bluuebunny/crossref_metadata_2025_split huggingface dataset:
P39 ATRIAL MASS IN HEART TRANSPLANTED PATIENT WITH CLINICAL HISTORY OF LYMPHOMA
Authors: Scirpa R , Follesa F , Battistoni A , Volpe M 
Published: May 2022

Abstract
Atrial thrombosis is an uncommon complication of cardiac transplant, especially when performed with standard technique. Pathogenetic mechanisms might involve atrial anatomy distortion and abnormalities in its contractile function, which induce flow stasis and thrombus formation, mostly on the surgical suture. A 77–year–old man underwent orthotopic heart transplantation in 2000 for post–ischemic dilated cardiomyopathy. In 2019 he was diagnosed with diffuse large B–cell lymphoma treated with chemotherapy. On March 2021, during follow up period, he had a total body CT scan which showed a submandibular space–occupying lesion, likely as a disease recurrence, and a large atrial mass (30x50 mm). For this reason, he was admitted to the emergency department. Echocardiography documented a massive hyperechogenic formation in an enlarged left atrium. In order to rule out a neoplastic nature, a cardiac CMR was performed, confirming the presence of an oval mass adhering to the posterior left atrial wall with partial involvement of pulmonary veins ostia, with inhomogeneous isointense signal on T1–weighted sequences and hyper–isointense signal on T2–weighted sequences, without significant contrast enhancement, likely representing an endoluminal thrombotic formation. Given the patient’s clinical status and his hemodynamic stability, a surgical excision was deferred. The patient was discharged on oral anticoagulant therapy with Warfarin (INR target 2–3). Three months later, a chest CT showed a meaningful mass reduction (11x18mm), which was no longer visible at echocardiography. About 9 months later, complete disappearance of the atrial mass was found at a CT scan. According to scientific literature, differential diagnosis of a newly discovered atrial mass in a transplanted heart includes thrombosis or neoplasia. Thrombosis occurs usually early after surgery, but due to promoting factors, it can arise after many years. The most likely triggering condition is an acquired prothrombotic status: in our case the likely lymphoma recurrence may have led to thrombogenesis. In order to exclude with confidence cardiac metastasis, histological examination would have been necessary. Nevertheless, the meaningful mass reduction, as early as three months after starting oral anticoagulation, and its disappearance nine months after, strongly suggests for atrial thrombosis.
P47 MITRAL VALVE REPAIR FOR INFECTIVE ENDOCARDITIS: A PROPENSITY MATCHED STUDY
Authors: Malvindi P , Berretta P , Alfonsi J , Zingale A , Luthra S , Pierri M , Ohri S , Di Eusanio M 
Published: May 2022

Abstract

Background
The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis remain not clearly established. We aim to review the clinical experience in mitral valve surgery for infective endocarditis looking at mid–term survival.

Methods
Prospectively collected data of patients who underwent cardiac surgery for infective endocarditis between 2001 and 2021 at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest–neighbour propensity score matching, including twelve preoperative variables, was performed to account for differences in patients’ profile between the repair and replacement subgroups.

Results
In the unmatched populations, mean age of the patients was 60±15 years and 72% were male. Active infective endocarditis was described in 226 cases (80%). Thirty–four patients (12%) suffered cerebral embolism and in 10% of the cases preoperative inotropic support and/or mechanical ventilation were required. Associated procedure were CABG, aortic valve replacement and tricuspid valve repair, 13%, 36% and 9% of the cases, respectively. Mitral valve repair was performed in 96 cases (32%). Overall in–hospital mortality was 6.7% and was not significantly different between patients who underwent repair or replacement of the mitral valve (7.2% vs 6.4%, p = 0.79). Propensity matching provided 72 well–matched pairs. Mean age was 59±15 years, 75% of the patients were male. Sixteen patients (11%) had a recent cerebral event. An emergency operation was carried out in 15% of the cases, 10% of the patients presented a NYHA class&gt;III and 14 patients (10%) underwent a redo procedure. CABG and aortic valve replacement were associated in 14% and in 35% of the cases, respectively. Overall in–hospital mortality was 6.9% with no difference between the repair and the replacement cohorts 9.7% vs 4.2%, respectively (p = 0.19). Survival probabilities at 1–, 5– and 10–years were 89%, 71% and 67%, respectively after mitral repair, and 90%, 77% and 57%, respectively after mitral replacement; log–rank p = 0.90.

Conclusions
Mitral valve repair was associated with acceptable in–hospital mortality and survival in a high–risk and comorbid cohort of patients with mitral valve infection. We found no difference in early and mid–term survival between patients who underwent repair or replacement of the mitral valve in the setting of infective endocarditis.
P71 LEFT MAIN ANGIOPLASTY: TWENTY YEARS OF EXPERIENCE OF A HIGH–VOLUME SINGLE CENTRE WITH ANGIOGRAPHIC FOLLOW–UP
Authors: Franzé A , Quadri G , Cerrato E , Rolfo C , Tomassini F , Zanda G , Piedimonte G , Varbella F 
Published: May 2022

Abstract
Long term result of left main angioplasty nowadays is still debated. The retrospective analysis of our reporting software detected from 11/2000 to 11/2021 a total of 956 patients that underwent percutaneous transcatheter coronary angioplasty (PTCA) on unprotected left main with de–novo lesions. The average age of our sample was found to be 72 years old (+–10), mainly male (76,4%). The prevalence of hypertension was 74,6%, of diabetes was 26,2%, of dyslipidaemia was 51,7%, of smoke was 49,8%. The indication for PTCA was ACS in 63,8% of patients (610), in particular STEMI were the 19,5% (186) of patients, NSTEMI were the 29,4% (281) and unstable angina were the 15% (143). Of these ACS in 29 patient the presentation was with cardiac arrest. Patient with CCS were the 36,2% (346). Intubation was necessary in 36 patients. Intra–aortic balloon pump was used in 341 patients (35,7%), in 90,9% of cases before the beginning of the procedure. Radial (45,1%) and femoral access (54,9%) were equally used. Among 773 bifurcations (the 80% of patients), a single stent technique was used in the 66,5% of cases (provisional). Considering the two stent techniques, the Crush was used in 12,7% of cases, the Culottes in 11,1%, the TAP in 6,7%, and the SKS in the 3%. Final kissing balloon was achieved in the 80,2% of bifurcations. Intracoronary imaging was used in the 48,4% of cases (463 patients), mainly IVUS (457). In our centre, as experimental protocol, an angiographic follow–up at 1 year is performed in most of patients that undergo angioplasty on left main. Overall, an angiographic follow–up is available for 607 patients (the 63,5% of patients) with an average lenth of 546 days. The indication for the new angiography was STEMI in 1,9% of patients, NSTEMI in 4,1%, unstable angina in 2,4%, stable angina in 8,6%, and only protocol in the 46,5%. Re–stenosis with redo of angioplasty on left main happened in 89 patients (14,7%), but of these only in 50 patients (56%) was clinically driven. Stent thrombosis was in all cases very–late (average 1609 days) and happened only in 7 patients (1,2%). A new PTCA in non–left main segments was performed in 153 cases (25,2%) and was clinically driven only in 50,4% of patients. Angiographic follow–up of complex PTCA such as those on unprotected left main could, in addition to potentially preventing adverse events, also provide interesting and real–world data about the effectiveness of the procedures and of their various technical aspects.
P72 TWO SIDES OF THE SAME … PATIENT: CRITICAL LEFT MAIN STEM STENOSIS IN A CANDIDATE FOR TAVI
Authors: Varotto L , Nicoletti I , Segala P , Bonanno C , Angheben C , Caprioglio F 
Published: May 2022

Abstract
Best timing for left main stem (LMS) revascularization (staged or combined) is matter of debate in patients with severe aortic stenosis (AS), candidates for transcatheter aortic valve implantation (TAVI). LMS disease represents an additional challenge for 3 reasons: 1) the potential interaction between the coronary stent and the prosthesis due to the anatomic proximity of the LM ostium to the aortic annulus; 2) the risk for hemodynamic compromise during LMS percutaneous coronary intervention (PCI) in the presence of severe AS or TAVI; 3) the optimal treatment strategy for LMS bifurcations. Previous studies showed that outcomes of TAVI plus LMS–PCI were not influenced by an unprotected/protected LMS, the location of the stent or the timing of PCI. Case report. We present the case of an 82–year–old man with severe AS presenting with non–ST–segment elevation myocardial infarction. Coronary angiography revealed a highly complex, calcific LMS lesion. To safeguard the patient, in the event of rapid deterioration of cardiac output and coronary perfusion, a rescue balloon aortic valvuloplasty (BAV) and the Impella device were arranged. PCI was successfully performed by predilatation with Grip and non–compliant balloons, followed by double stenting with Mini–Crush technique. An additional stent in the ostium of the LMS was required without using a circulation support system. Due to the low take–off of the ostium of the LMS, an Edwards Sapien 3 was implanted, protecting the LMS with a guide–catheter and guide–wire. The patient was discharged from hospital on Day 5 post–procedure. Discussion. According to guidelines, decision should be performed case by case, based on the severity/complexity of either AS or LMS disease. The strategy of treating LMS lesions first may limit the risk of potential ischaemic complications during TAVI; its downside is the risk of hemodynamic crash with potential catastrophic evolution in case of PCI complications in severe AS. Mini–crushing can be a good, quick way to treat complex diseases of the LMS bifurcation, less complex to perform in emergency situations. “Bailout BAV” and Impella technology can be helpful bystanders to prevent any complications, being a salvage–strategy in case of advanced status of haemodynamic impairment. These approaches are a very last resort, while appropriate pre–procedural planning is still highly recommended in order to prevent potentially fatal procedural complications in this fragile clinical setting.
P80 PROGNOSTIC IMPACT OF NEW ONSET ATRIAL FIBRILLATION AFTER SINGLE OR DOUBLE STENT LEFT MAIN BIFURCATION PCI
Authors: Rigatelli G , Zuin M , Gianese F , Pastore G , Zanon F , Roncon L 
Published: May 2022

Abstract

Objective
Incidence and prognostic value of new onset atrial fibrillation (NOAF) after single versus double stent strategy in bifurcation Left Main (LM) disease has not been yet investigated.

Methods
We retrospectively analysed the procedural and medical data of patients referred to our center for complex LM bifurcation disease, treated using Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT) techniques between January 1st, 2008 to May 1st 2018. Multivariate Cox–regression analysis was used to assess the role of different stent strategies, adjusted for confounders, on the risk of NOAF during the follow–up period.

Results
Five hundred and two patients (316 males, mean age 70.3±12.8 years, mean Syntax score 31.6±6.3) were evaluated. At a mean follow–up of 37.1±10.8 months (range 22.1–39.3 moths), Target lesion failure (TLF) rate was 10.1%. Stent thrombosis and Cardiovascular mortality were observed in 1.2% and 3.6% in of cases, respectively. NOAF occurred in 23 out of 502 patients (4.6%). Patients with NOAF resulted more frequently female, older, obese, diabetic and more frequently experienced TLF and cardiovascular death. NOAF free survival favoured single versus double stent technique and among double stent techniques NIT compared to the others. Single stent strategy had a lower risk of NOAF compared to double stent technique on multivariate analysis (HR: 1.14, 95% CI: 1.10–1.19, p &lt; 0.001 vs HR: 1.28, 95% CI: 1.23–1.32, p &lt; 0.0001).

Conclusions
NOAF in distal LM bifurcation disease treated with PCI had a low incidence but resulted more frequent after double than after single stenting technique and associated with worse outcomes.
P117 INCIDENTAL FINDING OF A PAPILLARY FIBROELASTOMA WITH UNCOMMON LOCATION: CASE REPORT
Authors: Salvatore T , Ceriello L , De Rosa M , Lavorgna A , Ruggieri B , Giancola R , Fabiani D , Napoletano C 
Published: May 2022

Abstract

A 64–year old man with no cardiological history came to our laboratory to perform a transthoracic echocardiogram because of increased blood pressure. Patient was asymptomatic. Echocardiogram revealed the presence of a small mass attached to the proximal part of the interventricular septum (IVS) (Fig. 1), characterized by high mobility within the left ventricular outflow tract (LVOT). Transesophageal echocardiogram confirmed the presence of a 8 mm pedunculated mass with implant base on IVS, 2 cm below the aortic valve and oscillating in LVOT (Fig. 2). The high risk of peripheral embolization led the Heart team to propose cardiac surgery. The operation was conducted through a J–ministernotomy on a fourth intercostal space, cannulation of ascending aorta and right atrium, transverse aortotomy and identification of the mass via the transaortic route. The appearance of the mass, glossy brown and with a gelatinous consistency, first appeared to be attributable to papillary fibroelastoma. The histological investigation (Fig. 3) confirmed the diagnosis. Postoperative course was regular and the patient was discharged on fifth postoperative day.

Discussion
Papillary fibroelastoma is the third most common primary cardiac tumour, after myxoma and lipoma, with an incidence of around 10%. In 90% of the cases the origin is from the valvular endocardium (the aortic and mitral valve surfaces are the most affected sites), while the origin from the endocardium of left ventricle, as in the case of our patient, is much more rare (less than 10% of cases). Atypical locations, in addition to IVS, are papillary muscles, tendinous chords and atrial endocardium. Although most patients are asymptomatic, consequences related to peripheral embolization can be very serious (neurological complications, acute coronary sindrome, peripheral ischaemia, pulmonary embolism). Mobility rather than size appears to be an indipendent predictor of death and non fatal embolization; for this reason, in the presence of mobile and pedunculated mass, surgical intervention is always reccomended. Surgical excision is associated with a low operative risk and the minimally invasive approach, as in our case, allows for a rapid recovery.
P127 PERI–VASCULAR ADIPOSE TISSUE ATTENUATION ON CHEST COMPUTED TOMOGRAPHY IN PATIENTS WITH MARFAN SYNDROME: A CASE SERIES
Authors: Tuttolomondo D , De Filippo M , Sartorio D , Nicolini F , Niccoli G , Gaibazzi N 
Published: May 2022

Abstract

Background and aim of the work
Marfan Syndrome is a genetic disorder that determines histopathological alterations of the aortic vascular wall leading to increased inflammatory component. The peri–vascular adipose tissue attenuation is a method able to capture localized vascular inflammation by mapping spatial changes of perivascular tissue attenuation on computed tomography.

Methods
We measured peri–vascular adipose tissue attenuation around the ascending aorta in three consecutive subjects with confirmed genetic diagnosis of Marfan Syndrome. All subjects received the genetic diagnosis of fibrillin–1 gene mutation as part of the family screening of patients with known Marfan Syndrome. Chest computed tomography was performed in such asymptomatic subjects after genetic confirmation of Marfan Syndrome. None of these subjects showed aortic aneurysms or suffered from chronic inflammatory/infectious disease.

Results
In the three subjects identified with Marfan Syndrome the value of aortic peri–vascular adipose tissue attenuation measured at chest computed tomography was higher than normal and the volume of aortic peri–vascular adipose tissue was lower.

Conclusion
These preliminary observations suggest that peri–vascular adipose tissue attenuation is unexpectedly high in patients with Marfan Syndrome, notwithstanding the normal aortic diameter at the time of computed tomography. Whether this observation may find a clinical use in suspected Marfan Syndrome or in predicting aortic complications in Marfan Syndrome is worth to be assessed in prospective studies.
P141 CORRELATION BETWEEN TAKO–TSUBO SYNDROME AND OCCULT CANCER
Authors: Isola U , Pittau R , Marchetti M , Boscarelli D , Tuveri M , Caggiari L , Maiani S , Contini F , Montisci R 
Published: May 2022

Abstract

Introduction
Tako–Tsubo Syndrome (“TTS”) is a cardiomyopathy characterized by an acute reversible left ventricular dysfunction, mainly triggered by emotional or physical stress. Several variants have been reported, including reverse TTS, characterized by hypokinesia of basal segments and hyperkinesis of the apical ones. TTS has a clinical presentation similar to acute coronary syndrome but without evidence of obstructive coronary artery disease. A surprising association between TTS and cancer arose out of recent studies.

Case Presentation
74–year–old patient got to the emergency room of our hospital for the appearance, apparently in the health, in the absence of physical or emotional stress of oppressive chest pain. On the ECG, there was evidence of ST–segment elevation in inferior leads, for which urgent coronary angiography was performed. It did not show significant stenotic lesions nor evidence of elevated troponin values. The Echocardiogram showed hypokinesia of the basal segments and hyperkinesis of the mid–apical ones, with EF 40%. In the following days, the patient performed MRI–heart with detection of LGE of the intramyocardial type (non–ischemic pattern) in correspondence with the inferior wall in the medioventricular area. During hospitalization on routine chest x–ray, hypodiaphanous image was found in the left apex for which an HR CT scan of the chest was performed which a lesion in the left apical lung area with spiculated margins of a heteroplastic nature, associated with multiple bilateral lesions suggestive of secondaryism. Therefore, the patient was taken over by the Oncology service.

Conclusions
Such case confirms the association between TTS and occult cancer. In the absence of obvious physical or emotional stress that may explain the onset of TTS, it is important to research for any silent neoplastic pathology. The literature shows that the prevalence of malignant diseases is high in patients with TTS. Recent studies have pinpointed the activation of the sympathetic nervous system promotes cardiac inflammation by upregulating ICAM–1 and the expression of p53. Furthermore, inflammation can lead to the activation of p38 MAP Kinase, thus contributing to myocardial stunning. The specific role of inflammation as a cofactor of adrenaline–induced stunning deserves further investigation in the specific context of malignant tumors, which are frequently associated with an enhanced inflammatory state.
P156 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT IN OVER 60 YEARS OLD PATIENTS
Authors: Marzullo R , Gaio G , Giordano M , Palladino M , Ancona R , Scognamiglio G , D‘Alto M , Russo M , Sarubbi B 
Published: May 2022

Abstract

Background
Ostium secundum ASD (ASDII) is the most common type of congenital heart disease in adults. Percutaneous closure has emerged as the first–line treatment for the majority of ASDII. However, the occurrence of Pulmonary Hypertension (PH) with combined pre– and post–capillary component may render ASD management challenging in elderly patients.

Methods
We report the hemodynamic data and clinical findings of elderly patients (&gt; 60 years old) undergoing transcatheter closure of an ASDII at our department.

Results
From 2000 to 2021, 82 elderly patients were scheduled (mean age 65,4+ 4,4) of which 60 (73%) were female. Systemic arterial hypertension and supraventricular arrhythmias were the most common comorbidities accounting respectively 51% and 38% of cases. The right ventricular overload supported the ASD closure in 76 cases (93%) and paradoxical embolism in the remaining 6 (7%). 17 patients (21%) were in NYHA class III– IV. At right heart catheterization, 33 patients had normal pulmonary arterial pressure and 49 patients showed a mean pulmonary artery pressure &gt; 20 mmhg. In the latter cohort, 33 showed a pulmonary artery wedge pressure (PAWP) &lt; 15 mmHg (Group I) and 16 &gt; 15 mmHg (Group II). The device implantation was completed in all patients except one with elevated pulmonary vascular resistance (PVR) of the Group I. For 14 patients of Group II, balloon occlusion test was required during the catheterization. ASD closure was achieved promptly in 10 patients. However, to reduce the risk of acute pulmonary oedema, in one case we created a small fenestration in the occluder device and in other case we retained the patency of additional defect (both patients exhibiting slightly PAWP increase during balloon occlusion test). In one patient showing significantly PAWP increase during balloon test, delayed ASD closure was performed ensuring the improvement of hemodynamic parameters at 3 months initiation of medical therapy with angiotensin–converting enzyme inhibitor and loop diuretic diuretics. For the remaining 4 patients, the percutaneous closure was not been done because of prohibitive hemodynamic parameters. Overall, ASD closure was performed successfully in 94% of cases.

Conclusions
Age and comorbidities are not absolute contraindications to ASDII percutaneous closure. In the complex cases, both medical therapies and balloon occlusion test may be use to support the decision–making process.