The secundum type of atrial septal defect is one of the most common conditions associated with pu... more The secundum type of atrial septal defect is one of the most common conditions associated with pulmonary arterial hypertension. In a series of 274 consecutive patients who have undergone percutaneous atrial septal defect device closure at our institution we observed an increase in pulmonary artery pressure with age, but only three patients had overt pulmonary arterial hypertension.
Echo in surgical interventions / Echocardiography/Doppler 1097 Methods: We enrolled 23 patients [... more Echo in surgical interventions / Echocardiography/Doppler 1097 Methods: We enrolled 23 patients [16 male (70%), mean age 59±10 years] with CTRCAO and without stenosis of LAD and 13 [5 male (38%), mean age 62±10 years] age matched control subject without cardiovascular disease. All patients underwent a PCI attempt aiming the opening of the CTRCAO. All patients and control subjects underwent detailed TTDE at the beginning of the study. Patients with successful CTRCAO PCI underwent a repeated DCFV assessment by TTDE. DCFV were assessed by TTDE interrogating the proximal LAD. Peak (PDCVF) and velocity-time integrals (DCFVTI) of the DCFV spectrums were measured. Results: The mean Rentrop collateral grade was 2.2±0.7 in CTRCAO patients. Both DCFV parameters were significantly higher in CTRCAO patients before PCI compared to control subjects (PDCFV: 74.9±31.9 vs. 45.8±15.6 cm/sec, p<0.01; DCFVTI: 21.8±6.3 vs 14.5±7.9 cm/sec, p<0.05). The PCI was successful in 18 patients (78%). PDCFV and DCFVTI decreased significantly after successful PCI of CTRCAO when compared to DCFV values measured before interventions (Table). Before CTRCAO PCI After CTRCAO PCI p value Peak LAD DCFV (cm/sec) 72.8±31.4 52.2±20.6 p<0.01 VTI of LAD DCFV (cm) 22.4±4.1 15.2±7.7 p<0.05 Results are expressed as mean ± SD; CTRCAO = chronic total right coronary artery occlusion; DCFV = diastolic coronary flow velocity; VTI = velocity time integral; PCI = percutan coronary artery intervention. Conclusion: Presence of CTRCAO is accompanied by elevated DCFV profile of the non-diseased LAD coronary artery. Successful PCI of CTRCAO results in significant decrease of LAD DCFV values.
Objective By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Ita... more Objective By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the ‘Hub-and-Spoke’ model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. Methods We describe a modified ‘Hub-and-Spoke’ model – that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. Results From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal ...
Percutaneous pulmonary valve implantation (PPVI) allows treatment of both pulmonary valve stenosi... more Percutaneous pulmonary valve implantation (PPVI) allows treatment of both pulmonary valve stenosis and regurgitation ([1][1]). Originally used only in stenotic conduits through Melody Transcatheter Pulmonary Valve (Medtronic, Minneapolis, Minnesota) implantation ([2][2]), with the advent of larger
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Objective: To analyze the more recent outcomes of fetuses with different laterality defects. Mate... more Objective: To analyze the more recent outcomes of fetuses with different laterality defects. Material and methods: Out of 1508 fetuses with congenital heart disease (CHD) diagnosed by echocardiography between January 1995 and December 2015, 94 (6.3%) presented abnormal visceroatrial situs: 42 till December 2002 (group 1, analyzed retrospectively) and 52 since then until December 2015 (group 2, analyzed prospectively). Twenty-one had left isomerism (Lisom), 22 right isomerism (Risom), 16 situs inversus-dextrocardia (SVI-dx), 5 situs inversus-levocardia (SVI-levo), and 30 situs solitus-dextrocardia (SSol-dx). Results: Seventy-six cases (81%) had CHD, more frequently complex atrioventricular defect. Eighteen cases showed normal heart: half of subgroups SVI-dx and SVI-levo, a third of SSol-dx. Postoperative mortality in continuing pregnancy in group 2 was 43.7 versus 40% in group 1, lower in SVs-dx (0 versus 50%) and Lisom (33.3 versus 66.7%), worse in Risom (71.4 versus 25%). Total mortality in group 2 was 48.3 versus 55% in group 1, better in Ssol-dx (37.5 versus 50%) and in Lisom (27.4 versus 71.4%). In isolated forms all but one case are alive. Conclusions: Our fetal cases presented a relevant mortality in both periods. The outcomes were slightly better in a more recent era in SSol and Lisom. WHAT IS KNOWN ABOUT THIS TOPIC? Out of laterality defects, the heterotaxies (i.e. left and right isomerism) are known to be associated to a relevant mortality in fetal and neonatal cases. Heterotaxies have a variable position of the heart, but some authors evaluated only those with dextrocardia in their studies on different laterality defects. Controversial data are presented in the literature for the outcomes of fetuses with laterality defects. Many large studies analyzed the data of a very long time period in which it is opinable to compare the results of the treatment, because of a recent improved management and surgical techniques.
The aim of this study was to evaluate the impact of percutaneous pulmonary valve implantation (PP... more The aim of this study was to evaluate the impact of percutaneous pulmonary valve implantation (PPVI) and surgical pulmonary valve replacement (SPVR) on biventricular and pulmonary valve function using cardiac magnetic resonance. Thirty-five patients aged 20±8 years (mean±SD) underwent PPVI, whereas 16 patients aged 30±11 years underwent SPVR. Cardiac magnetic resonance examinations were performed before and after the procedures with an average follow-up interval of 10 months. Cine steady-state free precession sequences for cardiac function and phase-contrast sequences for pulmonary flow were performed. The right ventricle (RV) and left ventricle (LV) functions were evaluated using a dedicated software. The RV end-diastolic volume index (mL/m) decreased significantly after PPVI and SPVR, from 74 to 64 (P=0.030) and from 137 to 83 (P=0.001), respectively. The RV ejection fraction increased significantly after SPVR, from 47% to 53% (P=0.038). The LV end-diastolic volume index increased...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 3, 2017
Paediatric patients with mitral valve (MV) disease have limited options for prosthetic MV replace... more Paediatric patients with mitral valve (MV) disease have limited options for prosthetic MV replacement. Based on a long experience with the stented bovine jugular vein graft (Melody Valve) in the right ventricular outflow tract, we tested the use of the Melody Valve as a surgical implant in the mitral position in patients with congenital mitral disease. Eight patients, age 3 months to 6.2 years, with congenital MV dysplasia had undergone Melody valve implantation in mitral position between March 2014 and October 2015. Once sutured to the MV annulus, the Melody valve was expanded through a balloon catheter to achieve the best diameter (12-20 mm). Two patients needed ECMO assistance after traditional MV repair and a Melody valve was successfully implanted as possible bailout. However, none of them recovered from multiorgan failure and both died in spite of the well-functioning Melody prosthesis. During follow-up only one patient underwent catheter-based balloon expansion of the valve. ...
Aims We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve imp... more Aims We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction. Methods Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve. Results No procedural-related complications occurred.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2016
Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic v... more Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic vein drainage anomaly, with only a few cases reported among congenital heart disease (CHD), around 20 cases published in the medical literature. The inferior vena cava connection with the left atrium, also very rare, can appear directly or in heterotaxy. Clinical suspicion arises due to the presence of cyanosis in the absence of other specific clinical signs (without other associated CHD). We present the cases of two children with abnormal superior and inferior systemic venous return. The first case is an abnormal connection of right superior vena cava to the left atrium associated with persistent left superior vena cava draining into the right atrium through the coronary sinus. The second case is an interruption of the inferior vena cava with hemiazygos continuation, drained into the left superior vena cava, which drained into the left atrium. The diagnosis was imagistic - echocardiograp...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 17, 2016
Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries a... more Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size ...
World journal for pediatric & congenital heart surgery, Jan 6, 2016
We describe a 13-month-old patient with tetralogy of Fallot, left pulmonary artery discontinuity,... more We describe a 13-month-old patient with tetralogy of Fallot, left pulmonary artery discontinuity, and supracardiac totally anomalous pulmonary venous drainage to the azygos vein. The diagnosis and the management of this rare association are briefly discussed.
The difficult performance of certain percutaneous interventions in the field of congenital heart ... more The difficult performance of certain percutaneous interventions in the field of congenital heart disease is well known. Crossing pulmonary arteries in patients who have previously undergone surgical repair or stenotic pulmonary veins in infants can be typical examples of these technical challenges in the catheterization laboratory. The Venture wire 6 Fr control catheter (St Jude Medical) is compatible with a steerable tapered radiopaque tip that can be manually angulated (up to 90°) by clockwise rotation of a knob located in the proximal handle. This mechanism directs any 0.014″ guidewire and provides back-up support. This catheter has been successfully used in coronary artery intervention for crossing severely tortuous vessels, extreme angulations of side-branch ostia, jailed stents, saphenous vein graft anastomoses, and chronic total occlusions. We report the first use of the Venture wire control catheter (St Jude Medical) in the field of congenital heart disease. Patient #1 was d...
Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increas... more Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increased the profile of efficacy and safety of this procedure. Here we report on a 32-year-old woman with significant aortic recoarctation associated with aortic wall aneurysm and close proximity of both lesions to the origin of both the subclavian arteries. It was decided to manually and partially uncover the proximal part of the stent to have a hybrid stent that could act as a bare stent at the level of the origin of the subclavian arteries and as a covered stent at the level of the aneurysm.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 2, 2015
Intravascular stenting is the procedure of choice in the treatment of vascular stenoses. However,... more Intravascular stenting is the procedure of choice in the treatment of vascular stenoses. However, in infants and small children large sheaths are needed, and adult-size stents cannot be implanted. The Valeo Biliary Lifestent (Edwards Lifesciences Irvine, CA) is low profile and can be dilated up to 18-20 mm. We aimed to report on early and mid-term results with the use of Valeo stents in infants and children with congenital heart disease. Twenty-five subjects were treated in our experience. Mean age and weight were 39 ± 35 months (range 1-132) and 10.4 ± 6.7 kg (range 3-30), respectively. Two groups of patients were: Group A: patients with pulmonary artery stenosis (21 subjects); Group B subjects in whom stenting was applied in other vessel or heart sites (four subjects). A total of 35 stents were successfully used. Fluoroscopy time was 32 ± 11 min. No intra-operative death or hospital mortality was recorded. Stent post dilatation was performed in nine patients. The incidence of comp...
To measure the magnetic resonance (MR) artefact produced by a percutaneous pulmonary valve stent ... more To measure the magnetic resonance (MR) artefact produced by a percutaneous pulmonary valve stent and to evaluate the changes in volumetric and functional right ventricle (RV) parameters due to percutaneous pulmonary valve implantation (PPVI). A Melody valve was studied in vitro using clinical cardiac MR (CMR) sequences. In vivo, we analysed the CMR examinations obtained before and after PPVI of 27 consecutive patients. The echocardiography pressure gradient (PG) and catheter PG were measured. The Wilcoxon test was used for comparisons. In vitro, the least difference between artefact extent and actual valve size (0.1 mm) was obtained with a steady-state free precession (SSFP) sequence. In vivo, RV end-diastolic volume (ml/m(2)), end-systolic volume (ml/m(2)) and ejection fraction (%) were 79 ± 42, 43 ± 41 and 49 ± 13 before PPVI and 64 ± 21 (p = 0.054), 30 ± 14 (p = 0.021), and 54 ± 12 (p = 0.018) 6 months after PPVI, respectively. The PG and regurgitation fraction (RF) were 36 ± 15 mmHg and 14 ± 18 % before PPVI and 13 ± 15 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and 2 ± 5 % (p = 0.013) after PPVI, respectively. No significant differences were found comparing the PG measured with CMR, echocardiography and catheter. We showed in vitro that the SSFP sequence produced the most accurate valve measurement. After PPVI, CMR showed a strong decrease of PG and RF with a significant improvement of RV function.
The right ventricle (RV) is of lesser importance in acquired heart disease, but its role is of in... more The right ventricle (RV) is of lesser importance in acquired heart disease, but its role is of increasing importance in congenital heart disease (CHD). Despite major progress being made, precise measurements of the RV are challenging because of its peculiar anatomical structure that is not adaptable to any planar geometrical assumption. This is particularly true in adult patients with CHD where the RV shape eludes any standardization, it may assume various morphologies, and its modality of contraction depends on previous surgical treatment and/or pathophysiological conditions. However, reliable and repeatable quantification of RV dimensions and function for these patients are essential to provide appropriate timing for intervention to optimize outcomes. In this population, echocardiographic evaluation should not be limited to an observational and subjective functional assessment of the RV but must provide quantitative values repeatable and clinically reliable to help the decision‐ma...
Catheterization and Cardiovascular Interventions, 2014
BackgroundBare stents has become the first line therapy for aortic coarctation. Covered stents ha... more BackgroundBare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice.ObjectivesThe present study, reports comparatively 15‐year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center.MethodsFrom 1997 to 2011, 143 patients with native or postoperative aortic coarctation were treated at our institution. Seventy‐one subjects (median age 17 years (range from 4 to 70 years) underwent bare stent implantation (Group 1) while 72 patients (median age of 17.5 years (range from 6 to 68 years) underwent covered stent implantation (Group 2).ResultsSuccess rate in the whole group was 95%. More complex and tighter coarctations were treated using covered stents. Incidence of related‐procedure adverse events was higher in Group 1 than in group 2 (21.1% vs. 8.3% P = 0.035). Aortic wall complications occurred in 7% of patients in Group 1 (one death) and 0% in Group 2 (P...
The secundum type of atrial septal defect is one of the most common conditions associated with pu... more The secundum type of atrial septal defect is one of the most common conditions associated with pulmonary arterial hypertension. In a series of 274 consecutive patients who have undergone percutaneous atrial septal defect device closure at our institution we observed an increase in pulmonary artery pressure with age, but only three patients had overt pulmonary arterial hypertension.
Echo in surgical interventions / Echocardiography/Doppler 1097 Methods: We enrolled 23 patients [... more Echo in surgical interventions / Echocardiography/Doppler 1097 Methods: We enrolled 23 patients [16 male (70%), mean age 59±10 years] with CTRCAO and without stenosis of LAD and 13 [5 male (38%), mean age 62±10 years] age matched control subject without cardiovascular disease. All patients underwent a PCI attempt aiming the opening of the CTRCAO. All patients and control subjects underwent detailed TTDE at the beginning of the study. Patients with successful CTRCAO PCI underwent a repeated DCFV assessment by TTDE. DCFV were assessed by TTDE interrogating the proximal LAD. Peak (PDCVF) and velocity-time integrals (DCFVTI) of the DCFV spectrums were measured. Results: The mean Rentrop collateral grade was 2.2±0.7 in CTRCAO patients. Both DCFV parameters were significantly higher in CTRCAO patients before PCI compared to control subjects (PDCFV: 74.9±31.9 vs. 45.8±15.6 cm/sec, p<0.01; DCFVTI: 21.8±6.3 vs 14.5±7.9 cm/sec, p<0.05). The PCI was successful in 18 patients (78%). PDCFV and DCFVTI decreased significantly after successful PCI of CTRCAO when compared to DCFV values measured before interventions (Table). Before CTRCAO PCI After CTRCAO PCI p value Peak LAD DCFV (cm/sec) 72.8±31.4 52.2±20.6 p<0.01 VTI of LAD DCFV (cm) 22.4±4.1 15.2±7.7 p<0.05 Results are expressed as mean ± SD; CTRCAO = chronic total right coronary artery occlusion; DCFV = diastolic coronary flow velocity; VTI = velocity time integral; PCI = percutan coronary artery intervention. Conclusion: Presence of CTRCAO is accompanied by elevated DCFV profile of the non-diseased LAD coronary artery. Successful PCI of CTRCAO results in significant decrease of LAD DCFV values.
Objective By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Ita... more Objective By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the ‘Hub-and-Spoke’ model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. Methods We describe a modified ‘Hub-and-Spoke’ model – that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. Results From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal ...
Percutaneous pulmonary valve implantation (PPVI) allows treatment of both pulmonary valve stenosi... more Percutaneous pulmonary valve implantation (PPVI) allows treatment of both pulmonary valve stenosis and regurgitation ([1][1]). Originally used only in stenotic conduits through Melody Transcatheter Pulmonary Valve (Medtronic, Minneapolis, Minnesota) implantation ([2][2]), with the advent of larger
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Objective: To analyze the more recent outcomes of fetuses with different laterality defects. Mate... more Objective: To analyze the more recent outcomes of fetuses with different laterality defects. Material and methods: Out of 1508 fetuses with congenital heart disease (CHD) diagnosed by echocardiography between January 1995 and December 2015, 94 (6.3%) presented abnormal visceroatrial situs: 42 till December 2002 (group 1, analyzed retrospectively) and 52 since then until December 2015 (group 2, analyzed prospectively). Twenty-one had left isomerism (Lisom), 22 right isomerism (Risom), 16 situs inversus-dextrocardia (SVI-dx), 5 situs inversus-levocardia (SVI-levo), and 30 situs solitus-dextrocardia (SSol-dx). Results: Seventy-six cases (81%) had CHD, more frequently complex atrioventricular defect. Eighteen cases showed normal heart: half of subgroups SVI-dx and SVI-levo, a third of SSol-dx. Postoperative mortality in continuing pregnancy in group 2 was 43.7 versus 40% in group 1, lower in SVs-dx (0 versus 50%) and Lisom (33.3 versus 66.7%), worse in Risom (71.4 versus 25%). Total mortality in group 2 was 48.3 versus 55% in group 1, better in Ssol-dx (37.5 versus 50%) and in Lisom (27.4 versus 71.4%). In isolated forms all but one case are alive. Conclusions: Our fetal cases presented a relevant mortality in both periods. The outcomes were slightly better in a more recent era in SSol and Lisom. WHAT IS KNOWN ABOUT THIS TOPIC? Out of laterality defects, the heterotaxies (i.e. left and right isomerism) are known to be associated to a relevant mortality in fetal and neonatal cases. Heterotaxies have a variable position of the heart, but some authors evaluated only those with dextrocardia in their studies on different laterality defects. Controversial data are presented in the literature for the outcomes of fetuses with laterality defects. Many large studies analyzed the data of a very long time period in which it is opinable to compare the results of the treatment, because of a recent improved management and surgical techniques.
The aim of this study was to evaluate the impact of percutaneous pulmonary valve implantation (PP... more The aim of this study was to evaluate the impact of percutaneous pulmonary valve implantation (PPVI) and surgical pulmonary valve replacement (SPVR) on biventricular and pulmonary valve function using cardiac magnetic resonance. Thirty-five patients aged 20±8 years (mean±SD) underwent PPVI, whereas 16 patients aged 30±11 years underwent SPVR. Cardiac magnetic resonance examinations were performed before and after the procedures with an average follow-up interval of 10 months. Cine steady-state free precession sequences for cardiac function and phase-contrast sequences for pulmonary flow were performed. The right ventricle (RV) and left ventricle (LV) functions were evaluated using a dedicated software. The RV end-diastolic volume index (mL/m) decreased significantly after PPVI and SPVR, from 74 to 64 (P=0.030) and from 137 to 83 (P=0.001), respectively. The RV ejection fraction increased significantly after SPVR, from 47% to 53% (P=0.038). The LV end-diastolic volume index increased...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 3, 2017
Paediatric patients with mitral valve (MV) disease have limited options for prosthetic MV replace... more Paediatric patients with mitral valve (MV) disease have limited options for prosthetic MV replacement. Based on a long experience with the stented bovine jugular vein graft (Melody Valve) in the right ventricular outflow tract, we tested the use of the Melody Valve as a surgical implant in the mitral position in patients with congenital mitral disease. Eight patients, age 3 months to 6.2 years, with congenital MV dysplasia had undergone Melody valve implantation in mitral position between March 2014 and October 2015. Once sutured to the MV annulus, the Melody valve was expanded through a balloon catheter to achieve the best diameter (12-20 mm). Two patients needed ECMO assistance after traditional MV repair and a Melody valve was successfully implanted as possible bailout. However, none of them recovered from multiorgan failure and both died in spite of the well-functioning Melody prosthesis. During follow-up only one patient underwent catheter-based balloon expansion of the valve. ...
Aims We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve imp... more Aims We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction. Methods Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve. Results No procedural-related complications occurred.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2016
Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic v... more Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic vein drainage anomaly, with only a few cases reported among congenital heart disease (CHD), around 20 cases published in the medical literature. The inferior vena cava connection with the left atrium, also very rare, can appear directly or in heterotaxy. Clinical suspicion arises due to the presence of cyanosis in the absence of other specific clinical signs (without other associated CHD). We present the cases of two children with abnormal superior and inferior systemic venous return. The first case is an abnormal connection of right superior vena cava to the left atrium associated with persistent left superior vena cava draining into the right atrium through the coronary sinus. The second case is an interruption of the inferior vena cava with hemiazygos continuation, drained into the left superior vena cava, which drained into the left atrium. The diagnosis was imagistic - echocardiograp...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 17, 2016
Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries a... more Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size ...
World journal for pediatric & congenital heart surgery, Jan 6, 2016
We describe a 13-month-old patient with tetralogy of Fallot, left pulmonary artery discontinuity,... more We describe a 13-month-old patient with tetralogy of Fallot, left pulmonary artery discontinuity, and supracardiac totally anomalous pulmonary venous drainage to the azygos vein. The diagnosis and the management of this rare association are briefly discussed.
The difficult performance of certain percutaneous interventions in the field of congenital heart ... more The difficult performance of certain percutaneous interventions in the field of congenital heart disease is well known. Crossing pulmonary arteries in patients who have previously undergone surgical repair or stenotic pulmonary veins in infants can be typical examples of these technical challenges in the catheterization laboratory. The Venture wire 6 Fr control catheter (St Jude Medical) is compatible with a steerable tapered radiopaque tip that can be manually angulated (up to 90°) by clockwise rotation of a knob located in the proximal handle. This mechanism directs any 0.014″ guidewire and provides back-up support. This catheter has been successfully used in coronary artery intervention for crossing severely tortuous vessels, extreme angulations of side-branch ostia, jailed stents, saphenous vein graft anastomoses, and chronic total occlusions. We report the first use of the Venture wire control catheter (St Jude Medical) in the field of congenital heart disease. Patient #1 was d...
Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increas... more Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increased the profile of efficacy and safety of this procedure. Here we report on a 32-year-old woman with significant aortic recoarctation associated with aortic wall aneurysm and close proximity of both lesions to the origin of both the subclavian arteries. It was decided to manually and partially uncover the proximal part of the stent to have a hybrid stent that could act as a bare stent at the level of the origin of the subclavian arteries and as a covered stent at the level of the aneurysm.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 2, 2015
Intravascular stenting is the procedure of choice in the treatment of vascular stenoses. However,... more Intravascular stenting is the procedure of choice in the treatment of vascular stenoses. However, in infants and small children large sheaths are needed, and adult-size stents cannot be implanted. The Valeo Biliary Lifestent (Edwards Lifesciences Irvine, CA) is low profile and can be dilated up to 18-20 mm. We aimed to report on early and mid-term results with the use of Valeo stents in infants and children with congenital heart disease. Twenty-five subjects were treated in our experience. Mean age and weight were 39 ± 35 months (range 1-132) and 10.4 ± 6.7 kg (range 3-30), respectively. Two groups of patients were: Group A: patients with pulmonary artery stenosis (21 subjects); Group B subjects in whom stenting was applied in other vessel or heart sites (four subjects). A total of 35 stents were successfully used. Fluoroscopy time was 32 ± 11 min. No intra-operative death or hospital mortality was recorded. Stent post dilatation was performed in nine patients. The incidence of comp...
To measure the magnetic resonance (MR) artefact produced by a percutaneous pulmonary valve stent ... more To measure the magnetic resonance (MR) artefact produced by a percutaneous pulmonary valve stent and to evaluate the changes in volumetric and functional right ventricle (RV) parameters due to percutaneous pulmonary valve implantation (PPVI). A Melody valve was studied in vitro using clinical cardiac MR (CMR) sequences. In vivo, we analysed the CMR examinations obtained before and after PPVI of 27 consecutive patients. The echocardiography pressure gradient (PG) and catheter PG were measured. The Wilcoxon test was used for comparisons. In vitro, the least difference between artefact extent and actual valve size (0.1 mm) was obtained with a steady-state free precession (SSFP) sequence. In vivo, RV end-diastolic volume (ml/m(2)), end-systolic volume (ml/m(2)) and ejection fraction (%) were 79 ± 42, 43 ± 41 and 49 ± 13 before PPVI and 64 ± 21 (p = 0.054), 30 ± 14 (p = 0.021), and 54 ± 12 (p = 0.018) 6 months after PPVI, respectively. The PG and regurgitation fraction (RF) were 36 ± 15 mmHg and 14 ± 18 % before PPVI and 13 ± 15 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and 2 ± 5 % (p = 0.013) after PPVI, respectively. No significant differences were found comparing the PG measured with CMR, echocardiography and catheter. We showed in vitro that the SSFP sequence produced the most accurate valve measurement. After PPVI, CMR showed a strong decrease of PG and RF with a significant improvement of RV function.
The right ventricle (RV) is of lesser importance in acquired heart disease, but its role is of in... more The right ventricle (RV) is of lesser importance in acquired heart disease, but its role is of increasing importance in congenital heart disease (CHD). Despite major progress being made, precise measurements of the RV are challenging because of its peculiar anatomical structure that is not adaptable to any planar geometrical assumption. This is particularly true in adult patients with CHD where the RV shape eludes any standardization, it may assume various morphologies, and its modality of contraction depends on previous surgical treatment and/or pathophysiological conditions. However, reliable and repeatable quantification of RV dimensions and function for these patients are essential to provide appropriate timing for intervention to optimize outcomes. In this population, echocardiographic evaluation should not be limited to an observational and subjective functional assessment of the RV but must provide quantitative values repeatable and clinically reliable to help the decision‐ma...
Catheterization and Cardiovascular Interventions, 2014
BackgroundBare stents has become the first line therapy for aortic coarctation. Covered stents ha... more BackgroundBare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice.ObjectivesThe present study, reports comparatively 15‐year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center.MethodsFrom 1997 to 2011, 143 patients with native or postoperative aortic coarctation were treated at our institution. Seventy‐one subjects (median age 17 years (range from 4 to 70 years) underwent bare stent implantation (Group 1) while 72 patients (median age of 17.5 years (range from 6 to 68 years) underwent covered stent implantation (Group 2).ResultsSuccess rate in the whole group was 95%. More complex and tighter coarctations were treated using covered stents. Incidence of related‐procedure adverse events was higher in Group 1 than in group 2 (21.1% vs. 8.3% P = 0.035). Aortic wall complications occurred in 7% of patients in Group 1 (one death) and 0% in Group 2 (P...
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Papers by Luciane Piazza