Publications (113)295.18 Total impact
-
Article: Medical and surgical management of primary cardiac tumours in infants and children.
[show abstract] [hide abstract]
ABSTRACT: Primary cardiac tumours in infants and children are extremely rare, with an estimated incidence of 0.2% according to echocardiographic studies. Owing to their rarity, there is very little literature available, and most knowledge is based on collections of case reports. Therefore, we reviewed retrospectively our 27 years of clinical experience on the overall management of cardiac tumours among children in order to improve not only our knowledge but also to provide others with information about the incidence, clinical presentation, management, and long-term outcome of this rare disease. Between April, 1982 and April, 2009, 52 children were diagnosed with cardiac tumours at our Institution. Medical records and follow-up echocardiographic evaluations were studied. The diagnosis was prenatal in 35% of the patients. The most frequent tumour types were rhabdomyomas (61.5%), fibromas (15.4%), and myxomas (5.8%). There were no cases of primary malignant tumours. All diagnoses were achieved using two-dimensional echocardiography, and for 12 patients a pathological analysis was carried out. A total of 41 patients (79%) were managed medically, whereas 11 (21%) patients underwent surgical treatment. At a mean follow-up of 7.2 ± 5.4 years, two patients died of complications related to cardiac transplantation; all the remaining patients are in excellent clinical condition. In conclusion, cardiac tumours in paediatric practice are usually clinically and histologically benign. Only a few cases need surgery. Up to one-third of the cardiac masses are detectable prenatally. Rhabdomyoma is the most common histotype, followed by fibroma and myxoma. The long-term prognosis is generally good.Cardiology in the Young 03/2013; · 0.76 Impact Factor -
Article: Cardiac resynchronisation therapy associated with pulmonary artery banding in an adult with severe right ventricular dysfunction after Mustard repair for complete transposition of the great arteries: results after 2 years of follow-up.
[show abstract] [hide abstract]
ABSTRACT: Late dysfunction of the systemic right ventricle in patients with complete transposition of the great arteries after Mustard or Senning procedures and progressive deterioration of the clinical status has been demonstrated. However, evidence-based data on the effective therapy for systemic right ventricular dysfunction in these patients are yet to be defined. Our patient shows an improvement in the right ventricular systolic function, with a reduction in tricuspid regurgitation and a consequent better exercise tolerance after a hybrid approach consisting of an upgrading of a previous transvenous-implanted dual-chamber Implantable Cardiac Defibrillator to biventricular pacing associated with pulmonary artery banding via an anterior thoracotomy.Cardiology in the Young 02/2013; · 0.76 Impact Factor -
Article: The Evolution of the Right Anterolateral Thoracotomy Technique for Correction of Atrial Septal Defects: Cosmetic and Functional Results in Prepubescent Patients.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: The aim of this study was to evaluate the results of a cosmetic right anterolateral thoracotomy (RALT) in prepubescent girls who underwent repair of atrial septal defect (ASD). METHODS: All prepubescent girls who underwent RALT for ASD closure since January 1998 were included. Patient satisfaction with the cosmetic approach and the impact of RALT on breast development were evaluated. One hundred healthy women were used as controls. RESULTS: One-hundred forty-one patients were included. Median age at repair was 4.6 years (range, 8 months-12 years). The median length of the surgical incision was 9 cm (range 3-20 cm); it was shorter during the last 5 years of our experience (median, 5 cm; range, 3-10 cm; p = 0.001). Fourteen patients (9.9%) experienced a transitory mild sensitive skin deficit in the mammary area, which was associated with the length of the RALT (p = 0.05). At median follow-up of 10.1 years (range, 1.5-14.5 years), 3/60 patients (5%) who had complete breast development had relevant asymmetrical breast development (indexes of breast symmetry > 2 standard deviations of the median value for controls). Six additional patients who underwent RALT (10%) had mild asymmetrical breast development, which was comparable to the control population (p = 0.1). The satisfaction rate for the cosmetic result of RALT was 97.8% (138/141 patients). Reasons for dissatisfaction were the presence of asymmetrical breast development (n = 2) and the presence of a keloid at the incision level (n = 1). CONCLUSIONS: RALT is a reliable surgical technique that combines excellent cosmetic and functional results in almost all patients. With the latest technical refinements, it is our gold standard treatment for ASD in prepubescent girls.The Annals of thoracic surgery 10/2012; · 3.74 Impact Factor -
Article: R25C mutation in the NKX2.5 gene in Italian patients affected with non-syndromic and syndromic congenital heart disease.
[show abstract] [hide abstract]
ABSTRACT: AIMS: Heterozygous mutations in the transcription factor Nkx2.5 indicate a genetic cause for congenital heart diseases (CHDs) in human beings. The present study aimed to assess the prevalence of NKX2.5 mutations in Italian patients with sporadic non-syndromic and syndromic CHD, as well as to appraise any genotype-phenotype correlations. METHODS: One hundred Italian patients affected with CHD (90 had sporadic non-syndromic CHD and 10 had syndromic CHD) were screened for NKX2.5 mutations. The coding region and flanking regions involved in gene splicing of the CSX/NKX2.5 gene were amplified from genomic DNA by PCR, and mutational analysis was performed using denaturing high performance liquid chromatography and DNA sequencing. RESULTS: One previously reported NKX2.5 mutation (c.73C>T, p.R25C) was identified in two of the 100 CHD patients (2%). We have detected the p.R25C alteration in a woman showing aneurysm of the membranous septum, aortic coarctation and bicuspid aortic valve, that was a different phenotype from those previously reported, and for the first time in a patient with syndromic CHD with Down's syndrome (posterior ventricular septal defect, atrial septal defect, left superior cava vein ' sinus, and patent ductus arteriosus). CONCLUSION: Our results confirm that NKX2.5 mutations are not a common cause of CHD; furthermore, the p.R25C variation may increase susceptibility to development of CHD in patients with and without chromosomal abnormalities.Journal of Cardiovascular Medicine 09/2012; · 1.51 Impact Factor -
Article: Extracellular matrix graft for vascular reconstructive surgery: evidence of autologous regeneration of the neoaorta in a murine model.
[show abstract] [hide abstract]
ABSTRACT: The study aimed to evaluate the efficacy of the porcine small intestine submucosa extracellular matrix (SIS-ECM) in a murine model, as a possible vascular patch for clinical use in reconstructive vascular and potentially cardiac surgery. Fifteen adult male Sprague Dawley rats and five green fluorescent protein (GFP) rats were enrolled in this study. The SIS-ECM graft (6 mm long, 4 mm wide) was implanted for patch plasty on the abdominal aorta of the animal, after excising part of its anterior wall. Histology and immunohistochemistry were used to evaluate the results at 15, 30, 90 and 180 days post-surgery. Graft re-population was demonstrated 15 days after implantation. The luminal surface of the regenerating tissue was partially covered by endothelial cells, and intimal hyperplasia occurred in the central part of the graft. Complete re-endothelialization of the patch with smooth muscle cells colonizing the graft and acting as the neoaortic wall was observed after 30 days. Near complete absorption of the biomaterial was observed after 180 days. No inflammatory cell reaction occurred. All animals survived and no graft aneurysm was observed. A SIS-ECM patch allowed the colonization of host endothelial and smooth muscle cells in the graft. This material may be an ideal substitute for reconstructive vascular surgery, and its use could be extended to surgical repair of cardiac defects.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2012; 42(5):e128-35. · 2.40 Impact Factor -
Article: Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results.
[show abstract] [hide abstract]
ABSTRACT: Outcomes evaluation is enhanced by assignment of operative procedures to appropriate categories based upon relative average risk. Formal risk modelling is challenging when a large number of operation types exist, including relatively rare procedures. Complexity stratification provides an alternative methodology. We report the initial application in the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons (STS) and the European Association for Cardio-thoracic Surgery (EACTS) of an empirically derived system of complexity adjustment to evaluate surgical case mix and results. Complexity stratification is a method of analysis in which the data are divided into relatively homogeneous groups (called strata). A complexity stratification tool named the STS-EACTS Congenital Heart Surgery Mortality Categories (STAT Mortality Categories) was previously developed based on the analysis of 77 294 operations entered in the Congenital Heart Surgery Databases of EACTS (33 360 operations) and STS (43 934 patients). Procedure-specific mortality rate estimates were calculated using a Bayesian model that adjusted for small denominators. Operations were sorted by increasing risk and grouped into five categories (the STAT Mortality Categories) that were designed to minimize within-category variation and maximize between-category variation. We report here the initial application of this methodology in the EACTS Congenital Heart Surgery Database (47 187 operations performed over 4 years: 2006-09) and the STS Congenital Heart Surgery Database (64 307 operations performed over 4 years: 2006-09). In the STS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 17332, (2): 20114, (3): 9494, (4): 14525 and (5): 2842. Discharge mortality was (1): 0.54%, (2): 1.6%, (3): 2.4%, (4): 7.5% and (5): 17.8%. In the EACTS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 19874, (2): 12196, (3): 5614, (4): 8287 and (5): 1216. Discharge mortality was (1): 0.99%, (2): 2.9%, (3): 5.0%, (4): 10.3% and (5): 25.0%. The STAT Mortality Categories facilitate analysis of outcomes across the wide spectrum of distinct congenital heart surgery operations including infrequently performed procedures.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2012; 42(5):775-80. · 2.40 Impact Factor -
Article: Iatrogenic Aortopulmonary Fistula Occurring After Pulmonary Artery Balloon Angioplasty: A Word of Caution.
[show abstract] [hide abstract]
ABSTRACT: We describe the natural history of an adolescent patient who developed an aortopulmonary fistula (APF) after transcatheter stent placement for left pulmonary artery stenosis after neonatal repair of d-transposition of the great arteries. Due to its rarity, the APF was not initially diagnosed and treated until 4 months later. The APF was occluded with a covered stent. Because this is not an isolated report in the literature, we believe it should be considered as a potential complication in all patients after balloon dilation of stenotic pulmonary artery branches after arterial switch surgery.Pediatric Cardiology 05/2012; · 1.30 Impact Factor -
Article: Surgery for primary cardiac tumors in children: early and late results in a multicenter European Congenital Heart Surgeons Association study.
[show abstract] [hide abstract]
ABSTRACT: To evaluate indications and results of surgery for primary cardiac tumors in children. Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate (P=0.006). Overall mortality was associated to malignancy (P=0.0008), and adverse events during follow-up (P=0.005). Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.Circulation 05/2012; 126(1):22-30. · 14.74 Impact Factor -
Article: The role of cardiac surgery in adult patients with congenital heart disease.
[show abstract] [hide abstract]
ABSTRACT: The number of adults with congenital heart disease (CHD) has constantly increased as medical and surgical treatment of CHD - either simple or complex - continues to improve. Over the past half century, advances in surgical techniques have continued with the evolution of traditional surgical repair and introduction of new surgical procedures for complex lesions which were previously considered to be irreparable. We sought to analyze the current role of cardiac surgery in the treatment of congenital anomalies of the heart in those patients who have reached adulthood with or without surgical repair or palliation, with particular attention to future directions and perspectives.Journal of Cardiovascular Medicine 05/2012; · 1.51 Impact Factor -
Article: Efficacy of fibrinogen/thrombin-coated equine collagen patch in controlling lymphatic leaks.
[show abstract] [hide abstract]
ABSTRACT: We report the use of fibrinogen/thrombin-coated equine collagen patch (Tachosil(®) ) as a sealant agent in six patients who underwent heart surgery for congenital heart disease (CHD) and developed an intraoperative lymphatic leakage detected at the time of surgery. The use of fibrinogen/thrombin-coated equine collagen patch proved to be safe and effective in preventing the development of postoperative chylothorax.Journal of Cardiac Surgery 05/2012; 27(4):441-2. · 0.87 Impact Factor -
Article: The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND AND OBJECTIVE: Progressive pulmonary valve (PV) regurgitation leads to right ventricular failure after repair of tetralogy of Fallot (TOF). We sought to evaluate our results with the preservation of the PV in selected patients with TOF. METHODS: All patients with TOF who were scheduled for PV's preservation between June 2007 and May 2010 were enrolled. Surgical correction involved the combination of early transatrial repair and intraoperative balloon dilation of the PV annulus. RESULTS: Of 18 patients, 16 (89%) underwent a successful preservation of the PV. Median age at surgery was 3.1 months (range 2.4-4.7 months). Median preoperative PV Z-score was -2.5 (range -1.4 to -3.12) and the median peak right ventricle outflow tract (RVOT) gradient was 80 mm Hg (range 49-90 mm Hg). No procedure-related complications were reported. The size of the PV annulus after the balloon dilation was appropriate for body surface area in all patients. Median follow-up time was 1.4 years (range 0.5-3.3 years). Reoperation was needed in one patient 3 months after repair because of residual subvalvar RVOT obstruction. The remaining 15 patients are alive and well. The median PV Z-score is 0 (range -0.2 to 1). Median peak RVOT gradient is 20 mm Hg (range 12-32 mm Hg). The PV is competent in seven patients; mild PV regurgitation is present in seven patients and moderate in one. CONCLUSIONS: The integrity of the PV annulus and PV function can be preserved in selected patients during early repair of TOF when using concomitant balloon dilation. The PV preservation will hopefully prevent long-standing RV dysfunction. © 2012 Wiley Periodicals, Inc.Catheterization and Cardiovascular Interventions 05/2012; · 2.29 Impact Factor -
Article: Stratification of Complexity Improves the Utility and Accuracy of Outcomes Analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database
[show abstract] [hide abstract]
ABSTRACT: Quality-of-care evaluation must take into account variations in “case mix.” This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.Pediatric Cardiology 04/2012; 30(8):1117-1130. · 1.30 Impact Factor -
Article: Saccular aneurysm of the descending aorta after surgery for aortic arch interruption.
The Annals of thoracic surgery 03/2012; 93(3):1000. · 3.74 Impact Factor -
Article: Extracorporeal membrane oxygenation: the simplified weaning bridge.
The Journal of thoracic and cardiovascular surgery 02/2012; 143(4):e27-8. · 3.41 Impact Factor -
Article: The effects of basic fibroblast growth factor in an animal model of acute mechanically induced right ventricular hypertrophy.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the effect of a continuous infusion of basic fibroblast growth factor on the adaptive potential of the right ventricular myocardium after 30 days of mechanically induced overload in rats. Materials and methods We banded the pulmonary trunk, so as to increase the systolic workload of the right ventricle, in six Lewis/HanHsd rats at the age of 11 weeks, using six adult rats as controls. The six adult rats were also banded and received an additional continuous infusion of basic fibroblastic growth factor, using six rats with a continuous infusion of basic fibroblastic growth factor only as controls. We analysed the functional adaptation and structural changes of the right ventricular myocardium, blood vessels, and interstitial tissue 30 days after the increased afterload. The pulmonary artery banding induced an increase in the right ventricular free wall thickness of banded rats when compared with controls, which was mainly justified by an increase in cardiomyocyte area and in the percentage of extracellular fibrosis. The infusion of basic fibroblastic growth factor promotes a more extensive capillary network in banded rats (p < 0.001), which modulates the compensatory response of the right ventricle, promoting the hypertrophy of contractile elements and limiting the areas in which fibrosis develops (p < 0.001). The subcutaneous infusion with osmotic pumps was a valid and reproducible method of delivering basic fibroblast growth factor to heart tissue. This infusion contributed to better preserve the right ventricular capillary network, hampering the development of interstitial fibrosis.Cardiology in the Young 01/2012; 22(4):436-42. · 0.76 Impact Factor -
Article: Near-infrared spectroscopy for monitoring leg perfusion during minimally invasive surgery for patients with congenital heart defects.
The Journal of thoracic and cardiovascular surgery 12/2011; 143(3):756-7. · 3.41 Impact Factor -
Article: Right posterior-lateral minithoracotomy access for treating congenital heart disease.
[show abstract] [hide abstract]
ABSTRACT: A modified right posterior-lateral minithoracotomy with the aid of peripheral cardiopulmonary bypass is a surgical option that has been adopted in our institution in selected patients with simple congenital heart disease. We present our selection criteria, describe our technique, and analyze our results with this modified technique.The Annals of thoracic surgery 12/2011; 92(6):2278-80. · 3.74 Impact Factor -
Article: Giant intramural left ventricular rhabdomyoma in a newborn.
Circulation 11/2011; 124(20):2275-7. · 14.74 Impact Factor -
Article: Intraoperative diagnosis of bilateral coronary ostia stenosis: a rare case of ischemic heart disease in a 3-month-old patient.
[show abstract] [hide abstract]
ABSTRACT: We report a case of a 3-month-old child, presenting with signs of myocardial ischemia and hemodynamic instability, requiring extracorporeal membrane oxygenation support. Due to the unclear preoperative instrumental findings, a surgical exploration was performed revealing the presence of coronary ostia stenosis and an intramural course of both coronary arteries. The child underwent a successful plasty of the coronary artery ostia by resecting the excessive obstructing fibrous tissue followed by unroofing of the intramural coronary artery course with restoring of a normal myocardial perfusion and function.The Annals of thoracic surgery 11/2011; 92(5):1875-7. · 3.74 Impact Factor -
Article: Traumatic aortic dissection in a boy with Loeys-Dietz syndrome.
[show abstract] [hide abstract]
ABSTRACT: A 9-year-old boy was admitted to the emergency department for interscapular chest discomfort. Bidimensional echocardiography revealed a severe aortic root and sino-tubular junction dilatation with a suspicion of intimal flap at the aortic isthmus and a pseudo-aneurysm which was confirmed by a computerized tomography scan. The patient was immediately transferred to the operating room for an emergent replacement of the aortic isthmus. His recovery after surgery was uneventful, and he was discharged home 12 days later on beta blockers and angiotensin II receptor antagonist. A genetic recognition confirmed the diagnosis of Loeys-Dietz syndrome type I.The Annals of thoracic surgery 10/2011; 92(4):1520-2. · 3.74 Impact Factor
Top co-authors
Top Journals
Institutions
-
1995–2013
-
University-Hospital of Padova
Padova, Veneto, Italy -
Universidad de Málaga
- Facultad de Ciencias
Málaga, Andalusia, Spain
-
-
2003–2012
-
University of Padua
- • Department of Medicine DIMED
- • Department of Cardiac, Thoracic and Vascular Sciences
Padova, Veneto, Italy
-
-
2010
-
Leids Universitair Medisch Centrum
Leiden, South Holland, Netherlands
-
-
2009
-
Great Ormond Street Hospital NHS
London, ENG, United Kingdom
-
-
2008
-
Royal Brompton & Harefield NHS Foundation Trust
Harefield, ENG, United Kingdom -
McGill University
Montréal, Quebec, Canada -
Seattle Children's Hospital
Seattle, WA, USA -
The Children's Hospital of Philadelphia
Philadelphia, PA, USA
-
-
2004–2008
-
McGill University Health Centre
Montréal, Quebec, Canada
-
-
2005–2007
-
University of South Florida
Tampa, FL, USA -
Florida Heart Research Institute
Miami, FL, USA
-
-
2006
-
Clinical Institute Città di Brescia
Brescia, Lombardy, Italy -
Onassis Cardiac Surgery Center
Kallithéa, Attiki, Greece
-
-
2000
-
Medical City Children’s Hospital
Dallas, TX, USA
-
