are usually benign masses of unknown pathogenesis. Currently few cases are reported in literature, with no differences in gender distribution.

Clinical Case
A 63–year–old patient presented to our emergency room complaining chest pain and dyspnea on exercise. Her medical history shows severe obesity, hypertention, past surgical removal of several systemic lipomas (uterus lipoma, right ovary lipoma, right thigh and leg lipoma, right forearm and wrist lipoma). A coronary angiography was performed showing the lack of angiographically significant lesions. On suspicion of microvascular angina, she began therapy with Ranolazine and Beta–blockers. Echocardiographic examination showed a lipomatous interatrial septum in the postero–superior tract with a maximum of 22.5mm thickness (image 1). At 12 months, chest CT and MRI scan showed a hyperintense mass on interatrial septum measuring 32x34mm. The formation, mainly protruding in the right atrium, does not obstruct the outlet of the hollow veins, nor the outlet of the pulmonary veins. No hemodynamic compromise and compression were detected. Last follow–up visit our patient presented dyspnea and chest pain, the echocardiogram showed a slight increase of the mass size (see image), with unchanged thicknesses and biventricular pump function.

Conclusions
In literature there is no evidence of malignant transformation of cardiac lipomas, however well–differentiated cell tumors can coexist with liposarcomas. There are no guidelines for the treatment of cardiac lipomas, radical resection is practiced in the majority of symptomatic patients and should be considered in all patients with cardiac lipoma. Asymptomatic lipomas can excessively grow up and infiltrate into the myocardium, resulting in negative outcomes to a possible subsequent resection. According to the worsening of the clinical course, the patient under consideration was referred for lipoma resection surgery.
P155 SINGLE CENTER EXPERIENCE ICD IMPLANTATION IN PEDIATRIC AGE
Authors: Fumanelli J , Elhyka A , Rotella M , Ferretto S , Di Salvo G , Iliceto S , Leoni L 
Published: May 2022

Abstract

Background
Despite sudden cardiac death (SCD) is a rare phenomenon in pediatric age, the use of the implantable defibrillator (ICD) is progressively increasing in consideration of its life–saving role. Our work aims at evaluating our pediatric population to verify the protective role of the device in terms of SCD prevention, acute and chronic complications and to evaluate the role played by the device as a bridge to transplantation.

Methods
The retrospective study includes patients under the age of 18 underwent ICD implantation, following the guidelines and recommendations currently in force, in the time period between March 2000 and July 2020. Each device has been programmed in a personalized way based on age and cardiac pathology. All patients were then followed–up by evaluating the appropriate shocks, the acute and chronic complications, especially the inappropriate shocks.

RESULTS
The study group includes 55 subjects (41 males and 12 females) with a mean age of 14±4 years (range 2–18) and a mean follow–up time of 6.2 years. Thirty subjects had cardiomyopathy (CM), 15 electrical disease (ED) and 10 congenital heart disease (CHD) respectively. We used three different implantation technique (endocavitary, subcutaneous and hybrid technique) depending on the size of the patient and the cardiac anatomy. CHD and CM are mostly implanted in primary prevention. The rate of appropriate shocks in secondary prevention is higher than that in the primary one regardless of the disease (67% vs 33%). Thirty–eight percent of patients received appropriate shock, of which 66.7% were patients who had received defibrillator as a bridge to heart transplant. Two patients (3.6%) received inappropriate shocks on supraventricular tachycardia. There were no acute post–implantation complications. None dysfunctions or ruptures of the shock catheter or episodes of T wave oversensing took place. Peri–procedural and post–transplant mortality is zero.

Conclusions
The study confirmed the protective role of the device, in terms of prevention of sudden cardiac death, and its relevance as bridge to heart transplantation in pediatric age. An implant technique adequate to the size, age and heart disease of the patient associated with an adequate programming of the device significantly reduced inappropriate shocks in our patients.
P157 THE UNFORESEEABLE LINK: A CASE OF CORONARY–PULMONARY ARTERY FISTULA BRIDGING THE RIGHT CORONARY AND FIRST SEPTAL BRANCH OF THE LEFT ANTERIOR DESCENDING ARTERY
Authors: Michele B , Bertozzi R , Bertolini D , Di Nicola F , Pizzi C , Galiè N 
Published: May 2022

Abstract
Coronary–pulmonary artery fistulas are a rare clinical entity with a variety of potential clinical manifestations. Albeit rare, such anomalies may in some instances involve multiple coronary arteries and go unnoticed until old age producing little to no clinical manifestations. We hereby present the case of an 83–year–old man, heavy smoker, with a history of cor pulmonale due to severe chronic obstructive pulmonary disease (COPD) who was recently diagnosed with metastatic lung adenocarcinoma. Incidentally, one of the ECGs performed revealed negative T waves in the precordial leads in the absence of symptoms and with a negative troponin curve. Echocardiography was thus performed and revealed severe left ventricular systolic dysfunction (EF 31%) with infero–postero–lateral akinesia. The patient underwent CT coronary angiogram, which ruled out any significant coronary stenosis but revealed a most surprising finding. An ectatic arterial branch running anteriorly and draining into the pulmonary artery connected the the proximal segment of the right coronary artery to the first septal branch of the left anterior descending (LAD) artery. Unfortunately, the severe left ventricular failure contraindicated any chemotherapy and the patient was discharged with a plan to start palliative radiotherapy. Three months later, the patient returned to our Hospital due to worsening weakness, cachexia and one episode of pre–sincope. During this hospital stay, he developed atypical chest pain with a significant troponin curve. A HRCT and pulmonary angiogram was performed, which revealed neoplastic progression with bilateral lung involvement and bone metastases, as well as bilateral segmental pulmonary emboli. Echocardiography demonstrated new segmental areas of akinesia (apical septum and mid–apical anteroseptal segment) suggestive of focal ischemic damage. Given the documented pulmonary embolism and the anomalous connection between pulmonary artery and coronary circulation, this event may have been caused by paradoxical embolism travelling from pulmonary to coronary circulation (most likely affecting the LAD artery territory). Due to the patient’s frailty however, this hypothesis could not be confirmed by coronary angiography. Despite their relative rarity, coronary–pulmonary artery fistulas involving multiple coronary arteries can occur in the elderly population with no previous clinical manifestations and may give rise to apparently unfathomable clinical constellations.
P161 INCIDENTAL FINDING OF QUADRICUSPID AORTIC VALVE IN A YOUNG ASYMPTOMATIC PATIENT
Authors: Ceriello L , Salvatore T , De Rosa M , Marrone G , Ruggieri B , Fabiani D , Napoletano C 
Published: May 2022

Abstract

Background
Quadricuspid aortic valve (QAV) is a rare congenital heart disease, eventually leading to aortic regurgitation (AR) and heart failure. In up to one–third of patients, QAV is associated with other coexisting cardiac defects, particularly aortic dilation and coronary arteries abnormalities.

Case Report
A 48–years old man without significant past medical history was referred to the Cardiologist for newly diagnosed arterial hypertension. The patient was asymptomatic and no abnormal findings were noticed on physical examination. Transthoracic echocardiography showed normal end–diastolic volume and diameter of the left ventricle and preserved systolic function. However, a mild dilation of the aortic root (40 mm) and ascending aorta (38 mm) with concomitant moderate–to–severe AR were described. Transoesophageal echocardiogram (TOE) was performed to better visualize the aortic valve anatomy and to define the exact mechanism of the AR. 2D–TOE revealed a QAV with equal–sized cusps (type A according to the Hurwitz–Roberts classification), with a central quadrangular coaptation defect and a moderate AR (vena contracta width: 4 mm) [Fig. 1–2]. The regurgitant jet conditioned a pseudo–prolapse of anterior mitral leaflet with consequent mild–to–moderate mitral regurgitation. 3D–TOE allowed a better characterization of valve morphology and the individuation of the sole left coronary artery ostium. A coronary artery computed tomography was requested to investigate a probable abnormal origin of the right coronary artery. The patients was subsequently addressed to a regular clinic and echocardiographic follow–up for the surveillance of AR and aortic dimensions and a prompt management of an eventual symptoms onset.

Discussion
We describe a rare case of type A QAV with moderate AR, mild dilation of aortic root and ascending aorta and suspected anomalous origin of the right coronary ostium. The broad diffusion of imaging techniques has recently led to an increase of incidental diagnosis, even in asymptomatic patients. The complex valve anatomy, with many possible morphologies of the supernumerary cusp, and the association with other congenital defects, particularly anomalous coronary ostia location, pose many technical issues in case of valve replacement. A multimodality imaging approach is essential for a clear description of valve morphology and coronary anatomy to avoid intraoperative complications in both surgical and percutaneous valve replacement procedures.
P163 BOTALLO ARTERIAL DUCT SURGICALLY TREATED IN URGENCY
Authors: Magnano R , D‘Alleva A , Forlani D , Di Marco M , Pezzi L , Vitulli P , Fulgenzi F , Verrengia E , Paloscia L 
Published: May 2022

Abstract
The Botallo arterial duct connects the pulmonary artery and the aorta during fetal life; after birth there is a progressive fall in pulmonary resistance mediated by the increase in oxygen concentration and the decrease in prostaglandins with a vasodilating action. In these physiological conditions, spontaneous closure of the duct is observed within the first 48–72 hours of life. In the preterm infant the patency of the Botallo duct is very frequent due to the peculiar anatomical and physiological characteristics of the preterm infant. The incidence of PDA is higher the lower the birth weight and gestational age are.
We report a case of Manuel, a baby born at 32 weeks of gestational age from elective CT due to transverse presentation with difficulty in extraction and anhydrosis. 37–year–old mother hospitalized for reduction of amniotic fluid (AFI 85 index) with no apparent rupture of the membranes, for which she began a cycle of glucocorticoids 12mg twice a day. At birth, the weight of the child was 1,780 g, length 42 cm, skull circumference 28 cm, absence of valid respiratory activity, bradycardia (78 bpm) APGAR index of 4. At 5 ‘of life he was intubated with a 3 Fi rush tube fixed to 8 cm from the buccal rim with neopuff with PIP 20 cmH2O, PEEP 5 cmH2O, FiO2 0.40, transferred to the NICU, placed in the incubator, connected to the ventilator and ventilated with A/C mode with PIP 23 cmH2O, PEEP 5 cmH2O, FiO2 0, 40 –&gt; 0.60, given surfactant alfa 200 mg/kg. Anemic, plasma and red blood cells were administered multiple times; infectious disease tests (aerobic–anaerobic haemocolutre, umbilical culture, culture of OT tubes, BAL, ear and throat swabs) were negative. After 3 days, systolic heart murmur appeared 2–3/6 radiated to the axilla. The echocardium showed the persistence of the Duct of Botallo, with a mosaic jet in the pulmonary artery and a “growing” ductal flow pattern. He started treatment with indomethacin 0.2 mg/kg every 12 hours x 3 doses, but on echocardiographic control the picture remained unchanged. At 16 days of age, the newborn was transferred to the Bambin Gesù in Rome and underwent cardiac surgery via the left posterolateral thoracotomy to close the arterial duct with a Weck clip. The post–operative course was regular. Manuel was discharged 2.5 months after birth in good general conditions, good growth–weight, with a weight of 2460 g.
P167 ECG ABNORMALITIES AND DOUBLE CORONARY FISTULA
Authors: Viele A , Trivisonno A , Porchetta N , Guerrera L , Giannotti G , Cuzzola B , Colavita A 
Published: May 2022

Abstract
Coronary artery fistula (CAF) is defined as anomalous communication between coronary arteries and cardiac chamber or a major thoracic vessel. CAF are a rare coronary anomaly, mostly congenital, first described by Krause in 1856. In literature the incidence in general population is approximately 0,002%. Detection of CAF during coronary angiography is usually accidental. In 50% of cases CAF originate from right coronary artery, in 30% they originate from LAD, while in the rest of the percentage CAF originate from left circumflex artery. CAF drain into low–pressure chamber (right ventricle or right atrium, superior Vena Cava or pulmonary artery). We can distinguish CAF into little or medium sized, usually with silent clinical course, and large sized CAF, with variable clinical signs, depending on the extent of the shunt and on the hemodynamic overload of the receiving chamber. We describe the case of a 57 y.o woman with hypertension, admitted for femur fracture. ECG showed bifasic T waves in the anterior leads, already described in a previous ECG. Normal systolic function and no valvular defect were found on the echocardiogram. Patient was asymptomatic. Coronary angiography documented normal coronary arteries, with a double coronary fistula: the first from a septal branch of posterior descending and the second one from distal branches of the first diagonal. Even if CAF have often a favorable clinical course with no relevant consequences for the patient, it’s crucial to obtain more information about their functional implication and their anatomic connections. Indeed, rare cases of sudden cardiac death have been described in patients with CAF involved in myocardial ischemia based on the theft syndrome mechanism. Echocardiographic evaluation of the patient to detect associated congenital abnormalities, pressure overload of the receiving chambers and the extent of the shunt on the coronary angiography are crucial for the proper management of CAF. In the case described above we decided to optimize therapy adding beta–blocker (to reduce the overload caused by the two coronary fistula).
P168 A RARE CASE OF HYPERTROPHIC CARDIOMYOPATHY WITH HIGH RISK OF SUDDEN CARDIAC DEATH: WHAT CAN WE DO UNTIL MIECTOMY?
Authors: Renda M , Iannucci L , Minardi S , Romano S 
Published: May 2022

Abstract
A 43–year–old Indian man with obstructive hypertrophic cardiomyopathy (HCMO) and a family history of sudden death presented with heart palpitations associated with chest discomfort and syncope during moderate physical activity despite beta–blocker therapy at maximum dose (New York Heart Association–NYHA III). Transthoracic echocardiography demonstrated ejection fraction 55% and ventricular septum (SIV) (23 mm) and posterior wall hypertrophy (12 mm). There was evidence of dynamic left ventricular outflow tract obstruction (maximum LVOT gradient 30 mmHg at baseline and 45 mmHg after Valsalva) and systolic anterior movement of the amterior mitral flap responsible of moderate regurgitation. It also showed a bicuspid aortic valve with fusion of the right and left cusps and mild regurgitation. ECG Holter showed sporadic supraventricular premature ectopic beats and abnormality of the ventricular repolarization that were accentuated during exercise. Exercise stress test showed 3 mm ST depression in V4–V5 leads. Cardiac magnetic resonance (CMR) and Cardio–CT confirmed HCMO diagnosis and showed a junctional origin of the coronaries, a bifurcated interventricular artery, coronaries free from significant stenosis, intramural late gadolinium enhancement (LGE) of the mid–ventricular SIV and sub–endocardium LGE of the basal SIV. The high HCM– Sudden Cardiac Death Risk score and the presence of LGE on CMR identified a high–risk status and prompt consideration for primary prevention automatic implantable cardioverter defibrillator (AICD) therapy. Thus, in order to treat major life–threatening ventricular arrhythmias, AICD was placed (ESC guidelines 2014 Class IIa). Invasive treatment is indicated for symptomatic patients, NYHA class III and IV refractory to optimized medication and who have gradients in the LVOT. Aortic transvalvular–myectomy is the procedure with the longest experience and considered the gold standard. However, in this case surgical treatment was temporarily postponed. So a sequential rhythm pacing with reduced A–V delay was set up in order to induce a left bundle branch block and a “paradoxical” movement of the SIV with reduction of LVOT gradient. After 2 weeks the LVOT gradient was 20 mmHg and the symptoms were improved. This case suggests the usefulness of a single device for the treatment of different aspects in HCMO waiting to undergo surgical treatment: prevention of sudden cardiac death and improvement of symptoms refractory to medical therapy.