Alessia Cerutti

University of Padova, Padua, Veneto, Italy

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Publications (12)31.73 Total impact

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    ABSTRACT: Background: Breath-holding spells (BHS) are benign non-epileptic paroxysmal events of infancy, rarely occurring with high frequency and complicated by prolonged syncope, convulsions and even status epilepticus. In these cases response to medical treatment is often unsatisfactory. Pacemaker implantation is a possible therapeutic option, but its indications, efficacy and complications have not been clarified yet. Objective: To report a new case of BHS treated with pacemaker and to review its indications and efficacy in patients with severe BHS. Methods: We extensively searched the literature in PubMed on cardiac pacing in patients with BHS and we described a new case. Results: A previously healthy boy presented at the age of 4 months with frequent BHS inconstantly associated to prolonged syncope and post-anoxic non-epileptic and epileptic seizures. Parental reassurance, iron supplementation and piracetam were ineffective. After cardiac pacing at the age of 16 months, BHS and their complications disappeared. We identified 47 patients with BHS treated with pacemaker in the literature. Based on the available data, in all patients asystole or marked bradycardia were documented during BHS or stimulating maneuvers; syncope complicated BHS in 100% of cases and post-anoxic convulsions in 78.3%. Medical treatment before pacing, when administered, was ineffective or poorly tolerated. After pacing, BHS complications disappeared in 86.4% of cases, and decreased in 13.6%. Technical problems with the device were reported in 25.7% of patients and mild medical complications in 11.4%. Conclusions: Pacemaker could be reasonably considered in subjects with frequent and severe BHS, poor response to medications, and demonstration of cardioinhibition during spells.
    Brain & development 01/2014; · 1.74 Impact Factor
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    ABSTRACT: Limited options do exist for mechanical circulatory support as a bridge to transplantation in the pediatric population. This is especially true when it comes to intracorporeal technologies. We describe our successful experience with the use of HeartWare ventricular assist devices (HeartWare, Inc., Framingham, MA, USA) in three patients <16 years of age, as a successful and feasible bridge to transplant in patients weighing greater than 20 kg.
    Artificial Organs 10/2013; · 1.96 Impact Factor
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    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; · 0.95 Impact Factor
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    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. · 3.45 Impact Factor
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    ABSTRACT: Congenital heart defects (CHDs) occur in 1% of live-born infants and frequently are associated with extracardiac malformations. This study aimed to assess the feasibility and accuracy of three-dimensional ultrasonography (3DUS) in fetuses with CHD and to investigate whether 3DUS can add information about the heart and general fetal morphology that shows other congenital malformations or suggests syndromes. For 30 fetuses affected by CHD, 3DUS was performed using a Sonos 7500 ultrasound machine with a cardiac 3D transducer. In 44% of the exams, 3DUS was completely diagnostic for the CHD, providing additional information in 28% of the exams. Furthermore, 3DUS showed 82% of associated malformations, providing the complete diagnosis in 57% of the cases and helping with recognition of syndromes in others. The diagnostic accuracy of 3DUS was superior, with a higher number of acquisitions per exam. Performance was better in fetuses younger than 24 weeks for general morphologic details and in fetuses older than 24 weeks for the heart morphology.
    Pediatric Cardiology 04/2011; 32(6):724-36. · 1.20 Impact Factor
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    ABSTRACT: Postoperative chylothorax represents one of the early and most serious complications after cardiothoracic operations. When conservative measures are not effective, an operation is mandatory. We describe a case of persistent chylothorax after a "one-and-a-half ventricle" repair in an infant with complex congenital heart disease, which was successfully treated with a transabdominal ligation of the cisterna chyli. At the 1-year follow-up, she is in excellent clinical condition, without recurrence of pleural effusion or the requirement for nutritional support. Ligation of cisterna chyli may represent a safe and effective ultimate treatment in children with persistent chylothorax.
    The Annals of thoracic surgery 11/2010; 90(5):1732-4. · 3.45 Impact Factor
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    ABSTRACT: Pompe disease (PD) is a metabolic myopathy caused by a deficiency of acid-alpha glucosidase (GAA), a lysosomal enzyme that cleaves glycogen. The classic infantile-onset form is characterised by severe hypotonia and cardiomyopathy. Untreated patients usually die within the first year of life due to cardiorespiratory failure. Several studies involving patients with infantile-onset PD have shown that enzyme replacement therapy (ERT) with alglucosidase alfa, recombinant human GAA (rhGAA), significantly prolongs survival, decreases cardiomegaly, and improves cardiac function and conduction abnormalities. However, the efficacy on motor, cognitive and social milestones appears to be more related to the condition of the patient before the start of treatment. To date, the sample of early diagnosed and treated patients is small and the length of follow-up is still limited. We report the results of a long-term follow-up of one patient presenting severe bradycardia and cardiomyopathy at birth, diagnosed in the third day of life and successfully treated by ERT. Serum muscle enzymes at diagnosis were AST 200 U/L, ALT 99 U/L and CPK 731 U/L (n.v. 0-295); the molecular study identified the homozygous missense mutation c.1933 G> A p.Asp645Asn (GAA exon 14). Left Ventricular Mass Index (LVMI) at baseline was 171 g/m(2) (Z-score = 4.3) and decreased to normal values since the 3-month follow-up. A muscle biopsy performed at 18 months after the start of therapy, showed only a low degree of muscle involvement. To our knowledge, this is the longest ERT treatment follow-up in a symptomatic neonatal patient with Pompe disease.
    Journal of Inherited Metabolic Disease 09/2010; 33:389-393. · 4.07 Impact Factor
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    ABSTRACT: Stenting of the patent ductus arteriosus (PDA) has been recently introduced to palliate patients with duct-dependent pulmonary circulations. We evaluated the surgical outcome of patients who had a previous PDA stent, focusing on their pulmonary arteries status. This study included 15 patients (11 boys, 4 girls) who underwent cardiac operations after PDA stenting between August 2004 and April 2009. Outcomes included hospital mortality, morbidity, and need for reintervention or operation on the PDA and on the pulmonary artery branches. Thirteen patients underwent elective cardiac operations at a median of 11 months (range, 0.3 months to 3.7 years) from PDA stenting. Two patients underwent emergency operations due to stent migration during percutaneous positioning. Six patients (46%) required a preoperative interventional cardiology procedure, including PDA stent dilatation in 5 and multiple left pulmonary artery dilatations in 1. During elective surgical repair, PDA stents were completely retrieved in 3 patients (23%) and partially removed in 10 (77%) due to the fusion of the stent to the vascular wall. Seven patients (53.8%) required surgical pulmonary artery plasty. One in-hospital death (6%) occurred after an emergency operation. Median follow-up was 16.7 months (range, 1 month to 2.5 years). Two late deaths (14%) occurred at 4 and 9 months. Four patients required additional interventional procedures on the left pulmonary artery after surgical repair. Operations after PDA stenting are safe and low-risk. The presence of PDA stents requires additional surgical maneuvers on pulmonary arteries in near half of the patients, and postoperative interventions can be required.
    The Annals of thoracic surgery 08/2010; 90(2):605-9. · 3.45 Impact Factor
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    ABSTRACT: Due to the shortage of organ donors, heart transplantation cannot be offered to many infants with end-stage heart failure; this issue leads to mortality rates of 30-50% in patients in the paediatric age group awaiting operation. ABO-incompatible heart transplantation has been performed safely with no particular or invasive preparatory procedures other than plasma exchange during cardiopulmonary bypass for removing preformed antibodies, with no reports of hyperacute rejection. We report our first clinical experience of heart transplantation on a 2-month-old-infant (blood group O), diagnosed with intracardiac tumour, in which the donor was a 19-day-old newborn of blood group A. Sharing the know-how about ABO-incompatible heart transplantation in newborns and infants awaiting transplantation will help in decreasing mortality among this group of patients.
    Journal of Cardiovascular Medicine 09/2008; 9(8):854-7. · 2.66 Impact Factor
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    ABSTRACT: Twenty years after the first successful pediatric heart transplantation (HTx), the long-term outcome of this population is still unknown. Current study analyzes our results in pediatric HTx population. Between 1985 and 2005, we performed 604 HTx. Forty-three patients (7%) were less than 18-years old and six patients were less than 1-year old. Mean age at HTx was 9.7+/-6.3 years (38 days-18 years). Indications were: cardiomyopathy in 33 patients (76%), congenital in 9 (21%), tumor in 1 (3%). Chronic immunosuppression was Cyclosporine A and Azathioprine-based. Overall survival at Kaplan-Meier analysis (CI 95%) was 82.5% at 1-year post-HTx, 73.5% at 5 years, 72.2% at 10 years, 62.1% at 15 years, and 49.3% at 20 years, respectively. We had 14 deaths (32%): 7 within the first year after HTx (early mortality, EM), 7 occurred later (late mortality, LM). Causes of EM were: graft failure (43%), acute rejection (43%) and post transplant lymphoproliferative disease (14%). Causes of LM were: neoplasms (57%), infection (28%), graft vasculopathy (15%). At late follow-up, cardiac function, somatic and psycoaffective development were normal. Fifteen patients (34%) developed neoplasms, nine patients (21%) hypertension, and three patients (8%) developed kidney dysfunction. Neoplasms were found to be an independent predictor of outcome (p=0.039) (OR=7). Overall survival in the pediatric population is better than adults' population (62.1 vs 48% at 15 years after HTx). Neoplasms were the main comorbidities and causes of LM: at multivariate analysis, their incidence was related with hematic Cyclosporine A levels after 10 years from HTx (p=0.01).
    European Journal of Cardio-Thoracic Surgery 09/2007; 32(2):220-4. · 2.67 Impact Factor
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    ABSTRACT: Heart transplantation, formerly the final option for terminally ill children, has now become the treatment of choice for a number of serious acquired or congenital cardiac conditions, which cannot be treated conservatively. Nevertheless, several problems remain unsolved. First of all the shortage of donors, mainly in the first months and years of life, which has become more and more significant with time, regardless of the country, religious belief or culture of the people. Secondly, the long-term impact of immunosuppression in a developing organism, and its possible inter-relation with the primary disorder, which leads to intractable heart failure. Whether a heart transplant is a cure or an ongoing disease for both the child and the family is another matter of concern. These and other topics are covered in this article.
    Journal of Cardiovascular Medicine 02/2007; 8(1):67-71. · 2.66 Impact Factor
  • The Annals of thoracic surgery 03/2005; 79(2):717. · 3.45 Impact Factor