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ABSTRACT: Patent foramen ovale (PFO) is a known cause of cryptogenic stroke and, when associated with a condition of thrombophilia, its closure has been shown to reduce the recurrence of cerebral embolic events. Here we present a case of a young man, with a history of previous recurrent cerebral ischaemic episodes, that developed an inferior acute myocardial infarction (AMI) with angiographic evidence of thrombotic occlusion of the right coronary artery (RCA). Thrombus aspiration followed by balloon angioplasty was performed and, after 24 h of glycoprotein IIb/IIIa inhibitor infusion, thrombus was no longer evident at coronary angiography. Screening for thrombophilia revealed heterozygosis for prothrombin G20210A polymorphism. At transoesophageal echocardiography (TOE), a large PFO with right-to-left atrial shunt was present. Given the history of multiple thrombotic clinical events and the associated state of thrombophilia, transcatheter PFO closure was successfully performed. At 12 months of follow-up the patient was completely asymptomatic.
Case Reports 01/2009; 2009.
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European Heart Journal 04/2008; 29(16):1974. · 10.48 Impact Factor
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ABSTRACT: Syncope may be a manifestation of pulmonary embolism. Occlusion of a pulmonary artery with cardiac output drop, sometimes resulting in cardiac arrest, is the main underlying mechanism. In this letter we describe the case of a patient in which the persistence of a long remnant of the embryonal Chiari's network could have worked as an anatomic barrier preventing massive pulmonary embolism and cardiac arrest.
International journal of cardiology 12/2007; 132(1):e40-1. · 7.08 Impact Factor
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ABSTRACT: We describe a minimally invasive echo-guided placement of the cardiac tube in a ventriculoatrial shunt in a young pregnant woman, in order to avoid any radiological procedure.
We used a central venous catheter placement kit for percutaneous echo-guided right internal jugular vein puncture located by a 7.5 mHz microlinear probe. Through the catheter, the distal portion of the shunt device was positioned into the internal jugular vein to the right atrium using ultrasound control by a 2.5 to 3.5 mHz probe in a four-chamber transthoracic view.
Sonographic guidance in percutaneous placement of a vertebral artery shunt is a safe and fast minimally invasive technique that improves success rates and decreases complications such as incidental puncture of the carotid artery and pneumothorax. The use of a two-dimensional echocardiographic apparatus in a four-chamber transthoracic view is an accurate and simple method to verify the position of the distal tip of the shunt in the mid-right atrium with no risks for the patient.
The use of these two techniques allows a minimally invasive, safe, accurate, and complete x-ray-free procedure.
Neurosurgery 12/2007; 61(5 Suppl 2):E398; discussion E398. · 2.79 Impact Factor
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Andrea Scapigliati,
Tommaso Sanna,
Roberto Zamparelli,
Claudio Sandroni, Christian Colizzi,
Peter Fenici,
Gabriella Arlotta,
Carmen Nuzzo,
Carmela Bonarrigo,
Fulvio Bellocci,
Rocco Schiavello,
Gianfederico Possati
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ABSTRACT: The 1-day immediate life support course (ILS) was started in the United Kingdom and adopted by the ERC to train healthcare professionals who attend cardiac arrests only occasionally. Currently, there are no reports about the ILS course from outside the UK. In this paper we describe our initial Italian experience of teaching ILS to nurses. We have also measured the impact that ILS has on the resuscitation knowledge of nurses.
The ILS course materials were translated by Italian ALS instructors who had observed the ILS course previously in the UK. From March to November 2005 nurses from a single hospital department attended the Italian ILS course. Candidate feedback was collected using an evaluation form. The change in knowledge of candidates was measured using a pre- and post-course test. Variables associated with candidate performance on course papers were investigated using multivariate linear regression analysis.
A total of 119 nurses attended nine ILS courses. All candidates completed the course successfully and gave high evaluation scores. ILS produced a significant increase from pre- to post-course score (10.15+/-2.75 to 13.19+/-2.53, p<0.001). The pre-course score was higher for nurses working in ICU compared with those coming from non-intensive wards, but this difference disappeared in the post-course evaluation (13.89+/-2.18 versus 12.79+/-2.65, p=ns).
We have reproduced the ILS course in Italy successfully. ILS teaching resulted in an improvement in resuscitation knowledge of the first group of nurses trained.
Resuscitation 04/2007; 72(3):451-7. · 3.60 Impact Factor
